Dog attacks: it's time for doctors to bite back
BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39129.471505.94 (Published 22 February 2007) Cite this as: BMJ 2007;334:425
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It would be interesting to know, for comparison, the numbers of human
bite cases (on humans) seen in accident and emergency departments. Also
whether many vets have seen dogs bitten by humans - I remember one case of
this. Other forms of deliberate trauma towards animals are of course much
commoner.
I think in general vets are more aware of potential problems in this
area and most at least try to make appropriate recommendations for
referral. The hardest thing is sometimes ensuring owners are aware there
is indeed a problem that needs taken seriously and intelligently with
adequate follow up, preferably at an early stage because to the
experienced eye there are plenty warning signs. Problem dogs cannot be
dealt with in the absence of owner commitment and involvement. In effect,
the owner has to be taught to be their own pet's animal behaviourist -
that takes time and effort.
Competing interests:
None declared
Competing interests: No competing interests
Dr Clarke has missed the point of my Personal View regarding dog
bites (1,2).
Careful reading of my article would have highlighted my view that
education
to dog owners, parents and children as key to preventing further bites and
hospital admissions. In addition I have not dismissed vets as educaters,
but
suggested that doctors, vets and schools need to work together.
Dr Clarke has rightly pointed out the vital work carried out by
organisations
such as Guide Dogs for the Blind. Of course these dogs, and most
importantly
their owners, are thoroughly trained.
I am sorry that Dr Carke appears to have missed the irony in my
suggestion
of neutering all dogs since, by implication, if all dogs were neutered,
dogs
would soon cease to exist.
As a lifetime dog owner and paediatrician, I have seen first-hand the
positive
influence that owning a dog can bring. Clearly current education is not
working at some level, otherwise hospital admissions due to dog bites
would
not have doubled in the last decade despite no increase in dog ownership.
Dr Rachel E J Besser BSc MBBS (Hons) MRCPCH.
Paediatric specialist
registrar
and trainee at the London Deanary rachelbesser@hotmail.com
(1) Besser R.Dog attacks:it's time for doctor's to bite back BMJ
2007;334:425
(2) Clarke K. Education of dog owners is key to reducing attacks BMJ
2007;334:489
Competing interests:
None declared
Competing interests: No competing interests
Sir
We welcome the publication of the clinical review Dog Bites (1) as a
valuable
source of evidence for those involved in either pre-hospital or in-
hospital
care. However, we do not agree that cervical spine immobilization is
required
in all head and neck bites in children.
The application of the collar is technically difficult, it causes
agitation in small
children and it may restrict expansion of neck haematomas causing airway
compression. This is more likely to occur if inexperienced staff apply
the
collar. It also demands a stretcher and an ambulance, which may not be
required.
A search of the relevant literature (Ovid Medline 1990-2007, Pubmed
1990-2007) reveals only one case of cervical spine injury due to dog
attack in
a 2-year-old child, while blood vessel and airway injury are more common
(2).
We recommend that dog bites to the head and face in children be treated as
any wound in this area, based on the mechanism of injury and severity,
always honouring the Hippocratic primum non nocere! Pre-hospital providers
should take spinal immobilization precautions according to local
protocols.
Other carers should use the SAFE approach (3) as minimize agitation may be
the best form of cervical spine immobilization.
References
1. Morgan M, Palmer J (2007). Dog bites. British Medical Journal.
334:
413-417
2. Mitchell RB, Nanez G, Wagner JD et al (2003). Dog bites of the Scalp,
Face and Neck in Children. Laryngoscope. 113: 492-495
3. Advanced Paediatric Life Support Group (2001). ALSG BMJ Books
Competing interests:
None declared
Competing interests: No competing interests
Figures for German Shepherds (Alsatian) take no account of the
significant
number of legitimate bites by Police and other Security services whilst
dogs
are detaining suspects who have run off. The modern GSD has a much improved
temperament.
I know of no study which would back up the statement that neutering would
ultimately solve the problem.
Hugh D.Coryn MRCVS
Competing interests:
None declared
Competing interests: No competing interests
Sir,
The Review of Morgan and Palmer (BMJ 2007:334:413-7) is a timely reminder
of some of the dangers associated with dogs, in light of the recent
tragedy of Ellie Lawrenson, but should not obscure the enormous benefits
dogs bring to a society, which increasingly seems to see banning or
exclusion as a solution. Unfortunately the more we remove ourselves from
those with whom we share common space the more we are likely to provoke
further misunderstandings and violence as a consequence. As Morgan and
Palmer point out, most attacks are “apparently unprovoked” and this is
more a reflection of our ignorance than the true nature of the problem.
Dogs rarely, if ever, bite without reason, it is just that they see the
world differently to us. What might seem innocuous or friendly to us might
be seen as potentially threatening or intimidating to another which uses a
different communication system.
It is a shame that in the UK, in contrast to some other European
countries, it is increasingly difficult for owners to fully incorporate
their dogs into their lives as “No dogs allowed” seems to become the norm.
As a result people do not understand normal canine behaviour and we must
seek to educate them accordingly. There are a number of excellent recent
research-informed, initiatives in this direction, in addition to the Blue
Dog programme (www.thebluedog.org) for young children mentioned by Besser
(BMJ 2007:334: 425) which seeks to teach appropriate behaviour rather than
precautionary behaviour around dogs, (the outcome of the “Prevent-a-bite”
scheme in Australia). These include the text “The canine commandments” by
Kendal Shepherd, who is also developing an educational package compatible
with Personal, Social and Health Education requirements within the
national curriculum for older children, which is being supported by the
Association for the Study of Animal Behaviour.
However, there is a need for further research and funding for such
initiatives. At present there is a dearth of knowledge concerning the
circumstances of most attacks, simply because we don’t ask the right
questions. With this in mind, I would like to propose an initial scoping
meeting to identify research priorities for prevention and would be
delighted to hear from colleagues willing to contribute to an initial
discussion.
Yours sincerely,
Daniel S. Mills BVSc PhD CBiol MIBiol Dip ECVBM-CA MRCVS
Professor & RCVS Recognised Specialist in Veterinary Behavioural
Medicine,
Head of Dept of Biological Sciences,
University of Lincoln,
Riseholme Park,
Lincoln
LN2 2LG
e-mail dmills@lincoln.ac.uk
Competing interests:
None declared
Competing interests: No competing interests
Dear Sir,
As a veterinary surgeon I picked up my husband’s copy of the BMJ
dated 24th February 2007 with interest. The dramatic front cover drew my
attention to the article on page 425 titled “Managing Dog Bites”. After
reading the review I felt saddened at them author’s attitude towards dogs
and was surprised to read that she was a life long dog owner.
I would be the first to admit that a dog that has bitten, especially a
child is in many cases best destroyed and I would not hesitate to
euthanase such an animal. However to tar all dogs with the same brush and
to suggest a dog ban to prevent biting is unfair.
The negative opinions in this article contrast with the positive impact of
dog ownership on human health described in editorial published in the
Veterinary Record this very week [1]. The Record cites research showing
that dog owners tend to be fitter, have lower blood pressure and
cholesterol and a greater level of physiological well being [2]. The NHS
should weigh up the cost saving implications of the above with the cost of
treating dog bites. Let us also not forget the life enriching work carried
out by the Guide Dogs For The Blind, Hearing Dogs For The Deaf, and Dogs
For The disabled. These charities must save the NHS thousands of pounds in
carers fees.
Education of dog owners is the key to reducing dog bites but I disagree
with Ms Besser’s suggestion that vets do little to advise owners. Animal
behaviour makes up a significant part of the veterinary undergraduate
curriculum and veterinary practices are very conscious about the need to
spend time with owners of new dogs especially puppies discussing dog
behaviour. Indeed many will run puppy socialisation and training classes.
To suggest neutering all dogs would solve the bite problem is naïve. Dogs
bite for many reasons. Neutering with behavioural therapy can reduce the
incidence of dominance aggression but it can have an adverse effect in
anxious dogs and make them more prone to displays of nervous aggression.
Mrs Kate Clarke MRCVS
1 Benefits of dog ownership on human health. The Veterinary Record,
vol 160 issue 7 p 209, February 17 2006.
2 Wells, D.L. (2007) Domestic dogs and human health: an overview. British
Journal of Health Psychology vol 12, pp145-156.
Competing interests:
None declared
Competing interests: No competing interests
Dear Sir
Ref: Dog Bite articles in BMJ / Blue Dog Programme
I was very interested to read the paper (Morgan & Palmer) and
comment (Besser) in the recent BMJ on dog bite incidents and treatment..
As the authors rightly point out, dog bites are a serious issue causing
not only distress to the unfortunate victim, but also a financial drain on
the NHS.
Understandably, the really serious incidents receive much media hype,
and sadly the “knee jerk” reaction of the authorities is to blame specific
breeds. Available data shows this is not the real problem, as most bites
occur in children within their own home by their own dog. A comment in the
BMJ article even suggests a ban on all dogs!!! However, having a pet dog
has been shown scientifically to enhance the health of the owners as well
as helping with child development. Dogs are being increasingly used in
therapeutic settings, especially in relation to older people. The
challenge therefore is to devise a way of retaining all the benefits of
pet ownership yet reducing the risks.
I am a veterinarian in practice in Upminster Essex, but I am also the
secretary of the BLUE DOG TRUST. This has developed by collaboration
between professionals of multi disciplines (veterinarians, pediatricians,
dog behaviorists, educational psychologists, teachers, graphic artists) to
devise an appropriate educational tool for young children to help address
this problem. Valuable lessons were learnt from the changing emphasis in
other accident prevention programmes (eg Road Traffic accidents), where it
has been shown that teaching children to recognize risk situations is more
effective than simply providing them with a list of rules. Accordingly, an
interactive CD ROM with a parent guide has been developed. It is hoped
that the child will learn to recognise risk situations while enjoying the
CD as a game (so called “edutainment”). Its efficacy as a learning tool
has been assessed by Dr Kerstin Meints at the Child Psychology Department
at the University of Lincoln.
Since the launch of the program at the World Small Animal Veterinary
Association Congress in October 2006, we have had fantastic feedback from
vets throughout the World. Translation of the parent guide into many
languages is now under way.
We are currently trying to make inroads into the teaching profession
within the UK. It is also essential to involve the medical profession. A
multi-discipline group is already being set up in Belgium, and it would be
good to have a similar group within the UK. I would be keen to hear from
medical colleagues with an interest in this problem.
Further details can be found on our website:
or contact me on:
The project is managed by THE BLUE DOG TRUST, which is registered as
a non-profit making organisation. All surpluses made from royalties
received from the sale of the product will be used to fund further
research and development. This research can be broadly classified into:
1. Further investigations into the efficacy of the existing CDROM and
Parent guide
2. Investigations into aspects of child behavior that might trigger bites
3. The study of the trigger factors that initiate bite incidents in other
cultures and the development of appropriate educational tools for these
situations. This has special relevance to rabies control programmes, and
the developing world and the BLUE DOG TRUST has formed a partnership with
the Alliance for Rabies Control (ARC) for this specific purpose.
Yours sincerely
Ray Butcher MA VetMB MRCVS
(Secretary BLUE DOG TRUST, 196 Hall Lane, Upminster Essex RM14 1TD)
Competing interests:
Secretary of BLUE DOG TRUST
Competing interests: No competing interests
I read the article by Ms Besser with a deal of interest. As an owner
of a rescue greyhound I can concur with most of what she writes.
Dogs are descended from wolves and so will retain some of these
vulpine traits. Yet how often are parents cajoled by little Wendy “to have
one of those fluffy puppies” as seen nightly advertising toilet tissue.
Most people forget that puppies grow up, require looking after for food
and toilet and have teeth. Interestingly a set of teeth is called ‘canine
teeth’ in humans! So indeed it is rarely the dog’s fault when it is hungry
and then disturbed with “its kill” by little Wendy pulling its ears or
tail. Yet, some form of control is possible. One can limit the breeds so
more aggressive breeds are not bred or are more heavily controlled by
legislation. Many rescue centres do routinely neuter the dogs and chip
them as well as vetting potential owners.
It is also worth remembering how much dogs have given humans aside
form work dogs. Greyhounds in the 1960’s and 70’s who failed on the track
in Belfast were taken for medical research. The development of cardiac
defibrillators was part of this. The energy damage was assessed on living
greyhounds to ascertain the energy of shock that heart muscle could
withstand without further damage.
However, aside from rescue centres it is humans who profit from dogs.
Greyhounds make money for their owners, trainers and some punters, yet,
when they fail a race they are either discarded or murdered at the track
(the human euphemism of “being put down” is used); similarly dog breeders
make a handsome profit from each litter, up to £350 for a Labrador pup. A
rescue greyhound, neutered, chipped and vaccinated comes in about £100.
Further, aggression can be bred out of dog breeds, as happens with
greyhounds, to prevent competitiveness on the track. Greyhounds prefer to
sleep for 20 hours a day and require x3 walks a day – not miles of
running.
As to dog free parks and muzzles, this situation is occurring in
Manchester whereby the proposal is for a £80 fine for a dog off the lead,
despite the fact that 50% of park users are dog walkers and who also pay
Council Tax to maintain the park for the teenage drinkers who seem to
inhabit them. I reckon few could afford such a fine which is £20 more than
driving a car with a mobile phone to one’s ear. Rather than dog free
parks, why not dog zones that are fenced off so that dogs can exercise off
lead and away from the public – safer for the dog and safer for the
humans.
Finally, as to ‘fouling’ responsible owners do pick up dog faeces and
bin it (if ever one can find a bin) yet the faeces of feral cats and urban
foxes remains well below the radar of City Councils in their ‘pest’
control.
Ms Besser is correct, it is to humans one must look to resolve dog
issues. Dogs do what comes naturally to them and perhaps too many children
see too many toilet paper advertisements and so forget, or are unadvised,
that they are playing with the descendants of wolves, some of whom have
given much to human medical research.
Competing interests:
None declared
Competing interests: No competing interests
Dog Bites: A Better Alternative Than Breed Bans
In 2004, an investigation tasked with finding a solution to the
escalating incidence of dog bites was launched in Canada. Three years
later we resurfaced, with an evidence-based series of corrective actions
identified through a formal risk assessment and entitled the "7-Step
Dangerous Dog Risk Mitigation Protocol". It, and the rest of our research,
is available at no cost on: www.PreventDogBites.com and
www.PreventDogBites.ca.
This 7 Step Protocol consists of the specific corrective actions
needed to eliminate the problem of dangerous dogs, without breed bans, and
without infringing on the rights of responsible owners. Once fully
implemented, these controls are projected to reduce the incidence of dog-
human attacks and Dog Bite-Related Fatalities by as much as 90%.
(We determined this through a standard Failure-Mode Effects Analysis,
whereby quantified risks are broken down into their component exposures,
one or more corrective actions identified to address each exposure, and
the probability of the exposure occurring in light of implemented controls
is recalculated.)
We are currently seeking a researcher interested in analyzing the
results of a year-long 2009 pilot of Dog-Trax. (The risk assessment
indicated that implementation of just one control -- the tracking of
problem dogs and owners-- could result in as much as a 70% reduction in
dog bites.)
If readers are aware of any researchers that might be interested in
participating in the study, please alert them to this need. This system
was developed in Canada, but was designed for global application, so
running a pilot in the UK is feasible.
Thanks for any assistance you can provide.
Competing interests:
Designer and Owner of the Dog-Trax database and the PreventDogBites websites
Competing interests: No competing interests