Episode 3  ·  17m 44s

Triage Behind the Scenes — How Emergency Vets Prioritize Cases

Dr. Michael LoSasso, DVM & Julie Schwenzer Frisco Emergency Pet Care
Triage Wait times ER communication End-of-life Most common emergencies Ingestions
"My job, from the way I see it, is to make sure that you understand what's going on with your pet — and that as far as you're concerned, your pet's the only one I've got to deal with."
— Dr. Michael LoSasso, DVM

Episode summary

This episode pulls back the curtain on one of the most misunderstood aspects of emergency veterinary care: why you might wait hours when the parking lot appears empty. Dr. LoSasso explains that emergency triage is not first-come, first-served — it is based entirely on medical urgency, and the most critical patients take priority regardless of when they arrived.

He walks through how cases are actually categorized: patients in respiratory distress or suspected of internal bleeding go first. Ingestions — socks, corn cobs, medications — are also seen very quickly because early removal dramatically changes the outcome and the cost. Patients presenting for euthanasia are prioritized because of the emotional weight involved. Stable patients with diarrhea or mild GI issues may wait while more urgent cases are handled.

Dr. LoSasso also discusses the emotional and communication challenges of emergency medicine — how to make each client feel that their pet is the only patient, even while managing a full ICU. And he reveals something unusual about Frisco Emergency Pet Care: a licensed social worker on staff, available to help families through the most difficult moments.

"The ICU can feel like we're spinning plates. We're just trying to keep everything up in the air because we don't want anything to drop. And so we've got maybe critical cases we're dealing with that are hospitalized, in addition to those that present to us."
— Dr. Michael LoSasso, DVM
Something unique about Frisco Emergency Pet Care

FEPC has a licensed social worker on staff — one of only a handful of veterinary hospitals in the country to offer this. The social worker supports both families going through difficult decisions and the clinical team dealing with the emotional weight of emergency medicine. Dr. LoSasso's only complaint: she works 40 hours a week, and they are open 168.

Questions answered in this episode

The following questions are answered by Dr. LoSasso in this episode, drawn directly from the conversation. These are real clinical answers from a practicing emergency veterinarian with 30+ years of experience.

Dr. LoSasso explains that the waiting room does not reflect what is happening in the hospital. The ER may have multiple critically ill patients hospitalized and being managed simultaneously, plus new patients arriving and being assessed. The triage system means critical cases go first regardless of arrival order. Additionally, each client interaction takes significant time — communicating clearly about a complex diagnosis, treatment options, and costs so a family can make a fully informed decision. That process cannot be rushed.
Triage is based entirely on medical urgency, not arrival time. Patients seen immediately include those that are not breathing or in respiratory distress, those suspected of internal bleeding or collapse, and those presenting for euthanasia (because of the emotional urgency involved). Ingestions — any pet that has eaten something dangerous — are also seen very quickly because early decontamination dramatically changes outcomes and cost. Stable patients with GI symptoms like diarrhea may wait while more urgent cases are handled.
Dr. LoSasso explains that if a pet has eaten a sock, corn cob, medication, or toxic substance, early treatment — typically inducing vomiting — can resolve the problem for a few hundred dollars and no surgery. Waiting until symptoms appear means the substance has been absorbed or the object has moved further into the GI tract, which often means thousands of dollars in surgery and hospitalization. Getting there quickly is dramatically better for the pet and for the owner's wallet.
Dr. LoSasso says families presenting for euthanasia — or with a pet whose condition will almost certainly require euthanasia — are prioritized because they are in an emotional crisis. It seems only fair to get to those families quickly rather than having them sit in a waiting room. FEPC's comfort rooms are in a separate, quieter part of the hospital with their own exit, and all procedures can be performed there so the pet never has to be taken away.
Dr. LoSasso says Frisco is a very different city than it was 30 years ago when it was rural farmland and hit-by-car cases dominated. Today, the most common presentations are ingestions (socks, corn cobs, rat bait, medications), GI cases including vomiting and diarrhea, and congestive heart failure in older pets. He notes that as pets live longer, heart disease cases have become increasingly common.
Yes — Dr. LoSasso says FEPC has a licensed social worker on staff, which he believes makes them one of only two or three emergency veterinary hospitals in the country to offer this service directly to clients (not just staff). The social worker helps families work through the emotional aspects of difficult decisions, including end-of-life situations. She is available during her working hours, though Dr. LoSasso notes with humor that his only complaint is she works 40 hours a week while the hospital is open 168.
JulieWhen several critical patients arrive at the same time, how do emergency veterinarians decide who gets treated first?
Dr. LoSassoIt's something that pet owners really need to understand, if nothing else for their own mental health — because it can be really frustrating. Most people who come in have quite a bit of fear because they just don't know what's going on. In terms of how we triage: in an ideal world, we see you in the order you come in, and for stable cases that's exactly what we do. But if you bring in a dog that's had diarrhea for a couple of days and he's otherwise stable, and something comes in that is having a hard time breathing or has collapsed, or someone presents a patient for euthanasia — then your wait time just got longer, because we will handle those serious cases first.
Dr. LoSassoNobody likes to wait, and you're sitting there thinking nothing's happening back there — there weren't even any cars in the parking lot. But you don't know how long those pets have been there, whether we're managing things by phone, or how many hospitalized patients we're juggling simultaneously. The ICU can feel like we're spinning plates. We're just trying to keep everything up in the air because we don't want anything to drop.
JulieHow does communication with owners factor into managing multiple emergencies?
Dr. LoSassoMy job, from the way I see it, is to make sure that you understand what's going on with your pet — and that as far as you're concerned, your pet is the only one I've got to deal with. I give you very focused time, whether that's on the phone or in person. Not only do you have to have all the information, you have to understand all the information. So we have to present that in a way that's not medical speak — in terms everybody can wrap their mind around, so that we can together make good decisions for your pet going forward.
JulieWhat are the most common emergencies you see in Frisco today?
Dr. LoSassoWhen I was in Frisco 30 years ago, we kind of built that practice on broken bones from hit-by-cars. This was rural farmland with two-lane roads and no leash law. Nowadays Frisco is a very modern city, so people do a better job. I don't see many hit-by-cars. We see a lot of ingestions — socks, corn cobs, rat bait, medications. We see a lot of GI cases — diarrhea, vomiting. And we see a lot of congestive heart failure as our pet population lives longer. I'm seeing more 17, 18, 19 year old dogs than I saw 20 or 30 years ago.
JulieYou mentioned a social worker on staff — that seems unusual for a veterinary hospital.
Dr. LoSassoTo my knowledge, a social worker in the hospital is present in probably only two or three hospitals in the country. There are some bigger corporate practices that use them as a regional resource, but that's almost always for staff — not for clients. Ours certainly takes good care of our team too, because it can be a pretty stressful job. My biggest beef with her is that she only works 40 hours a week, and we're open 168. She's there 25% of the time, but when she's there, she can help people through the emotional part of the decision making. She's a licensed social worker. We've got those options.

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