University of Vermont AAHS
AMEA

August 1998, Vol. IX, Number 3

 Table of Contents

NEISS Horse Related Injuries 
Sports Popularity
Equestrian Mortality
AMEA Annual Meeting
How About Riding Lessons?
4-H and Helmet Use
Equestrian Helmet Safety
Intracranial Hematoma
News Items



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NEISS HORSE RELATED INJURIES

Preliminary Figures for 1997

The National Electronic Injury Surveillance System (NEISS) of the US Consumer Product Safety Commission through the National Injury Information Clearinghouse provides figures on horse related injuries that go to hospital emergency rooms over the nation.

NEISS explains that the sample was updated in 1990 and again in 1997 to reflect the most current universe of hospital emergency rooms in the US.  It states that the 1997 sample update took into account changes between the 1985 and 1995 sampling frames.  These changes include opening of new hospital emergency rooms, closing of some hospital emergency rooms and changes in the caseload in other hospital emergency rooms.

The sample updates caused changes in the level of the estimates.  Estimates from years prior to a sample update are not directly comparable to estimates after the update.  Percent figures are used for prior years rather than the corresponding numbers.

AREA OF BODY INJURED
 
 
Body Part
Total 1997
% of Known  1997
% of Known 1992-96
Lower Trunk
9638
16.5
15.0
Head
6425
11.0
11.6
Upper Trunk
5441
9.3
10.4
Wrist
4057
6.9
7.2
Ankle
3714
6.3
5.3
Lower Arm
3849
6.6
5.3
Shoulder
3814
6.5
7.7
Face
2283
3.9
5.2
Finger
2157
3.7
4.4
Knee
2724
4.7
3.7
Foot
1717
2.9
3.7
Lower Leg
2947
5.0
4.3
Elbow
1550
2.7
2.8
Hand
2068
3.5
2.7
Upper Leg
875
1.5
2.3
Upper Arm
1046
1.8
1.6
Neck
1554
2.7
2.4
Toe
372
0.6
0.8
Mouth
547
0.9
0.6
Eyeball
267
0.5
0.4
Pubic Region
372
0.6
0.6
25-50% Body
632
1.1
1.3
Ear
111
0.2
0.1
All Parts Body
329
0.6
0.5
Total Known
58489


Not Stated/Unknown
221


TOTAL
58710


 
Summary of Previous Table
Body Part
Total 1997
% of Known 1997
% of Known 1992-96
Trunk
19265
32.9
33.8
Upper Extremity
24727
25.2
24.0
Lower Extremity
12349
21.1
24.0
Head
9633
16.5
17.9
Neck
1554
2.7
2.4
25-50% Body
632
1.1
1.3
All Body
329
0.6
0.5
Total Known
58489


Unknown
221


TOTAL
58710


 

 The preliminary figures for 1997 compared with the previous four years 1992-1996, show little change.  Lower extremity injuries perhaps have deceased which may have been increased use of proper footwear (raised heel with ankle covering).

TYPE OF INJURY

 
 
Type of Injury
Total 1997
% of Known 1997
% of Known 1992-96
Contusion/Abrasion
16681
28.6
32.9
Fracture
16149
27.7
28.1
Sprain/Strain
10503
18.0
16.5
Laceration
4756
8.2
9.0
Concussion
2070
3.6
3.5
Internal Injury
2331
4.0
2.8
Dislocation
1168
2.0
2.2
Hematoma
268
0.5
2.1
Puncture
66
0.1
1.2
Crushing
24
0.0
0.4
Avulsion
158
0.3
0.4
Amputation
23
0.0
0.3
Foreign Body
39
0.1
0.2
Derma/Conjunct
141
0.2
0. 1
Hemorrage
88
0.2
0.1
Burn
6
0.0
0.1
Nerve Damage
0
0.0
0.0
Dental
66
0.1
0.0
Other
3720
6.4

Total Known
48257


Not Stated/Unknown
390


TOTAL
58647


 

There is little change in these figures from 1992-96.  Contusion/abrasions have decreased.  More importantly fractures have decreased and what might have been a fracture may now be a sprain or strain.  The percent of concussion although increased by one tenth of one percent, in estimates of this nature, cannot be considered a change.  As mentioned in 1997 AMEA NEWS (August 1997 Vol. VIII Number 2), we feel that the number of horse related injuries have decreased which may be the result of more riders wearing ASTM SEI fitted and secured helmets, but those that are injured may not be wearing protective helmets, which keeps the percent of concussions at the same level.

GENDER OF INJURED
 
Gender of Injured
Total 1997
% of Known 1997
% of Known 1992-96
Male
25135
42.9
41.6
Female
33509
57.1
58.4
Total Known
58644


Unknown
66


TOTAL
58710


 

These figures may show an increase for 1997 in the percent of males injured compared with the preceding period of 1992-1996. Female percent of injuries still out number males but the difference between the two is less .  This trend has been evident every year since 1992. Whether a greater number of males are horseback riding or whether females are taking safety information more seriously, these figures cannot tell us.

AGE OF INJURED

 
AGE
Total 1997
% of Known 1997
% of Known 1992-96
0-4
1222
2.1
2.2
5-14
12105
20.6
20.2
15-24
20385
17.7
20.9
25-44
21417
36.5
39.6
45-64
12029
20.5
15.5
65 +
1486
2.5
1.7
Total Known
58644


Unknown
66


TOTAL
58710


 
 

These figures show what we were seeing in the NEISS figures of the previous four years with some changes.  The years 0-4 have approximately the same percent of injuries as 1992-1996.  The 5-14 year age group may have had a slight increase in percent.  This is of special concern for we would hope that these ages would continue their previous decrease in percent of accidents.  These are the riders of tomorrow; safety education at this age lasts for a lifetime.   The figures which give us the greatest pleasure are the figures of the 15 to 44 years of age in which the percent was 41% in 1987-91 decreasing to 39.6% in 1992-1996 and appears to have continued this decrease and is now at 36.5%.  This is showing that safety education learned in the younger riders is practiced as they grow older.  The riders over 45 do not seem to learn and their percent of injuries continues to climb although this may be that with increased life spans there are more riders in this age group..

HEAD INJURY AND RELATION TO AGE
 
 
AGE
Head Injury
% of Injury 
% Injury at Age
0-4
325
5.1
2.1
5-14
1998
31.1
20.6
15-24
923
14.4
17.7
25-44
1709
26.6
36.5
45-64
1312
20.4
20.5
65 +
158
2.5
2.5
TOTAL
6425


 

Children 0-4 years old have a greater percent of head injuries than the percent of total injuries would predict. If a child of this age has an injury, he/she is more likely to have a head injury than the other age groups. These injuries are frequently on the ground. The young child is stepped on or kicked by the horse.  Their injuries must be prevented by the parent or caregiver.  If a young child falls from a horse the head is often the area injured because of the large mass of the head compared to the body mass.

The 5 to 14 year old children had a higher percent of head injuries above that of the total injuries.  This age would serve as the greatest challenge to 4-H, Pony Clubs, and youth divisions of the breed associations, horse clubs which include youth members and riding instructors who teach young riders.

The 15-24 and the 25-44 year old riders both have fewer numbers of head injuries in relation to the percent of  riders at this age.  If they have an injury, it is less likely to be a head injury than the younger two groups.  One hopes that the riders who choose to remain in the sport have learned lessons of safety including wearing protective headgear..

The 45 to 64 and over 64 year old groups have the same percent of head injuries as they have accidents.

LOCATION OF ACCIDENT WITH INJURY
 
 
Location
Total 1997
% of Known 1997
% of Known 1992-96
Home
10316
34.9
42.1
Sports
11257
38.1
31.1
Farm
3087
10.4
11.6
Public
4242
14.3
13.0
Street
512
1.7
1.6
School
160
0.5
0.6
Total Known
29576
 

Unknown
29135
 

TOTAL
58711


 

The percent of injuries at home and in sports have changed positions with sports having the higher percent of location of injuries in 1997 over 1992-1996.  The other figures are essentially unchanged from 1992-1996 with farm and school possibly continuing to show a decrease in percent.   We will not know if this is an aberration or the beginning of change until future years figures are available.  Home has ranked first as the location of most injuries since 1979 and several years before 1979.  The percent of injuries at home has increased every year through 1996.  If these figures are valid, the horse sports rule authors have greater opportunities to influence and make rule changes which will improve safety and decrease injury figures in horse sports. In home/farm horse related injuries  rules and  regulations cannot change behavior. The horse community must rely on education and knowledge of the riders in their pleasure activities to reduce injuries.

From US CONSUMER PRODUCT SAFETY COMMISSION
4330 East West Highway, Bethesda, MD 20814.

Comments: Doris Bixby Hammett, MD
Editor AMEA NEWS.

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SPORTS POPULARITY

The National Sporting Goods Association (NSGA) released data on sports participation in the 10 largest U.S. Metropolitan areas. Horseback ridings was number one in Los Angeles/Long Beach area with an index of 168, number four in New York with an index of 135 and Riverside/San  Bernardino with an index of 105.

 "An index is a different way of looking at popularity.  It takes into account many variables," NSGA Vice President of Information & Research Thomas B. Doyle said.  "Variables include changes in participation for each sport at a national and city level, as well as regional differences in weather and economic conditions that affect sports participation."  On the NSGA index, the national average for each sport equals 100.  The index is created by dividing a city's percentage of participants in a particular city by its percentage of the U.S. population.

The 10 largest metropolitan areas covered in this survey are Los Angeles-Long Beach, New York City, Chicago, Philadelphia, Washington DC/MD/VA, Detroit, Boston,  Houston, Atlanta and Riverside/San Bernardino, CA. In compiling the study, NSGA analyzed participation in 50 Metropolitan Statistical Areas for the following activities:  Aerobic exercising, backpacking/wilderness camping, baseball, basketball, bicycle riding, billiards, bowling, calisthenics, camping (vacation/overnight), exercise walking, exercising with equipment, fresh-water fishing, salt-water fishing, football, golf, hiking, horseback riding, hunting with firearms, running/jogging, downhill skiing, soccer, softball, swimming, target shooting, table tennis, tennis and volleyball.

Reported in  "Sports Participation in 1996 City by City."

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EQUESTRIAN MORTALITY:

A COMPARISON OF 1975-1990 AND 1991 IN ALBERTA, CANADA

 Introduction:  Alberta is famous in equestrian circles as the home of Spruce Meadows, (jumping) and the Calgary Stampede.  There are an estimated 150,000 horses  in Alberta.  One out of seven Albertans is involved with horses either for profit or pleasure.[1]

Aronson reported on Alberta equestrian mortality data for 1975 -1990 and stressed that only one of 38 fatalities involved a rider wearing an approved helmet.  Most deaths to mounted riders were due to head injury (68%) and she recommended the use of helmets to anyone working near or riding a horse.2  Chitnavis et al3 in Britain and Bixby-Hammett 4 in the United States have compared  previous injury rates in equestrians with more recent information and have concluded that a decrease in head injury, by 46% an 25% respectively, occurs with increased use of approved helmets. The present comparison was undertaken to determine if head injury deaths in Alberta have decreased.

Method:   Mortality data was obtained from a summary compiled by Safe Kids Alberta Campaign5  based on information provided by the Office of the Chief Medical Examiner from 1975-1995.  This data was examined regarding gender distribution, head injury deaths and age of the rider.  Chi-square analysis was applied to the head injury data to determine if there was a significant difference between the two time frames..

Results:   There were an average of 1.67 deaths per year to mounted riders and 0.87 deaths to people near horses in the years 1975-1990.  This compared to 3 deaths per year to mounted riders in 1991 - 1995.  Using Chi-square analysis this was not a significant difference.  Data is not available on people on the ground during this time frame.

The percentage of male gender was consistent in both time intervals (54 and 55%).  Comparing only the 25 mounted riders in the first study and the 15 mounted riders in the second study there were 68% and 60% respectively which were the result of head injury.  No significant difference could be proven using the Chi-square. Two people wore helmets in the later five year interval.  One person's helmet was not fastened and the other was a polo helmet.  Interestingly, the unmounted died most often of injuries to the trunk in the years 1975-1990 (61%).[2]

The ages of the riders in the first time interval ranged from 3 years old to 63 years old.  In fact, 47% of the fatalities were in youngsters under the age of 20 years. The more recent 5 years show no one under the age of 13 died due to horseriding.  In fact 80% were over the age of 21 years.

Discussion:  The total fatalities per year due to horse injuries  has not changed in Alberta over the past twenty years.  The large representation of men in this study compared with British and  American studies [3,4] probably reflects the many working ranches in Alberta and the fact that cowboys shun helmets.  This may account for the lack of improvement in the mortality from head injury during the same time that other areas of the world have shown improvement.

The fact that no children under 13 years old died in the past five years as a result of riding is very encouraging.[5]  Whether this improvement is a result of better quality helmets, the Safe Kids Campaign which stresses the use of American Society of Testing Material equestrian standard/ Safety Equipment Institute certified (ASTM/SEI)  helmets, better instructors or more watchful parents is unknown. Unfortunately, the mortality data on unmounted horse-related injuries is not available and some injuries to toddlers do occur when playing near horses.[6,7] Obviously, there is much work necessary before helmet use will be widespread and the subsequent decrease in head injury deaths occurs in Alberta.

References:

1 .Ministry of Agriculture for the Province of Alberta 1996
2. Aronson H. Tough SC Horse-related Fatalities in the Province of Alberta, 1975 - 1990   M J of Forensic Med & Path 14(1): 28 -30 Mar 1993
3.Chitnavis, JP, Gibbons,CLMH, Loyd Parry, J and Simpson, AHRW Accidents with  horses: what has changed in 20 years? Injury 1996 27(2)103-105
4. Bixby-Hammett, D.M.   AFP 1987 (36) 3;209-214
5. Safe Kids Alberta Campaign, Agriculture and Agri-food Canada
6. Sorli, JM Equestrian Injuries: a Survey unpublished data
7. Ingamarson, H, Grevsten, S. and Thoren, L.  Lethal Horse-riding Injuries, Journal of  Trauma 1989:29(1)25-30

Janet M. Sorli. MD
1675 - 128  Street
Surrey, B.C., Canada V4A 3V2

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AMEA ANNUAL MEETING

NOVEMBER 6-7, 1998,  DURHAM, NORTH CAROLINA

The 1998 American Medical Equestrian Association meeting will be held November 6-7 at the Radisson Governor's Inn in Research Triangle Park, North Carolina.  The program is aimed at physicians and other healthcare professionals with an interest in increasing the safety of equestrian activities.

Well known event rider, trainer and teacher Mr. Denny Emerson will be presented with the inaugural Ayers-Hammett Award in recognition of his outstanding contributions to promoting safer horsemanship.

Sessions will be held on improving teaching/coaching for equestrians, therapeutic riding programs, mechanisms of head and spine injuries and preparing to host a safe equestrian activity.  A group outing is planned to the featured Friday night jumper classes at the Duke Children’s' Classic Benefit Horse Show.  Participants can also make arrangements to tour the large animal facilities of the NCSU School of Veterinary Medicine in Raleigh.

For more information contact AMEA meeting chairman:
Dr. Maureane Hoffman, 5408 Sunny Ridge Drive, Durham, NC 27705;
e-mail - maureane@med.unc.edu

1998 Annual Meeting and Equestrian Medicine Symposium November 6-7, 1998
Research Triangle Park. North Carolina
Jointly Sponsored by The American Medical Equestrian Association and Duke University School of Medicine Continuing Medical Education

SYMPOSIUM OBJECTIVE
This symposium will provide a forum to learn about the epidemiology, mechanisms and treatment of equestrian injuries and to develop means by which the AMEA and individual physicians can promote safe riding and horse management practices.

Through lecture, panel discussions and question/answer sessions attendees will:

*Enhance their awareness of the role of good instruction in preparing equestrian athletes to safely  pursue their sport or pastime

*Participate in developing approaches that physicians can take to prevent equestrian injuries by promoting good instruction

*Learn how horses can be used in programs to treat patients with medical disorders

*Enhance their understanding of prevention mechanisms, and management of head and spine injuries

*Learn to deal with injuries that commonly occur during equestrian activities, and the legal liability incurred in treating such injuries

Friday, November 6, 1998
11:30   Registration
12:00   Session I - How Can the Physician  Promote Equestrian Safety?
        Ayers-Hammett  Safety Award and Keynote Address -  Denny Emerson
12:45   Developing Standards for Coaching
        Designing a Program to Teach Safety
1:45    Informal Discussion and Refreshments
2:00    Panel Discussion - What can AMEA Members  do to Facilitate Teaching
to Improve Riding Safety?
3:00   Providing Medical/Safety Information to the Equestrian Community
3:20   Session II - Injuries to the Equine Athlete
        Biomechanical Effect of the Rider on the Horse
        Preparing to Manage Equine Injuries
 4:15   Adjourn
 5:00   Reception and Cash Bar
 6:30   Attend Duke Children's Classic Horse Show

Saturday, November 7, 1998
8:00    Registration and Continental Breakfast
8:30    Session III - Therapeutic Riding Modalities
        Therapeutic Riding Instructor Training, Special Olympics, Hippotherapy
10:00   Informal Discussion and Refreshments
10:15   Session IV - Injuries to the Equestrian
        Mechanisms of Cervical Spine Injuries
        When Should an Athlete Return to Competition Following Head Trauma?
        Rehabilitating Equestrian Injuries:  A Physiotherapist's Approach
12:30   Lunch With the Experts and Poster Viewing
1:45    Session IV - Providing Medical Coverage at Equestrian Events
        Preparing for Medical Coverage at an Event
        Managing Injuries Before You Get to the ER -
        Liability Issues
3:00    Informal Discussion and Refreshments
3:15    Session V - Epidemiology of Injuries
        Equestrian Injuries in British Columbia
        Jockey Injuries
----------------------------------------------------------------------------
ACCOMMODATIONS - A block of rooms has been reserved at the Radisson Governor's Inn. For reservations, contact the hotel before October 15, 1998. Mention that you will be attending the AMEA Meeting to receive the special rate of $70  plus 11% tax  per room (single or double). One night's deposit will guarantee your reservation.

Radisson Governor's Inn, Interstate 40 at Davis Drive
Research Triangle Park, NC, (919) 549-8631
REGISTRATION - The fee includes CME credit, proceedings, coffee breaks,
reception and luncheon.
$175     -      Doctoral level
$150     -      AMEA Member and registrations received
                        before October 1, 1998
$  50/day -     Non-doctoral, resident or fellow
$  25     -     Non-refundable fee for cancellations
Accreditation Statement: The Duke University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians.

Credit Statement: The Duke University School of Medicine designates the educational activity for a maximum of (10) hours in Category 1 credit towards the AMA Physician's Recognition Award.  Each physician should claim only those ours of credit that he/she actually spent in the educational activity.

PARTIAL FACULTY LIST:

Kevin Guskiewicz, PhD
Physical Ed, Exercise and Sport Science
Univ of North Carolina at Chapel Hill
******************************
Ann M. O'Shallie
Wilson College
Chambersburg, PA
******************************
Elizabeth Greene, PhD
Washington State Univ
Pullman, WA
******************************
Johanna Harris, MA
Exercise Physiologist
Black Mountain, NC
******************************
Barry Myers, MD, PhD
Biomedical Engineering
Duke University
******************************
Carol Theberge,
Coordinator, Equestrian Games of the
   1999 World Special Olympics
******************************
Anna Waller, ScD
Emergency Medicine,
Univ of North Carolina at Chapel Hill
******************************
ORGANIZERS:

Maureane Hoffman, MD, PhD
Duke University Medical Center
maureane@med.unc.edu
        and
Richard Mansmann, VMD, PhD
Chapel Hill, NC
ccep@mindspring.com

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HOW ABOUT RIDING LESSONS?

Linda Liestman

Riding instruction offers obvious advantages to the beginner.  Most instructors have school horses on which you can learn without needing to purchase a horse, plus the fact that you can learn more about horses before making a buying decision.  Taking 10 to 20 hours of lessons in the horse handling and basic instruction from a reputable instructor, trainer, or coach is generally the safest possible way to learn about horses.  Before considering the purchase of a horse, it is a good idea to visit several stables where lessons are given..  The instructor should be willing to visit at length with you about your experience, desires and goals.  If your interest is in English or Western style riding, the instructor should have expertise and experience in teaching that particular discipline.  Instructors should be able to give you lessons either on their school horses or on your own horse.

Instructors should be willing to work with beginners, not just on riding skills but also on horse care and handling to show the aspiring horseman all facets of horse ownership.  They should also be willing to provide you will names and phone numbers of other students for references.

Beginner lessons are usually priced between $10.00 and $35.00 per lesson, and lesson times can run from 30 to 60 minutes.  Beginners need to go through 10 to 20 hours of lessons before they can fully determine if horses are for them.  It takes this length of time to work through the pain of using new muscles and the development of coordination that can only be learned through repetition of exercises.  It is a great day when a beginner finds that balance and application of command aids and cues have become second nature.  A bit of patience always goes a long way when learning any new and challenging sport.

Riding instructors should be chosen according to the safety records of their students, not only during instruction, but in their students' private riding.  Riding instructors should also be accountable for safety practices and a high degree of skill in their own personal riding and horse training experience.  In many instances, instructors maintain certification accreditation through an instructional organization that establishes teaching and safety standards.  You should feel free to ask about this.  However, there are some fine instructors that may not be certified due to the cost, travel and other reasons.

Potential students or parents should not hesitate to ask the following questions of a potential riding instructor: 1) What are your qualifications? 2) Is there documentation to verify such qualifications or certification?  3) Does your facility carry liability insurance? 4)  What ages are the school horses and how long have they been used as school horses?  5)  What procedure is established and practiced for emergencies? 6) Is the instructor or someone on premises certified in CPR or First Aid? 7) Are barn rules posted and practiced, and are child students supervised at all times while on premises?  8) Are records kept of all horse or person incidences?  9) What policies determine the fitness and soundness of a horse to become and remain a school horse?  10)  Is the equestrian facility accredited by a recognized organization?

Private instructor-to-one or semi-private one-instructor-to-two-student lessons provide more individual attention not usually possible in larger group lessons.  The rider should also read several beginner's books relating to the nature of the horse, horse care, horse handling, and beginner riding skills.  It is also recommended that all persons have a physical examination and receive participation approval from a doctor prior to riding the first time.  Besides other consideration, the spinal column, hips, reflexes, heart, blood pressure, balance and overall physical strength should be within normal limits.  Extreme obesity may place a rider at higher risk.. Pregnant women should only ride under the advice of their physicians.  This exam is a rider's responsibility or that of a rider's parent or guardian. Such early precautions can reduce chances for injury and complications.  For most riders, proficiency will only come after 100 to 200 hours of riding experience.

From WELCOME TO THE WONDERFUL WORLD OF HORSES  (AMEA NEWS Vol 5, Number 1, November 1995) $6.00 for a single copy, North American Horseman's Association, :PO Box 223, Paynesville, MN 56362

Linda Liestman is founder and president of North American Horseman's Association started in 1987.  Linda pioneered the safety program concept for the insurance and horse industry and also the use, importance, and development of industry specific release and warning forms.

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4-H and Helmet Use

Dr. James Seitz
State 4-H Office
1901 University Inn
302 East John Street
Champaign, IL 61820
 

April 12, 1998

Dear Dr. Seitz:

I am writing to express my distress at the State 4-H Office's inaction regarding the adoption of a helmet requirement for Illinois 4-H equestrian activities.  Last week I received an article from the American Medical Equestrian Association which reported that in April 1994 Allan T. Smith, National 4-H Program Leader, wrote to Program Leaders in 4-H Youth Development concerning equestrian helmet use in 4-H.  He attempted to raise the moral sense of State 4-H Leaders by providing evidence that needless traumatic brain injuries occur in children because they are not wearing equestrian safety helmets while riding.  His letter was sent to State 4-H Offices four years ago and it appears that the Illinois State 4-H Office has ignored his plea for action.

As a school psychologist, I work on a regular basis with children who have suffered brain injury.  I also work with their parents, who wish that they could turn back time to undo the injury that has been done to their children.  Brain injuries may be hypothetical constructs to many but for me they are unfortunate realities.  As a volunteer leader in 4-H, a program that focuses on serving youth, I do not see how we can ignore the issues that have been raised regarding children's safety in 4-H equestrian activities.  None of us wants to be in the position of wishing that we had acted sooner so that a child could have lived a fuller (and sometimes longer) life.

As a member of Boone County 4-H Committee I have experienced, first-hand, many of the abuses that are flung upon individuals who advocate for helmet requirements in equestrian activities.  Parents have angrily told me that I have no right to tell them their child has to wear a helmet.  I have even experienced committee members abandoning their focus on safety after initially voting to adopt a helmet requirement for the Boone County 4-H Drill Team.  However, in all of the arguments, threats, and undermining that has gone on, I have not heard one legitimate reason why children should not wear safety helmets while riding.  It has all amounted to a "tempest in a teapot."  Surely as adult leaders in 4-H, we can withstand this kind of tempest and do what is right for children.

Mary Kay Munson at the Illinois State 4-H Office, Lexington Safety Products, and the American Medical Equestrian Association have all referred me to a video, "Every time...Every ride." produced by the Washington State 4-H Foundation.  My personal position regarding children's helmet use was strengthened after viewing this video.  Previously, I rationalized that it was okay to allow children to sometimes  ride without safety helmets.  Now I realize that I was "bargaining with the devil" so to speak.  I was justifying some rides without helmets to appease and bargain with the fury I knew was coming.  I also strongly suspect that the State 4-H Office's inaction is a result of not wanting to deal with the same predictable tempest.  Please view the video, "Every time...Every ride."  I am certain that the inaction that Illinois State 4-H youth have experienced regarding equestrian safety will become action.

The Illinois State 4-H Office has been shirking its responsibility to 4-H youth in Illinois by not requiring the most basic of safety measures, an ASTM/SEI equestrian helmet for 4-H equestrian activities.  Please do not delay any longer.  Assume the responsibility for children's safety that mandates a helmet requirement.

Sincerely,
Lea Halsey
Boone County 4-H Volunteer Leader
2520 Harlem Boulevard, Rockford, IL 61103

Editor’s note:  Since Lea Halsey's letter April 12, 1998, the Boone County Executive Extension Council appointed a Children's Equestrian Safety Task Force to develop an overall safety plan for all Boone County 4-H equestrian activities. The Task Force believes that Boone County safety plan may be a pilot for Illinois 4-H.  The Task Force has met three times and continues to work on the plan.  It is hoped that the AMEA NEWS will have access and be able to share the adopted plan with our readers.

Doris Bixby Hammett, MD, Editor

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EQUESTRIAN HELMET SAFETY

AN INDEPENDENT STUDY

Kim Wingfield, a highschool physics student and 4-H member, began her research on helmet safety in the fall of 1997.  She requested information from the American Medical Equestrian Association and in returned promised to provide her paper to the AMEA on her research.  After four months of reading, she determined to test the equestrian helmets herself. Below is a summary of her paper.

Background Research:  Don't become a statistic, WEAR a helmet

Many horse accidents happen close to the rider's house or farm.  Of the 30 million Americans riding horses a year, 70,000 people go to emergency departments to receive medical attention from horse injuries.  More than 17% of all horse-related injuries are head injuries.  Head injuries are associated with more than 60% of equestrian related deaths. Falling from the horse cause 49.6% of horse related injuries.  Being stepped on or kicked by a horse while on the ground accounts for 15% of horse related injuries.

Less than 20% of people who were involved in a riding accident wore helmets. A very important approach to reduce the risk of head injuries is  " Never mount a horse without protective headgear."  The use of  properly fitted protective equipment will not eliminate all injuries, but should substantially reduce the severity and frequency of injury.  ASTM standard  F1163 requires testing the "impact attenuation, retention, penetration, fit, and perceived user acceptability."

The helmet works on reducing the impact energy at the time of the impact.  A helmet's impact absorbing part, the liner, is made of a time-tested material called expanded polystyrene (EPS)  used in most ASTM/SEI helmets.  Three other types of liner materials are the expanded polypropylene (EPP), expanded polyurethane (EPU) and GECET. which is used in some premium helmets.  The helmet's core is the foam liner, with a shell or microshell used to cover the helmet.  The helmet's liner absorbs energy which allows the head's velocity to slow before the initial collision with the ground or an equestrian hazard.

The advantages of wearing a helmet offset the disadvantages by numerous reasons.  Approved helmets can help save equestrian's lives each and every day.  There is nothing odd about wearing a helmet. It is stupid not to wear one.

Velocity and Force Dealing with Equestrian Headgear

The experiment used Safety Equipment Institute (SEI) certified equestrian helmets provided by LEXINGTON Safety Products, non-approved headgear (a baseball cap), balloons, water, a ladder, meter stick, a mass scale and a stopwatch.   Balloons were used to simulate the head in an impact.  The balloons were weighed to ascertain that the mass was equal.  The impact was measured by the distance the water in the balloons splattered on impact.  This was done with three different approved helmets and the unapproved headgear for six  trials.

There were no visible signs of the helmet being dropped other than a few slight scratches.  After the second trial, only one helmet showed visible signs of being dropped.  The helmet's EPS liner cracked on the inside of the helmet.  The data showed that the water dispersed a greater distance after the first trial showing that the liner lost its ability to absorb the force and decrease the velocity in the impact..  The non-approved ball cap water traveled a greater distance than that of the approved helmets.

Result: The approved helmets did absorb more of the force helping to decrease the velocity of impact. than the non approved cap.  Water traveled a greater distance from the non-approved cap in comparison with to the approved helmets.  My results show that wearing an approved helmet will help the rider decrease the intensity of head injuries.  I was surprised that the outward appearance of the helmet after being damaged  was deceiving to the human eye.

Conclusion: Wear an approved SEI helmet.

Take caution in buying a used helmet.

Kim Wingfield, 371 N. Dugan, Urbana, OH 43078.

Summary by Doris Bixby Hammett, MD, Editor AMEA NEWS.

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INTRACRANIAL HEMATOMA IN

EXPERIENCED TEENAGE EQUESTRIANS

Gary N. McAbee, DO, and Peter F. Ciminera, MD
Pediatr Neurol 1966;15:235-236

Intracranial hematoma in pediatric equestrians is rare, notwithstanding the lack of uniform standards and requirements for the use of protective headgear during equestrian events.  We report two teenage helmeted equestrians who sustained severe head trauma with intracranial hematoma due to falls during equestrian events.

Case 1

A 12 year old helmeted girl with 1 full year of riding experience was riding at an equestrian camp when her horse suddenly jolted into a gallop causing her to lose her balance and fall into a wooden post, one of several which had been placed on the perimeter of the riding path. Her helmet consisted of a hard plastic shell covered in velvet. The helmet did not meet SEI standards and was marked "for dress only" on the inside.  Cranial  CT scan revealed a left frontal-zygomatic fracture with minimal displacement; a small left frontal subdural hematoma; a contrecoup right frontal-parietal depressed skull fracture, and a moderate frontoparietal epidural hematoma with mass effect.  Her recovery was marked by gait ataxia,   four-extremity dysmetria, and diplopia which improved but was still present 6 months after the accident.

Case 2:

A 13 year old helmeted rider with 5 years of riding experience was thrown from a horse against a tree.  She had forgotten her personal helmet and had borrowed a poorly fitting one from another rider.  The helmet had fallen off after she was thrown from the horse but before impact An initial cranial CT scan demonstrated a nondepressed fracture of the right temporal bone and a right frontal contusion.  The next day she developed headache, disorientation, lethargy, sluggishly reactive pupils, and a tonic-clonic seizure. A repeat cranial CT scan demonstrated a right temporoparietal skull fracture extending and involving the sphenoid bone, a right temporal subdural hematoma. small bifrontal contusions, and a large right temporal contusion with edema and mass effect.  EEG on day 4 revealed frequent left parasagintal sharp waves (countracoup injury) and moderate bihemispheric slowing.  MRI on day 12 demonstrated a right frontotemporal subdural hematoma, a small left frontal subdural hematoma, and a right temporal contusion with edema. Nine months after the injury, MRI demonstrated right temporal encephalomalacia and EEG demonstrated bihemispheric slowing.  Follow-up at one year revealed continued episodes of nasal burning and decreased in academic performance.

Discussion

In 1988, the American Society for testing and Materials (ASTM) passed new standards for equestrian helmets that afforded a higher level of protection for riders.[1,2]

Helmets that meet the ASTM standards are now certified by the Safety Equipment Institute (SEI) by a seal on the inside of the helmet containing the date and manufacturer's lot number.[3]  However the United States Pony Clubs is the only national organization that requires use of an ASTM helmet for all equestrian activities.[4]  The American Horse Shows Association (AHSA) and the United States Combined Training Association (which follows AHSA rules) require protective helmets (but do not define protective helmets) only for specified activities (i.e. primarily jumping).[5.6]   The Committee on Sports Medicine & Fitness of the American Academy of Pediatrics has endorsed the U.S. Pony Club recommendations. The policy of the American Medical Association is less explicit and requires neither specific standards such as those of the ASTM nor specific recommendations regarding when headgear must be worn.[7]   The American Academy of Neurology has no official policy on the issue.

Both our patients sustained serious intracranial injury, and one sustained serious sequelae, even though they had been wearing helmets and chin straps.  However, the helmets did not meet ASTM/SEI standards and one did not fit properly, causing it to fall off when the rider was thrown.  Whether the injuries would have been less severe if properly fitted SEI certified helmets and chin straps had been worn is speculative. The severity of intracranial injury in the two riders suggests that the U. S. Pony Club recommendations for ASTM/SEI certified helmets during all equestrian events are prudent and should be adopted by both equestrian and medical organizations. Moreover, appropriate supervision for the use of property fitted helmets and chin straps should be mandatory for all pediatric equestrians.

FOOTNOTES

1.  American Society for Testing and Materials, Specifications for Headgrear Used in Horse Sports and Horseback Riding.  Standard No. F1163-88.  1916 Race Street, Philadelphia, PA.

2.  Committee on Sports Medicine & Fitness, American Academy of Pediatrics, Horseback riding and head injury.  Pediatrics 1992, 89:512.

3.  Safety Equipment Institute, 1307 Dolly Madison Blvd., Suite 34, McLean, VA 22101

4.  United States Pony Clubs, Inc.  4071 Iron Works Parkway, Lexington, KY 40511.

5.  American Horse Shows Association, 220 E. 42nd Street, #409, New York, NY 10017

6.  United States Combined Training Association, Inc., 525 Old Waterford Road, NW, Leesburg, VA 20176.

7.  American Medial Association, Proceedings of the House of Delegates, No. 107 Protective headgear for horseback riders, Chicago, IL 1984 (reaffirmed 1994).

EDITORIAL COMMENTS

Once again, the risks of head injury in horseback riding have been emphasized in this article.  Although both riders wore a helmet with a chin strap, neither met the equestrian standard of the ASTM.  One helmet was of such poor fit that it fell off as the rider was thrown.  Both riders sustained a skull fracture, intracranial hematoma and persistent neurological deficits.

These injuries emphasize the importance of appropriate protective headgrear for horseback riding.  At the present time the standard of protection is afforded only by the ASTM standard.  Helmets which do not meet this standard provide less protection.  The AMEA supports the use of the ASTM standard for protective helmet as providing the best protection known to reduce the severe sequelae that are associated with head injuries and horseback riding.  The teenage equestrians presented in this paper underscore the importance of strict adherence to this standard and to make certain that the helmet is properly fitted and the chin strap secured.

William H. Brooks, MD
Neurosurgical Associates
1401 Harrodsburg Road
Suite B 405
Lexington, KY 40504

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NEWS ITEMS

AMEA EXECUTIVE SECRETARY'S REPORT
 
Having worked with a number of organizations, it is gratifying to see so many members of the AMEA who are actively involved with and concerned about the issues addressed by the Association.  I receive many phone calls from members and non-members expressing their appreciation for the publications which the AMEA produces, or offering to help with programs.

This is not a surprise, but the membership is a self-selecting group of caring individuals most of whom are regularly engaged caring for people.  Still, the prospects for an organization are so much better when there are committed members.

The primary goal of the Board for 1998 has been to identify and focus the concern of other people and organizations in the horse world on safety issues.  We had hoped to hold the first national Rider Safety Summit in June, but scheduling conflicts forced postponement.  The Summit has been rescheduled for September 19 and 20 in Washington, DC during the annual convention of the American Horse Council.

Many of you have volunteered to help with the Summit, and those offers are greatly appreciated, and we are planning to use a few members to help with specific work groups.  However, the goal is to involve breed associations, discipline bodies, trainers and instructors and others who have an immediate impact horse activities and the way they are conducted.  We are minimizing the involvement of members, because you are already aware of the need and committed to the goals. Wishing to keep the numbers small enough for effective work groups, the decision was made to concentrate the effort of key governing bodies and groups which can mandate changes to increase safety.

If there is sufficient interest by those who attend the Summit, we believe the AMEA will then become the industry's "safety committee." and we will need much more assistance. At that point we will call on the membership to take a more active role.

Another way that you can become more involved with the work of the AMEA is to become a member of the Board.  Elections will be held at the November meeting.  If you are interested in serving, please contact me at the AMEA address listed on the newsletter masthead.  The Board meets once a year at the annual meeting, and participation is open to both Active and Associate members.

Michael Nolan, Executive Secretary, AMEA
 

GROUND HANDLING HORSES SAFELY
Video Facilitator Guide and Lesson Plan

By understanding life from the horse's point of view, you can learn to anticipate and safely react to your horse's natural instincts.  This video demonstrates safe and proper methods for approaching, haltering, leading, tying and general handling of the horse. (AMEA NEWS February 1996 Vol VI Number 1).

Professional educators at three universities, Washington State, University of Idaho, and University of Nevada, specializing in safety, horse and educational video production produced the "Ground Handling Horses Safely" video in a cooperative effort.  The purpose of this video is to present accurate and quality information in a manner that is suitable for both youth and adult audiences.

The Facilitator Guide was developed as a result of feedback from youth and adults requesting such a tool for use in bringing major points of safety and handling to the forefront.  The information and exercises provided in this Facilitator Guide are to be used as supplemental material when deemed appropriate.  Instructions are given on how to use the Facilitator Guide with the Video.

The educational material is divided into:  1) Instincts and Natural Perceptions of the Horse; 2) Horse Behavior;  3) Handler and Horse Interactions; 4) Proper Use of Equipment; 5) Proper Attire and Gear.  The last two sections 6) Handouts and 7) Other Resources and References give methods by which the material can be supplemented.

This video and the Facilitator Guide is endorsed by the American Medical Equestrian Association.  The video is available at $19.95 plus $5.00 shipping and handling.  The Facilitator Guide and Lesson Plan is $3.00 plus $2.00 for shipping and handling.  Cost for both curriculum and video together is $25.00 plus $5.00 shipping and handling.  Checks should be made out to "Equine Video."  address Betsy Greene, Ph.D., 126 Clark Hall, PO Box 646310, Pullman, WA 99164-6310, Phone 509/335-2881, e-mail: greeneb@wsu.edu.

Review by Doris Bixby Hammett, Editor
 

BETTY BENNETT-TALBOT RECOGNIZED

Three safety-oriented horse organizations, the American Medical Equestrian Association, CHA-The Association for Horsemanship Safety &. Education, and North American
Horsemen's Association have joined to recognize Betty Bennett-Talbot of Lake Placid, Florida, by giving her a life-time achievement award.

These allied organizations recognize the pioneering efforts and life achievements Betty Bennett-Talbot has directed toward establishing a safer horse industry, both personally and as co-founder and president of Horsemanship Safety Association, Inc. (HSA). Betty's dedication to the implementation of safety standards in riding and riding instruction has improved the quality of riding experiences for countless thousands of riders.

Betty Bennett-Talbot, the wife of John A. Talbot, MD, and mother of eleven children, has lived in Lake Placid, FL, since 1986. Betty's roots are in the Milwaukee and Madison areas of Wisconsin, where in 1964 Betty and her late husband, john Bennett, founded Hoofbeat Ridge School and Camp where she taught and worked with as many as 450 youth each week. From that experience grew the next logical step of forming Horsemanship Safety Association, Inc., in 1978. HSA has since certified many instructors and clinicians who have taught other riders and instructors all around the US.

Other recognition Betty Bennett-Talbot has received include the National Safety Council Award (1995), The Horse and Rider Hall of Fame Award (1996), and the American Camping Association's highest recognition, the ACORN Award (1996).

from the
North American Horsemen's Association
Box 213
Paynesville, MN 56362
 

SITE AND DIRECTOR SOUGHT FOR AMEA ANNUAL MEETING 1999

The American Medical Equestrian Association is seeking a director and site for the annual meeting 1999.  We seek a physician member of the AMEA to lead the program.  We look for an equestrian event in the area, good air access, prefer October or early November.  If you are interested please contact Michael Nolan, Executive Secretary AMEA.
 

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