Medical Alert vs Response: What’s the Difference?

You’re sitting at a table in a restaurant with friends. All of a sudden your service dog breaks his down-stay to alert. Or did he? One of the biggest debates in the service dog community is where the line between a true ALERT and a RESPONSE behavior actually occurs. Now, this distinction doesn’t matter when it comes to whether the dog can be considered a service dog per ADA guidelines. But it can make a difference in training.

Medical Alerts

A true alert comes before the symptoms start. True alerts are typically in response to physiological changes and occur prior to any symptoms showing externally. Both natural and trained alerts can fall into this category. Seizure alert dogs are the best example of what a natural alert looks like. These dogs have a natural ability to sense oncoming seizures. It is currently not known exactly what it is they are picking up on, so it is not a trainable alert. However, it is most definitely an alert as the dogs typically give their handlers 15-30 minutes of warning prior to the seizure presenting in symptoms.

Training an Alert

There are very few true alerts that can be trained. Seizure alerts are the most commonly known natural alerts. Blood sugar alerts are often considered true alerts that can be trained. Blood pressure and heart rate alerts can sometimes be considered other examples of true alerts that cannot be trained.

Scent Training an Alert

Dog NoseBlood sugar alerts are scent trained. Saliva samples are collected during episodes of low sugar or high sugar and the dog is taught to perform the alert behavior whenever it smells the scents associated with each chemical change. Technically the chemical change within the body has to have already happened for the dog to be able to smell it.

However, these are considered alerts because the dog notifies the handler in advance of symptoms. So while a service dog cannot alert to a low sugar 10 minutes before it happens, a dog can be trained to alert the handler, before the handler even knows, to a change that will ultimately result in severe symptoms or a medical emergency. Service dogs scent trained for blood sugar alerts are often able to detect changing sugars before the handler starts feeling symptoms, and many times are well in advance of continuous monitoring devices.

When an Alert is Actually a Response

On the other end of the spectrum are tasks that may appear to be alerts to the general public but are actually response tasks. Anxiety “alerts” fall into this category. (Please note that the use of quotation marks does not in any way detract from the validity of the tasks, only to indicate that it is not a true alert as I will explain.) These appear to be alerts, and may even be called alerts by the handlers at times, but are actually the dogs responding to already presenting symptoms and alerting their handler to those symptoms.

An Alert Occurs Before Symptoms Begin

The term alert is often used as the handler may be unaware of the increase in symptoms, so to them it is an alert. However, the dog is not giving warning before symptoms begin. The dog is responding to the behavior(s) that has already started by communicating it to the handler. This could look like a dog pawing at its handler in response to skin picking or picking up on an increased breathing rate indicating the start of an anxiety attack and leading the handler to a quiet location. These are considered response tasks because the dog is noticing behaviors the handler is showing and responding accordingly. They are not notifying the handler in advance of external symptoms, but indicating they have appeared prior to the handler being aware of them.

Service Dog Leni

Leni is a scent trained medical alert dog who also performs response tasks, such as epipen retrievals.

As mentioned earlier, this in no way makes it less of a task than a true alert. The definition of a service dog is one that has been trained to mitigate a disability. Medical response is very much a valid task. The main reason there is even a distinction between alerting and responding at all is because it CAN make a difference in training.

Gray Areas

Blood pressure and heart rate fall into a bit of a gray area when it comes to alerts vs responses. Some people have dogs that appear to perform natural alerts to changing blood pressure or heart rate. In these cases, both are similar to seizure alerts as there is currently no way to train actual blood pressure or heart rate alerts.

However, for some people, training response tasks to these symptoms can be incredibly helpful. Dropping blood pressure can often result in passing out. A dog can be trained to notice specific symptoms, such as shaking, unsteadiness, rapid breathing, etc., that often precede an actual episode of fainting and give the handler enough time to sit or lie down. This is not an alert because it is not in advance of external symptoms.

It is most definitely a response, though, as a service dog may be able to pick up on these symptoms before its handler may be aware of them. Same with a heart rate task. Natural alerts to heart rate changes cannot be trained, but there are often symptoms that come along with tachycardia or bradycardia that a dog can be trained to respond to.

Alerts and Responses are Both Valid Tasks

Both alerting, trained or natural, and responding are valid tasks. Many service dogs do both. Medical alert dogs that have been scent trained may also be trained in response tasks to perform after the initial alert. The only time this distinction really matters is in training. If a dog chosen as a prospect does not have a natural ability to alert and the alert is not a trainable alert, there may be valid response tasks that can be trained that will still mitigate the handlers disability.

Medical alert or medical response is a technical difference. Not an indication of the usefulness of the task or benefit to the handler. So back to the example I presented at the beginning. Was the dog performing a true alert or a response? Bottom line is, it doesn’t matter.







Kylene Boka
Kylene is a grad student living in Ohio with her husband and two dogs, Bonk and Leni. Leni is her service dog and is scent trained to alert to severe allergic reactions and hypoglycemia due to Kylene’s mast cell disease. To learn more about life with mast cell disease and a service dog, you can check out Kylene’s blog,