University of Vermont AAHS
AMEA

November 1998, Vol. IX, Number 4

 Table of Contents
 
 Injury in the Wilderness
 Comparing Headgear
 Drugs in Horse Activities
 AAHS Brings Safety to Navajo Reservation
 Equitation 1960
 Jockey Injuries in 1997
 USPC 1997 Accident Study
 Rodeo Standard for Protective Helmets
 Ten Legal Commandments
 World Equestrian Games, 1998
 Executive Secretary's Report

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INJURY IN THE WILDERNESS
 FROM THE RlDING PHYSICIAN VIEWPOINT
 
If you are a physician who foxhunts or trail rides, then inevitably you are going to be called to evaluate an injured or ill rider. The location is often remote and for example, in the Midland Fox Hound country where I ride, sometimes difficult to access even with a 4 wheel drive vehicle.

 Some critical decisions often need to be made and they can be stressful for everyone involved, especially if you are a riding dermatologist. What if your 52 year old riding buddy starts having chest pain? What do YOU do if you are trail riding in a remote area and someone falls off her horse and is knocked unconscious? How should you evacuate the person? When should you leave to call for help? When can you leave an injured person alone to go for help? What do you do with the horses?
 
The first step in answering any of these questions is to be prepared. Keep in mind and mentally rehearse what you would do in any of these scenarios. Tell someone where you are going and when to expect your return. Know the country in which you are riding as best you can and if unfamiliar to you should get a map well in advance. If you are a physician you will save yourself a lot of trouble by carrying a cell phone on your belt in case of an emergency. If it in on the horse, the phone may leave with your horse. Most hunt staff have radios and giving one to the physician of the day greatly facilitates communication. We frequently have at least one or two physicians in our hunt field and usually one of us volunteers to stay with an ill or injured rider.  A rotation keeps the burden lighter on everyone. Know what hospitals are in your area, their capabilities and which one is the closest. Fortunately we have a familiar relationship with our nearest community hospital, the EM nurses recognize an injured rider is coming when muddy people with boots on and lots of scratches on their faces appear at the door.
 
Take common sense safety precautions. Urge everyone in your field to wear an ASTM-SEI helmet with chinstrap fastened. Encourage riders that have potentially serious medical problems like diabetes, seizures or heart conditions to wear a med alert bracelet. You may not feel you are responsible for the medical care decisions of everyone with whom you trail ride or foxhunt but you will be when they have a fall from a horse and you are the only medical person available.    Anyone who rides or is around horses should have an up to date tetanus immunization. Hunt staff should have preexposure rabies inoculation.
 
Know what medical skills are available, who is trained in first aid or CPR. Does the local EMS service have a 4 wheel drive ambulance (most don't)? What areas do you go into that might require a person being hand carried out on a backboard? Which is the closest hospital with capabilities to handle major trauma or head injuries? Do they have a CT scan or a neurosurgeon on call?
 
Carry or have available some basic medical supplies. For a days foxhunting or a local trail ride I carry in my sandwich case an ampoule of 1/100 epinephrine, a TB syringe, a vial of injectable Benadryl, a 5cc syringe, a 14 g angiocath, a cotton triangular sling (never a lack of clavicle fractures in riders), Advil, Tylenol and  hydrocodone tablets. If you are going on an extended ride of more than a day then you will need a more comprehensive pack as well as to obtain a medical screening sheet on each rider before you go. Put a backboard, hard cervical collar, sheet rolls, and duct tape in the horse trailer and leave it there. (Your local EMS service will usually give this stuff to you when it becomes worn or outdated). One day you may be very thankful.
 
Review emergency procedures with the other medical personnel on your ride, as well as with the MFH and hunt staff. Follow basic precautions in courtesy and etiquette. One of the cardinal rules of foxhunting or trail riding is do not leave the field of riders without notifying the fieldmaster or trail boss. This is basic common sense and helps avoid situations in which you may be left alone and injured. When someone is injured in OUR hunt we usually ask that the fie1d of riders go on leaving one person to hold the injured rider's horse, another to attend to the victim (calling for any riding medical personnel if not present) and a third or fourth person to stay to hold the other horses and help the physician or person who is assuming care of the patient.
 
When an injury does occur you must assess the urgency and make a decision. Can the person walk out to the nearest vehicle?  Can they ride out or do the need experienced EMS evacuation? In general helicopter evacuation from the scene is not a good idea when you have multiple people in the area on horseback. Before you know it YOU are going to have a lot more problems on hand. Evacuating a patient by ground is often faster and less risky.
 
Initiate a call for immediate evacuation if the patient has the following: persistent altered mental status after a fall with loss of consciousness, orthostatic syncope, chest pain that is clearly not chest wall in origin, the return of loss of consciousness following head injury, debilitating pain, or evidence of a spinal cord injury such as intense neck or back pain, arid  numbness or weakness in the extremities. (1)
 
What if you are riding with just one other person? If you have no communication device then you  are going to be forced to try to stabilize the person to the best of your abilities and get help as soon as possible. This may range from staying with the patient and hoping someone comes along  that can go for help (obviously not an option in a remote area) to leaving an injured person alone and going for help. Follow the ABC's of resuscitation and keep in mind that you should not leave a confused patient who might inflict further harm on himself or others, someone who is bleeding copiously without controlling the bleeding or an unconscious person who is vomiting or has an obstructed airway. Of course make sure you know where you are going and how to get back.
 
References:
1) Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care.  Edited  William W, Forgey, MD.  IGS Books, Inc., 1995

2) Medicine For The Outdoors, Paul Sauerbach, MD. Little, Brown and Co. 1986.

Julie Ballard, MD
Haralson Farm
5067 Smokey Road
Newnan, GA 30263
 
Dr. Julie Ballard is an emergency physician at Piedmont Hospital in Atlanta, GA, a life long equestrian, who spent the first part of the summer in bed recovering from her own horse-related accident.
 
 

Injury in the Wilderness: Editorial Comment

Julie Ballard has a great article on wilderness riding and first response.  If you are reading this article, I assume you are "cursed" with the prospective that things do go wrong, how can I help prevent it, and what can I do when it happens.

The American Medical Equestrian Association mission is to educate the oblivious riders who see no consequences of their poor decisions.  Follow the Boy Scout motto of "Be Prepared."  The AMEA's goal is to educate and be a source of information to anyone who seeks help.

Unfortunately bad things happen.  I was involved this past weekend with a barn fire with eleven horse deaths and burns to one of the  rescuers.  I do not think we can save the world but I feel we need to be the voice of safety in the horse community.

William Lee, MD
Desert Foothills Medical Center
PO Box 2150
Carefree, AZ 85377

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HOW DOES EQUESTRIAN HEADGEAR COMPARE
AND WHAT SHOULD I WEAR?

Drusilla Malavase replies:

Two in-depth studies compare ASTM/SEI helmets to British, EuroStandard, and Australian helmets.  These studies show that the ASTM equestrian standard is more protective that the other standards.  One Australian helmet does pass ASTM testing and is available in the United States.  I will provide copies of these studies as they are multiple pages with drawings, tracings, tables, etc. for the research scientist who is interested.  Mail me your address and what study you wish.

If you are more interested in the comparison of ASTM/SEI with what I call Vanity Helmets ( labelled "item of apparel only" ), I would suggest that you have a look at the video "Every Time, Every Ride", available from the Washington 4H Foundation, the American Association for Horsemanship Safety (www.law.utexas.edu/dawson/), and the USPC bookstore (bookstore@ponyclub.org ).  There are huge differences in energy management and the retention systems of vanity helmets and protective ones.  It is all very well to praise the small size and familiar fit of the former, but why strap on something which protects you from little more than the sun and the rain ?

If you want to know what particular ASTM/SEI helmets are most effective, all of them with the SEI seal surpass the ASTM equestrian standard, and your decision should really be made by your type of riding (competition? pleasure? hot weather? racing?) and the model within that category which fits you best.  This presupposes that you are willing to go to a dealer who carries more than one manufacturer's products ( good service!) and that you are smart enough to read the manufacturer's fitting instructions carefully (and you would be horrified to know how many riders and tack store owners don't!)  I have found that there is a model which fits each of us best, with the greatest degree of comfort possible; however, some of us lucky "average head" people can be happy in any correctly fitting model if we will give it a chance for a couple of rides.

Drusilla Malavase
Chairman, ASTM Subcommittee Equestrian Headgear
2270 County Road #39, RR #2
Bloomfield, NY 14469
e-mail address: drumalavase@hotmail.com.

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DRUGS IN HORSE ACTIVITIES

Let's pretend. It's something we all do as kids but tend to grow out of as we mature and become adults. But take a moment now and pretend that you own, run or are an investor in a stable of horses worth hundreds of thousands of dollars...maybe even millions. If you were in a conventional business you might consider these horses as inventory or equipment. Certainly all the tack and other support equipment counts as an asset. As such, you would probably have alarm systems, security guards and a comprehensive drug and alcohol testing program for the employees.

Let's pretend that you do all of these things. Which program do you think is doing the most to protect your assets? Well there's no doubt that alarms and guards are valuable but they are basically like locks; they keep honest people honest. A determined thief will get in despite your security measures. But what about drugs? Not just cocaine and marijuana...but also alcohol, amphetamines/methamphetamines, heroin and others are all readily available. If you don't have a drug testing program in place you don't know if you have a problem or not. Suffice it to say, the odds are heavily weighted that drugs are being used/abused on your grounds and the potential for losses is tremendous!

If your employees live and/or work in an area where most employers perform drug testing and you don't can you guess what type person you are most likely to attract as an applicant? If the applicant can't pass the test they tend to look for the jobs that don't test. If you hire this person what are you getting for your money other than a warm body? How about a 300 % increase in their use of medical benefits, increased absenteeism, a 3x increase workers' compensation injury claims and decreased productivity (as compared to the non-abuser).

So how do you start a drug testing program and what does it cost? First and foremost you develop a comprehensive drug testing policy. Don't skimp and try to copy someone else's policy. You train your horses using your own methods and style so why do you want to copy someone else's style of employee management? A good, comprehensive policy can usually be prepared for you for under $500.00 in most cases by a knowledgeable attorney familiar with your states drug testing laws and benefits. In some states, compliance with the state regulations allows a discount on your workers compensation insurance. Once you have a policy you need to notify all of your employees of the date the policy will go into effect. This waiting period varies from state to state and can be as short as immediate to as long as 60 days before you can test current employees. New hires are subject to testing immediately. Look for a good Medical Review Officer (M.R.O.) to interpret all test results for you. If you are not a doctor, and you don't even play one on TV, leave this to the professionals. In fact, many are Certified Medical Review Officers from organizations like the American Association of Medical Review Officers (A.A.M.R.O.), American College of Occupational and Environmental Medicine (A.C.O.E.M.), or American Society of Addictionology Medicine (A.S.A.M.). The M.R.O. is an M.D. or D.O. that will interpret the test results obtained from the laboratory and will determine if an abuse of drugs is evident. Many M.R.O.'s can offer turnkey programs for multiple sites in multiple states. This offers the large employer the greatest control over their programs and is often the most cost effective method of running a drug testing program.

So you decide to set up a program and it's up and running. What should you expect? Expect the unexpected! You will catch people you never suspected of having a drug problem and will probably find that some of the people that you have a hunch are using drugs actually are not! One of the greatest benefits, however, is the overall improvement in your workforce and your workplace safety. You will see an improvement in both attitude as well as morale and, in the long run, for every dollar you spend on your drug testing program you can expect a return (a savings) of $3.00 or more. So what do you say, let's stop pretending and get real. After all, you live and work in the real world.

Other sites/Resources:

American Association of Medical Review Officers: www.aamro.com
Alcohol and Drug Testing Procedures: Office of Drug and Alcohol Policy Compliance:
        www.dot.gov/ost/dapc
Drug testing and Legal Issues Web Site: www.ol2.com

C. B. Thuss, Jr., M.D.
President and Certified M.R.O.
Absolute Drug Detection Services,  Inc.
Certified by A.A.M.R.O.
Email: cthuss@absolutedrug.com
Web Page: www.absolutedrug.com
1400 Urban Center Drive
Suite 115
Birmingham, Al. 35242
800-878-7786, 205-969-1387 Fax

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AAHS Brings Safety to the Navajo Reservation
 

The American Association for Horsemanship Safety, Inc. (AAHS) has made major strides in bringing horsemanship safety to the Navajo Reservation.  Over the last two years, AAHS has been working with (one current and one former) nationally recognized PRCA bull riders to decrease horse related injuries on the Reservation through education.  J. P. Paddock and Harry Begay originally became involved with AAHS when they participated in an AAHS Instructor Clinic in Arizona.  Both earned Instructor status at that clinic, and were identified as potential AAHS Clinicians.  Harry and J.P. were very concerned with the number of horse related injuries on the Reservation, especially those that involved children.   They were drawn to the AAHS system since it was originally developed through the observation of rodeo horse and bull riders.  In addition, the fact that it is a systemic approach to teach people to teach riding quickly and efficiently was very appealing.

Harry and J. P. traveled down to Golondrina Farm in Fentress, TX, to earn their pre-clinician status and to discuss potential methods for raising funds to increase safety awareness on the Navajo Reservation.  In December of 1997, Jan Dawson and Dr. Betsy Greene wrote a grant to Indian Health Services (IHS) for funding that would allow for completion of Harry and J. P.'s Clinician requirements and the production of four "Keep it Natural" clinics to be presented in four locations on the Navajo Reservation.  The grant was awarded, which allowed Harry and J. P. to assist with the largest clinic that AAHS puts on each year at Camp Stewart for Boys in Hunt, TX.  At the clinic they became more adept in instruction of the system of teaching riders to develop Secure Seat(sm), evaluating potential instructors, and providing constructive feedback and solutions for instructors that were struggling in their efforts.

This past June, Harry, J.P., Dr. Greene and Jan Dawson gathered in Window Rock, AZ, to conduct the first of four clinics on preventative health care and natural, safe training and riding methods.  The clinic, attended by many people including Ralph Fulgham (IHS grant administrator), his wife and child was well received by all.  During the clinic, J.P. gave personal testimony of the value of Secure Seat(SM) .  He described how his young daughter had quite an adventure on her first efforts at riding his big horse "Brownie" instead of her own pony.  She and Brownie were riding when Brownie decided to run up a draw.  She lost her reins and Brownie kept running, but his daughter maintained her seat until the horse stopped.  J.P. was noticeably touched as he passed on the story, and you could tell that he had, at that point in time, totally bought into the value of the Secure Seat(SM)  riding system.

Although the clinics were not advertised as "Safety Clinics," it became very clear to the attendees that safety was a number one priority since all clinicians were using certified safety helmets.  Harry and J.P. gave riding demonstrations while Jan Dawson narrated the Secure Seat(sm) and "Keep it Natural" concepts throughout the clinics.  As the clinics progressed, Harry and J.P. both became more active in the presentations, and often switched between English and Navajo languages when explaining concepts for the audience.

Throughout the clinics in Window Rock, Chinle, Kayenta and Tuba City, it became obvious that riding on the Reservation was not comparable to the "typical" lesson program.  One of the unique aspects of "riding around home" on the Reservation is that "home" may include a five-mile radius of desert land.  There seems to be considerably less arena riding and a great deal of open land, on which the youth often ride alone.  This understanding of differences in riding habits and cultures made it clear that the most important thing to teach the young Navajos was to simply stay on the horse.  The Clinicians came to the conclusion that the standard operating procedure would not be the most effective method of reaching this particular audience.  This observation helped AAHS to establish a considerably different, but effective effort in horse safety education for this particular audience.  Harry and J. P. have worked with AAHS to develop a mirror organization entitled Native American Association for Horsemanship Safety, Inc. (NAAHS).

Since rodeo is the third major industry on the Navajo Reservation, J. P. and Harry are heroes to many young Navajos, and this provides an excellent avenue for promoting helmet use and horse safety.  Both endorse the use of approved helmets and their strong endorsement helped the audience to begin to accept helmet use.  AAHS and NAAHS have plans to continue their joint efforts of increasing safety awareness and practices through the development of educational materials.  Another method of delivery will include presentations by Harry and J.P. at schools and Chapter Houses on the Reservation.  Overall, this has been a very positive step in reaching a new audience for safe horsemanship.

Elizabeth Greene, Ph.D.
Equine Extetnsion Specialist
Washington State University
Clark Hall 126
Pullman, WA 99164

SECURE SEAT(sm)

"Secure Seat(sm) is a defensible and systematic METHOD of teaching the balanced seat, and has been successfully developed and field tested by American Association for Horsemanship Safety, Inc.  This method of teaching is presented in "Teaching Safe Horsemansip" by Jan Dawson. Storey Publishing.  (AMEA NEWS Vol VII No 2  May 1996)

Betsy Greene

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Jockey Injuries in 1997
 

The JOCKEY NEWS reports Accidents and Mishaps for their membership's information. These following figures are from the reports for 1997. The reported accidents were for Jockey's Guild riders only.

Injuries were reported by 365 jockeys who were involved in 620 mishaps with 794 injuries. Five jockeys reported 6 accidents in 1997, 9 reported 5 accidents, 12 reported 4 accidents, 38 reported 3 accidents, 80 reported 2 accidents, and 221 reported one accident.

TABLE I
Number of Jockey Injuries
  No Injuries No Jockeys    Total Injuries        Percent
       6          5                30              1.37%
       5          9                45              2.47%
       4         12                49              3.29%
       3         38               114             10.41%
       2         80               160             21.92%
       1        221               221             60.55%
     Total      365               620

Percent is based on the number of jockeys injured.
 

There were 143 race tracks which reported these accidents. The track with the greatest number of injuries was Charles Town with 48; second was Penn National with 38, followed by Beulah Park 27, Turf Paradise 26, Calder Race Course 24, and Evengeline Downs with 20 accidents.
 

TABLE II
Race Tracks with Mishaps
 Charles Town          48
 Penn National         38
 Beulah Park           27
 Turf Paradise         26
 Calder Race Course    24
 Evengeline Down       20
 Remington Park        19
 Sam Houston           18
 Sunland Park          17
 Delaware Park         16
 Delta Downs           14
 Portland Meadows      14
 Ladbroke DRC          13
 Turfway Park          13
 Blue Ribbon Downs     12
 Oaklawn Park          11
 Retama Park           11

 All other race tracks have 30 or below Guild Jockeys in accidents.
 

The area of the body most often reported was the back with 15.8% of the injuries, followed by the leg 14.9%, shoulder 14.4%, ankle/foot/toes 12.9% with other areas of the body in the single digits. Types of injuries were reported in only 9% of the accidents. Of these reports 39.3% were sprain/muscle pull, 28.6% bruise/abrasion/contusion, 26.8% fracture with concussion, laceration, and dislocation each accounting for 1.8%.

The second column of figures are from the National Electronic Injury Surveillance System (1) and the third are from the survey by Joel Press of professional jockeys. (2)

The National Electronic Injury Surveillance System horse related injuries for the five years of 1992-1996 are given for comparison. Our medical studies have no standard by which findings are reported. In the Jockey study the leg includes the thigh, knee, as well as the ankle/foot and toes, and the arm contains the elbow, forearm, wrist, hand and fingers. The injury listing are different but some comparisons can be made. NEISS figures give 15% for the lower trunk and 10.4% for the upper trunk which includes the back. The jockey's back has the greatest frequently of injury (15.8%) but comparisons are not possible. The leg, shoulder, and ankle/foot/toe, knee and neck have greater frequency of injuries in professional jockeys. All other parts of the body have less frequency of injury.
 

TABLE III
Body Part Injured

Injuries            Total   %    Neiss 92-96  Nat'l Jockey
                                              Injury Study

Dorsal/lumbar spine  98   15.8%                   10%
Leg                  92   14.9%      4.3%         24%
Shoulder             89   14.4%      7.7%         22%
Ankle/foot/toe       80   12.9%      9.8%          0%
Wrist/hand/finger    49    7.9%     14.4%          0%
Face                 47    7.6%      5.2%          0%
Arm                  47    7.6%      7.6%         19%
Chest/rib            43    6.9%     10 4%         12%
Pelvis/hip           42    6.8%     15.0%          3%
Knee                 40    6.5%      3.7%          0%
Neck                 36    5.8%      2.4%          0%
Head                 33    5.3%     11.6%          9%
Abdomen              10    1.6%                    0%
Dental                8    1.3%      0.6%          0%
Clavicle              7    1.1%                    0%
Buttock               7    1.1%                    0%
Thigh                 5    0.8%      2.3%
Elbow                 2    0.3%      2.8%          0%
None                  6    1.0%
Not known            53    8.6%
Total               794             338710        706
 

TABLE IV
Type of Injury

Type Injury         Total   %    Neiss 92-96  Nat'l Jockey
                                              Injury Study

Sprain/muscle pull   22   39.3%     16.5%         10%
Bruise/abrasion      16   28.6%     32.9%         10%
Fracture             15   26.8%     28.1%         64%
Concussion            1    1.8%      3.5%          8%
Laceration            1    1.8%      9.0%          5%
Dislocation           1    1.8%      2.2%          7%
Tear                                               5%
Puncture                             1.2%          5%
Contusion                                          4%
Internal Injury                      2.8%          2%
Neurological Injury                  0.1%          2%
Total Reported       56            338710        1757
Percent Reported     7.l%

In reporting injuries immediately, more sprains and muscles pulls are remembered than when the injury is remembered some time later as in the Jockey Survey figures. After some time from the injury only the more severe injuries will be reported.

(1) NEISS Horse Related Injuries. AMEA NEWS, August 1998
(2) Press JM, Davis PD, Wiesner SI, et al. The National Jockey Injury Study: An Analysis of Injuries to Professional Horse-Racing Jockeys.  Clin. Jour. of Sports Med. 5:236-240, 1995.

Doris Bixby Hammett, MD
103 Surrey Road
Waynesville, NC 28786
Phone/TAX 704/456/3392
email: dhammett@primeline.com

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United States Pony Clubs’ 1997 Accident Study

Introduction

A total of 136 accident reports of United States Pony Clubs members and 11 adults and one participant were received. Only Pony Club members appear in the following figures.

Accidents which cause concern were those related to horses bucking and/or rearing without discernible causes. Whether or not this was related to the rider is less important than the match of a youngster with a horse that rears or bucks with minimal or no provocation.  The rider/horse combination should receive more attention from the instructor. The instructor will have means by which these unacceptable behaviors can be minimized. "Old horses teach young riders, old riders reach young horses" is excellent advise and one which we promote with the D and lower C levels.

The largest area of interest and concern remains the D level. Two horses refused or tripped doing grid work. Ten mounted accidents included the horse tripping or falling. Ten riders fell off because the horse refused a jump. Horses "spooked' in 13 accidents, reared in 5 and bucked in 17. An inappropriate match of rider and horse presupposes the increased likelihood of an accident.

Anytime humans and horses meet accidents are going to happen. The unacceptable behavior of rearing, bucking or spooking should be monitored closely because these actions have resulted in the most serious injuries. Children should experience the thrills of victory, even if the victory is simply completing the task at hand, not the agony of an injury which may have been avoided. We should encourage positive experiences on which horses and riders can gain confidence.

RATINGS

Rating      Data 97 Accidents   % Known     92-96 Accidents

Unrated          8                6.6%                18.2%
D?               7                5.8%                19.1%
D1              15               12.4%                 8.0%
D2              33               27.3%                11.6%
D3              21               17.4%                11.9%
D Total         76               62.8%                50.6%
C?               2                1.7%                 7.7%
C1              18               14.9%                 9.3%
C2               8                6.6%                 6.4%
C3               7                5.8%                 5.3%
C Total         35               28.9%                28 7%
B                1                0 8%                 1.2%
HA               1                0.8%                 0.7%
A                0                0.0%                 0.5%
Total Known    121               89.0%                  561
Unknown         15
TOTAL          136
 

The records on ratings before 1992 did not break down the D and C ratings-into levels 1, 2, and 3. As one reviews the above percent the figure for D rated accidents in 1997 (62.8%) appears to be much higher than in the 5 year report (50.6%). However, if the unrated are added to the D's the figures are the same (69.4% vs 68.8%). The conclusion is that Pony Club is succeeding in getting the unrated members rated quickly.

C rated percent of accidents remain the same and the numbers of accidents with B, HA, and A are so small that any comparisons are not valid.

AGE

Ages are easier to record than ratings so we have comparison with the membership for 1997 and with the 15 year accident study. If these figures are valid, the USPC gave closer supervision in 1997 for the members below the age of 9 years so that this group has a lower percent of accidents than the membership would predict and that occurred during the previous 15 years of accident records. The ages above 17 years also had fewer accidents than their membership would predict and less than the 15 year figures. The over 17 year Pony Clubbers have developed maturity, knowledge of safety and skills to avoid-accidents.

AGE

  AGE   Accidents  % Known     % Known            82-96
          Number    1997         USPC         Accidents

0-5         0         0          0.4%
6-8         5        4.3%        6.3%              6.1%
9-11       33       28.2%       23.5%             25.3%
12-14      35       29.9%       35.0%             35.2%
15-17      37       31.6%       24.6%             25.9%
18 & over   7        6.0%       10.2%              7.5%
Total     117                   11953               906
Unknown    19                    226
TOTAL     136                  12179
 

LOCATION

Location           Accidents    % Known          82-96
                    Number        1997       Accidents

Outside Course        31          40.3%          29.2%
Arena                 13          16.9%          23.8%
Outside Ring          11          14.3%           7.4%
Barn Area              6           7.8%
Ring                   5           6.5%          11.6%
Pasture                4           5.2%           6.5%
Trail                  2           2.6%           4.6%
Other                  5           6.5%          11.0%
Total                 77
Unknown               59          43.4%
TOTAL                136                           730
 

The outside course location remains the area where most Pony Club accidents occur. The Arena and the Ring follow at a much lesser percent. Only 77 accident locations are known with 43.4% unknown in 1997. Although the percents are different, this same frequency of location of accidents occurred in the 15 year report.

MOUNTED/JUMPING

Pony Clubbers were mounted in 79% of the accidents, 12.6% were not mounted and 7.9% of the accidents were Pony Club activities but were not horse related. In the 16 not mounted accidents, 37.5% were stepped on, 18.8% were kicked, 12.5% were bitten, and one accident occurred in each of the following: vaulting, saddling, loading, horse trampled handler, horse raised head hitting the handler. In the 10 not horse related accidents three cuts were reported (cut on games equipment, cut finger with knife, picking up glass in warmup area), two had foreign matter in the eye, one each of bee sting, burn on a heater, fall from trailer moving jumps, and heat illness.

Of the mounted accidents the PC was jumping in 50% and 50% of the accidents occurred in other mounted activities.

GENDER

Gender    Accidents   % Known   1997   82-96      82-96
           Number      1997     USPC    USPC   Accident

Male         11         8.2%    9.0%   11.3%       9.0%
Female      123        91.8%   91.00%  88.7%      91.0%
Total       134                l2179                957
Unknown 2
TOTAL 136

The percent of male/female accidents continue to show that males have fewer accidents than their membership would predict. The percent of males in the: membership has decreased as have their percent of accidents compared to the previous 15 years.

AREA OF BODY INJURED

Injuries                         % of Injured
                 Number      1997            82-96

Ankle/foot/toe     20       15.4%            12.2%
Wrist/hand/finger  17       13.1%            13.0%
Head               15       11.5%            18.5%
Dor/lum spine      15       11.5%            11.8%
Face               10   ..   7.7%            12.0%
Shoulder            7        5.4%             8.3%
Leg                 7        5.4%             6.6%
Pelvis              5        3.8%             7.3%
Knee                5        3.8%             7.3%
Neck                5        3.8%             6.6%
Upper Arm           4        3.1%             6.6%
Buttock             4        3.1%             2.0%
Chest/rib           4        3.1%             4.3%
Abdomen             3        2.3%             2.9%
Elbow               3        2.3%             5.7%
Dental              2        1.5%             l.0%
Forearm             2        1.5%             7.9%
Clavicle            1        0.8%             4.9%
Thigh               1        0.8%             3.6%
                  130
None                        22.1%
TOTAL REPORTS                136
Injuries                     130              1097

DENTAL included in FACE in first 10 years
BUTTOCK included in PELVIS/HIP first 1O years
Two areas of injury could be reported.

PERCENT is figured on the number of injured Pony Clubbers

Body Part                  % Injuries
                        1997         82-96

Upper Extremity         25.4%        33.3%
Lower Extremity         25.4%        29.8%
Head                    24.6%        31.5%
Trunk                   20.8%        41.5%
Neck                     3.8%         6.6%
Number Injury             30           72
# PC Injured             106          768
Total Injuries           130         1097
 

In 1997, the most frequent body parts injured are the ankle/foot/toe and the wrist/hand/finger with the head and the trunk third and fourth in frequency. When the body is divided into areas (the clavicle, shoulder and pelvis are listed as part of the trunk, face and dental as part of the head) the upper and lower extremities are equal in the percent of injuries. The head, which includes the face and teeth, has almost one fourth of the injuries (24.6%).

When the 15 year figures are compared, every region of the body has decreased in the percent of areas injured. There may be two reasons for this: in the early stages of the United States Pony Club study, only the more severe accidents, with injuries were reported, and secondly the injuries with accidents are less severe today and involve fewer parts of the body.
 

TYPE OF INJURY

Injury Types                         % Total
                     Number       1997        82-96

Bruise/abrasion        46         39.0%       37.5%
Closed FX              22         18.6%       12.3%
Sprain/muscle pull     17         14.4%       13.8%
Laceration/no          10          8.5%        4.4%
"Shook Up"              8          6.8%        8.0%
Concussion/unconscious  5          4.2%        8 4%
Laceration/Sutured      3          2.5%        3.2%
OTHER                   2          1.7%          0
Sunstroke/Exhaustion    2          7.7%        2.6%
Open FX                 1          0.8%        1.3%
Internal Injury         1          0.8%        1.7%
Dental Chipped          1          0.8%        0.7%
Dislocation/Sept        0            0         2.9%
Injuries              118                      1070
Total PCs with Injury 104                       756
NO INJURY              32                         ?
TOTAL                 136                       939

Percent is on the number of PC injured
Several types of injury may be reported

In 1997 the most frequent injury is a bruise or abrasion.  At a much lower percent closed fracture followed by sprain or muscle pull and laceration not requiring sutures.

As the figures for 1982-1996 are compared, the more severe injuries have decreased (concussion/unconscious, open fracture, internal injuries, heat illness, laceration with sutures, sprain and muscle pull, heat illness, "shook up" ie emotionally upset) whereas the less severe injuries of bruise/abrasion and laceration requiring no sutures have increased. One serious injury, closed fracture has increased in percent. These figures speak well for the safety education of Pony Club.

TREATMENT OF INJURY

Treatment         Number  1997 % Known  82-96  % of Change
Hosp Drs Office/
Unable to return    43        31 6%       37 7%      16.2%
RX Grounds/
Returned to Ride    27        19.9%       13.8%     -44.0%
RX Grounds
Unable to return    12         8.8%        6.9%     -27.1%
Hosp Drs Office
Returned to Ride    10         7.4%       10.9%      32.5%
Hospitalized         2         1.5%        7.5%      80.3%
Expired              1         0.7%        0
No Treatment        41        30.1%       23.2%     -30.0%
Total              136                     936

Percent is on total reports.

In 1997, nearly one third of those injured did not require treatment. Of those treated, most went to the hospital or the doctor's office and were not able to return to the activity. In some cases the activity was completed. The next most common treatment was those who were treated on the grounds and returned to the ride. This may be a Band-Aid, ice, or cleaning of the abrasion.

There was one death in 1997 in Pony Club activities (USPC NEWS Summer 1997 Number 74). During the over 20 years I have followed USPC accidents, there have been no deaths in the Pony Club horse activities.

These figures indicate that safety education in Pony Club brings results. Hospitalization percent decreased 80% over the preceding 15 years. Treated at the hospital or the doctors office and returned to the ride decreased by 33% and those not able to return to ride decreased by 16%. In contrast the lesser treatments; treated on the grounds and returned to ride increased by 44% and unable to return to ride increased by 27% while those receiving no treatment increased by 30%.

This trend of lesser severity of injury has been occurring every year. The United States Pony Clubs have a program of instruction for the leaders and members which is modified every year as indicated by needs. The Safety Committee gives input into the instruction council relative to needed changes for safety. Education concerning the safety and health of the Pony Club member is one of the chief contents of instruction.

Doris Bixby Hammett, MD
Safety Committee
United States Pony Clubs
 
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EQUITATION 1960
In the 1960's, Jack C. Hughston, MD, Hughston Sports Medicine Foundation, Inc. wrote in SPORTS SAFETY, Accident Prevention and Injury Control in Physical Education, Athletics, and Recreation:

The majority of serious injuries incurred in horseback riding fit into three categories.

First, it is the inexperienced rider who buys a country place and a horse and then puts the horse out to pasture.  The owner goes to the county every few weeks and on one weekend decides to ride the horse.  The rider is either frightened or overconfident.  In either case, the horse gets going at too great a speed and the rider falls, or the girth isn't fastened and the rider falls, or the stirrup straps are not inspected and they break.

Secondly, a youngster is having a birthday party.  The mother thinks it would be nice for all the children to ride around on a horse as a part of the entertainment.  She knows a neighbor who owns a horse, but she does not know the horse and usually does not know the essentials of safety in riding.  The most frequent cause of the resultant broken wrist or broken arm is a loose girth, which allows the child to roll off the horse, even at a walk.

The third example involves teenagers who rent horses from a riding stable which rents horses by an hourly rate to anybody who wants to ride, without inquiring about the person's riding ability, and where the rider does not know enough to ask any questions about the horse and equipment.  The result is usually an inexperienced rider on a horse that is accustomed to galloping vigorously for the entire hour, or on a horse accustomed to turning back and heading for the barn at the first opportune moment.  Such horses are often untrained or incorrectly handled;  and frequently the riding equipment is in poor condition....
Fox hunting, show jumping, pony clubs, one day events of the United States Combined Training Association, and general horse shows seldom involve injury.  Why are injuries in these areas so infrequent? The answer lies in the proficiency of skills attained by the riders and horses participating in these activities.

Editorial Note
The first scientific study of horse related accidents in the United States was in 1975 by Leslie Williams, DVM, Dr.PH, et al. then at Colorado State University, "The Blue Tail Fly Syndrome:  Horse-Associated Accidents." and presented at the American Public Health Association at its annual conference.  The figures were from hospital emergency rooms in Colorado.   At the same time, Anthony Seaber and W. S. Mahaley, Jr. MD. Ph.D. at Duke University Medical Center from their study of The United States Combined Training Association  recommended protective headgear for horseback riders to prevent head injuries which were frequent in the study.

The first attempts at protective headgear for U.S. equestrians used the
Snell motorcycle helmet standards.  The only passing model, the Buco, was made in Mexico in 1974, and was never put into production   In 1978 the U.S. Polo Foundation paid Wayne State University's Dr. Voight Hodgson to develop a standard for their sport.  The resulting helmets from both these standards were bulky, heavy, and sometimes poorly balanced.  They were not accepted by the equestrian community.

The United States Pony Clubs appointed an ad hoc headgear committee in 1979 which used the NOCSAE football and United States Polo Association standards to test helmets to what became known as the the United States Pony Club standard. The USPC Standard helmets were lighter and smaller than the Snell and USPA models, and were mandated by the USPC in 1983 and by other organizations in 1984.

The American Society for Testing and Materials developed its equestrian helmet standard from 1984 to 1988, when it was published. It replaced the USPC standard starting in that year.

 An industry wide meeting of the equestrian community, organized by Haborview Injury Prevention Center, Abraham  Bergman, MD,  and held in Washington, DC, in 1994 and attended by representatives of many national horse organizations including the American Medical Equestrian Association.  Since then many medical studies of horse activities have been done including the USPC which is now in its 17th year.  Many of these studies appear in the AMEA NEWS  with other studies being summarized in the publication..

These studies give more figures than were available to Dr. Jack Hughston in the 1960's. Different recommendations for prevention are now made from these studies.  His examples still may occur, but we know that ASTM SEI protective headgear measurably reduces injuries, and experience does not prevent accidents and injuries. Rider knowledge has a better effect on accident reduction than experience does.

Doris Bixby Hammett, MD
Editor AMEA NEWS
 
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WORLD EQUESTRIAN GAMES, 1998
With barely a year to prepare, the Italians staged the World Equestrian Games in an admirable fashion.  The Three Day and Driving competitions were held at Pratoni del Vivaro, an hours drive outside of Rome.  Medical Director Dr. Stefano Dragoni had few problems with which to contend during the cross country phase as there were no major falls or accidents.  Equestrian athlete care was aided by those countries which brought their own team physicians.  Team physicians in attendance were:  Dr. Craig Ferrell, U.S.A., Dr. Eric Favory, France, Dr. Craig Macauley, Australia, and Dr. Micheal Dooley, Britain.

The American team was glad it had Dr. Ferrells' services when an American dressage rider suffered a significant knee injury the night before her competition ride.

The indispensable Dr. John Lloyd Parry, Medical Advisory to the FEI, coordinated discussions about medical problems at the equestrian events.  In addition, he is helping the FEI develop a consistent policy on drug testing for equestrian athletes at international competition.  The next world games will be held in Spain, 2002.

Julie E. Ballard, MD

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Ten Legal Commandments
 
As a professional instructor or coach, you have a responsibility to your students. Our legal system makes it very clear that you must do what is reasonable and prudent to keep your students from getting hurt. To help you determine how you should act, I turned to a list of 10 commandments compiled by Sandra Tozzini, Esq., editor and publisher of Horse Law News (Negligent Trainer Supervision: Could This be You? May–June 1998). The author states, "These 'Ten Commandments' certainly are not all inclusive, but they'll give you a leg up on acting reasonably."

1.      Suit the horse to the rider.
2.      Don't put riders on injured or sick horses.
3.      Make certain that all riders are adequately supervised.
4.      Advance students appropriately.
5.      Assess which students may be at higher risk of injury and adjust instruction  accordingly.
6.      Make fitted secured ASTM SEI safety helmets mandatory.
7.      Verify that all subordinate trainers [coaches or instructors] are qualified for their job  level.
8.      Inspect/clean tack on a regular basis.
9.      Set forth written procedures and policies and review and update them regularly.
10.     Post safety instructions conspicuously and have all riders sign a copy of the  instructions.

[To learn more about the newsletter Horse Law News – Horse Law for Horse Lovers, visit www.piebaldpress.com or call 1-888-NAGS-001.]
 
Johanna Harris
from "Equestrian Athlete"
118 Lower Sand Branch Road
Black Mountain, NC  28711

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STATUS REPORT ON RODEO STANDARD FOR PROTECTIVE HELMET

A proposal for the testing to be included in a standard for evaluating  rodeo helmets will be presented at the ASTM winter meeting on December 9, 1998.  Feed back from the members of ASTM will be collected and reviewed for possible inclusion in the standard.  In early 1999 a draft standard will be prepared by the rodeo helmet task group chaired by Karen Strumlock and sent out to the headgear committee for a vote to accept the standard.  Discussion of the vote by the ASTM F09 Headgear Committee members will take place in spring of 1999. If  there are no negative votes from the ASTM committee members on the content of the standard (this is sometimes difficult to get; my guess is that we will have to go through the process twice to get out all the negative votes. ) we should keep the publishing date for the standard.  Also the possibility of SEI accepting and offering certification to the standard might be included. After the publication of the standad manufacturers can submit for voluntary testing to the standard as early as the year 2000.

Karen Strumlock
Intertek Testing Services
3933 US Route 11
Cortland, NY 13045
Ph - 607-758-6357, Fax - 607-756-4173
E-Mail - kstrumlock@itsqs.com

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EXECTUIVE SECRETARY'S REPORT

By the time most of you read this issue of the AMEA News, the Annual Meeting will be upon us.  My first year at AMEA has been informative, exciting, and disappointing.  Working with the excellent individuals on the Board has been a pleasure.  Responding to calls, letters and email from members and from members of the public and media has also been very interesting.

The greatest disappointment for 1998 has been the failed efforts to involve more industry organizations in safety programs.  Two separate attempts to hold a Rider Safety Summit attracted attendance from many organizations already active in this area and from a few other breed associations and show disciplines, but -- with two exceptions -- the organizations representing English riding had too little interest to participate.

The second major disappointment is the difficulty in getting out the message about approved protective headgear to riders (and the parents of young riders).  The office has received many calls this year from parents who have just learned about the ASTM/SEI helmets.  Most learned  in time, and were primarily interested in information about different types of headgear or proper fit of helmets (see accompanying article by Dru Malavase).  In two cases, a member of the family had suffered a head injury, and wanted to learn about head protection.

There are many myths and a great deal of misinformation circulating in the horse world.  "Helmets cause heat stroke."  "The weight of a helmet can increase the risk of neck injuries."  "All helmets give some protection, regardless of whether they meet the ASTM standard." Tragically, much of the bad information is coming from trainers, coaches or other riders.

A major riding program (hunter/jumper) I visited recently does not require helmets for riders over 18, and does not require ASTM helmets for the younger riders because, "they don't fit well and they are too heavy."  This program had a riding fatality last year from a head injury, but learned nothing!

As members of ASTM, I urge you to redouble your efforts and to speak out about rider safety.  If you talk with riders -- particularly novice riders -- be certain they understand the value of a protective helmet. If you do not have copies of AMEA's brochure "When Can My Child Ride a Horse?" please contact the office for free copies.  If you have an opportunity to use a video, the Washington State 4-H Foundation video Every Ride...Every Time can be purchased for $15, or members may borrow a copy from the office for 30 days for a rental of $3.  The AMEA's Rider Safety Video is available for $17.95, and covers a variety of safety issues.

The AMEA is slowly making a difference, but the daily involvement of  AMEA members can help speed the process, and that can mean many lives saved.
 
Michael Nolan
AMEA Executive Secretary
 
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