University of Vermont AAHS
AMEA

November 1994, Vol. IV, Number 4

Table of Contents

Parents Honor Son by Working for Safety
Horse-Related Fatalities in the Province of Alberta: 1975-1990
Horse-Related Injury Survey: Lower North Coast Health Service, Australia
Editorial Comment: Australian Survey
The New South Wales Study
Farm Horse Related Injury
A Horse of a Safer Color
Equestrian Safety in 4-H
Mandatory Helmet Usage in State 4-H Equestrian Programs
Editorial Comment: 4-H Programs
Asphyxiation in Horse Trailers
Safety Education Opportunities of Benefits Rides


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Parents Honor Son by Working for Safety

Michael Thomas Stephens, an eight year old who had just started riding lessens, died from head injuries when he became tangled in his pony's lead line. His parents, David and Roberta Stephens, do not want their son's death to be in vain. They are doing whatever they can to get riders to wear secured certified protective helmets when riding or working with horses. David Stephens wrote, "We would like to help educate all parents with children who love horses about safety so that they never experience the anguish we are living."

Here are his thoughts on safety around horses:

1. Safety should be the first thing taught when giving riding lessons and then reviewed and tested for understanding,

2. Rules should be set, visibly posted, and enforced in the barn/tack room/corral, and at all time when mounted whether in the ring or the trail, in the show or when schooling or riding at leisure.

3. People working with horses must never wrap a lead rope or reins around any part of their body.

4. People must wear a certified, secured protective hat when mounted or working around horses. Publicizing accidents like Sean's will help people see why safety is important and must never be compromised.

5. More information of safety products to the horse community. (I thought of but did not know of the existence of a Western protective hat.)

6. Riders must wear footwear with heels.

7. Educate people how to approach and handle horses safely, and know when dangers make approach unwise.

8. Make safety products attractive so people will want to wear them, not only because of safety but because it looks good too. Educate the horse community to look for and expect safety products to be used by all riders.

David and Roberta Stephens
469 Mayville Road
Silverwood, MI 48760

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Horse-Related Fatalities in the Province of Alberta, 1957-1990

This retrospective descriptive study reviewed 38 horse-related fatalities that occurred between 1975-1990 in the province of Alberta, Canada. There were two identifiable patterns of injury. The first occurred while riding a horse and involved either a fall from the horse or the horse falling and crushing the rider (25/38 65.8%). Of these 25 victims, 17 (68%) died of head injuries while 8 (32%) died of truncal injuries. The second pattern of injury involved people who were on the ground near the horse when the fatal incident occurred (13/38 34.2%. Of these, five (38.5%) died of head injuries and eight (61.5%) died of truncal injuries.

Of the total 38 fatalities, 22 people (58%) died of head injuries. Of the 38 deaths, 20 were adult deaths (52.6%) aged 21 or older), seven deaths (18.4% under 5 years with the remaining 10 (26.3%) between 5 and 20 years of age. There were 21 male (55.3%) and 17 female (44.7%) fatalities. Twenty-three (60.5%) were accompanied at the time of the incident. Only one victim wore an approved helmet.

After reviewing horse-related incidents resulting in death, we make the following recommendations.

1. Dealing with horses can be unpredictable. Many of the cases reviewed illustrate the dramatic and unexpected manner in which injuries can occur. Public education concerning the potential hazard of dealing with horses would sensitize the public.

2. Children taught to ride by qualified instructors would learn safe riding and handling techniques. Accidents decrease with increased knowledge and skill in handling horses.

3. Mandatory and proper use of approved helmets while mounted on the horse should be considered. In this study, 68% of 25 people died as a result of head injuries experienced secondary to a fall. If approved protective headgear had been properly worn, the results might have been very different.

Howard Aronson, MD
Suzanne C. Tought, M.Sc.

Horse-Related Fatalities in the Province of Alberta, 1975-1990
American Journal Forensic Medicine and Pathology
14(1):28-30, 1993
Reprints/Correspondence
S.C.Tought
Office of the Chief Medical Examiner
4070 Bowness Road NW
Calgary, Alberta T3B 3R7 Canada

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Horse-Related Injury Survey: Lower North Coast Health Service, Australia

MARCH 1994

PURPOSE

The reasons for the survey were to determine a credible population prevalence estimate for horse related injury in rural areas, to detail etiological factors important in horse related injury, and to obtain baseline data for injury prevention programs.

METHOD

In September 1992 an overseeing group of horsepersons consisting of local Pony Club representatives, injury prevention professionals and interested members of the community was convened to supervise the project study. The detection points for horse related injuries were the accident and Emergency Unit (A&E) at Bulahdelah, Gloucester, Inverell and Taree Hospitals.

A sample of horse related injury occurrences were selected for survey using; a prepared questionnaire developed in conjunction with the overseeing committee. The survey -was done in a one to one interview situation and sought respondents answers an rider, environmental and vector factors operating at the time of injury. Additionally interviewers were asked to rate interviewees equine knowledge and rider skill.

Four interviewers, each with extensive equine knowledge, were recruited. 'The interviews took place within six weeks of the injury and were undertaken in accordance with set instructions. A Chi-square analysis of the two groups by gender indicated no significant difference between the interviewed and non interviewed injury groups, giving confidence to the representativeness of the sample.

RESULTS

Age and Gender: Female injury is dominated by a peak in adolescence, which then declines until a second small peak between 30-39 year age range than gradually falls. The male pattern rises gradually to the 25-29 year age range then gradually falls. The significant feature is the high representation of adolescent females.

PREVALENCE

Horse related injuries represented 2.58% of the 5,886 injury examinations. Level of injury increased with the distance from the coast and metropolitan areas. Although a small sample, this may reflect the influence of rurality or relative isolation. There were 31 hospital admissions representing 20.4% of all horse related injury examinations. Almost one-fifth (18%) of injuries were sustained when not mounted on the horse.

RIDER FACTORS

The peak of injury examinations is in females age 10-19. Over 25% of injuries occurred with less than one year of riding experience, but the highest percent occurred in those riders with 2 to 5 years experience. The most severely injured individuals were visitors at the site. Over 60% of those injured reported wearing an ASA helmet. Over 30 % of those injured had inappropriate footwear. Fatigue was not commonly reported as a factor to injury. Little alcohol. or drug involvement was reported. Of those injured, 38% were unfamiliar with the horse.

Although the bulk of riders rode at least weekly, almost one-third rode only monthly or rarely. Leisure was the most common reason for riding. Relatively few injuries occurred at work or in competitive riding. Noise, dogs and traffic were seen as the most common hazards.

Nearly half of those injured knew only one way to stop a horse. Only 10% had no formal training, Of those who received formal training 75% had less than 5 years of training. Of those injured, 45% were deemed to have poor equine knowledge. Almost 55% of injured participants had less than adequate knowledge. Over 50% had a poor knowledge of riding hazards. About half of those injured were seen as having poor skills in this area. Over half of participants had reasonable strength.

ENVIRONMENTAL FACTORS

Peaks of horse related injury occurred around school holidays. Most injuries occur during mid-afternoon. Of the 83 injuries, 47% occurred on farms. Of these over half were on commercial properties. Showgrounds were also a significant contributor. Sunlight, wind, or rain did not appear to be a factor in injury.

Most injuries were on grassed areas. Most individuals were riding alone. Jumps and natural terrain objects were often involved in injury. Fences/gates which had been partially opened figured prominently. One quarter of injuries involved an unexpected event.

VECTOR FACTORS

Older horses were more prevalent in this sample, with the numbers dispersed evenly between geldings and mares. Most horses were within the 14-15 hands range. There was no clear indicator of breed as a factor in injury

Over one third of horses involved were not owned by the injured person or their family. Recent illness of the horse was not commonly reported. Horses were generally reported to be in very good to good condition. Almost one fifth of horses were known to be erratic prior to injury. Most horses were shod, and previous foundering did not appear to be a common factor. Over half of all horses were on supplementary feed. Over 90% of horses were handled at least weekly. A relative large proportion (24%) of horses were ridden only monthly or weekly. Most horses were ridden with a bridle, and the common type of bit was a snaffle. Of the injuries which occurred while riding,. over 20% did not have a saddle, with the type of saddle not related to injury. All saddles were reported to be in good or excellent condition. A range of stirrup types were utilized. In general, equipment failure was not an issue in injury.

DISCUSSION

A clear relationship between gender, age and injury exists with 34% of all injuries being females 10-19 years of age. As there is no denominator for age and gender distribution of people who ride, a prevalence rate cannot be determined. However, these figures provide a clearly defined target group for future preventive activities.

A number of less apparent factors were evident. These include the lack of use of protective equipment (helmet, footwear) poor knowledge (riding hazards, stopping a horse), and limited skills of the rider.

A number of directions can be suggested for educational intervention. Riding experience alone is not sufficient. Of more influence may be rider knowledge and skill. Overall knowledge and skill levels were judged to be poor, and should be the focus of educational initiatives.

Educational initiatives would appear to need to be more persistent and formalized. Such training should be commenced and focused on the first year of riding. A third of injured riders had only home based training. The quality of this training would vary enormously but it is not likely to reach the accepted standards of many equine organizations.

An obvious organization through which to provide formalized training is Pony Clubs. For participation the barriers around horse transport and subsequent financial constraints must be lessened by developing training schools for parents who can then train their own children at a time and place which is convenient to themselves. Other equine organizations can play a major role with Pony Club in facilitating the process.

Involvement of irregular riders in formal and persistent training is a major issue as 31% of all injuries are sustained by people who ride less than once a month. These irregular participants are a difficult target group to pinpoint; however broad based school programs and the availability of relevant information at riding centers are potential capture points.

In terms of educational content, attention to horse handling skills in education programs may need more fully to reinforce this issue as many individuals while acknowledging that riding involves some risk, feel that handling poses little to no danger.

Helmet wearing requires attention, Of those riding, 40% did not have on a riding helmet. This is likely to be an overestimate of helmet usage rates as the sample is highly biased to younger riders and groups in which helmet usage is compulsory (i.e. Pony Club). The wearing of riding boots needs to be stressed as well at the importance of using a saddle.

The major difficulty with engineering solutions is in obtaining compliance to apply the protective devices. Improved compliance rates for helmet usage related to issues such as appearance and sun protection. These may be overcome by the development of a helmet which looks like a broad brimmed felt hat but contains an internal shell which meets Australian Standards.

The preventive implications of factors related to horse age, temperament and the regularity of being handled/ridden are unclear from the study. Older horses are often considered to be less dangerous; however this study indicated a wide spread of age for the horses involved. In this study 80% of the horses were considered reliable. This suggests that the "bomb" proof horse is a fallacy.

A high percentage of horses were on supplementary feed. The extent to which overfeeding is a predictive factor in making horses "flighty" is unclear, but it is likely that a combination of overfeeding and under exercise is adding to the likelihood of injury.

Enforcement approaches appear to have limited application as most injury occurred on farms rather than public places or during organized activity. However, areas such as showgrounds, riding schools, Pony Club and rodeos may well be encouraged to introduce policies, practises and penalties to enforce the wearing of helmets and appropriate footwear. Additionally the introduction of competency standards as a prerequisite to competition, and quality control initiatives may be adopted. Finally work related injury groups could be influenced through compensation and insurance approaches, although these bring with them considerable acceptance and monitoring obstacles.

From these results it is evident that preventive interventions should give priority to

1. increased helmet usage.

2. increased availability of educational opportunities, particularly through equine organizations and schools

3. targeting females ages 10-19 years of age

4. increased availability of information to individuals who ride infrequently, particularly at riding centers, etc.

Dr. Kevin Wolfenden
Mr. Tony Lower

Coastal Public Health Unit
TAREE NSW 2430
Dr. Lyn Clarke
Australia Agricultural Health Unit
MOREE NSW 2400

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Editorial Comment: Australian Survey

The project funded by the National Injury Surveillance Unit, (NISU), New South Wales Australia, reinforces findings in previous horse related studies in the United States and provides new information related to injury.

The United States Pony Clubs accident study (1982-1991) showed that more females compared to males in the age group 6-21 were in accidents than their membership would indicate. The National Injury Surveillance System shows the 10 year age span from 15-24 have the highest number of horse related injuries with the ages 5-15 second in frequency, The figures from New South Wales and the states are similar in these findings.

We have no studies in the states relative to rural isolated horse related injuries compared to coastal metropolitan horse related injuries. The recent figures from NEISS indicate that horse related accidents on farms are decreasing and accidents at "homes" not on farms are increasing. Whether this indicates that the number of farms are decreasing in a rapid rate, or that farm injury education is more effective than that in areas not an farms is not known. (See Farm Horse Related injury in this issue.)

Leisure riding has been shown to have the greatest number of horse related injuries. Most injuries were o grassy surfaces which is in contrast to the study of fox hunting were more injuries occurred at road crossing where the surface was hard and New Zealand where the injuries were while riding on roads.

The number of accidents unmounted are higher(18%) than that in the US Pony Club study (11% of which 5% were not horse related), but it must be emphasized that handling horses is as risky as riding them, and this lesson must be taught in all horsemanship classes. The statement that the most severely injured riders were not mounted needs further clarification. Were they farriers, veterinarians or others caring for the horse, were they children around the horses feet, or had they fallen from the horse before they were injured by the horse? That riders were injured when not using a saddle is not unexpected, but the percent (20%) riding without a saddle would not be expected in the states.

Horse related deaths have been shown to have a high incidence of blood alcohol, but no studies have been done on horse related injuries and alcohol and drug usage in the states.

Two new factors appear in this study. the number of horses not owned by the injured person and those horses ridden less than weekly We have no studies which addressed the ownership of the horse, although it would be reasonable to assume that a horse not known by the rider would be more likely to be involved in injury. It is known in endurance, competitive, and steeplechasing an over conditioned and over fed horse is more difficult to control. Before this figure can be significant it would need to be compared to a similar number of horses being ridden/handled without injury to the person that are on supplemental feed. Perhaps 50% of all riding horses is Australia are on supplemental feed. However, the authors must have felt that this was a high percentage of horses on supplemental feed. Regular exercise and handling is known to benefit a horse for riding, but I have not seen it documented.

The use of protective helmets (in the states ASTM in Australia ASA) has been shown to decrease the number and severity of horse related accidents. No studies have been done here involving "boots" of other riding footwear that cover the ankles and have a raised heel. This is new documented information.

Those riding without a bridle are presumed to have used a bosal hackamore but this is not stated. There is a stylish cult in the states that postulate a well trained horse with a knowledgeable rider can be ridden without any head restraint. I have never seen this used in leisure riding and never recommend it for any riding.

The USPC study indicated that experience was not equivalent to knowledge and skill in preventing horse related accidents. This fact is shown again in the New South Wales study. The Pony Clubs and 4-H programs offer educational programs which can be utilized in increasing knowledge and skill of the targeted youth.

As in our horse related injury studies, we do not have a control group to show how many people who do not have injuries ride a borrowed horse or ride infrequently We cannot know the influence of these factors unless we have a comparison group of horsepersons not injured.

The educational aspects offered are not those being used in the states although they may have application here. The first lessons taught in riding must he related to safety: apparel, safe mounting how to stop a horse, and this information must be reinforced at every lesson and by example.

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

1 Harrison, C.S. Fox hunting injuries in America
Physician and Sportsmedicine
12(10)130-137, 1984.

2. Buckley S., Chalmers D, Langley J, Falls from Horses Resulting in Death and Hospitalization.
AMEA News Vol 1(4);8.

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The New South Wales Study

This study of horse-related injuries contains some unusual elements, such as the possibility of overfeeding supplements to horses as a possible accident predictor. In general, however, the similarities between the riding accidents in both countries are quite consistent, as Dr. Hammett indicated in her editorial.

Since the study places top priority on increased helmet use, perhaps some comments about the Australian riding helmet standard as compared to ASTM F1163 in the United States would be of interest. I am Chairman of the subcommittee within ASTM which developed the F1163 standard which has been in use for five years. I also volunteer my time to the Australian riding helmet subcommittee and have exchanged information with its manager for many years. In fact, their latest proposed revision, if adopted, would place their standard even closer in content to F1163. Over the years my committee has reviewed riding and driving helmet standards world-wide, and based on this study, my opinion is that of viable riding standards, ASTM is the most stringent, closely followed by ASA. The Australian helmet manufacturer, Equine Science, whose products are also sold in the United States, was able to pass F1163 with only minor modifications of his helmets. He has been an important contributor of suggestions for: improvement of the ASA standard.

The Australian standards for light helmets began with a base standard which is used for the testing of bicycle and other sport and utility helmets. Each group which may have additional needs writes an appendix specific to those requirements. Unlike our system of writing a separate standard from scratch for each activity's helmets, the Aussies have made it simple to speed up the process of adding a new activity. ASTM has seen the good sense in this method, and has just finished a base standard for all helmets, with an appendix for bicycle helmets. In the future groups will not labor for four years. as we did, to develop a- standard from the beginning. F1163 has been reaffirmed by our parent committee, and the parent committee will Continue to monitor advances being made in both the writing of test processes and technology. As needed, we can update and improve the clarity of the standard, without disrupting the equestrian community with drastic changes.

The one big surprise in the NSW study was a helmet compliance rate of 60%. I would love to believe that they are doing that well, but suspect that the respondents know that helmet use is considered politically correct, and don't want to appear to be reckless and frivolous. The comments in the study suggesting the need for a broad brimmed protective hat with a protective shell is interesting. Two U.S. manufacturers make such products, and have had some success in selling to people who generally consider protective headgear to be sissy and unnecessary.

I was encouraged that the authors recognized that Pony Clubs and other horse groups, as well as horse sports governing bodies, could assist in the necessary education of new riders regarding safety practices. In the U.S., 4-H is becoming, state by state, an important force in educating its members that proper protective headgear is important to their well being. This group has taught safety practices in its literature for many years, and because of its large membership and presence in every part of the country, can be a major contributor to an educational initiative.

Drusilla Malavase
2270 Country Road 39
Bloomfield, NY 14469

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Farm Horse Related Injury

The following abstract was submitted by the American Medical Equestrian Association to the Children's Safety Network, National Farm Medicine Center, 1000 North Oak Avenue, Marshfield, WI 54449-5790 for consideration for presentation at their conference March 8-9, 1995.

Study Objectives:

Evaluate horse related injuries in equestrian activities using this information to develop effective safety education.

Methods:

Evaluate the figures from the number of horse related injuries recorded by the National Electronic Surveillance System (NEISS) of the Consumer Product Safety Commission of the United States Government.

Results:


HORSE RELATED INJURIES


YEAR 1987-1989 1990-1992
LOCATION

Farm 26.9% 12.0%
Home 35.7% 48.3%


YEAR 1979-1982 1987-1992
AGE
0-4 2.0% 1.9%
5-14 27.1% 21.1%
15-24 33.5% 24.4%
25-44 29.6% 40.4%
45-64 6.8% 10.3%
65+ 1.0% 1.8%


Conclusions:

LOCATION OF ACCIDENT: Horse related injuries on the farm have decreased 45% during the three years 1990-1992 compared to the years 1987-1989, while horse related injuries at the "home" increased 40% during the same time period. These figures suggest that horse safety education for the farm has been more effective than horse safety education reaching riders at homes not on farms.

AGE: The percent of accidents comparing the three years 1979-1982 to the six years 1989-1992 decreased in youth 5-14 years of age by 22.2% and in teenagers and young adults 14-24 years by 27.3%. These figures suggest that horse safety-education for youth is effective.

Note: NEISS did not keep records on horse related injuries for the years 1983-1986. The actual figues reported by NEISS cannot be used as the program increased the number of reporting hospitals during the study periods.

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A Horse of a Safer Color

In 1992 alone, the U.S. Consumer Product Safety Commission estimates there were nearly 74,000 injuries associated with horses and riding. Horses are beautiful creatures, but not nearly as smart as they are handsome. People need to do the thinking. Here are some things you should consider before climbing aboard Old Paint.

DRESS PROPERLY

Always wear a properly secured, hard-shell riding helmet that has been tested and approved by the Safety Equipment Institute. Wear the helmet at all times when working around horses.

Two million Americans suffer brain injuries annually. Over one million will retain some form of permanent neurological or physical impairment. The riding helmet is a must!

Wear long pants and boots or shoes with at least a half-inch raised heel. The long pants will prevent chafing and the heel will help prevent getting one's foot caught in the stirrup and being dragged.

BEFORE MOUNTING

First and foremost, beginning riders should have competent riding instruction. Ask for a quiet horse.

Check all leather pieces for wear or cracking.

Check stitching for loose or broken threads.

Inspect the cinch strap that secures the saddle to the horse's back. It should be solid and tight.

Be sure your stirrups are properly adjusted.

ON AND AROUND THE HORSE

Horses are timid animals that frighten easily.

When approaching a horse: speak softly so the animal hears you coming walk where the horse can see you stroke him on the neck or shoulder first. approach from the shoulder at an angle

Do not run, yell or play around a horse. Avoid a horse's blind spots. Do not walk or stand directly in front of or behind a horse. If you must walk behind a horse, stay at least 15 feet away

Do not feed a horse from your hand.

Do not touch a strange horse unless its owner says the horse would welcome the attention.

Walk around a horse, not under its body or its neck or tie rope.

Never tie or wrap yourself to a horse. The Horsemanship Safety Association says you should always be able to escape your horse in three seconds or less.

If you need to adjust your equipment or clothing dismount.

ON THE ROAD OR TRAIL

Most riding accidents occur when a rider is separated from the horse in an untimely manner. To stay with your horse:

Watch for traffic at all times. Leave at least one horse length of spacing between your horse and other horses. Ride single file. Ride on the soil. Watch for unusual objects in the horse's path.

Reprinted with permission from
SAFETY Line
Publisher John Myre
1265 Rogue River Ct.
Chesterfield, MO 63017

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Equestrian Safety in 4-H

In April 1994, Allan T. Smith, National 4-H Program Leader, and Brad Rein, National Program Leader, Farm Safety, wrote the program Leaders in 4-H Youth Development concerning equestrian safely in 4-H. Their letter had two purposes:

1. To find out how many states already require 4-H horse project members to wear approved helmets when riding; and

2. To provide the program leaders with compelling evidence that equestrian helmet use is an issue 4-H can no longer ignore.

His letter stated the following: In 1993, 240,143 4-H'ers were enrolled in horses and ponies projects, the largest such enrollment of any youth-serving agency. How many of them fall off their horse (or are thrown) in the course of a year? We have no idea, but unless things have changed a great deal since I was a kid, probably most of them.

4-H has left it up to each state to determine if its program will require protective helmet use. Medical evidence is emerging that what may appear to be simple falls can have chilling long-term effects.

"The incidence of Traumatic Brain Injury (TBI) in children and youth is staggering. Each year in the United States alone, as many as 1 million children and youth will sustain brain injuries from falls, accidents, sports and abuse. Approximately 165,000 of these youngsters will be hospitalized with 16-20,000 of them suffering moderate to severe symptoms. Statistically, the largest number of traumatically brain injured people is in the 15-25 year-old age range, but the frequency is nearly as high for youngsters under 15 years of age." (Journal of Head Trauma Rehabilitation, 1991, 6(1):1.)

"The difficulty in serving individuals with TBI is that their condition is constantly changing. They do continue to get better but at varying rates. It is also often hard to tell which symptoms are the result of the brain injury and which are the results of other problems. Severe head injury is not hard to diagnose. The trauma to the head area is readily apparent. Milder cases are often invisible. Physicians are learning to recognize symptoms that result from minor head trauma. Impairments of memory, especially short- term memory, and disruption or attention and concentration are very common following minor head injury. Problems with emotional and behavioral dysfunction following head injury even without documental loss of consciousness are common." (The Journal of Head Injury, Vol II, No 3, 1991.) In other words, even minor head injuries can have debilitating consequences on school and job performance.

The legal establishment is beginning to contend that in the face of such medical evidence, those responsible for youth activities which could lead to head injury (such as horseback riding) can be held liable for permitting youth to participate without appropriate protection. We live in an increasing litigious society. Some parents of injured children are now more likely to sue everybody within reach.

We suggest strongly that if 4-H in your state does not already require the use of equestrian helmets, you share these materials and consult with your Extension Farm Safety Specialist and Horse Specialist. Even if only a few of our 4-H'ers are seriously injured each year because they have fallen off horses without adequate helmet protection, that is still too many.

Allan T. Smith
National 4-H Program Leader
4-H and Youth Development
Extension Service
United States Department of Agriculture
Washington, DC 20250-0900

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Mandatory Helmet Usage in State 4-H Equestrian Programs

All state 4-H offices were surveyed via electronic mail in the summer of 1994 to obtain information regarding their requirements for the usage of approved helmets in conjunction with their 4-H horse programs. All state 4-H programs which made the usage of approved helmets in any part of their 4-H program mandatory were asked to respond.

Twenty-one state 4-H programs currently require that approved helmets be used in at least some competitive events. All of these require helmets for Gymkhana events. Twenty require the use of approved helmets in over-the-fence hunter and jumper classes. Ten states require approved helmet usage in all mounted equine events. A few states specify that helmets are optional while training although required in competition. Only two states mention Rodeo and roping classes. Both require the use of approved helmets in these events.

Many states mention that their requirements are new, or being strengthened. There is considerable variation by region in the stringency of helmet requirements. Nine of thirteen northeastern states have some requirements for helmet usage. Eight of the nine require the use of helmets in all mounted events. New Hampshire in addition requires the use of approved helmets while being pulled by one or more equine. They are the only state 4-H program with such a requirement.

Four Western states require helmets in some classes. Of the Western states, only California and Hawaii require the use of helmets in all mounted events.

Three North Central and four Southern states require the use of approved helmets in hunter, jumper and Gymkhana events. Missouri requires helmets only in Gymkhana events.

Interestingly, the states which have traditionally had the strongest 4-H Rodeo programs either chose not to respond to the survey or have no requirements for helmet usage even though Rodeo events have high potential for head injury.

Most trends of all kinds start on the coasts and gradually move inward. That is likely to be the case with mandatory equestrian helmet usage as well. States which have not yet considered the need for such requirements should certainly do so. The incidence of severe head injury when falling from a horse, the effectiveness of approved helmets in preventing such injury, and the increasing frequency of successful lawsuits against leaders, coaches and sponsoring groups all suggest that requiring the use of approved helmets in all 4-H mounted events, both in practice and in competition, is an idea whose time has come!

Our 1993 ES-237 statistical report shows 240,143 4-H youth in horse and pony programs. That makes 4-H undoubtedly one of the national leaders in youth equestrian programs. It behooves us to remembers our "Health H" and do everything in our power to assure the safety of the youth who participate in this enjoyable lifetime sport.

Allan T. Smith
National 4-H Program Leader
4-H and Youth Development
United States Department Agriculture
Washington, DC 20250-0900

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Editorial Comment: 4-H Programs

In 1992 the American Medical Equestrian Association sent by surface mail a questionnaire to 49 state horse specialists (Alaska was omitted) asking concerning their safety educational program and the use of protective headgear. Forty-two states replied, with 38 replying that they recommended ASTM helmets in their program. ASTM standard helmets were required by 26 states in some and six requiring ASTM helmets for all activities. (AMEA NEWS Vol. II No 2, 3-6)

The 1994 survey was done by a single electronic request, in which the states were asked to reply if their program made the use of ASTM SEI approved helmets mandatory. Replies were received from 21 states, which would explain the differences between the 1992 and the 1994 figures. In 1992 only six states required helmets in all activities, with ten states requiring helmets in 1994. This is where the greatest improvement is seen.

The editorial recommendation from the AMEA in 1992 was: "The AMEA recommends every horse specialist, leaders, and program instructor be aware of the presently available information (on head injury and equestrian safety). They must share this information with the governing body of the program for their (members) understanding and rulings. They must teach by instruction, demonstration of the ASTM standard helmets to those in the program."

Allan T: Smith, National 4-H Program Leader, is to be commended for taking these steps and providing his leadership for the 4-H youth in horse programs.

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

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Asphyxiation in Horse Trailers

Two fatalities of eventers at USCTA recognized events in the past have occurred as a result of asphyxiation in the sleeping area of horse trailers. At the 1993 Prairie Creek (Texas) Horse Trials, a veterinarian used a kerosene heater in her horse trailer for heat at night. She died of asphyxiation. At the fall 1994 North Georgia Horse Trials, an eventer did not appear for her dressage test. Her stable neighbors noted that her horse had not been fed. After calling her parents, her locked trailer was opened and she was found to have a barbecue grill inside her trailer She died of carbon monoxide poisoning.

Carbon monoxide is a product of the incomplete combustion of organic substances. Common sources of carbon monoxide exposure are motor vehicle exhaust, fumes, smoke from fires, barbecue grills (even without smoke) and fumes from malfunctioning or poorly ventilated shelters. Deaths have been reported from children traveling in the back of pickup trucks under a rigid closed canopy. Two young, healthy mountain climbers succumbed to carbon monoxide from fumes generated by a small cook stove in the enclosed space of their tent at 14,200 feet.

Carbon monoxide is a nonirritating, odorless, colorless, and tasteless gas with an affinity 200 to 250 times greater than oxygen for hemoglobin, the oxygen carrying protein of our blood. Carbon monoxide intoxication can cause injury to hypoxia-sensitive tissues such as the brain and the heart resulting in permanent injury or death. Carbon monoxide intoxication is the leading cause of death by poisoning in the United States and accounts for 3,800 deaths annually. Some authors have described carbon monoxide poisoning as an "occult epidemic." Many cases occur during the winter when barbecue grills are mistakenly used indoors for heating and cooking during power outages. The use of gas or propane heaters without proper ventilation is also a cause.

Horse trailers generally do not conform to the standards of the Recreation Vehicle Industry Association (RVIA). The RVIA standards require each fuel burning appliance to have a combustion air inlet and a flue gas outlet. Propane heaters such as the highly portable Coleman propane heater require two openings of 24 square inches to provide adequate oxygen intake and fuel exhaust. Typical horse trailer dressing rooms and gooseneck beds have windows but no vents and are often used at horse shows as a place to sleep as well as change clothing. They are not designed as a place to use a heater without ventilation. (The same can be said of cooking with propane, kerosene, or Sterno.) Heaters utilize oxygen in combustion as well as generating carbon monoxide and other gases. Manufacturers of propane and kerosene heating units do not recommend they be used while asleep and only with adequate ventilation when awake. Members of the horse community should be aware of the extreme danger of using propane or kerosene heaters in horse trailers. A sleeping bag designed for cold weather exposure should be used instead.

David McLain, MD
Chairman, Safety Committee
USCTA
7325 Cahala Valley Drive
Birmingham, AL 35242

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Safety Education Opportunities of Benefit Rides

A benefit ride is an effective means by which the recreation rider can be reached. This rider is the most difficult to contact by the usual means through the horse news media, club programs, and tact shop displays. The recreation rider has the largest number of horse-related injuries and is at greatest risk for these injuries.

The Haywood horse community, lead by the Haywood Trail Riders, holds an annual benefit trail ride for KARE (Kids Advocacy Resource Effort), the local agency for abused and neglected children. Every rider who rides a sponsored horse must wear a fitted, secured, ASTM standard SEI protective helmet. Riders riding their own horse get an additional credit for their donation to KARE when they wear a SEI helmet. The program works in this way:

Local professional and business persons are asked for sponsorships for the ride. This sponsorship can be as entrance donation for them, their employees, or their selected customers. For those who do not designate a rider, the ride selects from children and youth identified by KARE. Included are children in foster care, the local children's home, and children who would benefit from their selection to ride in the activity. Local stables provide the horses as a community service.

The sponsored riders are divided into two groups: those who wish to go on an hour ride on a designated trail lead by a local horse club member with the second member riding at the end of the line. The second group of riders are the young and inexperience riders who ride 15 minutes on a horse with a side walker. The side walker is a knowledgeable member of the local horse community who enjoys working with children. All the riders in both groups must wear SEI helmets, usually provided by the ride, and fitted and secured before mounting.

The donations to KARE for the riders wearing the manufacturer's helmets are provided by contributors from the manufacturers: International Riding Helmets and Lexington Safety Products. The donation money amount is determined by the organizers with the approval of the manufacturer. The hat is checked for the name of the manufacturer and that it is SEI by a member of the local United States Pony Clubs. In addition, helmets worn by sponsored riders were provided by Troxil.

The participation has been excellent, the horse community has learned about protective helmets, and KARE has received all profits from the ride. This money serves as a major part of its year's funding. If you wish further information about the ride, contact

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

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