RECOVER first aid guidelines give veterinary teams a playbook for coaching clients

When a dog chokes on a toy at a boarding facility or a cat gets into a household chemical, the first person to help is rarely a veterinarian. New guidelines from the Reassessment Campaign on Veterinary Resuscitation (RECOVER) Initiative are meant to shape what that person does. They are written for the veterinary teams who will do the teaching.

The 2026 RECOVER First Aid Guidelines were released on August 25. The organization calls the document the first evidence- and consensus-based first aid guidelines for dogs and cats built through a systematic, transparent evaluation process.¹ The guidelines appear as 3 papers in a supplement to the Journal of Veterinary Emergency and Critical Care. Together they address 16 clinical questions with 50 treatment recommendations, including a separate paper on allergy and anaphylaxis.^1-4

“Animal emergencies often begin before a patient reaches a veterinary hospital,” Jamie Burkitt, DVM, DACVECC, guidelines co-chair of RECOVER and professor of clinical small animal emergency and critical care at the University of California, Davis, Weill School of Veterinary Medicine, said in the release. Daniel J. Fletcher, PhD, DVM, DACVECC, president of RECOVER, noted that the guidelines take the organization’s mission beyond the hospital. He described them as evidence-informed steps that veterinary teams and caregivers can use when time is short, while keeping animals headed toward veterinary care.¹

Beyond the naloxone, burn, and heatstroke recommendations dvm360 covered previously, the guidelines give practices tools to prepare clients before an emergency happens.

Built specifically with the veterinary team in mind

Written for veterinary professionals, the clinical guidelines paper is intended for veterinarians and staff to use to educate owners, handlers, and paraprofessionals, who are more likely to be the ones giving first aid.² The guidelines describe 2 main uses:

• Preparing clients ahead of time. One example is coaching owners of diabetic pets on handling hypoglycemic episodes when insulin is first prescribed.
• Guiding callers in the moment. Examples include unexpected burns or toxin ingestions.²

The authors also note that the recommendations can support veterinary teams during phone triage.² For that purpose, the guidelines include 1 general and 4 condition-specific “Recognize and Act” algorithms, along with 6 instructional figures. All are written in lay terms teams can share with clients.²

The general algorithm connects signs a layperson can recognize, such as an animal that is poorly responsive or in sudden, apparent pain, to the problems where first aid may help. Nearly every branch of the algorithm ends with a trip to the nearest veterinary clinic.² The authors say the heat-related illness algorithm, for example, can be described, emailed, or messaged to clients during triage calls.² The release lists other groups veterinary teams might train with these materials, including first responders, shelters, groomers, boarding facilities, and trainers.¹

The authors emphasize that every animal that receives first aid should be evaluated by a veterinarian as soon as possible afterward. They also recommend against providing first aid when the risk to the person giving it is high.²

Advice that may surprise clients

Several recommendations differ from what pet owners may have heard. All of them come from the clinical guidelines paper² unless noted.

Toxin ingestion. The authors recommend against routinely inducing vomiting before reaching the clinic after a dog or cat eats a noncaustic toxin. They cite reports of meaningful gastrointestinal injury in both species after oral hydrogen peroxide given at emetic doses. They suggest prehospital emesis only when the animal cannot get to a veterinary facility right away and a veterinarian or animal poison control center has recommended it. For dogs with pica or frequent toxin exposure that spend time in remote areas, the authors say veterinarians may consider prescribing ropinirole ophthalmic solution.

Choking. For a conscious dog or cat that appears to be choking, the guidelines recommend up to 5 firm back blows first. These are delivered over the caudodorsal thorax, to one or both sides of the spine. If back blows fail, the provider should try another technique. The authors base the back-blows-first approach partly on human evidence. In the only study directly comparing the 2 methods in people, back blows were about twice as likely as abdominal thrusts to work. The authors also advise against reaching into a conscious animal’s mouth. If the animal loses consciousness, they recommend against blind finger sweeps and call for chest compressions to begin right away. The guidance then calls for checking for a visible obstruction after 30 compressions, removing it if possible without a blind finger sweep, and providing 2 rescue breaths before continuing the resuscitation sequence. The authors note this compressions-first approach is a change to RECOVER’s guidance on starting basic life support. Animals that require intervention to clear an airway obstruction should be evaluated by a veterinarian immediately.

Hypoglycemia. For an at-risk dog or cat with signs of low blood sugar that is not having a seizure, the authors suggest applying a thick, simple sugar such as corn syrup or honey to the inside of the cheek, between the upper back teeth and the cheek. They specify 0.2 to 10 mL, or up to about 2 teaspoons depending on the animal’s size, with the goal of coating the gums rather than having the animal swallow it. This is a temporary first-aid measure, and the authors caution that it may not raise blood glucose enough to resolve life-threatening hypoglycemia. It should not delay transport to a veterinary facility, which should follow immediately. For an animal that is actively seizing, the guidelines recommend against giving anything by mouth. For animals on insulin with a low glucometer or continuous glucose monitor reading but no signs, the guidelines recommend feeding. The authors advise taking those animals in if signs appear or if blood sugar has not returned to the normal range within 20 minutes of feeding.

Severe limb bleeding. When direct pressure alone fails to control severe bleeding from a limb or the tail, the guidelines suggest a tourniquet for a conscious animal and recommend one for an unconscious animal. These interventions should be attempted only when doing so does not place the rescuer at significant risk. The authors say household items such as a scarf or necktie, ideally at least 2 inches wide, are reasonable choices for an improvised tourniquet. They advise leaving it in place during transport for the veterinary team to remove.

Breathing trouble. For dogs and cats with signs of difficulty breathing, the guidelines recommend supplemental oxygen during transport. If pulse oximetry is available, oxygen should be adjusted to a reading of 95% to 97%.

Allergic reactions. The separate allergy and anaphylaxis paper is written for veterinary professionals. For milder allergic reactions that are not affecting breathing, the authors recommend an oral antihistamine before arrival at the clinic. When a reaction is affecting breathing, they suggest against oral antihistamines. For anaphylaxis, they suggest intramuscular epinephrine before arrival, provided it does not delay transport. For pets that have had a previous anaphylactic reaction, the authors suggest veterinarians dispense prefilled epinephrine syringes dosed to the animal’s body weight, with instructions for home use.⁴

Limitations and next steps

The authors are candid about the limits of the evidence. Of the 38 recommendations in the clinical guidelines paper, 18 (47%) were based on expert opinion, and 15 (39%) were supported by low- or very-low-quality evidence. Much of the available research came from human studies, limiting how directly the findings could be applied to dogs and cats. Several recommendations rest on expert opinion alone. The full justification for each recommendation appears in a companion paper.³

RECOVER lists these among its highest-priority knowledge gaps²:

• How well cheek-applied sugar works for symptomatic hypoglycemia in dogs and cats. There are no data at all in cats.
• The risks and benefits of non-caustic emetics such as ropinirole in dogs before they reach the clinic.
• The safest and most effective ways to clear an airway obstruction in dogs of different sizes and body shapes.
• The best ways to cool animals with heat-related illness and when to stop cooling.

The authors say they plan to update individual recommendations continually as new evidence emerges.² RECOVER also plans a future first aid course for veterinary professionals, pet owners, and other animal caregivers.¹

References

1. RECOVER releases first evidence- and consensus-based first aid guidelines for dogs and cats. News release. RECOVER Initiative. August 25, 2026. Accessed October 15, 2026. https://recoverinitiative.org/resource/recover-releases-first-evidence-and-consensus-based-first-aid-guidelines-for-dogs-and-cats/
2. Mandell DC, Thawley VJ, Burkitt-Creedon JM, Fletcher DJ, Boller M, Fausak E. RECOVER guidelines: first aid for dogs and cats. Clinical guidelines. J Vet Emerg Crit Care (San Antonio). 2026;36(suppl 1):S36-S62. doi:10.1111/vec.70138
3. Thawley VJ, Mandell DC, Burkitt-Creedon JM, et al. RECOVER guidelines: first aid in dogs and cats. Evidence and knowledge gap analysis with treatment recommendations. J Vet Emerg Crit Care (San Antonio). 2026;36(suppl 1):S3-S35. doi:10.1111/vec.70139
4. Burkitt-Creedon JM, Mandell DC, Thawley VJ, et al. RECOVER guidelines: first aid. Evidence, treatment recommendations, knowledge gap analysis, and clinical guidelines for acute allergy and anaphylaxis in dogs and cats. J Vet Emerg Crit Care (San Antonio). 2026;36(suppl 1):S63-S89. doi:10.1111/vec.70137