As a trauma nurse for more than a decade, I have seen some horrendous injuries caused by dog bites.
These have been distressing for the child, families and indeed the staff involved.
Much needs to be done to reduce the incidence of dog bites and there are some strategies mentioned in this article that may help mitigate this increasing emotional and financial burden on society.
However, not all dogs are vicious (though any dog can bite) and over the centuries canines have been trained as valuable assets to assist people and indeed some have become a much-loved family member.
The dog, our oldest pet, was domesticated 14,000 years ago and currently there are an estimated 700 million domestic dogs worldwide, with approximately just over five million dogs across Australia.
It is unfortunate, though not surprising, that there are millions of people injured by dogs each year globally.
In Australia, according to the Australian Institute of Health and Welfare (AIHW) dog attacks result in more than 2,000 hospital admissions per year.
Dog bites make up approximately 1% of all Emergency Department (ED) presentations but are higher in the paediatric population.
Children aged 0-4 years tend to sustain facial and head injuries and those between five and nine years tend to sustain extremity injuries and occasionally bites to the torso in addition to bites to the face and head.
Children’s natural behaviours put them at risk for dog bite injuries, including actions such as running, yelling, grabbing, hitting, quick and darting movements and maintaining eye contact.
The close proximity of a child’s face to the dog’s face also increases the risk that facial injuries will occur.
Children are generally inexperienced when handling dogs, but with good early parental education, it is possible to reduce the incidence of dog bite-related injuries in children.
The types of wounds more commonly sustained following dog bites are puncture wounds or crush wounds.
These injuries result in pain due to disruption of the skin integrity.
Treatment considerations include antibiotics for infection prevention, and tetanus immunisation depending on the child’s vaccination status.
Surgery is required to thoroughly clean and remove all debris, further surgery to repair the wound and surgical reconstruction is often required.
The overall medical treatment of admission, medication, surgery and follow-up after dog bite injuries represent a significant financial burden to society.
Additionally, there is psychological distress for the child and emotional distress for the family and often euthanasia for the dog.
Dog bites have an incidence of infection of approximately 10%, these are predominately mixed aerobes and anaerobic infections.
The dog mouth flora includes pasteurella caninus, gram negative and non-motile coccobacillus and these present in the wound if left untreated, can cause skin necrosis and sepsis.
Rabies, though rare, should also be considered if the bite was from a dingo, a stray dog, an unwell-looking dog, or if the owner cannot produce evidence of the canine vaccinations.
At Queensland Children’s Hospital, there has been a staggering increase of almost 50 per cent of patients admitted for greater than 24 hours following a dog bite, when comparing data from 2020 to 2021.
Recognising the potentially devastating and widespread effects of dog bites, there is a dedicated trauma nurse navigator and a post-trauma social worker that provides a clinical, counselling and support service for children (and their families) that have been admitted following a dog bite.
The aim of this service is to improve the child’s well-being during their admission, with follow-up continuing up to two years after discharge.
The National Coronial Information System noted on average that 1–2 people died due to dog bites each year in Australia, between July 2000 and November 2010.
Sadly, there continues to be horrific and heart-breaking cases of fatal dog attacks.
As recent as January 2022, a 2-year-old boy was mauled to death in the Cassowary Coast region of Queensland.
In March 2022 in the Isle of Wight, UK, a 17-month-old girl was tragically fatally attacked by a dog that her parents bought only one week preceding the event.
To mitigate such incidents, more than 20 countries, worldwide, have tried to ban certain aggressive dog breeds under the well-intentioned auspices of Breed Specific Legislation.
The pit bull terrier has been the most common subject of restrictions and was deemed responsible for the majority of dog bite fatalities in the 1980s.
This breed was eclipsed by rottweilers in 1990.
The Australian Royal Society for Prevention of Cruelty to Animals (RSPCA) does not support breed-specific legislation.
Based on international scientific evidence they believe any dog may be dangerous, and dogs should not be declared as ‘dangerous’ on the basis of their breed.
According to Professor Kimble et al (2011), there are some basic rules that children should be taught to reduce the incidence of dog bites, including but not limited to:
- Asking for permission from the owner before slowly approaching an unfamiliar dog
to pat them
- Standing still if approached by a dog and if knocked over, rolling into a ball position,
and lying still
- Some other strategies include never disturbing a dog that is sleeping, eating or
caring for puppies
The Royal Australasian College of Surgeons (RACS) recommend the development of education programs for dog owners and potential dog owners, with the onus of responsibility for dogs, on the owner.
They recommend the registration of all dogs, desexing of dogs, and a restriction on the number of dogs per household.
The question remains, is there any value in dog ownership? Do you they serve a useful purpose?
Several themes have emerged from the research on the owner-dog relationship including increase independence, confidence, improved social interactions, as well as providing companionship and safety.
Kennel Club studies in the USA have shown that stroking and petting dogs lowers blood pressure and reduces levels of the stress hormone cortisol and this in turn can lessen cardiovascular problems.
Dogs have also been successfully trained into magnificent roles such as assistance or service dogs to assist people with disabilities.
For over 30 years in Australia, highly trained mobility assistance dogs have been placed with people suffering from physical disabilities such as cerebral palsy, spina bifida, multiple sclerosis, and those that have been significantly injured in serious accidents.
Some medical detection dogs have been taught to detect cancer, though odour signatures in a person’s skin, urine, and sweat, which if diagnosed early can lead to better outcomes for the person concerned.
Delta Society Australia offer a Delta Therapy-Dog-program which is a world-leading provider
of animal-assisted services with dogs that visit hospitals, aged care facilities, dementia wards, mental health facilities, palliative care units, disability services, health clinics, schools and correctional facilities every week.
More recently, these therapy dogs have provided comfort to both hospital staff and patients during the COVID-19 pandemic.
This too has been extremely successful with positive results reported by the healthcare staff.
The University of Adelaide is now participating in an international research program, specifically training medical detection dogs to be able to rapidly screen and identify positive COVID-19 cases.
These dogs are detecting COVID-19 faster, earlier and more reliably than any rapid antigen test currently used worldwide, with over 97 per cent accuracy.
Today, approximately 40 per cent of Australian households include at least one dog, making them the most popular type of pet.
To mitigate the incidence of dog bites, the responsibility lies firmly with the owner of the dog, in addition to puppy training and obedience classes, plus close supervision around children.
The enduring relationship between canine and handler is a close symbiotic relationship born from the everlasting bond of companionship, loyalty, fun and friendship.
Domestic dogs are our four-legged friends that provide constant entertainment and unconditional pristine love.
Most responsible dog owners know that life is better with a dog.
Tona Gillen is a Trauma Nurse Manager at Queensland Children’s Hospital.
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