Churchill Downs unveils triage center at Louisville track

In March, Churchill Downs Racetrack celebrated the grand opening of its new triage center, quarantine facility, and related capital improvements that bring advanced technology to equine athletes in need of immediate medical attention. It was a unique vision: construct an advanced triage facility that also would serve as a 24/7 midlevel medical center on the back side of the famous Kentucky complex. According to Mike Ziegler, director of racing at Churchill Downs Inc (CDI), construction began after an in-depth planning phase.

“We just needed somebody to help us understand what had to be constructed,” Ziegler says. “We didn’t want to make it too small. We didn’t want to underestimate what may be needed by veterinarians. We wanted to build [a center] that has the best specifications for the needs of our equine athletes.”

Churchill Downs took a leadership position in equine welfare and safety, emphasizes Stuart E. Brown II, DVM, at the time a member of Hagyard Equine Medical Institute in Lexington, Kentucky, who was integral in planning and designing the new facility. (Dr. Brown is now the equine safety director for racing and sales at Keeneland Association.) “The goal all along was to establish a facility that can handle an all-inclusive range of equine injuries and illness,” he says.

Instead of returning an injured or ill horse to the barn area, where there typically is a delay in accessing the equipment needed for rapid assessment or triage, Dr. Brown explains that the horse can be carefully moved—by equine ambulance, if necessary—from the track to the triage center equipped with the latest equipment and technology. “This staging area, along with a quarantine facility and new back side stable gate, benefits horse owners, trainers, veterinarians and, most important, the horses,” he says.

Turning vision into reality

It started in April 2019 with concepts similar to those adopted by equine hospitals at Belmont Park and Saratoga Race Course, both in New York. Churchill Downs needed a triage and medical center rather than a fully vested hospital.

What, where, and why?

“Unlike some racing venues,” Dr. Brown says, “Churchill Downs is located close to 2 highly regarded equine referral centers, Hagyard Equine Medical Institute and Rood & Riddle Equine Hospital (both in Lexington). What the track needed was a first-class triage center to stabilize a horse that gets injured during competition, evaluate the horse using advanced imaging and laboratory diagnostics, then prepare it for transport to either of the major referral centers.”

But, Dr. Brown adds, equal attention also was focused on 24/7 access for everyday medical care of equine athletes, including for colic or laminitis (founder), or when a horse becomes cast in its stall.

Based on initial discussion among CDI executives, regulatory personnel, American Association of Equine Practitioners (AAEP) veterinarians, attending and private veterinarians, owners, and other stakeholders, the concept evolved into an advanced staging area/triage center that would also serve as a midlevel medical center on the back side of the racetrack.

“Because this replaced the previous process of taking an injured or ill horse back to the barn for evaluation,” Brown says, “or trying to stabilize the horse in the barn before being transported to a referral facility, everyone involved in the planning stages envisioned a center that offered all the treatment equipment needed by private and on-call veterinarians,” as well as those who handle the horse or are familiar with its temperament.

“CDI recognizes the importance of the relationship between the horse and its trainer, groom, and attending veterinarian, all of whom are familiar with the major aspects unique to a particular horse’s health,” Dr. Brown adds. “This shared knowledge is vital to ensure success.”

With the vision identified, CDI asked Dr. Brown to flesh out what the facility would look like. To help determine those needs, Dr. Brown sought the expertise of Foster Northrop, DVM, owner of Louisville-based Northrop Equine and vice chairman of the AAEP Racing Committee. Together, Drs. Brown and Northrop worked with Ziegler’s team to answer several key questions:

• How much space should be allocated for examination?
• What would be needed to support accommodations for an equine ambulance?
• Should exterior doors be added to allow for extrication of a horse cast down in its stall?
• Is there ample room to access the patient from multiple locations?

From concept to footprint

Dr. Brown encouraged Ziegler’s team at CDI to visit the Hagyard Equine Medical Institute and observe the footprint used to admit emergency or recumbent equine patients. “To their credit, CDI planners and architects came to Hagyard, stood in our space, and looked at our facility, then revised their plans before eventually going to Jefferson County Zoning and Planning to get approval for the specifications and design of their new medical triage center,” Dr. Brown says.

Basically, equine triage is a temporary, albeit critical, fix that prepares a horse for transport to a veterinary hospital. The goal is to provide the care needed to improve survivability from an injury or illness. Triage may involve sedation, wound management, infection prophylaxis, limb stabilization, fluid therapy, analgesia, and a host of other supportive and diagnostic efforts to ensure safe rescue and transportation.

“There’s always the need to immediately assess a patient’s injuries and provide critical supportive care,” Dr. Brown explains. “All tools need to be at the disposal of the veterinarian(s) in charge of the horse so they can do whatever is needed at a moment’s notice.” According to equine orthopedic surgeons, temporary immobilization is crucial to improve chances of survival. If the horse is not properly stabilized in the beginning, the prognosis can worsen.

With every need in mind

As the design evolved, it became clear that higher, wider doorways and reinforced walls (if one needs to sling a horse) were needed to provide optimum care—and that’s how all potential needs were carefully built into the design, including on-site resources for imaging, lab work, and similar technology. In other words, Dr. Brown says, “we planned not only for major musculoskeletal and orthopedic emergencies, but also for metabolic emergencies, such as heat prostration, colic, or similar events.”

A horse’s primary caregiver is often the attending veterinarian. On important race days, Churchill Downs is responsible for hosting the event and getting an injured horse to the designated triage center, where everything is in place to assist the attending veterinarian. “[Assistance] might include regulatory veterinarians or on-call AAEP practitioners as requested by the primary caregiver,” Dr. Brown explains, adding that the practitioners who care for these horses typically have a strong relationship with trainers, jockeys, and owners.

Key to implementing significant safety initiatives was the newly appointed (November 2019) equine medical director, William E. Farmer, DVM, who oversees horse safety and care at Churchill Downs and other CDI racetracks.

Under Dr. Farmer’s watchful eye, the Equine Medical Triage Center was completed on time and ready to accept patients. “The impact of COVID-19 meant working with practitioners to identify what services and equipment are best suited for maximal impact on the safety of racehorses in the back side,” Dr. Farmer says.

The vision was never to build a facility to house patients, Dr. Brown explains. Rather, severely injured horses are triaged and stabilized, then transported for inpatient service at Rood & Riddle or Hagyard.

“The center was designed to be a 24/7 triage and midlevel care facility. Thus, all [medical-related] staffing for patient care will be the responsibility of the veterinarian. [We] are not set up to offer services but to be of service to veterinarians and their equine patients in need of advanced care,” Dr. Farmer says.

The final result

With staffing responsibilities determined, the facility’s final picture was in focus. Any lingering issues were resolved, and the vision became reality in March 2020, before the track officially opened for the season.

“There’s an open laboratory where practitioners can set up equipment to gather and process biological samples for 24/7 complete blood counts and biochemistry panels,” Dr. Farmer explains, indicating that if demand identifies the need for on-site support staff, it can be addressed at that time. Advanced imaging, such as ultrasonography, also is available 24/7.

The center has a large working bay that allows veterinarians to safely examine and treat an injured or ill horse. The building also has 4 stalls equipped with overhead hoists should a horse need assistance standing.

In addition, equine ambulances can be accommodated, regardless of whether they use glides, have removable floors or, as with the Kimzey equine ambulance, are flat to the ground. The center’s design allows the attending veterinarian and support staff to remain in safe proximity to a recumbent horse during transfer to or from the working bay.

Dr. Farmer continues to work with private veterinarians during COVID-19 to ensure that the equipment and services match the needs of horses stabled at Churchill Downs.

Portal to the public

The focus on care, wellness, and safety of racehorses reinforces the historic place of Churchill Downs as a preeminent racetrack, a high-profile facility that hosts world-class racing, including the Kentucky Oaks, Kentucky Derby, and Breeders’ Cup, and now offers a new facility not only on important race days but every day.

“It is important to help the public understand what we can do for horses, how much care and thought have been devoted to fulfilling our vision,” Dr. Brown says. “With completion of this center, Churchill Downs became a forum that helps people better understand what it means when a horse is being treated for a serious injury or illness.”

With time, the Equine Medical and Triage Center will become a notable portal for the public’s understanding of how excellent care of the racehorse is always priority at Churchill Downs.

“Dedication to achieve success in veterinary medicine is really rooted in having a true passion for what you do,” Dr. Brown says. “It’s about loving the horses, but it’s also about having an intense interest in the actual practice of veterinary medicine.”