University of Vermont AAHS
AMEA

February 1995, Vol. V, Number 1

Table of Contents

NEISS Recreational Injuries for 1990-1992
Horse Drawn Vehicles More Dangerous Than Commuter Flights
NEISS Horse-Related Fractures
Osteoporosis and Horseback Riding
1994 USPC Accident Study


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Recreational Injuries 1990-1992
National Injury Surveillance System

The National Injury Surveillance System of the National Consumer Product Safety Commission records injuries that go to hospital emergency rooms and from these figures gives national projections of injuries.

In an effort to evaluate horse activities compared to other recreational activities, the sports of golf, tennis, bowling, water and snow skiing for the most recent years of 1990 to 1992 were selected. These sports are dome on a individual basis and are not confined by age limits. We have no figures on the number of participants so these figures do not give rates of injury, only difference in injuries when the participant is injured.


             HEAD INJURIES

        Injuries Above the Neck



                        BODY PART

                     Head       Above Neck

    ACTIVITY

    GOLF             14.2%         47.6%

    HORSEBACK        10.6%         17.7%

    WATER SKIING      7.7%         30.8%

    SNOW SKIING       4.3%         12.1%

    TENNIS            3.4%         19.5%

    BOWLING           2.3%          6.5%



The highest percent of head injuries among those injured is in golf with 14.2% of the injured having head injuries, and 47.6% above the neck (eye, face, ear, mouth). Horseback riding is second with 10.6% head injuries, followed by water skiing. Golf, water skiing, and tennis have higher percent of injuries to the eye, face, mouth, and ear than horseback riding


              % Head Inj  % Concussion  If Head Inj

 ACTIVITY       of Total    of Total    % Concussion



 SNOW SKIING      4.3%         2.1%          47.4%

 HORSEBACK       10.6%         2.8%          26.4%

 TENNIS           3.4%         0.5%          14.2%

 BOWLING          2.3%         0.3%          12.0%

 WATER SKIING     7.7%         0.6%           7.6%

 GOLF            14.2%         0.5%           3.8%



However comparing the head injury with the diagnosis of concussion in the injury, snow skiing has the highest percentage with almost half of these having head injury sustaining a concussion. Golf which had the highest percentage of head injury, has the lowest related concussions. Horseback riding is second in severity with over one fourth of the head injuries having a concussion, followed by tennis and bowling.


                      NUMBER/GENDER

                    Sport 1990 to 1992



             MALE    FEMALE   TOTAL INJ   MALE   FEMALE

HORSEBACK    85123   134499    219663     38.8%   61.2%

BOWLING      34466    37927     72393     47.6%   52.4%

TENNIS       56299    37039     93361     60.3%   39.7%

SNOW SKIING 220688   156589    377501     58.5%   41.5%

GOLF         82355    29271    111669     73.7%   26.2%

WATER SKIING 54156    14971     69196     78.3%   21.6%



Snow skiing had the greatest number of participants injured, with horseback riding second, and golf third in number. Horseback riding had the greatest percent of female injured participants followed by bowling and snow skiing.


                    AGE

SPORT Horseback Golf Tennis Bowling SSkiing WSkiing

AGE

0-4     1.9%    6.3%   1.5%   6.2%     0.2%    0.3%

5-14   21.2%   24.9%  16.8%  14.6%    16.5%    5.6%

15-24  23.1%   10.0%  26.4%  22.3%    25.9%   36.8%

25-44  41.0%   25.6%  29.8%  36.3%    36.5%   53.2%

45-64  10.9%   17.5%  17.9%  13.2%    18.6%    3.8%

65-UP   1.9%   15.7%   7.6%   7.5%     2.2%    0.3%

TOTAL 100.0%  100.0% 100.0% 100.1%    99.9%  100.0%

Horseback riding has the largest percentage of its injured in the 20 years between 25 to 44 years but is exceeded by water skiing and followed by snow skiing. The highest percent of injuries in the ages of 15 to 24 years is in water skiing followed by tennis and snow skiing, all above the percent of horseback injury. Snow skiing has the highest percent of injuries in the ages 45 to 64 years, and golf in the ages 65 years and older. Golf has the greatest percent of injuries under the age of 5 years, followed closely by bowling.

                    FRACTURES

  As fracture is the most common injury in horseback riding,

a look at fractures in other sports is of interest.



SPORT              TOTAL FX    TOTAL INJ   % FX INJ

HORSEBACK           65985        219663       30.0%

SNOW SKIING         90209        377501       23.9%

BOWLING             12648         72393       17.5%

TENNIS              12542         93361       13.4%

WATER SKIING         7063         69196       10.2%

GOLF                 9251        111669        8.3%



In horseback riding 30% of all injuries that go to the emergency room are fractures, with the second highest snow skiing. Golf has the lowest percentage of fractures in these injured,

CONCLUSION:

The head is the most common part of the body injured in golf with horseback riding second in frequency. The most common sports whose injuries are to the mouth, face, eye, and ear are golf, water skiing, and tennis with horseback riding following. However when severity of the head injury is judged by concussion with the head injury, snow skiing has almost half of its head injuries associated with concussion, horseback riding over one fourth, with tennis and bowling following with their percent in the teens.

Snow skiing had the greatest number of participants inured with horseback riding second, and golf third in number. Horseback riding had the greatest percent of female injured participants followed by bowling and snow skiing. Water skiing had the greatest percent of its injured in the ages 15 to 44, golf in the ages under 15 and over 65. Snow skiing had the greatest percent of its injured in the ages 45-64.

In horseback riding 30% of all injuries that go to the emergency room are fractures, with the second highest snow skiing. Golf has the lowest percentage of fractures in those injured.

Doris Bixby Hammett, MD
Secretary, American Medical Equestrian Association
103 Surrey Road
Waynesville, NC 28786
704/456-3392

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Horse Drawn Vehicles More Dangerous than Commuter Flights

In the end of the year NEWSWEEK magazine December 26, 1994, in the article "Small Planes Make for Big Nightmares" the author states. "Over the past five years twice as many Americans died in animal-drawn wagons and sleighs than on commuter flights." This statement is not true.

Alan E Hoskin. Manager Statistics Department, National Safety Council provided the figures from the National Center for Health Statistics.




CATEGORY              1989  1991 1991 TOTAL PERCENT



Animal Rider           49    104  90   293    95.1%

Occupant Animal

Drawn Vehicle           8      4   3    15     4.9%

  Subtotal            107    108  93   308   100.0%





TRAFFIC ACCIDENT MOTOR VEHICLE DEATH



Animal Rider/Occupant

Animal Drawn Vehicle    7      5  15    27     8.0%



NON-TRAFFIC ACCIDENT MOTOR VEHICLE DEATH

Animal Rider/Occupant

Animal Drawn Vehicle    1      1   0     2     0.6%



  Subtotal              8      6  15    29     8.6%



TOTAL                 115    114 118   337



If we consider deaths involving animals ridden/driven, 95.1% are riders of animals, with only 4.9% drivers. Motor vehicles involved in animal ridden/driven traffic related deaths account for 8% of all animal related deaths, with only 0.6% non-traffic accident meter vehicle animal rider/driver related deaths. An example of this type of death was a race between the rider of a moped and horse in which an accident occurred between the moped and the horse with the driver of the moped being killed. In motor vehicle accidents distinction is not made between animals ridden and animals driven.

Two figures are of interest to the members of the American Medical Equestrian Association. These figures give only animals being ridden or driven. No animal related deaths are reported from non-mounted accidents: kicking, crushing, or dragging. Depending upon the study, these non-mounted accident/deaths range from 15 to 34%.

The year 1991 accounted for almost half of the horse related deaths involving motor vehicles. This figure may be the beginning of a trend and would indicate that each state horse community should review its statues relative to laws concerning horses on high- ways as New York State has done, and make the changes necessary to improve safety for the horse using community.

Reported by Doris Bixby Hammett, MD

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Horse Related Fractures

National Electronic Injury Surveillance System Age and Gender

Fracture is the most common horse related injury which takes the injured to the physician or the emergency room. More women ride horses than men in every age group except in the ages 65 years and older. Women post-menopausal have bone density loss and therefore are more subject to fractures. With these facts in mind, the study of the NEISS figures for horse related fractures related to age and gender was undertaken.

The figures used are from a compilation of information derived from horse associated injuries treated in hospital emergency rooms participating in the National Electronic Injury Surveillance System (NEISS) of the U.S. Consumer Product Safety Commission. The NEISS estimates are calculated from a sample of hospitals which are statistically representative of institutions with emergency treatment departments located within the United States and its territories. NEISS warns small figures in their statistics have a high margin of error and may not have significance. NEISS figures are based on estimates so the total may vary slightly. I have omitted "Unknown" in several tables for clarification.




      1998-1992 HORSE RELATED INJURIES

  AGE            NUMBER           PERCENT

0-4               4158              1.9%

5-14             46533             21.1%

15-24            51590             23.4%

25-44            89814             40.8%

44-64            23984             10.9%

65+               4058              1.8%

  TOTAL         220251             99.9%



The greatest number of injured riders are in the 20 years between 25-44 years, but there are more injuries each year in the ages 15-24. (15-24 years 51590/10 = 5159; 25-44 89814/20 = 4491) This would be explained in that the older rider is a more mature rider, is more concerned for safety and more likely to have knowledge and skill.


      1990-1992  HORSE-RELATED FRACTURES:  AGE



        AGE             TOTAL     PERCENT



         0-4            1450        2.2%

        5-14           15670       23.7%

       15-24            9364       14.2%

       25-44           29357       44.5%

       45-64            8497       12.9%

         65+            1627        2.5%

    TOTAL              65984      100.0%



Although the number of fractures are greater in the ages 5-14 than 15-24 when we have a greater number of injuries, this can be explained by the younger riders lack of experience and knowledge of safe riding.

If the greatest number of injured riders are between 25-44 years, it would be expected that the greatest number of fractures would be between those years. The number of fractures has not only increased in the 25-44 but is more than three times the number of fractures in the 15-24 year old. It can be postulated that the ages of 15-24 have the young bones, and although they have the greater number of injuries each year they have less fractures in the injury.




         1990-92 HORSE RELATED INJURIES: GENDER

AGE      MALE    FEMALE    TOTAL    % MALE    % FEMALE

  0-4    1811     2347      4158     43.6%     56.4%

 5-14    13030    33503     46533     28.0%     72.0%

15-24   17661    33027     50688     34.8%     65.2%

25-44   36845    52969     89814     41.0%     59.0%

45-64   12561    11423     23984     52.4%     47.6%

65+      3035     1022      4057     74.8%     25.2%

TOTAL   85055   134423    219478     38.8%     61.2%

The percent of horse related injured females outnumber males until the years over 44 when the number of males injured are greater in number than females, markedly increasing in the over 64 years of age.


    HORSE RELATED FRACTURES: AGE

AGE   1990-92 INJ  %INJ   1990-92 FX     %FX OF INJ

  0-4    4158      1.9%      1450           34.9%

 5-14   46533     21.1%     15670           33.7%

15-24   51590     23.4%      9364           18.2%

25-44   89814     40.8%     29357           32.7%

45-64   23984     10.9%      8497           35.4%

  65+    4058      1.8%      1627           40.1%

TOTAL  220251     99.9%     65984



It would be expected that the older injured rider would have a greater percent of fractures, and this is what we see. The young child has no understanding of safety, and the child from 5-14 has very little more. However, the lowest percent of injuries which are fractures are in older youth and young adults who now have knowledge for safety and have young bones which are less likely to fracture with trauma. From these ages there is an increase in the percent of injuries which are fractures becoming highest over the age of 64 years.


    HORSE RELATED FRACTURES: GENDER



        FRACTURES TOT     INJURIES TOT    % FRACT/INJ

AGE      Male   Female   Male   Female   Male   Female

  0-4    529      926     1811    2347   28.9%   39.5%

 5-14   4906    10764    13038   33503   37.7%   32.1%

15-24   4450     4913    17661   33027   25.2%   14.9%

25-44  12123    17233    36845   52969   32.9%   32.5%

45-64   4564     3931    12561   11423   36.3%   34.4%

65+      913      713     3035    1022   30.1%   69.8%

TOTAL  27485    38480    84953  134291   32.3%   28.6%



Except for the years 0-4 which cannot be relied upon because of the small number involved, at every age in which horse related injuries occur in the percent of these injuries which are fractures, men out number women until the ages over 64 years. Males have almost double the percent of fractures in the ages 15-24 years, but there is little difference in the percent in the ages 25 through 64 years. In the years over 64 years, fractures in women are over twice that of men. This figure may be exaggerated due to the low numbers involved. However, if a woman plans to ride in those years, she must make every effort for prevention of osteoporosis.

Doris Bixby Hammett, MD
103 Surrey Road
Waynesville, NC 28786

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Osteoporosis and Horseback Riding

Osteoporosis in horseback riding is important for several reasons. Women are especially susceptible to the development of osteoporosis. Age is a major variable in the development of osteoporosis. As many women ride and riding is an activity that can be enjoyed through later years, osteoporosis must be given specific attention.

The increased risk of fracture is the biggest concern with osteoporosis. Osteoporosis is implicated in approximately 1.5 million fractures each year. Fractures also represent a some-times serious type of equestrian injury, accounting for approximately 30% of injuries that require emergency room attention. Consequently, the concern of this combination, osteoporosis and horseback riding, is further magnified.

Osteopenia refers to reduced bone density. Osteoporosis is but one form of osteopenia due to a reduced quantity of bone. The bone that is present is of normal quality but is present in reduced amounts.

A number of risk factors are known to be associated with the development of osteoporosis, including advanced age, female gender, estrogen deficiency, thin body habitus, heredity, white and Asian races. Lifestyle risk factors include smoking, excessive alcohol intake, physical inactivity, excessive caffeine consumption, inadequate calcium intake, poor nutrition and chronic illness. Osteoporosis has also been associated with certain disease states and drugs such as corticosteroids.

Although osteoporosis will occur in all people as they age, its rate of progression and its effects can be modified with proper early diagnosis and treatment. The best form of management is prevention. Prevention and early management both require an awareness of the potential presence of osteoporosis. Unfortunately, osteoporosis is usually diagnosed only once a fracture has occurred. Although osteoporosis can be treated to reduce further bone loss, there are no proven methods of restoring lost bone.

When significant risk factors are present, especially for the female with a recognized cause of estrogen deficiency, a physician should be consulted for an appropriate evaluation and recommendations. The implications of osteoporosis should be clearly recognized by those participating in equestrian activities, especially with regard to the risks of fracture, which can occur spontaneously in association with severe osteoporosis.

Awareness and prevention goes beyond just those with recognized risk factors. Maximum hone density in females is achieved between ages 17 and 20 years. Attainment of peak density and subsequent maintenance of skeletal mass is most influenced by adequate dietary intake, exercise and a lifestyle emphasizing minimal alcohol and caffeine intake and avoidance of smoking.

J.W. Byrd, MD
Baptist Medical Plaza II
2nd floor
2021 Church Street
Nashville, TN 37203

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1994 Update
United States Pony Clubs
Accident Study

The United States Pony Clubs' Safety Committee has collected riding accident and injury information from its members since the beginning of 1982. In 1994 the members, all under 21 years of age, number over 12,000. Age, sex, riding rating levels, years of experience, accident details, and injury data are all recorded on uniform accident forms by the District Commissioners (DCs) of the member clubs.

USPC mounted activities include many of the English riding activities practiced worldwide: dressage, stadium jumping, cross country riding and jumping, games and gymkhana, vaulting and tetrathlon. Some clubs include driving of horses as well. Unmounted activities include all aspects of horse care and management, with a progressive testing system for levels of knowledge as well as riding.

Although we knew that not every accident or incident is reported, the compliance in reporting is impressive. The USPC Safety Committee has attempted to reassure the DCs that the information collected is not used to censure the clubs and instructors. Over the years the insights gained into accident causes has permitted the Safety Committee to make recommendations to the Horse Management Committee (whose judges oversee the safety aspects of competition), the USPC Board of Governors, and the membership at large. Any interested club member or leader can be provided a copy of the complete tables of information developed each year.

In 1994 the total number of reports filed was 65. Of these, 54 (83%) reported incidents which resulted in actual injury. This is below last year's 92.9% and the 93.5% reported in Dr. Hammett's 10 year Study of 1982-1991. Two additional reports involved non- members of USPC and were not included in the totals. This is a decrease from four nonmember injuries reported in 1993.

Because the USPC has been the leader in requiring the use of ASTM/SEI riding helmets for its members, the head injury reports have been followed with special interest. We are fortunate to have some long term base information about head injuries. A study in 1981 conducted by the American Horse Shows Association showed that head injuries were 43.1% of competitive injuries in children under the age of 14; for all ages of competitors, the percent was 29.5% This information predates the 1983 USPC independent testing and recommendation of improved headgear. Helmets made to the 1983 standard were in use in the USPC from 1983 through 1989 when ASTM/SEI helmets became available.

The ten year study showed a USPC head injury percentage of 24.2%. The five years of required ASTM/SEI helmet use show a percentage of 12.5%. In 1994 only 7.9% of Pony Club injuries were to the head.

All of the reported head injuries were concussions. Four of these six came from direct blows to the helmet, and two involved facial impacts, one with a jump rail and one from a pony which threw its head into the rider's face. The latter rider was one of two who lost consciousness; she was reported as being unconscious before she hit the ground. Both of the severely concussed riders were released from hospital observation within 24 hours. The other concussions were considered to be slight or only probable.

All the mounted accidents reported were to riders wearing properly secured ASTM/SEI helmets, except for two vaulters, who are not required to wear helmets. Neither of these had a head injury.

In 1994 the most injured sites were the face, the wrist/hand, forearm, dorsal/lumbar, and ankle/feet. Facial injuries which gave most concern were the two which caused concussions. One rider's horse reared and hit her in the face, causing her braces to cut her lip. Perhaps the suggestion of mouth guards for riders with braces should be reconsidered. In 1994 the American Medical Equestrian Association published a study on the subject.

Two members were kicked in the face while bandaging. One of these reported that a fly bit the horse at a crucial moment. Instructors way need to emphasize careful positioning of the person bandaging the horses legs. Of special concern is the report of a rider poked by her whip when her horse threw its head. She needed sutures fur a split eyebrow-- frighteningly close to the eye. The report does not record the rider's method of holding her whip, and she may have been carrying it correctly.

The most common type of injury remains the bruise/abrasion, with 41.3%. Sprain/muscle pull (17.3%), "Shook Up" (13.3%), closed fracture (9.3%) and concussion (8.0%) follow. In general the 1994 injuries appeared to be less severe. Closed fractures of all kinds are decreasing. Sprains/muscle pulls have increased.

For the past three years hospitalization after injury has decreased, dropping from 11.4% in 1992, to 8.6% in 1993 and 6.9% in 1994. The USPC 1994 figures show that 37.9% were treated for injuries at the emergency room or physician's office and could not return to the ride the same day; 17.2% came back to ride after treatment off the grounds. Of the injured who were seen in emergency rooms/physicians offices (n=32), 12.5% (n=4) were admitted to the hospital, The Consumer Products Safety Commission shows a hospitalization rate of 27% of all age riding accidents which came to emergency rooms. The USPC hospital admission is less than half of the national average. There were 17.2% treated on site and returned, and 20.7% were treated on the grounds but were not able to return to ride-often because the activity was over rather than because of their condition.

Rider rating levels were similar to last year's report. Unrated riders were 6.7%, 73.3%D level, 18.3% C level, 1.7% B level, and one at HA or A. The largest number of accidents-32.2%-occurred to riders with 3-4 years experience.

The injuries -were 84.6% mounted, 13.8% non-mounted, and 1.6% were not directly horse related. Most dangerous activities continue to be lessons, jumping, and cross- country. No activity, no matter -what the qualifications of its sponsors and attendees, is exempt from the possibility of injury.

The reported horse actions causing non mounted accidents changed between 1993 and 1994. This year's problems included kicks, stepping on the feet, (each 27.3%) and pulling (18.2%).

There was a loading accident in which the handler had wrapped the leadline around her hand--something we need to warn against on a regular basis. This mistake was made in 1994 by a young man who did not have USPC training with fatal results. His parents have asked the American Medical Equestrian Association to publicize their personal tragedy in hopes that all parents and instructors will make sure that young horsepersons are aware of the danger.

At a D Combined Training Rally a pony refused a stadium fence and ran out. The rider fell, and her paddock shoe laces caught on the sharp point of a released side-swivel safety stirrup. Her leg twisted as she hung from the stirrup. Fortunately the pony stopped after dragging her a short distance, and she required no medical treatment,

The quality of 1994 reporting was wonderful. USPC's accident record continues to reflect the good instruction and supervision given to its members by dedicated and knowledgeable volunteers, The Safety Committee is always interested in hearing suggestions for better, safer practices in handling horses and children.

Sets of the tables used in preparing this report are available by calling or writing:
Drusilla E. Malavase
USPC Safety Committee
2270 County Road 39 RD 2
Bloomfield, NY 14469
716/657-7053

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