EMERGENCY MEDICAL RESPONSE DOG TRAINING
Written by: Michael D. Goehring

Great Plains Assistance Dogs Foundation, Inc. now known as Service Dogs for America is among the premiere training centers for Emergency Medical Response Dogs (EMRD). An EMRD is a service dog that is specifically trained to intervene with seizures as well as diabetic highs and lows. These dogs notify their master to the unpredictable and disabling challenges that they face on a daily basis. As of August 2005 Great Plains Foundation has trained, placed and certified 32 EMRD’s. The majority of these placements [28] have involved Epilepsy and those living with conditions that include seizures. Of the remaining 4 cases 3 involve diabetes and 1 involves anxiety attacks involving psychiatric illness. Additional inquiries have prompted us to look into area such as those living at
high risk of stroke, heart attack or other similar potentially fatal conditions. The first consideration is that of the appropriateness of a service dog as an intervention with any given individual. While an EMRD is a wonderful tool for many people it is certainly not appropriate for the majority of those that inquire into program services.
Working with an EMRD is a life altering experience and can be very rewarding. Appropriateness lies largely with the cognitive ability, personality and lifestyle of the individual considering this type of intervention. Presently Great Plains Foundation is training our dogs to use several different systems.

The AlertDog ® System is our own twoway system that was specifically
designed to be used by dogs. Lifeline® is a national system that provides rapid emergency response. Great Plains also uses another of our own systems… the DoggieDoorbell is an alert system intended for use within the home. This unit is particularly helpful for children with night time seizure activity. The success of an EMRD with its human partner is largely dependent on capabilities of the human partner. The first item to take a look at is realistic goals. An EMRD is not going to stop seizure activity. An EMRD is not “Lassie”. The reality is that an individual can expect to receive a dog that has logged a lot of training hours. There will be additional training necessary from the proposed EMRD partner. It will take dedication and commitment from everyone involved. To that end it is necessary that the individual have the ability to form a solid
working relationship with the EMRD. Not everyone is a dog person. For some an EMRD is simply not an appropriate intervention. Stability is a key ingredient to success. Stability within the disability and in reference to any medical treatments is necessary. We suggest that no radical medical treatments be scheduled 1 month prior to and 3 months following team training. Stability with family, friends,
workplace or the school setting is a must. Dogs thrive on consistency therefore it is imperative that we strive for stability. In example we would not recommend placing an EMRD into a home where an individual has just recently divorced and is scheduled to have surgery a week following team training. We do exercise cautions in certain circumstances. An EMRD is not an appropriate intervention in a circumstance where there is a high likelihood of a fatal event. This is fairly simple to determine. Ask the question, “What if the EMRD fails to perform his trained skill”? If the answer is death, an EMRD is not appropriate.
Generally children under the age of 8 are inappropriate for this type of training. Success is dependent on a working relationship and a genuine bond between the child and the dog. Team training is intense and demanding. Few children under the age of 8 have this capability. Great Plains Foundation has had success with children as young as 5, however this is a rare circumstance. Another difficult situation is that of violent behavior brought on by seizure activity. This can become a safety issue for the dog. It is also confusing for an EMRD to experience negative behavior in response to an appropriate response or alerting skill. Violent behavior from others in the home or work environment will affect the
dogs behaviors as well. Whether the violent behavior is limited to vocalizations or should it involve physical violence this is an area of genuine concern that may make an EMRD an inappropriate intervention.
The presence of multiple pets in the home is of concern to us. It is not an
automatic disqualifier. Other pets will affect the behaviors, training and
performance of the EMRD. However, it may or may not be a negative affect. Each case needs to be evaluated on an individual basis. In some cases we will recommend that the individual find another home for the existing pets. Many service dog programs will deny an applicant based on the existence of other pets. Great Plains does not have such a policy however we do precede with caution and this does add to the difficulty of an EMRD as an intervention.

There are several considerations when Great Plains trainers evaluate a dog as an EMRD candidate. First and foremost the dog must be capable of passing the Public Access exam. In general this requires that the dog has been well socialized in public settings during its youth. The dog must exhibit a keen awareness to its surroundings and the subtle changes within its environment. A keen sense of awareness without being highly distracted is the description of the ideal EMRD candidate. Perhaps more than anything the dog must have the ability to develop a strong working relationship with its master. Dogs that reciprocate affection and who
focus fully on their human partners are good candidates. It is our experience that the breed and sex of the animal are not influencing factors. Another important factor is that the canine candidate must be able to handle itself in public settings while its master is unconscious. This is critical. Within the arena of service dogs this is the only area where the dog is asked to maintain a
professional demeanor while its master is unconscious. The EMRD will have to accept many situations during emergency events and the dog must remain steadfast. Dogs that do not work well are those that are highly distracted, have aggression issues or cannot maintain professionalism without a coherent alpha figure present.
Fifty six percent [18] of the thirty two [18] have provided an alerting behavior for their human partners. Additionally five graduates report that the dog displays a response behavior only. *Twenty nine of the thirty two EMRD’s that we have worked with involve seizures.
An additional six of the EMRD’s placed, while not providing alert or response work, do provide a tangible therapeutic benefit. This benefit manifests itself in a
calming effect which most often leads to a reduction in seizure activity or reduced severity of breakthrough events. The remaining four graduates report no measurable benefit beyond that of a pet dog.
In the latter years of working in this field the percentage of those dogs providing an alerting or responding behavior is higher than that of the overall average. Knowledge gained from our early work in this field has made for a better success rate. It is our contention that EMRD’s are a good intervention for a small percentage of those living with uncontrolled illnesses or conditions that spawn emergency medical events.
Success is achieved through knowledge and experience on the agency side of the equation and commitment and hard work on the part of the student (recipient).

Training
The training and preparation of an EMRD are as follows. Great Plains
implements a positive reinforcement based training methodology. Commonly known as “clicker training”, the methodology focuses on reward rather than older methodologies that use aversion techniques.
In the dogs youth we strongly encourage scenting abilities. In particular scenting directed towards us as handlers. Young dogs that include us in on new discoveries are ideal candidates. These puppies appear as though they feel an obligation to let us know about their every discovery. Socialization and exposure to odd circumstances is a must. Caution must be exercised as dogs move through their critical phases of development. Basic obedience and task training takes place as is standard within the service dog world. Customization begins at roughly 18 – 20 months of age and will continue on through placement and into followup.
At this phase standardization is more difficult to achieve. This is
attributed to the varied nature of the illness or condition with which we
are working.

Team Training
Special considerations do exist when partnering an EMRD with an individual with a condition or illness that requires emergency medical response. Great Plains
does implement a standard three week team training period. The first several days are spent orientating the student to the training methodology that has been used in training their dog. During this period the student will work with several dogs. This group of canines may or may not include the primary candidate that
has been selected for that individual. Caution is exercised in insuring that the student and staff are comfortable with that particular candidate prior to moving deeper into the team training period. Great Plains Foundation does have a strict policy regarding dog selection. Policy
disallows students from choice of breed, color, sex and other such selection qualifiers. Given that success is largely dependent on the bond that develops between student and the EMRD, it is important that the selection decision be made by those with knowledge and experience. We ask that applicants and students extend understanding to us regarding this matter. Students may indicate such preferences during the application process and we do take these matters into consideration. However, we will not guarantee any such requests.
Most often it is necessary for the student to bring a care attendant or training partner with them. Great Plains Foundation is not able to provide full time home health care for students. Students will find it helpful to have a training partner in trouble shooting problems as well as with the development of the alerting or responding behaviors. This is not a mandatory policy. Several have successfully gone through team training solo. This matter is discussed with each student prior
to their arrival. Great Plains Foundation conducts one on one team training sessions. During each three week team training session the staff here at Great Plains is fully focused on the EMRD and its new partner. Given the unpredictable nature of these conditions and illnesses one on one allows the flexibility needed to be successful.
There are essentially two goals that we are working on during team training. By day three the team will begin working on the first of those goals. Public Access
training begins with the basics and provides the student and EMRD with the means to develop a working relationship. Public Access training is also necessary to gain public access rights through our program.
The second goal is to create an association [for the EMRD] between the
emergency medical event, the trained response or alert skill and the verbal cue to perform that skill. Trainers and the training partner [if applicable] will work to
develop this association for the EMRD as the student experiences seizures or low blood sugars. It is worth mentioning here that we do not suggest or
encourage students to induce such events.
This is dangerous and presents unnecessary risk. It is also not advantageous in that the EMRD will detect anticipation and anxiety not present in a naturally occurring event. In example, by withholding someone’s seizure medication the body chemistry is altered from that which the dog would normally encounter during an actual event. By proceeding with this method the dog can inadvertently
be taught to respond to scent associated with anxiety and anticipation rather than the seizure event. This threatens to confuse the EMRD. Early indications are that diabetic control would present similar
issues. Each team training session progresses and ends with its own level of achievement. In some team training sessions we witness the EMRD doing his job
with top notch accuracy inside of the first week. In other cases we see the
individual ready to depart and we have not witnessed a single medical event. This is curious in that for some it is the longest duration that the individual has gone without an event. Some conclude that the distraction from everyday life and the focus on the task at hand are cause for this change in activity. This has not proven to be detrimental to the long term success of the EMRD. Equal to statistical averages more than half go on to provide alerting or response skill that we all worked toward.

IN CONCLUSION
The field of Emergency Medical Response Dog training is growing and
expanding. New programs and training efforts are starting all across the United States. We urge people to do your homework. Research programs thoroughly. As with any aspect of society people should use caution and good judgment.
There are many programs doing really good work in this field. However there are a few that are doing substandard work resulting in financial loss and heartache. It must also be said that a program that works well for one individual with a particular medical condition is not necessarily the right program for another individual with the same condition. Most programs have evolved of their own accord. Policies, methodologies, terms and cost vary significantly from program to program. The Great Plains program is a good fit for some people. Some may
be a good candidate for an EMRD as a tool for independence and not be a good match for our program. Researching a variety of existing programs is a must for the best results. Within this field of assistance dog training it is not about whom is the “best” training program. Rather it is a matter of which program is the best fit for any given person.
The information contained in this article is specifically written regarding Great Plains Foundation’s approach to Emergency Medical Response Dog training. It is not to be inferred that any other program has the same findings, conclusions or conducts its training in any similar manner. Nor are we suggesting that any other program should conduct their training in any similar fashion. Information in reference to any efforts to work with others in this field has been withheld.


www.adionline.org

The website listed above belongs to Assistance Dogs International. ADI is a nonprofit corporation whose members are 501 c 3 [or equivalent] organizations that provide assistance dog services. These programs are based in the United States and beyond.
To find an organization near you or to find additional information regarding assistance dogs we strongly encourage you to visit this site.

How do they do it?
Many people are perplexed as to how it is that dogs can provide early alerts to emergency medical events. The concept really isn't that far fetched when one
considers why a dog may be predisposed to this ability and how [through his senses] a dog is able to do it. As a matter of survival and as nature would have it his ancestors would have selected a physically ill animal as prey. It is quite possible that the canine’s instinctive ability to detect physical weakness within individual animals in a herd is in play here. In the wild this intrinsic influence is part of the very ebb and flow
of life. Perhaps it is remnants of this age old ability that he uses today to let us know that seizure activity is underway. This may, at least in part, explain why some dogs appear to be predisposed to this type of work. Moving beyond why, let’s take a look at how. The canine olfactory system is absolutely amazing in design and ability. It has been estimated that the dog has an ability to identify smell 1,000 to 10,000 times better
than humans. As compared to dogs, humans are truly nasally challenged. The canine species live by their nose. This combined with a keen sense of hearing and movement based vision, lends way to detecting subtle changes within their world. For anyone interested in good information regarding how the canine senses work and how they use the information gathered is strongly encouraged to read “How Dogs Think” by Stanley Coren. Once one understands how the canine minds works in conjunction with the senses the idea of a dog being able to provide this type of assistance is not so hard to believe. Few from the scientific community want to hear anything of the spiritual connection between us and our canine counterparts. However there are many that believe in this spiritual connectedness. Great Plains Foundation has learned
that the teams that develop this extraordinary relationship have the highest degree of success. Here at Great Plains we do not feel this is by coincidence. There simply is something special between dogs and humans. For thousands upon thousands of years man and dog have interacted and even cooperated in the name of survival. Dog lovers the world over have stories of incredible canine feats. Many of these anecdotes can be explained in scientific terms; however
there remain some that cannot be explained. Those of us that coexist in harmony with canines are not at all surprised by these stories. Maybe because we want to believe there is something mystical in play.
Within the Great Plains program we are working to duplicate some of the
miracles that have happened naturally. It was the dogs themselves that told us they can detect seizures, diabetic emergencies and more. We use humane methods to duplicate what does occur naturally. We use the best information available to further the effort. And we are the first to acknowledge that there is more to be learned.