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How I Train A Medical Alert Service Dog

by Jamie H Robinson 2 months ago in training

It's All About The Nose

This blog post is in response to someone who suggested that I write what I do for the public to see and then invite others to do the same.

Ok, so how is a service dog trained? What do I do that is the same or different than anyone else?

First off, most of the dogs trained over the last year, have been trained for a specific disorder that causes a person to go into anaphylaxis. Their throats close up preventing breathing, their faces turn red and blotchy, other parts of their bodies also swell with the over production of histamine and other attendant chemicals. This means EPI pens (epinephrine injectors) and trips to the ER.

Most of the service dogs I train are medical alert dogs. Under normal circumstances, the dog is trained from puppyhood and has a thorough understanding of what their job is and a commitment to doing it. In some cases, an older dog is found and trained until competent.

What I train:

  • Commitment to the scent involved in the disorder/disease
  • Strong, persistent alert to the presence of that scent
  • Multiple alerts depending on what the person is doing at the time the scent becomes present (for instance, capturing the foot if the person is standing or sitting with feet down, licking the face and standing on the persons body if they are laying down, or giving a hard bump to a part of the body repeatedly)
  • In some cases, more than one scent and more than one set of alerts
  • Self control to the point of being able to leave a plate of food on the coffee table alone, without being reminded
  • Impulse control when something falls to the floor or road kill is encountered on a walk
  • Proper heeling depending on need. For some dogs that means slightly ahead of the handler so the dog can block quickly or pull away from a trigger.
  • How to ignore strangers and other dogs
  • How to understand new environments based on known object types (a table is a table) so as to prevent or minimize anxiety in a new environment
  • The Its (drop it, leave it, take it, bring it, give it, do it)
  • Accept all kinds of handling from vets, groomers and overly excited children.
  • Stay with their handler even when the leash is dropped.
  • Sit, down, stand, come, stay and wait to a high level
  • How to do all that around a wheelchair, a dentist chair, an emergency room and more

And depending on what the client needs - much more.

Starting with a puppy, it takes 4 months to get through all the puppy stuff, but with a service dog puppy, that will include things that a pet puppy would never need to learn. Climbing stairs, getting in and out of cars, learning about different surfaces, being able to get on and off things on cue, moving around wheelchairs, walkers and canes, and much more.

Then at 6 months, the public access games start. Sit, down, come, heel and stay are a very small part of what is needed with public access. Being in restaurants, handling noise and lots of movement, lots of people and even other dogs, eliminating on cue and knowing that doing so otherwise when in public is not tolerated. Until the dog is 18 months, public access games continue wrapped around the task training.

For a medical alert candidate, scent training starts at 8 weeks with games that help the pup learn to follow a scent, find a scent, being creative and persistent about getting to the scent, solving puzzles and learning to solve problems and do what they’ve been asked to do no matter what distractions there are. By the time a medical alert candidate reaches 9 months they should be doing spontaneous alerts on strangers as well as alerting when the trainer brings out the target scent in session. A medical alert puppy also starts to learn about alert behaviors at a young age. They learn targeting and that its ok to climb on a human to get to the scent. And the humans, if they are involved at all in their puppy’s training, learn that it’s ok to allow the puppy to make choices and decisions about things. Intelligent disobedience is a necessity for a medical alert dog.

From 9 to 18 months, everything the dog has learned is honed and tested and proofed until the dog can find scent blindfolded, stay at heel with 20 kids jumping around, and ignore other dogs and prey animals. Bomb proofed.

It takes about 3 months to thoroughly train the first scent. More to get to 92% accuracy. Once that first scent is learned, it takes from 1 to 3 weeks to learn new scents. But each one still needs proofing. And that is with a trainer who knows how to train medical alerts. With anyone else it can take a lot longer.

But always remember, each dog is an individual and each handler is also. Train the dog in front of you and work with the handler that is being targeted. Don’t assume and don’t make generalities.

Why I Specialize In Medical Alert

For nearly 15,000 years dogs have lived with and served us as companions, hunters, shepherds and most recently detectives. Dogs trained to detect scents take advantage of the hundreds of millions of odor receptors they have in comparison to only a few million for humans. Over the last century, their incredible nose makes dogs sought after by nearly every segment of society.

A dog's sense of smell is much more incredible than you think. Dogs interpret the world through smell. They can smell up to 40ft below ground and follow whales by the smell of their waste.

But science can't keep up with the multitude of uses that have been developed for a dog's keen nose. There are also a multitude of uses of a dog's nose in areas that have up to now, only trained a dog for response after the fact.


Diabetic alert dogs have been around awhile. One company even tried figuring out what substance the dogs alert on in order to build a machine to do what the dogs do but no luck. What I've discovered however, in training dogs for other diseases, syndromes and/or conditions is that the dog ALSO alerts on blood sugar levels without having been taught.

Panic, Anxiety and PTSD

Even anxiety and panic has an odor. An alert can be trained to be 5 to 10 minutes before a panic attack based on smell and/or ticks (uncontrolled small movements like wringing the hands).


Whether or not a dog can be TRAINED to detect seizures is a hotly contested item on social media. I've been doing it for 11 years successfully, but because there is minimal research into this, there are many who claim it can't be done because science has yet to prove it.

Just recently research has started on whether or not a dog can smell a seizure. So far it has shown that what many of us have been training a dog to find for 10+ years, does in fact exist.


Allergies, also known as allergic diseases, are a number of conditions caused by hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include hay fever, food allergies, atopic dermatitis, allergic asthma, and anaphylaxis. Allergens can be anywhere and are often in food. The dog is trained to find and alert to these hidden substances based on what the handler is actually sensitive to.

Blood Pressure

A well known syndrome that has fluctuating blood pressure is POTS - Postural Orthostatic Intolerance. I.E. if you stand up you faint because your blood pressure is too low to get the blood to your head. There are other symptoms of POTS but the blood pressure issue is what is key. We've trained a few dogs to detect blood pressure fluctuations just like they detect blood sugar fluctuations.


Mast Cells (a form of white cell) release chemicals when they degranulate due to environmental triggers. The most well known is histamine which can cause severe inflammation in the airways causing anaphylaxis. Histamine has a smell.

There are other substances that Mast Cells release that we train the dogs to monitor as well, but histamine is the most well known. Included in training the dogs to monitor these body chemicals, we also trained them to alert to known triggers. Very much like allergen alerts.

There are many more conditions, syndromes, and disorders that have a smell component that a dog can be trained to detect. In the last 10 years I've trained for Lupus, MS, Meniere's, fainting spells, pain management, Narcolepsy, PANS, PANDAS, Rett Syndrome and more.

This is why I love training for Medical Alert. It's always fascinating and challenging.


Jamie H Robinson

Jamie Robinson has lived with and worked with dogs, cats, horses, and parrots for nearly 40 years. For the last 15 years, Jamie has written over 60 books and set up an online academy with over 40 classes. Jamie trains service dogs today.

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