The Reassessment Campaign on Veterinary Resuscitation (RECOVER) Initiative, a nonprofit organisation and global leader in evidence-based veterinary cardiopulmonary resuscitation (CPR) guidelines and training, has released the first evidence- and consensus-based first aid recommendations for dogs and cats developed through a systematic and transparent evaluation process.

The guidelines are designed to bridge the critical gap between recognising an emergency and reaching veterinary care. They provide practical advice for veterinary professionals to share with pet owners, professional handlers and other animal caregivers, helping them recognise emergencies, provide appropriate immediate assistance and seek veterinary care without unnecessary delay.

Importantly, first aid is not a substitute for veterinary diagnosis or treatment. Its purpose is to provide immediate support during an emergency and potentially prevent deterioration while the animal is transported to a veterinary facility.

The recommendations address several emergencies in which prompt action may influence outcome, including hypoglycaemia, non-caustic toxin ingestion, heatstroke, thermal and chemical burns, respiratory distress, choking, opioid exposure and severe extremity bleeding. RECOVER also provides First Aid Recognise and Act Algorithms and instructional figures that veterinary teams can use when educating owners, first responders, shelters, groomers, boarding facilities, trainers and other animal caregivers. Across every emergency, however, one principle takes priority: The safety of the person providing first aid must come first.

Safety first: Help without becoming the next casualty

Before attempting first aid, bystanders should assess the environment and consider whether other people or veterinary professionals are available. They should also be realistic about their own skills and whether the situation can be managed safely.

An injured or unwell animal may be aggressive because of pain, fear or temperament. Even an animal that is normally calm may bite when frightened or in pain. If the perceived risk to the first aid provider is high, first aid should not be attempted.

This safety principle applies across all the RECOVER recommendations. First aid should provide immediate support while veterinary care is being arranged or during transport, but it should never compromise the safety of the caregiver or delay professional treatment.

Hypoglycaemia: Recognise the signs and act early

Hypoglycaemia can occur in dogs and cats receiving insulin, as well as in neonatal puppies and kittens that have not received adequate caloric intake. Other potential causes include insulinoma, paraneoplastic insulin-like factors, xylitol ingestion in dogs, and pregnancy or labour.

Signs can include lethargy, reduced responsiveness, stumbling, apparent weakness, collapse and seizures. Severe hypoglycaemia can progress to collapse, seizures and cardiopulmonary arrest.

Caretakers should maintain awareness of hypoglycaemia in animals with known glucose abnormalities, including diabetic animals whose blood glucose is being monitored at home. Recognising and treating an episode early may prevent deterioration.

For an animal with documented hypoglycaemia but no clinical signs, dietary carbohydrate, such as pet food, should be provided.

For a symptomatic animal that is not actively seizing, a viscous simple carbohydrate such as corn syrup or honey can be applied to the buccal mucosa between the upper premolars or molars and the cheek. The recommended volume is approximately 0.2–10 mL, depending on the animal’s size. The objective is to coat a relatively large area of mucosa rather than encourage the animal to swallow the substance.

Oral or mucosal administration should never be attempted during active seizures, because of the risk to both animal and caregiver. It should also be avoided whenever the risk to the caregiver is considered high. Sugar administration must not delay transport to veterinary care. Intravenous dextrose administered at a veterinary facility is more effective for severe hypoglycaemia.

For insulin-treated animals that develop hypoglycaemia, feeding should take place immediately. Veterinary assessment is indicated if clinical signs develop or if blood glucose has not returned to at least the normal range within 20-minutes of feeding. Caregivers should also follow the specific instructions provided by their veterinarian for managing hypoglycaemic episodes.

Toxin ingestion: resist the urge to make them vomit

Non-caustic toxin ingestion is common in dogs and occurs occasionally in cats. Although gastrointestinal decontamination may form an important part of treatment, the RECOVER recommendations advise against routine induction of vomiting before reaching a veterinary facility.

Evidence from human medicine indicates that early vomiting does not improve survival, reduce clinical severity or shorten hospitalisation. It can also create additional problems, including delaying veterinary care and activated charcoal administration, reducing an animal’s willingness to ingest charcoal, or causing charcoal to be vomited.

Attempts to induce vomiting outside the veterinary setting can themselves be harmful. Hydrogen peroxide may cause significant gastrointestinal injury in dogs and cats at doses used to induce vomiting. Syrup of ipecac can result in severe vomiting, diarrhoea, sedation and other adverse effects. Vomiting itself can also lead to complications. The safest approach following suspected or confirmed non-caustic toxin ingestion is therefore to get the animal to a veterinary facility as quickly as possible.

There may be exceptional circumstances in which inducing vomiting outside a veterinary facility could provide more benefit than risk, such as when potentially dangerous toxin exposure has occurred but timely access to veterinary care is not feasible. In such circumstances, vomiting should only be induced when specifically recommended by a veterinarian or animal poison control service, with the first aid provider following those instructions.

For dogs with pica or frequent toxin exposure that spend significant periods in remote areas, veterinarians may consider prescribing ropinirole ophthalmic solution where appropriate.

Heatstroke: Cool first, transport fast

Heat-related illness is potentially fatal, particularly in dogs, although cats can also be affected. It occurs when the animal’s ability to dissipate heat is overwhelmed, potentially resulting in central nervous system dysfunction, systemic inflammation and multiple organ dysfunction.

Heatstroke may be environmental, such as when an animal is left in a hot, poorly ventilated vehicle, garage or enclosed space. It may also be exertional, occurring during running, hiking, playing or working.

Dogs are particularly vulnerable because they rely heavily on respiratory evaporation to lose heat. Brachycephalic conformation, higher body weight, obesity and increasing age can further increase risk.

Warning signs include constant panting in dogs; open-mouth breathing in some cats; reluctance to continue playing or exercising; unexpectedly lying down; withdrawal from activity; anxiety or restlessness; disorientation; stumbling; excessive salivation; vomiting; diarrhoea; and collapse.

When heat-related illness is suspected, the animal should immediately be moved away from the heat source and all activity stopped. Active cooling should begin immediately if it can be done safely.

Cool running water should be applied to the body from behind the neck, concentrating on areas with a thinner hair coat and soaking through to the skin. Running water is preferred to a single dousing because it supports continued heat loss through conduction, convection and evaporation. The face should be avoided because of the risk of accidental drowning.

Active cooling should generally stop when the rectal temperature reaches approximately 40°C. If the animal has stertor or stridor, cooling can continue until panting clearly improves, but must stop once the temperature reaches 38.6°C. If temperature cannot be measured, active cooling should continue for approximately 15-minutes before transport.

The animal should then be patted dry and transported immediately to the nearest open veterinary facility. Cooling should not be attempted if doing so places the caregiver at significant risk.

Burns: Cool the injury, but protect yourself

Thermal burns can result from flames, hot liquids or gases, hot surfaces, heating pads and grooming equipment. Animals that are restrained, sedated, anaesthetised or otherwise unable to escape a heat source are particularly vulnerable.

A burn may be obvious, with singed fur or reddened, blackened or damaged tissue. However, serious burns can be hidden beneath apparently normal fur. A burn should therefore be suspected after exposure to a heat source, particularly if the animal suddenly appears painful, guards an area or reacts by withdrawing or becoming aggressive when touched.

For thermal burns, clean, cool running tap or hose water should be applied as soon as possible for at least 20-minutes, ideally within three hours of the injury. Ice water should be avoided. Water should not be directed near the face because of the risk of drowning.

After at least 20-minutes of cooling, the animal should be transported to the nearest open veterinary facility. If cooling cannot safely be performed because of the risk to the caregiver, the animal should be transported directly.

Chemical burns require additional precautions. They may result from exposure to acidic or alkaline substances, including household cleaners and other chemicals. Liquid chemicals may become trapped against the skin by the animal’s coat, increasing exposure.

The first aid provider should wear protective equipment, including gloves and eye protection, and safely remove any substantial removable chemical. The affected area should then be flushed with clean running water for approximately 15-minutes, avoiding the face and mouth. An Elizabethan collar can help prevent the animal from licking the affected area. Immediate veterinary assessment is required following irrigation.

Respiratory distress: Support the journey to the vet

Respiratory distress can present with increased respiratory rate or effort, an abnormal posture with the head and neck extended, agitation, noisy breathing, wheezing or cyanosis. Dogs and cats with respiratory distress or suspected or confirmed hypoxaemia may benefit from supplemental oxygen in the prehospital setting and during transport. Oxygen can improve oxygenation and tissue oxygen delivery while reducing the sensation of breathlessness.

Depending on what is available, oxygen can be delivered using flow-by administration or a face mask. Some animals with chronic respiratory disease may have veterinarian-prescribed home oxygen delivered through an oxygen tank, oxygen tent or flow-by system.

If an animal remains in an enclosed space for more than a few minutes, adequate ventilation and temperature control are important. Where pulse oximetry is available, it can guide oxygen therapy. The recommended oxygen saturation target is 95%–97%, avoiding unnecessary excessive oxygen supplementation.

Choking: Act quickly when the airway is blocked

A foreign body airway obstruction can become fatal within minutes. Signs may include agitation, pawing at the mouth or face, extension of the head and neck, attempts to cough or gag without producing a sound, high-pitched breathing noises, pale or cyanotic mucous membranes and excessive salivation.

If the animal is conscious and the risk to the first aid provider is low, up to five firm back blows can be delivered over the caudodorsal thorax, to either side of the spine. If unsuccessful, an alternative technique can be attempted and the cycle repeated while the animal remains conscious. The caregiver should not reach into the mouth of a conscious dog or cat. Abdominal thrusts can cause significant injury and should be used cautiously.

If the animal becomes unconscious, chest compressions should begin immediately, starting with 30 compressions at 100–120 per minute. The airway should then be checked for a visible obstruction, which can be removed if possible. A blind finger sweep should not be performed.

Two mouth-to-nose breaths should then be provided, with the cycle repeated until the obstruction is cleared or help arrives. Even when an obstruction has been successfully removed, any dog or cat requiring first aid for choking should be examined by a veterinarian as soon as possible.

Naloxone: Rapid reversal of opioid exposure

Opioid exposure can cause life-threatening effects in dogs and cats, including profound sedation, respiratory depression, bradycardia, abnormal heart rhythms and cardiopulmonary arrest. Exposure may occur accidentally at home or in outdoor and workplace environments, with working and operational dogs potentially vulnerable during field activities.

Signs range from sedation to unconsciousness and may include poor coordination, central nervous system depression, collapse, vomiting, constipation, slow or absent breathing and reduced chest movement. Pupils may become constricted in dogs and dilated in cats.

When opioid exposure is known or suspected, naloxone should be administered in the prehospital setting to animals with altered mentation or a respiratory rate of <10 breaths per minute.

Naloxone can be administered intranasally using an atomiser or intramuscularly into the epaxial muscles over the lumbar region or the lateral quadriceps. A reasonable dose is 0.1–0.2mg/kg by either route, although the ideal dose has not been established.

If an animal is unresponsive, gasping, breathing abnormally or not breathing and opioid exposure is suspected, basic life support should be started immediately according to the appropriate out-of-hospital CPR algorithm. Naloxone should then be administered intranasally or intramuscularly as soon as possible.

A good response to naloxone does not mean the danger has passed. Re-narcotisation can occur, and the animal may require additional treatment or support. Veterinary assessment is therefore essential after suspected opioid exposure, even when the animal responds well.

Severe bleeding: When pressure is not enough

Haemorrhagic shock is a major cause of early death following trauma. Severe bleeding can result in shock, the need for blood transfusion and death before an animal reaches an open veterinary hospital.

When a traumatised dog or cat has external arterial spurting or otherwise subjectively severe bleeding, direct pressure should be applied if it is safe to do so.

For bleeding from the head, neck or trunk, direct pressure and timely transport to the nearest open veterinary clinic are the appropriate options because tourniquets cannot be placed in these locations.

If severe bleeding from a limb or tail does not stop or greatly improve with direct pressure, a tourniquet can be lifesaving. RECOVER suggests prehospital tourniquet application in conscious dogs and cats when severe extremity haemorrhage does not respond to direct pressure and recommends application if the animal is unconscious. The difference reflects both provider safety and the severity of the animal’s condition.

Tourniquets should only be placed on limbs or the tail and never around the head, pinna, neck, trunk or genitals. Purpose-made human tourniquets may not be available or physically suitable for dogs and cats. An improvised tourniquet using a scarf or necktie can be effective when applied correctly. Ideally, the material should be at least 5cm wide to reduce the pressure required to stop bleeding, as well as associated pain and tissue trauma.

The material should be placed circumferentially around the limb, proximal to the bleeding site, looped into a simple knot and tightened until the bleeding slows appreciably. If it slips towards the wound, it should be loosened slightly, repositioned more proximally and tightened again. Additional knotting or duct tape or similar adhesive tape can be used to secure it.

Severe bleeding may recur during transport, requiring the tourniquet to be tightened again. Once successfully applied, it should remain in place throughout transport and should be removed by veterinary professionals after evaluation at the veterinary hospital. However, trauma and tourniquet application are painful and can create a meaningful risk of bites. A tourniquet should not be applied if doing so places the rescuer at significant risk.

Conclusion

The RECOVER first aid recommendations provide veterinary teams with a structured way to help caregivers respond during some of the most critical minutes in a dog or cat’s emergency. The central message is consistent across every scenario: recognise the emergency, act appropriately and safely, and get the animal to professional veterinary care as quickly as possible.

Whether the emergency involves low blood glucose, toxin exposure, heatstroke, burns, respiratory distress, choking, opioid exposure or catastrophic bleeding, first aid is intended to buy time and limit deterioration—not replace veterinary treatment.

For veterinary professionals, the recommendations also provide an opportunity to equip owners, handlers and other caregivers with practical knowledge before an emergency occurs. Knowing what to recognise, what to do and, equally importantly, what not to do, can make the difference between helpful first aid and an intervention that creates additional risk.

In an emergency, the goal is not to turn every caregiver into a veterinary professional. It is to help them take the right first step, safely and without delay, until professional veterinary care takes over.

Reference

Mandell DC, Vincent J, Thawley JM, et al. RECOVER Guidelines: First Aid for Dogs and Cats. Clinical Guidelines. Journal of Veterinary Emergency and Critical Care, 2026.