Emergency and critical care team proves successful in its first year for equine medical center

Since opening its doors in 1984, the Marion duPont Scott Equine Medical Center has served Virginia, Maryland, West Virginia, and southern Pennsylvania as an emergency center for critically ill and injured horses. 

The equine medical center (EMC), located in Leesburg, is one of three animal health care facilities and teaching hospitals of the Virginia-Maryland College of Veterinary Medicine, based on the Virginia Tech campus in Blacksburg. 

Over time, providing critical emergency services to the equine community has become increasingly challenging. Fewer veterinary students are choosing to pursue an equine-focused career, and veterinarians today expect a more balanced work-life dynamic. 

These factors, combined with a staggering 58 percent rise in the center's emergency caseload since 2020, created an unsustainable situation for faculty and staff.  Significant changes were needed. 

Last year, the center introduced a dedicated emergency and critical care team to complement the existing medicine, surgery, and sports medicine teams. This new service has greatly benefited emergency and critical care patients and brought additional advantages to the center’s faculty and staff.

In the past year, Emily Schaefer and Sarah Dukti, clinical assistant professors of equine emergency and critical care, have had a busy but rewarding time. Between them, they admitted 66 percent of the emergency cases referred to the center, making a significant impact in a very short time. 

“Being at the EMC with the newest innovative technologies, backed up by a team of specialists in their fields, and an outstanding support team is a career-long dream,” Dukti said. “I feel privileged to work somewhere that enables me to provide the highest level of care possible to attempt to save lives.”

Historically, the equine medical center faculty managed the emergency caseload in conjunction with scheduled outpatient and elective appointments, often booked weeks in advance. When an emergency coincided with a scheduled appointment, non-emergency patients and their owners had to wait, which while necessary to provide lifesaving support to emergency patients, led to stress and inconvenience. 

Delivering top-tier specialty and emergency treatment remains the center’s ultimate goal. Adding two emergency and critical care (ECC) specialists, who thrive on the challenges of emergency cases, has benefited everyone. These dedicated professionals, who are not responsible for elective or outpatient care, are passionate about their roles — even when called in during the early hours to evaluate a critically ill patient.

Their specialized expertise has also provided learning opportunities for residents, interns, and clinical support staff. The emergency and critical care clinicians' passion and intrigue for emergency cases are reflected in the training of residents and interns, providing a safe and enthusiastic learning environment, even during inconvenient hours. They can dedicate more time to communications with clients and referring veterinarians and work collaboratively with other center staff to ensure clarity and optimal care for each patient. 

As a result, other clinicians at the center can now focus more fully on their areas of expertise. While they still support the emergency and critical care service, it’s to a much more manageable extent. The emergency and critical care schedule, set six months in advance, provides clear expectations for clinical staff about who will handle each emergency case, reducing workplace stress.

"Introducing the ECC program has allowed me and the rest of the faculty at the EMC to dedicate ourselves to our special areas of interest, which in my case is general elective surgery,” said Norris Adams, clinical associate professor of equine surgery. “Being fully rested contributes greatly to a positive attitude and greater attention to detail "  

Dukti and Schaefer take three to four 24-hour on-call days each week covering shifts with considerable flexibility. They handle most weekend and holiday shifts, allowing other faculty members to spend time with their families. The medicine and surgery teams cover the remaining shifts collaboratively, ensuring 365 days of emergency care coverage.

Schaefer describes her emergency and critical care specialty training during her fellowship at The Ohio State University as a fun and enriching experience. Initially focused on medicine, her first residency included extensive emergency training but little surgical training. Her training concentrated heavily on surgical skills. 

"The ECC fellowship is an incredibly flexible training program that allows specialists to focus on areas not covered in traditional medicine or surgery residencies," Schaefer said. "The goal is complete competency in both surgery and emergency and critical care, ensuring the best outcomes for equine patients experiencing acute health crises or severe injuries."

In contrast, Dukti’s first residency focused on surgery. During her emergency and critical care residency at the University of Pennsylvania’s New Bolton Center, she received in-depth training in emergency and critical care, internal medicine, and physiology, areas not covered during her surgical residency. 

“While completing my senior year as a veterinary student at The Ohio State University, I realized I had a passion for emergency care,” Dukti said. “I was inspired to learn from one of the first American College of Veterinary Emergency and Critical Care members as I watched her treat and save neonates and adult horses with critical diseases.”