First Aid – Guidelines Consensus Input
What and When: Welcome to the review and comment period for the proposed RECOVER First Aid Guidelines, set to publish by mid-2026. The comment period will close on April 7, 2026, at 8 am PDT.
This table contains the designator (e.g., FA-01), Population-Intervention-Comparator-Outcome (PICO) question, evaluated outcomes listed in order of descending priority, and the associated proposed Treatment Recommendation(s) for each question.
How to Comment: If you would like to comment on a proposed Treatment Recommendation, please click the link associated with that PICO, which will take you to the full Evidence Profile Worksheet for that PICO question. These Evidence Profile Worksheets include the consensus on science, treatment recommendation(s), and justification for each PICO, as well as Evidence Evaluator, Domain Chair, and Co-Chair notes about the evidence and a comprehensive list of sourced references. Final versions of the 3 draft figures will appear in the Guidelines papers to accompany their associated topics. In order to comment, you must sign in with a Google account. If you don’t have a Google account, you can sign up for one for free here by clicking on “Create Account”. Please comment directly on the pdf by highlighting the section in question and clicking the “Comment” tool icon on the pdf so all stakeholders can view one another’s comments. When commenting, please include your full name at the start of the comment. Only comments with full names listed will be considered when finalizing the Treatment Recommendations. If we have questions about your feedback, we’ll contact you using your Google account.
How to Contact Us: You are welcome to email us at [email protected] with any questions.
| PICO # | PICO Question with Outcomes Listed from Most Critical to Important | Treatment Recommendation(s) | Link for comment |
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FA-03 | In cats and dogs in the pre-hospital setting with signs of shortness of breath, difficulty breathing, or hypoxemia (P), does administration of oxygen (I), compared with no administration of oxygen (C), result in improved outcome (O)? 1. Survival to discharge 2. Incidence of CPA 3. Hospital length of stay | We recommend administering oxygen to dogs and cats with signs of difficulty breathing or hypoxemia (i.e., cyanosis, low SpO2) in the pre-hospital setting (strong recommendation, expert opinion). When such monitoring is available, we recommend titrating oxygen support to SpO2 95 – 97% in the pre-hospital setting to dogs and cats with signs of difficulty breathing or hypoxemia (i.e., cyanosis, low SpO2) (strong recommendation, moderate quality of evidence). | Link |
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FA-04 | In cats and dogs in the pre-hospital setting with external limb bleeding(P), does the application of a tourniquet (I), compared with not applying a tourniquet (C), result in improved outcome (O)? 1. Survival to discharge 2. Incidence of CPA 3. Functional recovery (including lasting complications attributed to tourniquet use) 4. Severity of clinical signs (bleeding) 5. Hospital length of stay | We suggest prehospital application of a tourniquet in conscious cats and dogs with severe extremity hemorrhage not responsive to application of direct pressure alone. (weak recommendation, very low quality of evidence) We recommend prehospital application of a tourniquet in unconscious cats and dogs with severe extremity hemorrhage not responsive to application of direct pressure alone. (strong recommendation, very low quality of evidence) In cases where the risk to rescuer is believed to be high, we recommend against application of a tourniquet in cats and dogs. (strong recommendation, expert opinion) | Link |
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FA-05 | In cats and dogs in the pre-hospital setting with thermal injuries (P), does active cooling of burns (e.g., cold water, ice) (I), compared with no active cooling of burns (C), result in improved outcome (O)? 1. Functional recovery 2. Severity of clinical signs (extent of burn) 3. Need for analgesia 4. Hospital length of stay 5. Harm to rescuer | We recommend active cooling of thermal burns in cats and dogs by applying cool running tap water for at least 20 minutes, as soon as possible and within three hours of injury.(strong recommendation, moderate quality of evidence) In cases where the risk to rescuer is believed to be high, we recommend against active cooling for burns in cats and dogs. (strong recommendation, expert | Link |
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FA-06 | In cats and dogs in the pre-hospital setting with symptomatic hypoglycemia (P), does administration of dietary forms of sugar (I), compared with no oral sugar supplementation (C), result in improved outcome (O)? 1. Survival to discharge 2. Incidence of CPA 3. Severity of clinical signs (admission glucose concentration) 4. Hospital length of stay (time to resolution of hypoglycemia) | In asymptomatic dogs and cats with hypoglycemia documented by continuous glucose monitor or glucometer in the prehospital setting, we recommend feeding dietary carbohydrate (e.g., pet food) (strong recommendation, very low quality of evidence). In dogs and cats with symptomatic hypoglycemia without active seizures in the prehospital setting, we suggest applying a viscous simple carbohydrate (e.g., corn syrup, glucose syrup) to the buccal mucosa between the maxillary premolars and the cheek, provided that this does not delay timely veterinary care (weak recommendation, very low quality of evidence). In dogs and cats with active seizures, we recommend against oral or mucosal administration of any substance in the prehospital setting (strong recommendation, expert opinion). In hypoglycemic dogs and cats in the prehospital setting, we recommend against oral or mucosal administration of any substance if there is perceived risk to the caregiver (strong recommendation, expert opinion). | Link |
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FA-07 | In cats and dogs in the pre-hospital setting with suspected heat injury or heat stroke (P), does active cooling before transport to a veterinary hospital (I), compared to no intervention before transport to a veterinary hospital (C), result in improved… (O) ? 1. Survival to Discharge 2. Incidence of CPA 3. Severity of Signs 4. Hospital length of Stay | We recommend moving dogs and cats showing signs of heat stroke to a cool environment as soon as possible (strong recommendation, expert opinion). We recommend prehospital active cooling in dogs and cats showing signs of heat stroke (strong recommendation, very low quality of evidence). We suggest actively cooling dogs and cats showing signs of heat stroke in the prehospital setting by applying cool running water to the animal’s trunk with emphasis on the area with the thinnest haircoat, usually the ventral abdomen, soaking to the skin (weak recommendation, expert opinion). We suggest actively cooling dogs and cats showing signs of heat stroke in the prehospital setting to a rectal temperature of 39.7°C –40°C (103.5°F –104.0°F), and then discontinuing active cooling measures (e.g., stop running water, dry the animal) (weak recommendation, expert opinion). We suggest continuing active cooling in dogs and cats with stertor or stridor that are showing signs of heat stroke in the prehospital setting until clear improvement in panting, or until temperature reaches 38.6°C (101.5°F), whichever is sooner (weak recommendation, expert opinion). We recommend against prehospital active cooling measures in dogs and cats showing signs of heat stroke if risk to the rescuer is perceived to be high (strong recommendation, expert opinion). We recommend dogs and cats showing signs of heat stroke be transported to a veterinary hospital immediately following prehospital active cooling (strong recommendation, expert opinion). | Link |
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FA-08 | In cats and dogs in the pre-hospital setting exposed to a caustic substance on the skin (P), does irrigation with water (I), compared with no irrigation (C), result in improved outcome(O)? 1.Survival to discharge 2.Severity of Clinical Signs 3. Hospital length of stay 4. Harm to the rescuer | We recommend performing immediate irrigation with cool running water in the prehospital setting for as long as possible (minimum 15 minutes) for cats and dogs with caustic substance exposure to the skin (strong recommendation, very low quality of evidence). We recommend the rescuer wear personal protective equipment (gloves, long sleeves, face protection, eye protection) while performing water irrigation for caustic substance exposure in dogs and cats.(strong recommendation, expert opinion) We recommend against performing water irrigation for dogs and cats with caustic substance exposure if risk to the rescuer is high.(strong recommendation, expert opinion) | Link |
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FA-09 | In conscious cats and dogs suspected to be choking (P), does performing back blows or other interventions (I), compared to abdominal thrusts (C) result in improved outcome (O)? 1. Survival to discharge 2. Incidence of CPA 3. Severity of clinical signs/time to resolution of choking/complications of choking 4. Need for intervention from medical professional 5. Harm to the rescuer | In conscious dogs and cats in the prehospital setting suspected to be choking, we recommend bystander intervention to help clear the airway if the risk to the rescuer is low.(strong recommendation, very low quality of evidence) In conscious dogs and cats in the prehospital setting suspected to be choking, we recommend first administering up to 5 back blows to help clear the airway.(strong recommendation, very low quality of evidence) In conscious dogs and cats in the prehospital setting suspected to be choking, we recommend trying alternative techniques to help clear the airway if 5 back blows are not successful.(strong recommendation, very low quality of evidence) In conscious dogs and cats in the prehospital setting suspected to be choking, we recommend against bystander intervention if the risk to rescuer is high.(strong recommendation, expert opinion) In unconscious dogs and cats in the prehospital setting suspected to have a foreign body airway obstruction, we recommend against blind finger sweeping to attempt to clear the airway.(strong recommendation, expert opinion) In unconscious dogs and cats in the prehospital setting dogs and cats in the prehospital setting suspected to have a foreign body airway obstruction, we recommend immediately starting chest compressions, following the RECOVER Initial Assessment Algorithm.(strong recommendation, very low quality of evidence) We recommend that any animal having required bystander assistance (e.g., back blows, abdominal thrusts) to clear the airway be evaluated by a veterinarian immediately.(strong recommendation, very low quality of evidence) | Link |
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FA-10 | In cats and dogs in the pre-hospital setting with suspected out-of-hospital cardiopulmonary arrest (P), does BLS performed by a bystander (e.g., the owner, a good Samaritan, etc.) (I), compared to no pre-hospital BLS (C), result in improved outcome (O)? 1. Survival to discharge 2. ROSC 3. Hospital length of stay 4.Harm to rescuer | We recommend immediate bystander-performed BLS for out of hospital cardiopulmonary arrest in dogs and cats as long as risk to the rescuer is low.(strong recommendation, moderate quality of evidence) We recommend transport to the nearest open veterinary clinic as soon as possible for dogs and cats experiencing OHCA.(strong recommendation, moderate quality of evidence) We recommend continuous BLS during transport to the nearest open veterinary clinic with a primary emphasis on rescuer safety and while following applicable vehicle passenger safety laws.(strong recommendation, expert opinion) | Link |
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FA-14 | In cats and dogs in the pre-hospital setting exposed to opioids (P), does administration of a reversal agent(I), compared to no reversal agent administration (C), result in improved outcome (O)? 1. Survival to discharge 2. Incidence of CPA 3. Severity of clinical signs (time to resolution of signs) 4. Hospital length of stay 5. Need for intervention from medical professional | We recommend administration of naloxone by the intranasal or intramuscular route in the prehospital setting to dogs and cats with altered mentation or a respiratory rate < 10 breaths per minute if opioid exposure is suspected.(strong recommendation, low quality of evidence) In the prehospital setting, if a dog or cat is unresponsive and agonal, gasping, or apneic, and opioid exposure is suspected, we recommend initiating basic life support per the RECOVER Initial Assessment Algorithm and thereafter administering naloxone intranasally or intramuscularly as soon as possible.(strong recommendation, very low quality of evidence) We recommend against administration of naloxone to dogs and cats in the prehospital setting if risk to the rescuer is high.(strong recommendation, expert opinion) We suggest giving naloxone by the intranasal or intramuscular route to dogs and cats that do not have established vascular access.(weak recommendation, low quality of evidence) | Link |
Allergy & Anaphylaxis subset | |||
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FA-01 | In cats and dogs in the pre-hospital setting experiencing anaphylaxis (P), does administration of IM epinephrine (I), compared to no epinephrine (C), result in improved outcome (O)? 1. Survival to discharge 2. Incidence of CPA 3. Hospital length of stay 4. Harm to rescuer | We suggest pre-hospital administration of IM epinephrine for dogs and cats experiencing anaphylaxis (Grade 2 or 3) (weak recommendation, very low quality of evidence). We suggest the dispensation of epinephrine prefilled syringes dosed to patient body weight with instructions for home use to the owners of dogs and cats that have experienced a prior anaphylactic event (weak recommendation, expert opinion). | Link |
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FA-02 | In cats and dogs experiencing anaphylaxis in the hospital (P), does administration of IV epinephrine (I), compared to IM epinephrine (C), result in improved outcome (O)? 1. Survival to discharge 2. Incidence of CPA 3. Severity of clinical signs 4. Hospital length of stay | In dogs and cats experiencing acute anaphylaxis (Grade 2) without hypotension in the hospital setting, we suggest that epinephrine be administered as early as possible by the IM route(weak recommendation, very low quality of evidence). In dogs and cats in the hospital experiencing anaphylaxis with hypotension (Grade 3), we suggest epinephrine by given by continuous IV infusion targeting MAP 70 mm Hg rather than by bolus IV dosing.(weak recommendation, very low quality of evidence) | Link |
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FA-12 | In cats and dogs in the pre-hospital setting with acute allergic reactions not affecting breathing (P), does oral antihistamine administration (I), compared to no oral antihistamine administration (C), result in improved outcome (O)? 1. Survival to discharge 2. Severity of signs 3. Need for intervention from medical professional 4. Hospital length of stay | We recommend administering an oral H1 receptor antagonist in the pre-hospital setting to dogs and cats with acute allergic reactions not affecting breathing (strong recommendation, low quality of evidence). We recommend administering an H1 receptor antagonist in the practice setting to dogs and cats with acute allergic reactions not affecting breathing (strong recommendation, low quality of evidence). We recommend against administering an oral H1 receptor antagonist in the pre-hospital setting to dogs and cats with acute allergic reactions not affecting breathing when risk to the rescuer is high (strong recommendation, expert opinion). | Link |
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FA-13 | In cats and dogs in the pre-hospital setting with acute allergic reactions affecting breathing (P), does oral antihistamine administration (I), compared to no oral antihistamine administration (C), result in improved outcome (O)? 1. Survival to discharge 2. Incidence of CPA 3. Severity of clinical signs 4. Hospital length of stay | In dogs and cats in the pre-hospital setting with acute allergic reactions affecting breathing, we suggest against oral administration of antihistamines.(weak recommendation, expert opinion) | Link |
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FA-29 | In cats and dogs in the pre-hospital setting with acute allergic reaction (i.e., urticaria including wheals and/or angioedema) (P), does routine glucocorticoid administration (I), compared to no glucocorticoid administration (C), affect outcome (O)?
| In cats and dogs in the pre-hospital setting with acute allergic reaction (i.e., urticaria including wheals and/or angioedema), we suggest against the routine use of glucocorticoids.(weak recommendation, very low quality of evidence) In cats and dogs with acute allergic reaction (i.e., urticaria including wheals and/or angioedema) that fail to respond to H1 receptor antagonists, we suggest adding a short course low-dose glucocorticoids (i.e., ≤0.5 mg/kg/day of prednisolone equivalent for ≤ 5 days) while continuing H1 receptor treatment.(weak recommendation, expert opinion) | Link |
| FA-30 | In cats and dogs experiencing anaphylaxis in the hospital (P), does administration of systemic glucocorticoids (I), compared to no administration of systemic glucocorticoids (C), result in …. (O)? 1. Survival to discharge 2. Severity of clinical signs 3. Length of hospital stay | In cats and dogs experiencing anaphylaxis in the hospital, we recommend against routine administration of systemic glucocorticoids (strong recommendation, very low quality of evidence) | Link |
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FA | First Aid Client Action Tree | Link | |
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FA | Heat Stroke Algorithm | Link | |
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FA | Allergy and Anaphylaxis Algorithm | Link |
