Dynamics of Veterinary Clinical Decision-making for Domestic Ruminants Affected by Wildfires in South Africa

Dynamics of Veterinary Clinical Decision-making for Domestic Ruminants Affected by Wildfires in South Africa | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Dynamics of Veterinary Clinical Decision-making for Domestic Ruminants Affected by Wildfires in South Africa Claudia L Cardoso, Catherine E May, Rhoda Leask This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6928100/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Wildfires pose a significant threat to livestock, frequently resulting in burn injuries. Assessing the affected animals in the field is crucial for making informed decisions. However, this evaluation is often subjective and relies on the experience of the evaluator, leading to potential misdiagnoses of burn severity and inefficient allocation of resources. This work consulted veterinary-trained individuals with varying clinical experience to better understand the dynamics of their decision-making processes when applied to wildfire burn cases in domestic ruminants. This study concluded that novice practitioners prioritise prognosis and cost of treatment when making decisions for burned ruminants. However, as the practitioner’s level of experience grows, there is a tendency to place less emphasis on economic factors and more on the animal’s welfare, especially concerning their systemic involvement and possibility of recovery with the available treatment intervention provided in the field, ultimately guiding the final decision. Clinical experience burns decision-making domestic ruminants wildfires 1. Introduction Wildfires have a significant impact on domestic ruminants worldwide. Direct impacts on livestock can be seen when they suffer skin burns, smoke inhalation and death. Furthermore, pastures and grazing land loss can lead to starvation and malnutrition. Indirect impacts of wildfires are seen as a consequence of smoke inhalation, which has long-term consequences such as pneumonia, affecting the animal’s overall health and productivity [ 1 ]. During evacuation and commingling at rescue points, stress from wildfire exposure can lead to decreases in milk production, weight gains, and reproductive performance. Hence, livestock deaths, injuries, reduced productivity, cost of veterinary care, feed replacements, and infrastructure repairs result in financial losses for farmers and ranchers [ 2 ]. Wildfires will become more frequent and severe in the following decades [ 3 , 4 ]. Animals are often trapped by fences and burned at different levels of severity. Furthermore, burn injuries and their repercussions at the systemic level can become more severe as time from the initial insult passes, and this will worsen the negative welfare state in which these animals are found [ 5 , 6 ]. The prognosis of the patient will be determined by the degree of burn severity, which is a function of the combination of the extent of the total body surface area affected (%TBSA) and the depth of the burn [ 7 , 8 ]. This judgment is entirely dependent on the evaluator’s clinical experience. Decision-making in veterinary practice encompasses a multifaceted interplay of ethical considerations, emotional influences, and professional development. Recent studies have shown the importance of structures, frameworks, and supportive multidisciplinary and collaborative environments in enhancing decision-making processes among veterinary practitioners [ 9 ]. Such frameworks are essential for addressing complex clinical situations, where decisions often involve ethical dilemmas and the welfare of animals. These considerations show the importance of emotional well-being as a pivot in shaping decision-making capabilities [ 10 ]. Veterinarians are taught to consider various factors, including financial implications and the human-animal bond, when making difficult decisions regarding animals in critical condition [ 11 ]. The influence of financial constraints on clinical decisions is crucial, as veterinarians often face pressures related to client expectations and the cost associated with treatments, which may skew decision-making [ 12 ]. Therefore, veterinarians need to balance clinical judgment with economic realities in all contexts of veterinary practice. Experience enables veterinarians to balance these considerations and to engage the client in shared decision-making, moving on to promoting more ethical decisions, better animal welfare and better client compliance and satisfaction [ 13 ]. A proactive approach to categorising the affected animals for clinical decision-making may reduce delays and allow for the allocation of more animals to the category for treatment. However, contradictory advice regarding the course of action for burned ruminants delays recovery efforts. To understand the source of contradicting advice in these cases, it was hypothesised that differing levels of clinical experience of first respondents could be the source of this contradiction. It is worth noting that not all veterinarians practising in rural areas commonly encounter wildfires; hence, the number of veterinarians with experience in diagnosing burns in ruminants is limited. However, scientific projections from the local Council for Scientific and Industrial Research (CSIR) projected that rising temperatures, prolonged droughts and lower humidity will extend the fire season and increase the number of fire-risk days across various regions of South Africa [ 3 ]. Therefore, the study aimed to determine how the level of clinical experience influences veterinary practitioners in assessing fire-affected livestock, focusing on prioritising clinical and non-clinical factors involved in decision-making. To the authors’ knowledge, this is the first study of this type conducted locally. 2. Materials and Methods Qualtrics XM-certified solutions ™ (Silver Lake, Seattle, Washington, United States) were used to design the questionnaire directed to veterinary practitioners with varying lengths of clinical experience. The scenario-based questions described a farmer consulting the veterinarian about fire-affected livestock. Respondents were asked to give their decision (treatment, slaughter or euthanasia) regarding previously defined triaged categories of burned ruminants [ 14 ]. Moreover, they were asked to prioritise the clinical factors, such as prognosis, based on burn extent/depth and smoke inhalation, veterinary supplies available, and personnel available, as well as the non-clinical factors, such as provisions for feed, water, and shelter. The participants were asked to rank the factors from most important to least important in terms of the influence each factor had on their decision-making. According to data provided by the South African Veterinary Council (SAVC), there are 3800 veterinarians registered in South Africa. Only 16% of them practice in rural areas and were considered for the study. These numbers fluctuate for different reasons, such as practitioners moving to the city, emigrating, retirement, etc. The sample size for veterinary participants was calculated based on a margin of error of 10%. Considering a target population of 500 veterinarians actively practising in production animals, the sample number calculated using Yamane’s formula (n = N/(1 + N*(e)∧2) was 83. The questionnaire was preliminarily run with four veterinary experts, a ruminant specialist, an epidemiologist, a theriogenologist, and a wildlife specialist with about the same years of experience in work related to production animals. After incorporating their feedback regarding legibility and overall survey flow, and having obtained a high degree of similarity in their responses, a link to the questionnaire was distributed through popular publications on three internet websites related to farming and amongst local rural veterinarians’ associations. In remote areas and amongst senior individuals, digital access proved difficult; thus, a hard copy of the survey was delivered via email to interested participants who contacted the principal investigator. The survey directed ‘veterinary-trained’ and ‘non-veterinary’ respondents to different sections of the questionnaire, which were independent. The non-veterinary respondents’ section did not receive participation and, therefore, was excluded from the study. A 49,40% response rate (41/83) was collected and analysed for veterinary-trained respondents. Descriptive statistics were used to summarise the data, and the Kruskal-Wallis non-parametric test was conducted to compare various groups with ordinal dependent variables. The correlation between variables was tested with Spearman’s (rho) test. 3. Results The results of the survey were divided into three cohorts based on years of clinical experience: <1 year; 2–5 years, and 6–10 years. Participants belonged to Gauteng, Western Cape, Eastern Cape and Free State provinces in South Africa. Participants were not required to have had previous experience with burn cases to participate in the survey. Veterinary-trained participants were involved in the field of production animals. Table 1 depicts the results regarding treatment decisions for burned ruminants based on their clinical severity (Table 1 ). Table 1 Treatment decisions based on evaluation of burn severity correlated to each cohort (< 1 year, 2–5 years and 6–10 years of clinical experience) presented as a proportion of the total number of participants in the cohort. Proportion of categories’ decision over experience % (N) < 1 year (n = 11) 2–5 years (n = 6) 6–10 years (n = 24) Treatment option Burn Severity T S E T S E T S E Mild 90.9 (10/11) 9.09 (1/11) 00.0 (0/11) 100.0 (6/6) 00.0 (0/6) 00.0 (0/6) 100.0 (24/24) 0.00 (0/24) 0.00 (0/24) Major 18.1 (2/11) 81.8 (9/11) 00.0 (0/11) 00.0 (0/6) 83.3 (5/6) 16.6 (1/6) 00.0 (0/24) 66.6 (16/24) 33.3 (8/24) Severe 00.0 (0/11) 18.1 (2/11) 81.8 (9/11) 00.0 (0/6) 00.0 (0/6) 100.0 (6/6) 0.00 (0/24) 4.1 (1/24) 95.8 (23/24) Key: T: Treatment, S: Slaughter, E: Euthanasia. Mild: 10–15% TBSA, partial-thickness, no smoke inhalation detected; Major: >20% TBSA partial-thickness, 20% TBSA partial-thickness, > 5% full-thickness burns, critical anatomic locations severely affected, signs of smoke inhalation. For the mild burns category, the cohort with < 1 year of experience (n = 11) strongly favoured treatment (90.9%, 10/11) as the final decision, with minimal (9.09%, 1/11) to no consideration given to slaughter or euthanasia, respectively. In both the cohorts with 2–5 years’ experience (n = 6), and 6–10 years’ experience (n = 24) all participants favoured treatment (6/6 and 24/24 respectively). A consistent and overwhelming preference for treatment across all experience levels indicated clear consensus on the decision regarding mild burns. For the major burns category, all cohorts predominantly elected slaughter (81,1%, 83,3% and 66,6% for the < 1 year, 2–5 years and 6–10 years cohorts, respectively) with the remaining participants electing euthanasia. For the severe category, the < 1 year of experience cohort predominantly considered euthanasia (81.8%, 9/11). In comparison, minimal (18.1%, 2/11) to no consideration was given to slaughter or treatment options. In the 2–5 years’ experience cohort, all favoured euthanasia (100%, 6/6), and in the 6–10 years of experience cohort, it was also the predominant choice (95.8%, 23/24). Building on question one, participants were asked to rank the four most influential factors from the provided list in the survey, in order of importance, that contributed to their decision. Table 2 shows how each factor was considered by the different cohorts (< 1 year; 2–5 years, and 6–10 years of experience). Table 2 Factors considered by each cohort (< 1 year; 2–5 years and 6–10 years of clinical veterinary experience) in the decision-making process when considering treatment options for burned livestock. Factors involved in decision-making Years of clinical veterinary experience < 1 year (n = 11) 2–5 years (n = 6) 6–10 years (n = 24) Prognosis 81.8 (9/11) 100.0 (6/6) 75.0 (18/24) Cost of treatment 90.9 (10/11) 83.3 (5/6) 66.6 (16/24) Welfare 36.3 (4/11) 66.6 (4/6) 66.6 (16/24) Return to production 54.5 (6/11) 50.0 (3/6) 29.1 (7/24) Value of animal 54.5 (6/11) 16.6 (1/6) 41.6 (10/24) Systemic affectation 27.2 (3/11) 16.6 (1/6) 37.5 (9/24) Length of treatment 27.2 (3/11) 00.0 (0/6) 33.3 (8/24) Nursing care needed 18.1 (2/11) 16.6 (1/6) 20.8 (5/24) Complications 9.0 (1/11) 33.3 (2/6) 12.5 (3/24) Feed/water availability 00.0 (0/11) 16.6 (1/6) 4.1 (1/24) Shelter availability 00.0 (0/11) 00.0 (0/6) 8.3 (2/24) Insurance 00.0 (0/11) 00.0 (0/6) 4.1 (1/24) When analysing key factors related to decision-making, all cohorts prioritised prognosis (81.8%, 100% and 75%, respectively), indicating its importance in guiding clinical decision-making. Cost of treatment was considered a significant factor amongst less experienced practitioners, while this diminished in importance with more experienced practitioners. Regarding return to production, a decline in importance over time was noted, and for the factor “value of the animal”, considerable fluctuation was seen amongst cohorts. Systemic involvement increased in importance as years of experience increased, with only 27,2% in the < 1 year of experience cohort considering it important compared to 37.5% of the 6–10 years of experience cohort. Experienced practitioners (6–10 years of experience cohort) were the only ones who considered non-clinical factors such as feed/water/shelter availability and insurance in their decision-making process. However, these factors were ranked low for all cohorts.. The data was then collated following an ‘importance scores’ distribution where the most named factor received a higher value (4), and subsequent factors were assigned reduced values according to answer frequency (3, 2, 1) with (0) designated for factors not considered in the answer. Table 3 shows the ranking of factors involved in the decision-making process for burned livestock according to cohort (< 1 year; 2–5 years and 6–10 years of clinical veterinary experience). When each decision-making factor was compared to years of clinical veterinary experience, all three cohorts ranked prognosis as the most important factor, while the cost of treatment was inversely related to the level of experience and welfare was considered more important as the years of experience increased. Value of the affected animal and return to production were the other two most frequently included factors for decision-making across cohorts, but they also appeared as less important as experience increased (Table 3 ). Table 3 Ranking of factors involved in the decision-making process for burned livestock correlated to cohort (< 1 year; 2–5 years and 6–10 years of clinical veterinary experience). Factors involved in decision-making Years of clinical veterinary experience < 1 year (n = 11) 2–5 years (n = 6) 6–10 years (n = 24) Prognosis 2.909 3.166 2.541 Cost of treatment 2.181 1.666 1.291 Welfare 1.090 2.666 2.083 Return to production 1.090 0.833 0.458 Value of animal 1.363 0.333 0.750 Systemic involvement 0.454 0.500 1.125 Length of treatment 0.454 0.000 0.500 Nursing care needed 0.181 0.166 0.416 Complications 0.272 0.333 0.333 Feed/water availability 0.000 0.000 0.125 Shelter availability 0.000 0.000 0.250 Insurance 0.000 0.000 0.125 The data showed an increased emphasis on prognosis and welfare as the level of experience increased. Table 4 shows the correlation coefficient analysed with Spearman’s (rho) test and corresponding p-values for each decision factor. Negative or positive rho values suggest the type of correlation for the factors considered; low p-values (< 0.05) indicate that the correlation is statistically significant. Table 4 Factors involved in the decision-making process for burned livestock correlated with years of veterinary clinical experience. Decision factor Spearman’s rho (95% CI) p-value Cost of treatment -0.349(-0.599, -0.037) 0.025 Return to production -0.262 (-0.534, 0.059) 0.098 Welfare 0.189 (-0.135, 0.477) 0.237 Shelter availability 0.184 (-0.140, 0.473) 0.248 Systemic involvement 0.176 (-0.148, 0.466) 0.271 Feed/water availability 0.129 (-0.195, 0.428) 0.422 Insurance 0.129 (-0.195, 0.428) 0.422 Value of animal -0.122 (-0.422, 0.202) 0.448 Prognosis -0.125 (-0.424, 0.199) 0.437 Length of treatment 0.117 (-0.207, 0.418) 0.467 Nursing care needed 0.071 (-0.251, 0.378) 0.661 Complications -0.010 (-0.325, 0.307) 0.953 The interpretation of the values obtained for prognosis indicates that the negative rho (-0.125) suggests a slight tendency for the prognosis factor to decrease in priority with experience, but it does not indicate statistical significance (p-value: 0.437). The factor “cost of treatment” shows a statistically significant (p-value: 0.025) negative correlation (rho: -0.349), indicating that as experience increases, the emphasis on the cost of treatment tends to decrease. Welfare, in turn, shows a positive rho (0.189), indicating a slight tendency for welfare considerations to increase with experience, but the result is not statistically significant (p-value: 0.237). Factors such as return to production and value of animals suggest that as experience increases, the emphasis on these decreases, while systemic effect consideration rises with experience. However, none of them showed statistical significance. 4. Discussion Veterinary practitioner participants with varied clinical experience were surveyed regarding their decision-making process for burned livestock. This step was important because the degree of clinical experience has been highlighted as one of the factors influencing accuracy when evaluating the most important prognostic indicators of burns. The extent and depth of the burn are directly related to burn survivability and will determine the need and volume of fluid therapy to be administered for resuscitation. Fluid therapy will greatly impact the cost and skills needed for effective treatment. A high degree of subjectivity surrounds the evaluation and decision-making concerning burned animals caught in wildfires [ 15 ]. This not only affects the field of production animals but also concerns companion animals, wildlife, and even human medicine, underscoring the overall difficulty that the evaluation of burn cases poses to practitioners [ 16 , 17 ]. Clinical experience, to a certain extent, increases prognosis accuracy [ 18 ]. The added challenge of evaluating animals in a disaster setting may prompt prioritising value preservation efforts, which fall through as the pathology evolves and complications ensue due to inadequate field treatment, leading to fruitless efforts and demoralising experiences for farmers when animals undergoing treatment do not progress as expected [ 19 ]. The survey results indicated that novice veterinarians place more importance on prognosis and economic factors as decisive factors. Hence, the “cost of treatment” had a major weighting in the decision-making process, as has been discussed by Lavigne and others (2021) [ 12 ]. Regardless of experience level, a strong and consistent preference for treating mild burns was noted. The main approach regarding major burns was slaughter, with an increasing indication of euthanasia as the participant was more experienced. Hence, it was concluded that slaughter was the preferred decision for animals with major burns across experience levels, and treatment was largely disregarded. Meat safety from livestock affected by wildfires is a growing concern. Recent research has explored various aspects of this topic, including the potential contamination of the meat, the implications for animal health and welfare, and the regulatory frameworks regulating meat inspection. Another significant concern is the potential for heavy metal contamination in meat from animals grazing on pastures affected by wildfires [ 20 ]. Although it has not yet been proven, it cannot be ignored. Wildfires can deposit ash contaminated with metals. It has been postulated that heavy metals can accumulate in wild animals and domestic animals, raising concerns about meat safety and public health [ 21 ]. Moreover, current protocols for abattoir inspections may not be suitable for animals affected by environmental stressors such as wildfires [ 22 ]. Euthanasia was the most common decision across cohorts to manage animals with severe burns, and this tendency increased with experience, suggesting that practitioners become more inclined to favour this approach for severe cases as they become more experienced veterinary practitioners. These trends indicate that as experience increases, there is a clear shift towards more aggressive decision-making for severe cases, reflecting a deeper understanding of the phenomenon and protocols in burn management among seasoned practitioners, and possibly also a greater understanding of food safety concerns. The decision to slaughter major and severely affected animals was mostly seen amongst novice practitioners who may have additionally failed to contemplate welfare considerations such as fitness for transportation and the systemic effects seen in severely affected ruminants. Furthermore, these animals cannot receive any pain relief medication due to drug withdrawal considerations. Overall, the survey results indicate that the cost of treatment is the only factor that shows a statistically significant negative correlation with experience, reinforcing the notion of a shift in priorities as practitioners gain expertise. Many factors, such as prognosis, welfare, and return to production, show no significant correlations, indicating that these factors may not be as influenced by experience as others. Most factors remain stable across different levels of experience, suggesting that certain decision-making factors are entrenched in practice regardless of how long a practitioner has been in the field. Experience informs decision-making, and it is shaped through exposure at different stages of the application of critical thinking and problem-solving skills. This process starts during educational training and further develops through professional practice [ 23 ]. This evolution is critical for improving patient outcomes and enhancing the quality of care provided to animal patients. The preceding analysis may help inform novice practitioners’ decision-making, training, and educational approaches by highlighting the importance of giving cost, welfare and ethical implications sufficient consideration, as practitioners develop their skills and priorities in veterinary decision-making. Veterinary practitioners, particularly those who are newly graduated, rely on established protocols and guidelines taught during training to inform their clinical decisions. As practitioners gain experience, they begin to internalise these guidelines and adapt them based on individual patient needs and contexts, as seen in this instance. This shift is supported by the concept of evidence-based veterinary medicine, which encourages the use of the best available evidence in conjunction with clinical expertise and patient care values [ 24 , 25 ]. Experience also enhances the ability to engage in shared decision-making with owners. Research indicates that experienced veterinarians are prone to facilitate discussions that incorporate client preferences and values into the decision process [ 26 ]. This approach increases client satisfaction and conformity with the decision. Implementing shared decision-making in order to improve outcomes in veterinary practice, especially supported by communication skills that develop with experience, is highlighted in the literature [ 27 ]. The ethical dimensions of clinical decision-making become more pronounced with experience. As ethical dilemmas present themselves in practice, such as balancing client desires and animal welfare, the practitioner develops a more sophisticated understanding of ethical frameworks which guide their decisions [ 28 ]. For example, ethical decision-making tools have been proposed to help veterinarians prioritise the welfare of the patient while considering the broader context of client relationships and economic factors [ 29 ]. Such tools can be used in managing complex scenarios and aligning decisions to professional standards and client expectations. Moreover, the integration of technology, such as computerised decision support systems, is becoming increasingly relevant in veterinary practice. These systems assist the practitioner in making informed decisions based on individual patient data, thereby enhancing decision-making processes [ 30 ]. Hence, clinical decision-making in veterinary practice is a dynamic process that evolves with experience, as confirmed by the results of the survey. As practitioners transition from novices to experienced veterinarians, they develop a more comprehensive understanding of evidence-based practices, enhance their communication skills for shared decision-making, tackle ethical dilemmas more effectively, and gradually adopt the use of technology to support their judgment while improving patient care and outcomes in veterinary practice. There is a need to broaden undergraduate knowledge on disaster management (especially wildfires), use of updated frameworks for welfare assessment in disaster situations (including transportation of injured animals), burn pathology (specifically concerning systemic involvement), and the effects of stress on meat quality influencing fitness for consumption. In conclusion, these findings reveal local key trends in veterinary decision-making for burned ruminants, such as a common choice of euthanasia for severe burn cases and slaughter for major burn cases. There is a need to further investigate the animal welfare and public health implications of the choice for major burn cases, which could be rooted in challenges related to food security. Treatment was the overwhelming choice for mild burn cases. These findings have significant implications for several areas of veterinary practice. At the education and training levels, there is a need to emphasise the importance of prognosis, animal welfare, and systemic health implications in burn management. Veterinarians should carefully consider ethical implications, such as animal welfare and the potential impact on public health, when deciding about burned livestock. The use of evidence-based decision tools aids veterinarians in making informed decisions, especially in complex and/or mass casualty cases, leading to more effective choices for the animals. Further research is required to explore the long-term consequences of burn injuries on animal health and welfare, as well as the impact of different treatment strategies. Declarations Author Contributions: Conceptualisation, methodology, C.L. Cardoso, C.E. May, R. Leask.; data analysis, C.L. Cardoso; data curation, C.L. Cardoso; writing—original draft preparation, C.L. Cardoso; review and editing, supervision, C.E. May, R. Leask. All authors have read and agreed to the published version of the manuscript.” Ethics Declaration: The study was approved by the Institutional Research and Ethics Committee of the University of Pretoria (protocol code REC 055-22), date of approval 17 April 2023. Consent to Participate Declaration: Informed consent was obtained from all individuals participating in the study prior to accessing the survey. Consent to Publish Declaration: not applicable. Clinical Trial number: not applicable. Data Availability Statement: Data can be obtained from the corresponding author upon request. Conflicts of Interest: The authors declare no conflicts of interest. Funding: This research received no external funding. References O’Hara KC, Ranches J, Roche LM, Schohr TK, Busch RC, Maier GU. (2021) Impacts from Wildfires on Livestock Health and Production: Producer Perspectives. Animals 11, 3230. Garces A, Pires I. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6928100","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":475332298,"identity":"b39d8748-c38d-43ed-913d-3daef9693aa6","order_by":0,"name":"Claudia L Cardoso","email":"data:image/png;base64,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","orcid":"","institution":"University of Pretoria","correspondingAuthor":true,"prefix":"","firstName":"Claudia","middleName":"L","lastName":"Cardoso","suffix":""},{"id":475332299,"identity":"e1b9532c-123c-416c-bdac-84dfbe684801","order_by":1,"name":"Catherine E May","email":"","orcid":"","institution":"University of Pretoria","correspondingAuthor":false,"prefix":"","firstName":"Catherine","middleName":"E","lastName":"May","suffix":""},{"id":475332300,"identity":"d9f1bc80-551a-4c63-97f9-8b58b3613575","order_by":2,"name":"Rhoda Leask","email":"","orcid":"","institution":"University of Pretoria","correspondingAuthor":false,"prefix":"","firstName":"Rhoda","middleName":"","lastName":"Leask","suffix":""}],"badges":[],"createdAt":"2025-06-19 06:38:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6928100/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6928100/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94650073,"identity":"986f2940-1e46-4c29-9493-54735e0b7f29","added_by":"auto","created_at":"2025-10-29 09:25:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":653615,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6928100/v1/cc7cd42c-24e4-4763-a5b2-b9c92a712ce8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Dynamics of Veterinary Clinical Decision-making for Domestic Ruminants Affected by Wildfires in South Africa","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eWildfires have a significant impact on domestic ruminants worldwide. Direct impacts on livestock can be seen when they suffer skin burns, smoke inhalation and death. Furthermore, pastures and grazing land loss can lead to starvation and malnutrition. Indirect impacts of wildfires are seen as a consequence of smoke inhalation, which has long-term consequences such as pneumonia, affecting the animal\u0026rsquo;s overall health and productivity [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. During evacuation and commingling at rescue points, stress from wildfire exposure can lead to decreases in milk production, weight gains, and reproductive performance. Hence, livestock deaths, injuries, reduced productivity, cost of veterinary care, feed replacements, and infrastructure repairs result in financial losses for farmers and ranchers [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Wildfires will become more frequent and severe in the following decades [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Animals are often trapped by fences and burned at different levels of severity. Furthermore, burn injuries and their repercussions at the systemic level can become more severe as time from the initial insult passes, and this will worsen the negative welfare state in which these animals are found [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The prognosis of the patient will be determined by the degree of burn severity, which is a function of the combination of the extent of the total body surface area affected (%TBSA) and the depth of the burn [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This judgment is entirely dependent on the evaluator\u0026rsquo;s clinical experience.\u003c/p\u003e \u003cp\u003eDecision-making in veterinary practice encompasses a multifaceted interplay of ethical considerations, emotional influences, and professional development. Recent studies have shown the importance of structures, frameworks, and supportive multidisciplinary and collaborative environments in enhancing decision-making processes among veterinary practitioners [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Such frameworks are essential for addressing complex clinical situations, where decisions often involve ethical dilemmas and the welfare of animals. These considerations show the importance of emotional well-being as a pivot in shaping decision-making capabilities [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVeterinarians are taught to consider various factors, including financial implications and the human-animal bond, when making difficult decisions regarding animals in critical condition [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The influence of financial constraints on clinical decisions is crucial, as veterinarians often face pressures related to client expectations and the cost associated with treatments, which may skew decision-making [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Therefore, veterinarians need to balance clinical judgment with economic realities in all contexts of veterinary practice. Experience enables veterinarians to balance these considerations and to engage the client in shared decision-making, moving on to promoting more ethical decisions, better animal welfare and better client compliance and satisfaction [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA proactive approach to categorising the affected animals for clinical decision-making may reduce delays and allow for the allocation of more animals to the category for treatment. However, contradictory advice regarding the course of action for burned ruminants delays recovery efforts. To understand the source of contradicting advice in these cases, it was hypothesised that differing levels of clinical experience of first respondents could be the source of this contradiction. It is worth noting that not all veterinarians practising in rural areas commonly encounter wildfires; hence, the number of veterinarians with experience in diagnosing burns in ruminants is limited. However, scientific projections from the local Council for Scientific and Industrial Research (CSIR) projected that rising temperatures, prolonged droughts and lower humidity will extend the fire season and increase the number of fire-risk days across various regions of South Africa [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Therefore, the study aimed to determine how the level of clinical experience influences veterinary practitioners in assessing fire-affected livestock, focusing on prioritising clinical and non-clinical factors involved in decision-making. To the authors\u0026rsquo; knowledge, this is the first study of this type conducted locally.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cp\u003eQualtrics XM-certified solutions \u0026trade; (Silver Lake, Seattle, Washington, United States) were used to design the questionnaire directed to veterinary practitioners with varying lengths of clinical experience. The scenario-based questions described a farmer consulting the veterinarian about fire-affected livestock. Respondents were asked to give their decision (treatment, slaughter or euthanasia) regarding previously defined triaged categories of burned ruminants [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Moreover, they were asked to prioritise the clinical factors, such as prognosis, based on burn extent/depth and smoke inhalation, veterinary supplies available, and personnel available, as well as the non-clinical factors, such as provisions for feed, water, and shelter. The participants were asked to rank the factors from most important to least important in terms of the influence each factor had on their decision-making. According to data provided by the South African Veterinary Council (SAVC), there are 3800 veterinarians registered in South Africa. Only 16% of them practice in rural areas and were considered for the study. These numbers fluctuate for different reasons, such as practitioners moving to the city, emigrating, retirement, etc. The sample size for veterinary participants was calculated based on a margin of error of 10%. Considering a target population of 500 veterinarians actively practising in production animals, the sample number calculated using Yamane\u0026rsquo;s formula (n\u0026thinsp;=\u0026thinsp;N/(1\u0026thinsp;+\u0026thinsp;N*(e)\u0026and;2) was 83. The questionnaire was preliminarily run with four veterinary experts, a ruminant specialist, an epidemiologist, a theriogenologist, and a wildlife specialist with about the same years of experience in work related to production animals. After incorporating their feedback regarding legibility and overall survey flow, and having obtained a high degree of similarity in their responses, a link to the questionnaire was distributed through popular publications on three internet websites related to farming and amongst local rural veterinarians\u0026rsquo; associations. In remote areas and amongst senior individuals, digital access proved difficult; thus, a hard copy of the survey was delivered via email to interested participants who contacted the principal investigator.\u003c/p\u003e \u003cp\u003eThe survey directed \u0026lsquo;veterinary-trained\u0026rsquo; and \u0026lsquo;non-veterinary\u0026rsquo; respondents to different sections of the questionnaire, which were independent. The non-veterinary respondents\u0026rsquo; section did not receive participation and, therefore, was excluded from the study. A 49,40% response rate (41/83) was collected and analysed for veterinary-trained respondents. Descriptive statistics were used to summarise the data, and the Kruskal-Wallis non-parametric test was conducted to compare various groups with ordinal dependent variables. The correlation between variables was tested with Spearman\u0026rsquo;s (rho) test.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eThe results of the survey were divided into three cohorts based on years of clinical experience: \u0026lt;1 year; 2\u0026ndash;5 years, and 6\u0026ndash;10 years. Participants belonged to Gauteng, Western Cape, Eastern Cape and Free State provinces in South Africa. Participants were not required to have had previous experience with burn cases to participate in the survey. Veterinary-trained participants were involved in the field of production animals. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e depicts the results regarding treatment decisions for burned ruminants based on their clinical severity (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTreatment decisions based on evaluation of burn severity correlated to each cohort (\u0026lt;\u0026thinsp;1 year, 2\u0026ndash;5 years and 6\u0026ndash;10 years of clinical experience) presented as a proportion of the total number of participants in the cohort.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"9\" nameend=\"c10\" namest=\"c2\"\u003e \u003cp\u003eProportion of categories\u0026rsquo; decision over experience % (N)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 year (n\u0026thinsp;=\u0026thinsp;11)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e2\u0026ndash;5 years (n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e6\u0026ndash;10 years (n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"9\" nameend=\"c10\" namest=\"c2\"\u003e \u003cp\u003eTreatment option\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBurn Severity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003eE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMild\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90.9 (10/11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.09 (1/11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e00.0 (0/11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0 (6/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e00.0 (0/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e00.0 (0/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e100.0 (24/24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.00 (0/24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.00 (0/24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMajor\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.1 (2/11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81.8 (9/11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e00.0 (0/11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e00.0 (0/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e83.3 (5/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16.6 (1/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e00.0 (0/24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e66.6 (16/24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e33.3 (8/24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSevere\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e00.0 (0/11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.1 (2/11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81.8 (9/11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e00.0 (0/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e00.0 (0/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100.0 (6/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.00 (0/24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.1 (1/24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e95.8 (23/24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eKey: T: Treatment, S: Slaughter, E: Euthanasia. Mild: 10\u0026ndash;15% TBSA, partial-thickness, no smoke inhalation detected; Major: \u0026gt;20% TBSA partial-thickness, \u0026lt;\u0026thinsp;5% full-thickness burns, some critical anatomic locations affected, no smoke inhalation detected; Severe: \u0026gt;20% TBSA partial-thickness, \u0026gt;\u0026thinsp;5% full-thickness burns, critical anatomic locations severely affected, signs of smoke inhalation.\u003c/p\u003e \u003cp\u003eFor the mild burns category, the cohort with \u0026lt;\u0026thinsp;1 year of experience (n\u0026thinsp;=\u0026thinsp;11) strongly favoured treatment (90.9%, 10/11) as the final decision, with minimal (9.09%, 1/11) to no consideration given to slaughter or euthanasia, respectively. In both the cohorts with 2\u0026ndash;5 years\u0026rsquo; experience (n\u0026thinsp;=\u0026thinsp;6), and 6\u0026ndash;10 years\u0026rsquo; experience (n\u0026thinsp;=\u0026thinsp;24) all participants favoured treatment (6/6 and 24/24 respectively). A consistent and overwhelming preference for treatment across all experience levels indicated clear consensus on the decision regarding mild burns.\u003c/p\u003e \u003cp\u003eFor the major burns category, all cohorts predominantly elected slaughter (81,1%, 83,3% and 66,6% for the \u0026lt;\u0026thinsp;1 year, 2\u0026ndash;5 years and 6\u0026ndash;10 years cohorts, respectively) with the remaining participants electing euthanasia.\u003c/p\u003e \u003cp\u003eFor the severe category, the \u0026lt;\u0026thinsp;1 year of experience cohort predominantly considered euthanasia (81.8%, 9/11). In comparison, minimal (18.1%, 2/11) to no consideration was given to slaughter or treatment options. In the 2\u0026ndash;5 years\u0026rsquo; experience cohort, all favoured euthanasia (100%, 6/6), and in the 6\u0026ndash;10 years of experience cohort, it was also the predominant choice (95.8%, 23/24).\u003c/p\u003e \u003cp\u003eBuilding on question one, participants were asked to rank the four most influential factors from the provided list in the survey, in order of importance, that contributed to their decision.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows how each factor was considered by the different cohorts (\u0026lt;\u0026thinsp;1 year; 2\u0026ndash;5 years, and 6\u0026ndash;10 years of experience).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors considered by each cohort (\u0026lt;\u0026thinsp;1 year; 2\u0026ndash;5 years and 6\u0026ndash;10 years of clinical veterinary experience) in the decision-making process when considering treatment options for burned livestock.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFactors involved in decision-making\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eYears of clinical veterinary experience\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 year (n\u0026thinsp;=\u0026thinsp;11)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u0026ndash;5 years (n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u0026ndash;10 years (n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrognosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e81.8 (9/11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0 (6/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75.0 (18/24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCost of treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90.9 (10/11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83.3 (5/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.6 (16/24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWelfare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36.3 (4/11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.6 (4/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.6 (16/24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReturn to production\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54.5 (6/11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.0 (3/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.1 (7/24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eValue of animal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54.5 (6/11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.6 (1/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41.6 (10/24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystemic affectation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27.2 (3/11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.6 (1/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37.5 (9/24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27.2 (3/11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e00.0 (0/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.3 (8/24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNursing care needed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18.1 (2/11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.6 (1/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.8 (5/24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9.0 (1/11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.3 (2/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.5 (3/24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFeed/water availability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e00.0 (0/11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.6 (1/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.1 (1/24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShelter availability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e00.0 (0/11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e00.0 (0/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.3 (2/24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e00.0 (0/11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e00.0 (0/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.1 (1/24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen analysing key factors related to decision-making, all cohorts prioritised prognosis (81.8%, 100% and 75%, respectively), indicating its importance in guiding clinical decision-making. Cost of treatment was considered a significant factor amongst less experienced practitioners, while this diminished in importance with more experienced practitioners. Regarding return to production, a decline in importance over time was noted, and for the factor \u0026ldquo;value of the animal\u0026rdquo;, considerable fluctuation was seen amongst cohorts. Systemic involvement increased in importance as years of experience increased, with only 27,2% in the \u0026lt;\u0026thinsp;1 year of experience cohort considering it important compared to 37.5% of the 6\u0026ndash;10 years of experience cohort. Experienced practitioners (6\u0026ndash;10 years of experience cohort) were the only ones who considered non-clinical factors such as feed/water/shelter availability and insurance in their decision-making process. However, these factors were ranked low for all cohorts..\u003c/p\u003e \u003cp\u003eThe data was then collated following an \u0026lsquo;importance scores\u0026rsquo; distribution where the most named factor received a higher value (4), and subsequent factors were assigned reduced values according to answer frequency (3, 2, 1) with (0) designated for factors not considered in the answer. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the ranking of factors involved in the decision-making process for burned livestock according to cohort (\u0026lt;\u0026thinsp;1 year; 2\u0026ndash;5 years and 6\u0026ndash;10 years of clinical veterinary experience).\u003c/p\u003e \u003cp\u003eWhen each decision-making factor was compared to years of clinical veterinary experience, all three cohorts ranked prognosis as the most important factor, while the cost of treatment was inversely related to the level of experience and welfare was considered more important as the years of experience increased. Value of the affected animal and return to production were the other two most frequently included factors for decision-making across cohorts, but they also appeared as less important as experience increased (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRanking of factors involved in the decision-making process for burned livestock correlated to cohort (\u0026lt;\u0026thinsp;1 year; 2\u0026ndash;5 years and 6\u0026ndash;10 years of clinical veterinary experience).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFactors involved in decision-making\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eYears of clinical veterinary experience\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 year (n\u0026thinsp;=\u0026thinsp;11)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u0026ndash;5 years (n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u0026ndash;10 years (n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrognosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.909\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.541\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCost of treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.666\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.291\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWelfare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.090\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.666\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.083\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReturn to production\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.090\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.833\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.458\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eValue of animal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.333\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.750\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystemic involvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.500\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNursing care needed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.416\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.333\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.333\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFeed/water availability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShelter availability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.250\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe data showed an increased emphasis on prognosis and welfare as the level of experience increased.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the correlation coefficient analysed with Spearman\u0026rsquo;s (rho) test and corresponding p-values for each decision factor. Negative or positive rho values suggest the type of correlation for the factors considered; low p-values (\u0026lt;\u0026thinsp;0.05) indicate that the correlation is statistically significant.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors involved in the decision-making process for burned livestock correlated with years of veterinary clinical experience.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecision factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpearman\u0026rsquo;s rho (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCost of treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e-0.349(-0.599, -0.037)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReturn to production\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e-0.262 (-0.534, 0.059)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWelfare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e0.189 (-0.135, 0.477)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.237\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShelter availability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e0.184 (-0.140, 0.473)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.248\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystemic involvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e0.176 (-0.148, 0.466)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.271\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFeed/water availability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e0.129 (-0.195, 0.428)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.422\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e0.129 (-0.195, 0.428)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.422\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eValue of animal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e-0.122 (-0.422, 0.202)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.448\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrognosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e-0.125 (-0.424, 0.199)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.437\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e0.117 (-0.207, 0.418)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.467\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNursing care needed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e0.071 (-0.251, 0.378)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.661\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e-0.010 (-0.325, 0.307)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.953\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe interpretation of the values obtained for prognosis indicates that the negative rho (-0.125) suggests a slight tendency for the prognosis factor to decrease in priority with experience, but it does not indicate statistical significance (p-value: 0.437).\u003c/p\u003e \u003cp\u003eThe factor \u0026ldquo;cost of treatment\u0026rdquo; shows a statistically significant (p-value: 0.025) negative correlation (rho: -0.349), indicating that as experience increases, the emphasis on the cost of treatment tends to decrease. Welfare, in turn, shows a positive rho (0.189), indicating a slight tendency for welfare considerations to increase with experience, but the result is not statistically significant (p-value: 0.237). Factors such as return to production and value of animals suggest that as experience increases, the emphasis on these decreases, while systemic effect consideration rises with experience. However, none of them showed statistical significance.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eVeterinary practitioner participants with varied clinical experience were surveyed regarding their decision-making process for burned livestock. This step was important because the degree of clinical experience has been highlighted as one of the factors influencing accuracy when evaluating the most important prognostic indicators of burns. The extent and depth of the burn are directly related to burn survivability and will determine the need and volume of fluid therapy to be administered for resuscitation. Fluid therapy will greatly impact the cost and skills needed for effective treatment.\u003c/p\u003e \u003cp\u003eA high degree of subjectivity surrounds the evaluation and decision-making concerning burned animals caught in wildfires [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This not only affects the field of production animals but also concerns companion animals, wildlife, and even human medicine, underscoring the overall difficulty that the evaluation of burn cases poses to practitioners [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Clinical experience, to a certain extent, increases prognosis accuracy [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The added challenge of evaluating animals in a disaster setting may prompt prioritising value preservation efforts, which fall through as the pathology evolves and complications ensue due to inadequate field treatment, leading to fruitless efforts and demoralising experiences for farmers when animals undergoing treatment do not progress as expected [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe survey results indicated that novice veterinarians place more importance on prognosis and economic factors as decisive factors. Hence, the \u0026ldquo;cost of treatment\u0026rdquo; had a major weighting in the decision-making process, as has been discussed by Lavigne and others (2021) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Regardless of experience level, a strong and consistent preference for treating mild burns was noted. The main approach regarding major burns was slaughter, with an increasing indication of euthanasia as the participant was more experienced. Hence, it was concluded that slaughter was the preferred decision for animals with major burns across experience levels, and treatment was largely disregarded.\u003c/p\u003e \u003cp\u003eMeat safety from livestock affected by wildfires is a growing concern. Recent research has explored various aspects of this topic, including the potential contamination of the meat, the implications for animal health and welfare, and the regulatory frameworks regulating meat inspection. Another significant concern is the potential for heavy metal contamination in meat from animals grazing on pastures affected by wildfires [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Although it has not yet been proven, it cannot be ignored. Wildfires can deposit ash contaminated with metals. It has been postulated that heavy metals can accumulate in wild animals and domestic animals, raising concerns about meat safety and public health [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Moreover, current protocols for abattoir inspections may not be suitable for animals affected by environmental stressors such as wildfires [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEuthanasia was the most common decision across cohorts to manage animals with severe burns, and this tendency increased with experience, suggesting that practitioners become more inclined to favour this approach for severe cases as they become more experienced veterinary practitioners.\u003c/p\u003e \u003cp\u003eThese trends indicate that as experience increases, there is a clear shift towards more aggressive decision-making for severe cases, reflecting a deeper understanding of the phenomenon and protocols in burn management among seasoned practitioners, and possibly also a greater understanding of food safety concerns.\u003c/p\u003e \u003cp\u003eThe decision to slaughter major and severely affected animals was mostly seen amongst novice practitioners who may have additionally failed to contemplate welfare considerations such as fitness for transportation and the systemic effects seen in severely affected ruminants. Furthermore, these animals cannot receive any pain relief medication due to drug withdrawal considerations.\u003c/p\u003e \u003cp\u003eOverall, the survey results indicate that the cost of treatment is the only factor that shows a statistically significant negative correlation with experience, reinforcing the notion of a shift in priorities as practitioners gain expertise. Many factors, such as prognosis, welfare, and return to production, show no significant correlations, indicating that these factors may not be as influenced by experience as others. Most factors remain stable across different levels of experience, suggesting that certain decision-making factors are entrenched in practice regardless of how long a practitioner has been in the field.\u003c/p\u003e \u003cp\u003eExperience informs decision-making, and it is shaped through exposure at different stages of the application of critical thinking and problem-solving skills. This process starts during educational training and further develops through professional practice [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This evolution is critical for improving patient outcomes and enhancing the quality of care provided to animal patients. The preceding analysis may help inform novice practitioners\u0026rsquo; decision-making, training, and educational approaches by highlighting the importance of giving cost, welfare and ethical implications sufficient consideration, as practitioners develop their skills and priorities in veterinary decision-making.\u003c/p\u003e \u003cp\u003e Veterinary practitioners, particularly those who are newly graduated, rely on established protocols and guidelines taught during training to inform their clinical decisions. As practitioners gain experience, they begin to internalise these guidelines and adapt them based on individual patient needs and contexts, as seen in this instance. This shift is supported by the concept of evidence-based veterinary medicine, which encourages the use of the best available evidence in conjunction with clinical expertise and patient care values [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eExperience also enhances the ability to engage in shared decision-making with owners. Research indicates that experienced veterinarians are prone to facilitate discussions that incorporate client preferences and values into the decision process [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This approach increases client satisfaction and conformity with the decision. Implementing shared decision-making in order to improve outcomes in veterinary practice, especially supported by communication skills that develop with experience, is highlighted in the literature [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe ethical dimensions of clinical decision-making become more pronounced with experience. As ethical dilemmas present themselves in practice, such as balancing client desires and animal welfare, the practitioner develops a more sophisticated understanding of ethical frameworks which guide their decisions [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. For example, ethical decision-making tools have been proposed to help veterinarians prioritise the welfare of the patient while considering the broader context of client relationships and economic factors [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Such tools can be used in managing complex scenarios and aligning decisions to professional standards and client expectations.\u003c/p\u003e \u003cp\u003eMoreover, the integration of technology, such as computerised decision support systems, is becoming increasingly relevant in veterinary practice. These systems assist the practitioner in making informed decisions based on individual patient data, thereby enhancing decision-making processes [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHence, clinical decision-making in veterinary practice is a dynamic process that evolves with experience, as confirmed by the results of the survey. As practitioners transition from novices to experienced veterinarians, they develop a more comprehensive understanding of evidence-based practices, enhance their communication skills for shared decision-making, tackle ethical dilemmas more effectively, and gradually adopt the use of technology to support their judgment while improving patient care and outcomes in veterinary practice. There is a need to broaden undergraduate knowledge on disaster management (especially wildfires), use of updated frameworks for welfare assessment in disaster situations (including transportation of injured animals), burn pathology (specifically concerning systemic involvement), and the effects of stress on meat quality influencing fitness for consumption.\u003c/p\u003e \u003cp\u003e In conclusion, these findings reveal local key trends in veterinary decision-making for burned ruminants, such as a common choice of euthanasia for severe burn cases and slaughter for major burn cases. There is a need to further investigate the animal welfare and public health implications of the choice for major burn cases, which could be rooted in challenges related to food security. Treatment was the overwhelming choice for mild burn cases. These findings have significant implications for several areas of veterinary practice. At the education and training levels, there is a need to emphasise the importance of prognosis, animal welfare, and systemic health implications in burn management. Veterinarians should carefully consider ethical implications, such as animal welfare and the potential impact on public health, when deciding about burned livestock. The use of evidence-based decision tools aids veterinarians in making informed decisions, especially in complex and/or mass casualty cases, leading to more effective choices for the animals. Further research is required to explore the long-term consequences of burn injuries on animal health and welfare, as well as the impact of different treatment strategies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e Conceptualisation, methodology, C.L. Cardoso, C.E. May, R. Leask.; data analysis, C.L. Cardoso; data curation, C.L. Cardoso; writing\u0026mdash;original draft preparation, C.L. Cardoso; review and editing, supervision, C.E. May, R. Leask. All authors have read and agreed to the published version of the manuscript.\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Declaration:\u0026nbsp;\u003c/strong\u003eThe study was approved by the Institutional Research and Ethics Committee of the University of Pretoria (protocol code REC 055-22), date of approval 17 April 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate Declaration:\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from all individuals participating in the study prior to accessing the survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish Declaration:\u003c/strong\u003e not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial number:\u003c/strong\u003e not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u003c/strong\u003e Data can be obtained from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e The authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This research received no external funding.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eO\u0026rsquo;Hara KC, Ranches J, Roche LM, Schohr TK, Busch RC, Maier GU. (2021) Impacts from Wildfires on Livestock Health and Production: Producer Perspectives. \u003cem\u003eAnimals\u003c/em\u003e 11, 3230.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarces A, Pires I. The Hell of Wildfires: The Impact on Wildlife and Its Conservation and the Role of the Veterinarian. Conservation. 2023;3:96\u0026ndash;108.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eForsyth G, LeMaitre LeRoux A, Ludick C. Green Book. The impact of climate change on wildfires in South Africa. Pretoria, South Africa: CSIR; 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUnited Nations Environment Programme. Spreading like Wildfire \u0026ndash; The Rising Threat of Extraordinary Landscape Fires. Nairobi: A UNEP Rapid Response Assessment; 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRogers J, Scholz T, Gillen A. 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(2018) Drawing the line in clinical treatment of companion animals: recommendations from an ethics working party. \u003cem\u003eVet.Rec. 182(23)\u003c/em\u003e:664.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGibson J, Brenan ML, Oxtoby C, Mossop L, White K. Ethical challenges experienced by veterinary practitioners in relation to adverse events: insights from a qualitative study. Vet Rec. 2023;193(12):e3601.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFox K, Fox J, Bexfield N, Freeman P. Computerised decision support in veterinary medicine, exemplified in a canine idiopathic epilepsy care pathway. JSAP. 2021;62(10):911\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Clinical experience, burns, decision-making, domestic ruminants, wildfires","lastPublishedDoi":"10.21203/rs.3.rs-6928100/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6928100/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eWildfires pose a significant threat to livestock, frequently resulting in burn injuries. Assessing the affected animals in the field is crucial for making informed decisions. However, this evaluation is often subjective and relies on the experience of the evaluator, leading to potential misdiagnoses of burn severity and inefficient allocation of resources. This work consulted veterinary-trained individuals with varying clinical experience to better understand the dynamics of their decision-making processes when applied to wildfire burn cases in domestic ruminants. This study concluded that novice practitioners prioritise prognosis and cost of treatment when making decisions for burned ruminants. However, as the practitioner\u0026rsquo;s level of experience grows, there is a tendency to place less emphasis on economic factors and more on the animal\u0026rsquo;s welfare, especially concerning their systemic involvement and possibility of recovery with the available treatment intervention provided in the field, ultimately guiding the final decision.\u003c/p\u003e","manuscriptTitle":"Dynamics of Veterinary Clinical Decision-making for Domestic Ruminants Affected by Wildfires in South Africa","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-24 12:00:55","doi":"10.21203/rs.3.rs-6928100/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8803cfcf-8a32-44f3-9389-bedb48a3a20a","owner":[],"postedDate":"June 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-29T09:24:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-24 12:00:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6928100","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6928100","identity":"rs-6928100","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}