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Given the nature of equine activities, accidents occur resulting in injuries and even death of participants. In some cases accidents arise from the negligence from the equine owner or sponsor, others arise from the negligence or unfortunate mishaps of the injured person. Litigation and insurance costs related to accidents constitute a major expense for equine professionals, individuals, businesses and groups.
A major reason for these high costs involves the nature of the injuries. Riding horses may involve greater risk of fatal injury than most other sports such as football and hockey. A study hospital emergency room data during 1989-1990 disclosed that approximately twenty percent of the 121,274 injuries from horseback-related injuries were head or neck injuries. The low level of use of protective helmets among equestrian riders was a contributing factor to these injuries.
A second major reason for the high costs involves the legal rules governing liability. Due to expanded liability rules, insurance costs have increased for equine owners and sponsors. While mishaps may inherently accompany equine activities, interest groups are advancing a new group of statutory provisions to limit the liability of persons sponsoring or operating equine activities. Washington was the first state to enact statutory provisions in 1989, and subsequently twenty other states have proceeded to adopt statutes that provide qualifying defendants immunity from liability for injuries and death. Bills or similar legislation have been or are being considered in at least twenty other states. This is a descriptive summary of the liability statutes.
There are two groups of equine legislative provisions:
The good Samaritan:
The good Samaritan statutes provide that persons intervening in a medical emergency without compensation generally will not incur liability for ordinary negligence.
Recreational use statutes were enacted to encourage owners to make property available to the public for recreational purposes. Recreational use statutes generally apply only if the property owner does not charge for the use of the recreational land.
The major justification for the new statutes is to provide immunity for benevolent sponsors that employed reasonable efforts to facilitate safe equine activities. Five distinct categories of activities involving equines are delineated as "equine activities," while two additional activities may qualify under some statues.
1. Equine activity means: equine shows, fairs, competitions, performances or parades that involve any or all breeds of equines and any of the equine disciplines, included, but not limited to: dressage, hunter and jumper horse shows, grand prix jumping, three-day events, combined training, rodeos, driving, pulling, cutting, polo, steeple chasing, English and western performance riding, endurance trail riding, games and hunting.
2. Equine training or teaching activities:
3. Boarding equines.
4. Riding, inspecting, or evaluating an equine belonging to another
5. Any activity of any type sponsored by an equine activity sponsor. Some statues include placing or replacing horseshoes and providing or assisting in medical treatment.
Some statues define inherent risks of equine activities that is employed as a qualification for statutory immunity. Inherent risks mean dangers or conditions that are an integral part of equine activities, and such risks include equine behavior, unpredictability of reactions, certain hazards such as surface and subsurface conditions, collisions with objects and other equines, and a participant's failure to maintain control over an animal.
Immunity provided by some statues is exclusively for equine activity sponsors and equine professionals so that the definition of these terms is critical. Equine activity sponsors are defined to include individuals and various groups that are affiliated with equine activities, such as pony clubs, 4-H clubs, riding clubs, school and college sponsored classes and programs, therapeutic riding programs, and operators, instructors, and promoters of equine facilities, including but not limited to stables, clubhouses, pony ride strings, fairs, and arenas at which the activity is held.
An equine professional is often defined as a person engaged for compensation in: (a) instructing a participant or renting to a participant an equine for the purpose of riding, driving or being a passenger upon the equine; or (b) renting equipment or tack to a participant.
Depending on the statute, the definition of equine activity sponsor and equine professional may omit evaluators (judges), inspectors, nonprofessional social hosts, veterinarians, and farriers.
Statutory immunity only applies to participants, both amateur or professional persons, who engage in an equine activity regardless of whether fees were paid. Engages in equine activity means riding, training, assisting in medical treatment of, driving, or being a passenger upon an equine, whether mounted or unmounted, or any person assisting a participant or show management. The definition usually does not include spectators.
The major purpose of the equine liability statutes is to limit the civil liability of persons associated with equine activities. Reasons given for the statutes are:
Economic benefits to the state
Encourage equine activity
Immediate preservation of the public peace, health, and safety.
A. Does the statute create statutory duties
B. Was it intended simply to limit liability.
The absence of a description of the purpose may detract from the future interpretation of the coverage of the immunity provided by the statutes.
Despite the similar directives of statutes, distinctions among other provisions mean that immunity varies considerably. Two distinct groups of statues are observed:
The first category limits immunity for injuries or death of participants to those resulting from the inherent risks (IR) of equine activities.
The second category limits immunity to equine activity sponsors and professional (SAP) for injuries or death of participants engaged in an equine activity. IR statutes may offer potential defendants greater protection than is provided by the SAP statutes. Six SAP statues limit immunity to sponsors and equine professionals. The immunity excludes defendant horse owners who have animals for pleasure rather than a business (social hosts). The statutory immunity is not available to defendants who are evaluating an activity inspecting an equine, serving as a farrier, and rendering veterinary services.
Many of the new equine liability statutes contain two notice requirements that apply to professional persons involved in equine activities.
Requirement for posting of warning notice by means of a sign. The sign must contain the exact statutory wording and be placed in visible locations near the areas where the equine activities are conducted.
Requirement of the inclusion of a warning in written contracts for professional service, instruction, and rental of equipment. The warning must contain the exact statutory wording and be easily readable. Several statutes provide that failure to comply with the warning requirements disqualifies the professional or sponsor from invoking the immunity provided by the statute.
The broad immunity available to qualifying defendants provided by the equine liability statutes is not absolute. The statutory exceptions may be categorized as:
A. Specific exemptions
There are five specific exceptions:
1. Situations that involve intentional injury of a participant.
2. An act or omission that constitutes something more than negligence (willful omission exception)
3. Horse racing
4. Fence laws
B. Faulty equipment or tack (equipment exception)
Providers with knowledge or implied knowledge of faulty equipment or tack causing a mishap do not qualify for statutory immunity. Questions of what is faulty, such as functional but worn equipment, are not settled by the statutes so that products liability law or commercial law provision may be employed to determine the definition of faulty equipment. Under these statutes, deference to products liability law allows negligence suits based on the failure to adopt updated safety features or the latest technology in equipment and tack.
C. Suitability of the equine (suitability exception)
The immunity of the equine liability statues is not available for persons who provide the equine and fail to determine the ability of the participant and equine to engage in a safe equine activity. This exception imposes three separate requirements on providers:
1. The provider must employ reasonable and prudent efforts to inquire about a participant's ability to engage in equine activities.
2. The participant's representations of ability need to be utilized in selecting safe equine activities
3. The participant's representations of ability need to be utilized in choosing an equine that can be managed safely by the participant.
In some, a fourth requirement:
4. Determine the ability of the equine to behave safely with the participant.
D. Land or facilities with a dangerous condition
A defendant provider who owns, leases, rents, or is in possession and control of land or facilities with a dangerous latent condition causing an injury for which no warning signs are posted may incur liability. Under the inherent risk statutes, inherent risks include "hazards such as surface and subsurface conditions" so that mishaps occurring due to conditions meeting this definition were intended to qualify for statutory relief. Applying the natural versus unnatural distinction to the IR statutes defendants would remain liable for mishaps arising from manmade conditions but would be immune to suits based on mishaps due to a natural subsurface condition.
The two states of Connecticut and Utah equine liability statues do not limit liability for any dangerous condition that causes an accident. Defendants in these states who own, lease, rent, or are in lawful possession and control of land or facilities who know or should have known of any dangerous condition that causes an injury or death would not have statutory immunity.
Terrence J. Cetner, Professor
College of Agriculture and Environmental Sciences
University of Georgia
301 Conner Hall
Athens, GA 30602
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Nichole Walters gave a brief review of the Equestrian Helmet Program and announced the establishment by Harborview Injury Prevention and Research Center of equestrian helmet programs in the states of California, Minnesota, New Jersey, New Mexico, Ohio, Oregon, Pennsylvania, and Vermont.
Morbidity and mortality of head injuries sustained during equestrian related accidents are significantly reduced with the use of ASTM standard SEI certified secured helmets. The behavior modification needed for this relatively simple intervention is less complicated than the behavior modification needed for other injury problems such as drowning and violence.
Since helmet usage of children in organized riding activities appears to be high, the real challenge is to stimulate helmet usage among unorganized riders. The involvement of health and safety organizations outside the horse-riding community is important to obtain. Lisa Kovner (American Horse Council) suggested the campaign address state level groups, such as state horse councils, owners and managers of public riding facilities, then approach the national councils and organizations. Nancy Young (Children's Safety Network, Rural Injury Prevention and Resource Center) stated that health departments in states where riding is popular would be a natural marriage within state-wide campaigns.
A Evaluation: by tracking the total number of helmet sales in the U.S. with the help of helmet manufacturers, the campaign will look for a minimum increase of 5% ASTM/SEI approved helmet sales each year. A decrease in equestrian-related head injuries each year would be the sine qua non.
B. Insurance Companies: Tom Augherton (Safety Equipment Institute) suggested educational materials on helmet safety created by Harborview should be included in risk management seminars for those providing insurance for horse farms, riding stables, rental/leasing of horses, and camps. Nancy Young suggested incentives should be explored with respect to the insurance companies enforcing protective headgear guidelines in farm policies. Carole Sullivan (American Academy of Pediatrics) and Mary Midkiff (Equine Resources) offered to provide contacts for the twenty insurance companies interested in helmet safety.
C. Camp Inspections: Elizabeth Madelener (United States Dressage Federation) suggested working with the health departments for public facilities, and suggest that the health departments mandate helmets for safety purpose at public riding camps. This would be monitored by the health departments who make the inspections to these facilities. She cautioned, however, about the concern of the horse community about-too much- intrusive regulation.
D. Public Service Announcements (PSAs), Helmet Video, and National Trail Day: Elizabeth Madelener suggested these as additional tools that can be used as part of an organized campaign.
E. Point of Purchase (POP) Displays (Manufacturers/Distributors): Lisa Kovner suggested building a relationship with helmet manufacturers and distributors that would help create educationally oriented POP displays within the retailers of approved helmets.
Tom Augherton announced that Dru Malavase (USPC Safety Committee, AMEA member, Chairman ASTM Sub-committee equestrian headgear) would be attending the ASTM standards committee May 19, in Montreal, Canada.
Melanie Heacock (United States Pony Club) suggest any future materials referring to a child equestrian should be named as a "junior" rider. This would be an effort to stay consistent with the universally accepted term that the American Horse Show Association uses for all riders under the age of 18 years.
Relationship of Harborview Injury Prevention and Research Center (HIPRC) with Helmet Manufacturers:
1) As a University of Washington program, the HIPRC is not allowed to provide commercial advantage to any firm.
2) The University of Washington provides no money to the HIPRC; all of its programs must be self-sustaining. The equestrian helmet program could not take place without money to pay for a part-time coordinator, production and mailing of educational materials, and travel.
3) The equestrian helmet campaign is modeled after the Center's successful bicycle helmet campaign in which three manufacturers participated. They were allowed to display their own product in any educational pamphlet or video that they subsidized.
4) All educational material prepared by the HIPRC endorses the use of any ASTM/SEI approved helmet.
5) Lexington Safety Products, International Helmets, Vision, and Troxel were all invited to help support the campaign in general, and specifically to participate in a discount coupon approach to reach a wider group of consumers than those served by traditional tack shops. Lexington did not wish to become involved with discount coupons, but instead has promoted the goals of the campaign in its print advertising. International has expressed support, but has not wished to participate financially at this time. Vision has gone out of business. Troxel was the only firm that desired to go after a wider audience. This approach was similar to its bicycle helmet campaign with the American Academy of Pediatrics.
6) Troxel pays the HIPRC $26,000/yr to support the part-time salary of a coordinator (Nichole Walters), produce and distribute educational material and travel. HIPRC in turn provides Troxel with technical advice on the educational material it distributes.
7) HIPRC will continue to work with any and all manufacturers interested in promoting the use of equestrian helmets.
Commitments Made by Those Who Attended:
A. The Children's Safety Network will: distribute an "equestrian injury packet" of educational materials, including those created by the HIPRC, to its primary mailing list of state health department injury control and maternal child health contacts; participate in a joint effort with Harborview in the distribution of the packets to state pediatric academy chapters; draft a new fact sheet (citing references and formal in nature) to be included with the packets distributed; work with the Wisconsin State 4-H and encourage it to adopt a mandatory helmet ruling for its members.
B. The National Head Injury Foundation will distribute the educational materials provided by the HIPRC and at total of 5,000 helmet discount coupons to all forty-eight state chapters. Additional efforts will also be made to establish which of its chapters needs assistance in promoting the campaign in its respective states. Any article covering the points of this meeting will be included in the next monthly newsletter. Eve Berger (National Head Injury Foundation) will suggest that the "TBI (Traumatic Brain Injury) Challenge" magazine focus one of its monthly issues on helmet safety. In addition, Ms. Berger will write and submit a press release covering equestrian-related head injuries on a local basis for the HIF Newsletter.
C. The American Horse Council will encourage editorial boards of the top thirteen national publications to write about the importance of helmets in an attempt to become an authoritative resource of helmet information and statistics. In doing so, the project will encourage and help program organizers create campaigns to promote helmets. In essence, this will help educate the non-organized equestrians who read these publications. Additional efforts will be made to contact mail order tack shops, such as State Line Tack, to include an educational brochure on helmets, and include statistics on equestrian-related head injuries on the pages on which the helmets appear in the sales catalogs. An article will be included in the next AHC Newsletter to announce its presence at this meeting with an overview of what was discussed.
D. The American Academy of Pediatrics will create and send article to its monthly newsletter and a publication, "Healthy Kids," highlighting its partnership in the equestrian helmet campaign. The AAP newsletter reaches 47,000 members, and "Healthy Kids" is a publication distributed through pediatrician offices for patients to take home.
E. The United States Pony Clubs will provide a public relations (PR) kit, outlining detailed steps on how individuals can set up their own helmet campaign--both children and adults will be addressed. This will be disseminated to regional and local level USPCs in an attempt to work with communities at the grass-roots level. The USPC has arranged for booth space at approximately five national horse events each year. If a video and display materials can be provided, they will be included in the booths at these events. An article will be published in the next USPC Newsletter announcing the participation of the USPC in the equestrian helmet campaign.
F. Mary Midkiff, from Equine Resources, offered to assist the HIPRC with a "challenge" campaign, directed at corporations, businesses, manufacturers, and organizations, to meet or exceed the current level of support (monetarily and in-kind contributions) to promote ASTM-SEI approved equestrian helmets. Additionally she offered to help interact with potential sponsors for the helmet campaign.
G. The National SAFE KIDS Campaign believes it can contribute to the national campaign by providing and distributing educational materials to those who request them through its state chapters. Additionally an announcement will be made through an article in the SAFE KIDS newsletter or a letter will be sent to each SAFE KIDS chapter, announcing its participation in the national helmets campaign.
H. The Harborview Injury Prevention and Research Center will continue to provide resources and technical support necessary to assist organizations and clubs in creating their own equestrian helmet campaign. The HIPRC will also collaborate with Mary Midkiff of Equine Resources in an effort to challenge corporations, businesses, manufacturers, and other organizations to meet or exceed the current level of support to promote ASTM/SEI approved equestrian helmets.
I. The American Horse Council has plans to distribute the educational materials provided by the HIPRC to its 37 state horse councils. In addition, a report on the helmet campaign has been added to the agenda, and will be presented by Elizabeth Madelener at the American Horse Council meeting June 5. Ms. Madelner will also contact the American Youth Horse Council to encourage its participation in the campaign.
J. The members of the American Medical Equestrian Association are primarily physicians and other health personnel. Its role will be to study the injuries in horse activities, body part injured, type of injury how they occur and from this information, make recommendations to the horse community for injury prevention. The study includes ten target states (CA, MN, NJ, OH, OR, PA, VT, WA, WI) on which the AMEA will focus on obtaining support for approved helmets from the state medical organizations and state AAP chapters. The AMEA will seek to obtain the records for horse related deaths and hospital admissions for the last ten years in the targeted states for statistical purposes. The AMEA responds to requests for information, consultation, and will give priority to medical concerns expressed by organizations and individuals. Copies of studies and articles are available without cost from the AMEA.
K. Lisa Kovner, from the United States Combined Training Association, will recommend to the USCTA board to make educational packets available to any member wanting to promote helmet safety. An article covering the points of this meeting will be printed in the next "USCTA News." Currently, the USCTA Safety Committee is working on the production of a poster campaign featuring the actor/rider Christopher Reeve promoting the use of ASTM/SEI approved helmets.
Safety Equipment Institute
National Head Injury Foundation
Harborview Injury Prevention and Research Center
Doris Bixby Hammett
American Medical Equestrian Association
United States Pony Clubs
American Horse Council & U.S. Combined Training Association
United States Dressage Federation
National SAFE KIDS Campaign
American Academy of Pediatrics
Harborview Injury Prevention and Research Center
Children's Safety Network, Rural Injury Prevention & Resource Center
Notes taken by
Equestrian Helmet Program Coordinator
Harborview Injury Prevention and Research Center
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New York State requires that all reported deaths within the state must be coded with the cause of the patient's demise. From 1979 to 1985 there were 34 deaths with all reporting the age of the rider/handler and if the deceased was mounted on the horse. Twenty-six reports recorded the site of injury.
Figure 1 New York Equestrian Deaths
Age Number Percent 0-5 1 2.9 6-10 2 5.9 11-15 1 2.9 16-25 5 14.7 26-35 5 14.7 36-45 5 14.7 46-55 5 14.7 56-65 7 20.6 66-80 3 8.8 Total 34 99.9
Figure 2 New York Equestrian Deaths
Site Total Percent Mounted Percent Non-Mounted Percent Head 19 73.1 17 89.5 2 28.6 Cardiac 1 3.8 0 0.0 1 14.3 Pelvis 1 3.8 0 0.0 1 14.3 Liver 4 15.4 2 10.5 2 28.6 Trachea 1 3.8 0 0.0 1 14.3 TOTAL 26 99.9 19 100.0 7 100.1
Where the injury site was specified, 73.1% of all deaths, and if the rider was mounted, 89.5% of the deaths were head injury deaths.
In 1994 I requested the New York State Department of Health (DOH) for an update of their records of horse-related deaths. Records are available for three years--1990 through 1992. There was only one recorded horse-related death during these years. This death involved an off-road motor vehicle collision and is believed have been a horse drawn buggy. Searching through several years of personal files the only other New York horse- related death was in 1989 in a Western rider who was riding without protective headgear.
There were but 7 reported hospitalizations each for 1990 and 1991 and 8 in 1992 as reported by a DOH representative. Using the records of the DOH, there was a reduction in horse-related deaths in New York from an average of 4.9 per year for the years 1979 to 1985 to 0.33 per year for the years 1990 to 1992.
What are possible causes of this decrease in horse related death?
1. Decline in the number and use of horses in New York State. This has not occurred in New York. In 1978 the number of horses was 180,200. In 1988, the most recent count, the figure was 182,000. The number of riding horses has remained remarkably similar over the last ten year period.
2. Vehicle and Traffic Law Change. New York State passed a Vehicle and Traffic Law regarding horses during the period between DOH reports. The use of caution around horses by drivers is mentioned in the state's Driver's Manual and it grants horses and their handlers the same rights and duties on the road as motor vehicle drivers.
3. Mandated protective helmets. (a) Youth riding organizations within New York State have required ASTM/SEI headgear for competitions and activities involving their members since early in 1990. New York 4- H programs were the first in the United States to update their headgear requirement from the 1983 standard helmets to ASTM/SEI. The United States Pony Clubs local affiliates came under rules to upgrade to ASTM/SEI helmets in 1990.
(b) The New York State Horse Council requires the use of ASTM/SEI headgear for all its activities, and has publicized its endorsement of the use of improved headgear for all equestrian activities beginning in 1991.
4. Coverage by the New York horse papers and magazines. The risks involving riding and handling of horses and the success in minimizing the effects of horse accidents by the use of protective equestrian headgear has received a great deal of publicity thanks to the papers and magazines which appeal to horse owners and riders.
5. Competitive horse sport organizations have, as a minimum, recommended the use of ASTM/SEI helmets during competition. In 1993 and 1994 several have passed rules requiring these helmets. The compliance rate in the case of recommended use varies from sport to sport. Generally, the more tradition-bound the sport the less likely the participants are to change from headgear which is now labeled "item of apparel only." However, the groups which have required ASTM/SEI headgear, even after a vote on the subject from the entire membership, report fewer complaints than they expected.
As a resident of New York, I am proud of the leadership shown by many of our horse organizations and by the good sense shown by many of our riders. By far the largest number of riders belong to no groups, and do not ride under any rules but those of their own common sense. Based on the accident and death statistics, our state has improved its horse riding and handling safety practices.
2270 County Road #39, RR 2
Bloomfield. NY 14469
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Year Number of Deaths 1983 5 1984 1 1985 3 1986 1 1987 3 1988 3 1989 4 1990 7 1991 7 1992 2 TOTAL 36Previous records show in the 5 years 1978 to 1982 there were a total of 14 deaths for an average of 2.8 deaths a year. For the years 1983 to 1987 there were 13 deaths for 2.6 deaths a year. For the years 1988 to 1992 there were 23 deaths for 4.6 deaths a year. With this few number no definite statement can be made, but the trend would appear that horse related deaths have increased in North Carolina.
We are seeing in North Carolina horse related deaths the same trend we see in the National Electronic Surveillance System (NEISS) horse related injuries. The older ages in the horse community are having an increase in the percent of injuries with the greatest increase from NEISS figures in the ages 25-44. This is true in the North Carolina medical examiner deaths but the ages of 45 to 64 years show the greatest increase. The ages 15-24 years have shown a decrease in NEISS but no change in the North Carolina figures.
AGE OF DECEASED AGE 1978-1982 1983-1987 1988-1992 0-4 0 0.0% 0 0.0% 0 0.0% 5-14 3 21.4% 2 15.4% 1 4.3% 15-24 2 14.3% 2 15.4% 3 13.0% 25-44 8 57.1% 7 53.8% 10 43.5% 45-64 1 7.1% 1 7.7% 8 34.8% 65+ 0 0.0% 1 7.7% 1 4.3% TOTAL 14 13 23
NEISS HORSE-RELATED INJURIES AGE 79-82 % 87-89 % 90-93 % 0-4 3318 2.0 2850 2.0 4158 1.9 5-14 45504 27.1 29379 21.1 46533 21.1 15-24 56185 33.5 36043 25.9 51590 23.4 25-44 49570 29.6 55325 39.7 84814 40.8 45-64 11422 6.8 13218 9.5 23984 10.9 65+ 1685 1.0 2455 1.8 4058 1.8 TOTAL 167683 139292 220251
The changes in the demographics may be that:
Youth are increasingly aware of safety, whereas the older rider has not changed riding habits.
Increasing numbers of older persons have more leisure and are involved in horse activities.
A decreasing number of youth are involved with horse-related activities due to increased urbanization and other interests and avenues for recreational activities for youth.
We can check these figures in North Carolina by comparing the numbers of youth involved in horse activities, ie 4-H.
4-H HORSE PROJECTS NORTH CAROLINA TOTAL Male Female 1987 6625 2019 4606 1988 9482 2153 7329 1989 10645 2936 7709 1990 12396 3557 8839 1991 16015 5754 9261 1992 16632These figures indicate that an increasing number of youth in North Carolina are involved in 4-H Extension Horse Projects and therefore the third statement under demographic change (above) is not correct for North Carolina.
Trends that may be significant:
Car/horse deaths may be decreasing. In 1980 a horse jumped into the side of a truck. In 1981 a horseback rider was hit by a station wagon. There have been no further reports of horseback riders hit by a car.
Drivers of motorized vehicles contribute to horse related deaths. In 1990 a man riding a moped was racing a horse when they collided, killing the man on the moped. In the same year a man riding in the passenger seat of a car struck two horses, killing the passenger (and the horses).
Horse drawn vehicle use may be on the increase. The persons riding in the vehicle should wear protective headgear as the riders of horses. In 1990 a woman riding in a carriage was thrown from the carriage resulting in a head injury death. In 1991 two persons riding in a pony cart were killed when hit by a car.
NORTH CAROLINA HORSE RELATED DEATHS GENDER 1978-1982 1983-1987 1988-1992 MALE 6 42.9% 8 61.5% 13 56.5% FEMALE 8 57.1% 5 58.5% 10 43.5% TOTAL 14 13 23
NEISS HORSE RELATED INJURIES GENDER 1979-1982 1987-1989 1990-1992 MALE 64964 38.8% 65908 47.3% 85055 38.8% FEMALE 102614 61.2% 73383 52.7% 134423 61.2% TOTAL 167578 139291 219498
The last two five year periods North Carolina male deaths have out numbered female deaths. NEISS shows female accidents outnumber male horse related accidents for the years 1979-1982 and 1990-1992 almost two to one. In general nationwide male horse- related deaths outnumber female deaths. This may be indicate males undertake more dangerous activities and ride less controllable horses and are less safety conscious resulting in injuries of great severity resulting in death.
The last two highly elevated blood alcohol in horseback riders deaths were in 1989 at 260 mg% and 310 mg%. The previous blood alcohol at that level was in 1984 at 360 mg%. The two recent elevated blood alcohol were not horseback riders--one was the rider of the moped at 220 mg% and the other a passenger in the car which hit the horses. He had a diagnosis of acute alcohol intoxication. In the past 10 years of 28 riders who had blood ethanol drawn, 3 were between 60 to 70 mgm%, one was 90 mgm%, 3 were above 200 mgm% mentioned above. One was diagnosed alcohol intoxication without a blood alcohol on the record,
Neg blood Alcohol Adult 16 64.0% Neg child 7, 7, 14, 19 4 Evidence blood Alcohol 9 36.0% Not Recorded 7 BLOOD TESTS 29 TOTAL 36 Adults 25
Adults in horse related deaths in North Carolina continue to have a high incidence of alcohol ingestion: 36% have evidence of blood levels of alcohol.
The 1988 to 1892 unmounted figures were increased because of three deaths while riding in a horse drawn carts. The United States Pony Clubs, a national organization for youth from the ages of 6 through 21, reported unmounted accidents for the 10 years from 1982 to 1991 were 15.6%. Unmounted deaths in North Carolina appear to be in this range.
MOUNTED MOUNTED 1978-1982 1983-1987 1988-1992 YES 12 85.7% 11 84.6% 15 71.4% NO 2 14.3% 2 15.4% 6 28.6% TOTAL 14 13 21 * *OMITTED Death on moped and passenger in car
The most common cause of death is head injury, followed by chest. Unexpected is the third place rating of cervical spine injury. Tied for fourth and fifth are multiple injuries and abdominal injuries. Medical conditions are not uncommon as many persons who have medical problems elect to continue riding horses. Deaths by drowning continue to be a factor in horse related deaths.
CAUSE OF DEATH 1978-1982 1983-1987 1988-1992 TOTAL Head 10 71.4% 8 61.5% 13 56.5% 31 62.0% Chest 2 14.3% 1 7.7% 4 17.4% 7 14.0% C Spine 1 7.1% 0 0.0% 3 13.0% 4 8.0% Multiple 1 7.1% 1 7.7% 1 4.3% 3 6.0% Abdom 0 0.0% 2 15.4% 1 4.3% 3 6.0% Drowned 0 0.0% 1 7.7% 0 0.0% 1 2.0% Medical 0 0.0% 0 0.0% 1 4.3% 1 2.0%
TOTAL 14 13 23 50
In only one cause of head injury death was it noted the rider was not wearing a helmet. In the admission history, medical emergency personnel do not question whether the injured horse person was wearing a helmet nor are they aware of the different types of helmets. The AMEA has requested from EM physicians that all helmets in head Injury cases be kept and returned to the manufacturer or the AMEA. Until we sensitize emergency personnel of the importance of this history, we will continue to be unsure the role protective headgear could play in preventing 62% of the head injury horse related deaths in North Carolina.
Doris Bixby Hammett, MD
103 Surrey Road
Waynesville, NC 28786
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