University of Vermont AAHS
AMEA

September 2001, Vol. XII, Number 3

 Table of Contents


United States Pony Club Accident Report 2000
A Note from the AMEA President
Question & Answer
Children Deserve Better
Horse and Rider Safety Committee Formed
National Injury Data Reveals Details About Accidents


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United States Pony Club Accident Report 2000

Introduction

The United States Pony Club has been reporting accidents involving its members to the Safety Committee since 1979. Both accidents resulting in injuries and those without injuries are being reported. Age, gender, rating, cause of accident, site of the accident, and if there is an injury, type of injury, body location, and treatment is tabulated by the Safety Committee. The Safety Committee uses this information to give an annual report to the Board of Governors, and if indicated, make recommendations aimed at providing the safest possible experience for our children.

A total of 110 accidents were reported nationally during United States Pony Club activities in the year 2000, of which 89 resulted in injuries. Although this represents an increase from last year’s total of 81 accidents reported, it still fell below the 130 reported in 1998, and is similar to the 106 reported in 1997. Although it is suspected that the vast majority of accidents resulting in injuries were reported, accidents which don’t result in injuries were probably underrepresented.

The charts below compare the percentages of children in each category for the years 1999 and 2000. The word "pony" is used loosely to refer to both horses and ponies.

 

UNR (Unrated) are not rated as to their riding ability.   A D1 rating requires a child to be able to mount and dismount correctly, sit in the saddle with a balanced seat, control the horse in a stop and turn while walking.  A D2 rating requires these controls at a trot, canter and the correct leads, riding in the open and jumping.  The D3 rating requires emergency dismounts, riding without stirrups, backing the horse, pulley reins to stop a horse and changing speeds.  C is an intermediate level of horsemanship with ability to ride independently and correctly on the flat, over fences, and in the open as well as beginning skill in teaching others horsemanship.  The B, HA, and A ratings are national ratings.  The A is divided into two parts:  The HA which covers horse management, teaching and training, and the A which tests the riding phase.  It includes being able to ride different horses at various stages of training, assessing each horse's level of schooling, recognizing problems, and formulating a long-term plan to improve the horse's training.

 

1999-2000 Accidents by Ratings
Percentage of All Accidents

Rating

1999

2000

UNR 7 5
D1 12 15
D2 27 27
D3 12 24
C1 12 15
C2 14 10
C3 6 1
B 4 0
H, HA 0 3
N/A 5 0

 

2000 Accidents by Membership Percentage

Ratings

Accident Percentage

Membership Percentage

UNR 5 21
D1 15 15
D2 27 20
D3 24 15
C1 15 12
C2 10 8
C3 1 5
B 0 2
H, HA 3 2

 

Ratings

The first table above shows the percentages of ponyclubbers involved in accidents for the last two years. The second table compares the percentage of differently rated ponyclubbers with the percentages they comprise of USPC membership. D3’s have seen the largest increase in the percentage of accidents as compared to last year, but accidents among all D’s and C1’s are on the rise. If one looks at the membership percentages, it appears that we are doing an excellent job of supervising our unrated ponyclubbers and at least a fair job with our D1’s. D2’s, D3’s, C1’s and C2’s all have numbers of accidents higher than the membership percentage would account for. Only 3% of all accidents were seen among the B’s, H’s, HA’s and A ponyclubbers. When one adds C3’s to this group, the rates of accidents of the higher ratings is about half that of the membership. Accidents appear to be less likely with education and experience. Although not listed on the table, eight percent of accidents involved male ponyclubbers which matches the membership percentage. Boys appear to be no more or no less likely to be involved in accidents.

 

Percentage Accidents by Age
1999-2000

Age

1999

2000

5 & under 1 0
6 to 8 5 3
9 to 11 23 22
12 to 14 35 42
15 to 17 26 28
18 & over 10 5

 

Age

Only 3% of accidents in 2000 involve children who are 8 years of age or younger, and they comprise about 5% of the membership . We seem to be doing an excellent job with supervision of this very young age group. One again, our oldest members, usually our most experienced and well-educated members, also seem to have a low accident rate as compared to their membership figures. Forty-two percent of all accidents involve children between the age of 12 and 14, and another 28% are seen in the 15 – 17 age group, for a total of 70%. We are seeing most of our accidents in the 12 – 17 age group, and their numbers surpass their membership percentages of 59%. This is a tough age group, they are adolescents who are balking at authority figures and are more likely to engage in risky behavior.

 

Percentage Accidents by Activity
1999-2000

Activity

1999

2000

Cross Country 22 17
Jumping 17 26
Mounted Meeting 17 26
Games 14 3
Rally 12 3
Other 17 25

 

Activity

Seventeen percent of the accidents were seen while schooling cross-country, and another 26% while jumping in an arena, for a total of 43% of the accidents being directly related to jumping. This is a slight increase over last year’s combined 39%. Another 26% occurred during general mounted meetings. Twenty five percent occurred in other activities not listed. Most of these occurred in the barn and stabling area, either before or after riding. Three percent of this 25% occurred during polocrosse, and four percent during dressage. Six percent of the accidents in the "other" group occurred during pony club activities but were not directly related to horses or riding, e.g. two children slammed their hands in stall doors. Four percent occurred while children were grooming their ponies. One accident each occurred while riders were loading, lunging, mounting, trailriding, foxhunting or leading their ponies. There was a large decline in the number of accidents associated with games and gymkhana.

Percentage of Accidents by Location
1999-2000

Location

1999

2000

Arena/Ring 37 53
Outside Course 40 26
Saddling 4 5
Trail 4 2
Pasture 11 5
Other 6 8


Location

 

The majority of the accidents in 2000 occurred in a riding arena or riding ring, with 53%. This is a significant increase over last year’s 37%. The number of accidents occurring on outside courses, primarily during cross country schoolings, has declined since last year, from 40% to 26%. Approximately four out of five accidents are occurring either in riding rings/arenas or on outside courses. This might be because this is where riders are spending most of their time. In 1997 and 1998, no accidents were reported in the saddling area. In 1999 and 2000, 4-5% occurred in the saddling area.

 

Percentage of Accidents by Causes
1999-2000

Causes

1999

2000

Pony refused jump 17 8
Pony fell or stumbled 17 9
Pony bucked/reared 15 27
Pony kicked rider 1 5
Pony spooked or shied 15 12
Pony overjumped 5 2
Rider not in control of pony 7 5
Rider out of position 12 19
Unrelated to riding 2 5
Other 7 6

 

Causes

 

The biggest jump in causes of accidents was seen in those involving ponies that either bucked or reared, thus unseating the riders, increasing from 15% to 27%. Another significant increase was seen in the number of riders getting kicked, increasing from 1% to 5%. Two of these children were kicked when they fell. Another was kicked when her pony spooked, one was kicked by another horse while on horseback, and one rider was kicked while bandaging her ponies front legs. In addition, not included in the statistics were two adults who were kicked by children’s ponies. Accidents related to riders being out of position, usually related to rider inexperience, also increased. Less accidents were seen that involved ponies that refused jumps or fell or stumbled.

 

Percentage of Accidents by Area of Body Injured
1999-2000

Area of Body Injured

1999

2000

Head 14 12
Face 6 12
Dental 1 2
Neck 7 6
Dorsal/Lumber Spine 6 13
Chest/Ribs 3 0
Collarbone 3 2
Shoulder 12 6
Upper Arm 3 0

Elbow

4 4
Forearm 7 7
Wrist/Hand/Fingers 25 12
Pelvis/Hip 12 12
Buttock 3 2
Thigh 3 2
Knee 10 3
Leg 3 9
Ankle/Foot/Toe 6 10

 

Area of Body Injured

 

There were a total of 89 injured ponyclubbers, but if more than one body area was injured, all injuries are included in these statistics. Facial injuries doubled from 1999 to 2000, jumping from 6% to 12%. Facial injuries were limited to lacerations and bruises and abrasions, but three ponyclubbers in 2000 required facial sutures. In addition, two children suffered dental injuries, double that of last year. Injuries to the dorsal/lumbar spine area also doubled, but once again, these were mostly limited to bruises and abrasions with two accidents involving muscular injuries. There were no actual spinal injuries among ponyclubbers. Shoulder injuries declined significantly, as did injuries to the hand and wrist, and injuries to the knee. There was a two-fold increase in injuries seen involving the leg (other than the knee) and the foot and ankle area over last year, but the 10% foot and ankle injury rate still falls below the 12% average seen in the previous fifteen year study (1982-1996).

 

Percentage of Accidents by Type of Injury
1999-2000

 

Type of Injury

1999

2000

Laceration/No sutures 0 2
Bruise/Abrasion 33 39
Closed Fracture 25 22
Sprain/Muscle Pull 17 18
Concussion/Conscious 9 6
Concussion/Unconscious 4 3
Laceration/Sutures 6 4
Dislocation/Separation 6 1
Open Fracture 0 2
Sunstroke/Heat Exhaustion 3 0
Internal Injuries 0 2

 

Type of Injury

 

Bruises and abrasions continue to be the most common type of injury, with 39% falling into this category. The number of fractures has remained steady at 23%, which is somewhat higher than the 17% reported during 1982-1996. Muscular injuries have also remained steady. No heat related injuries were seen in 2000, but there were two children who were reported to have suffered internal abdominal injuries, one of which was non-horse related. The number of concussions declined since last year, accounting for 9% of injuries, which is similar to the rate reported from 1982-1996. Education of our pony club parents and instructors about the signs and symptoms of concussions are likely causing more concussions to be identified than in earlier years, so this 9% may actually represent a decline.

 

Percentage of Accidents by Type of Treatment
1999-2000

 

Type of Treatment

1999

2000

No Treatment 30 31
Treated on Grounds, returned to ride 2 6
Treated on Grounds, unable to return to ride 4 1
Taken to Hospital, able to return to ride 3 3
Taken to Hospital/MD, Unable to return to ride 52 48
Hospitalized 0 2
Expired 0 1

 

Treatment

 

Almost half of accidents reported resulted in children requiring transport for medical treatment and being unable to return to ride that day. This number has remained steady since statistics were begun being gathered in 1982. The second largest number of accidents, 31%, required no treatment. This is higher than the 23% reported between 1982 and 1996. Three children were hospitalized. While this is higher than the numbers reported in 1997-1999, it is much lower than the almost 10% reported between 1982-1996. Tragically, there was one fatality this last year resulting from a traffic accident on the way to a pony club activity.

 

Conclusions

 

Our members are all wearing helmets that meet ATSM standards during all mounted activities, as required by Pony Club guidelines. From the information gathered from the accident reporting, compliance is a non-issue and as a result, the incidence of head injuries has declined significantly since these guidelines have been in place. Our riders are also wearing approved footwear when working around horses, thus contributing to the decline in foot and ankle injuries from the fifteen year study. The increase in 2000’s leg and foot injuries as compared to 1999’s injuries, however, needs further monitoring to determine if this was merely an increase limited to this last year. The use of vests is becoming increasingly commonplace, especially during cross-country schooling, although they are not mandated by USPC. Unlike helmets, the jury remains out as far as what level of protection vests actually afford. The vast majority of parents of children who do wear vests believe that the vests are preventing more serious injuries, but this is anecdotal at best.

Of the 110 ponyclubbers involved in accidents in 2000, 22 were wearing vests. There were two fractured collarbones in 2000, one rider of which was wearing a vest. There was one incident of abdominal internal injuries in a vest-wearing rider. The most common injury to the area covered by vests were bruises/abrasions to the lumbar spine. Eight of these occurred in riders not wearing vests only one in a vest-wearing rider, which would point to vests being helpful in preventing these sorts of minor injuries. One concern that had previously been aired was that vests would contribute to heat-related injuries. There were no heat injuries reported last year. We will need more numbers to make any type of valid conclusions about the efficacy of vests in reducing serious injuries, and more consistency in children wearing vests that meet the similar testing standards that are currently available with helmets.

Because so many of our accidents are related to jumping, we need to be sure that we have adequate supervision during jumping activities. Also, because many of these accidents are occurring on outside courses, with possibly difficult accessibility to medical care, we need to have a plan in place ahead of time should a medical emergency arise. We need to know what can possibly go wrong and devise a plan of action. In all activities, mounted or unmounted, this would include knowing the student’s medical histories. For example, are they allergic to bee stings? Are they asthmatic or diabetic? Prompt and appropriate interventions in these cases can prevent serious complications. As we continue to see a significant number of accidents occurring when children are unmounted, we need to make sure that we are providing supervision both before and after mounted meetings. With the increase being seen this year in the number of children being kicked, education should include a healthy respect for a pony’s back legs, and knowledge that horses can behave unpredictably when they feel frightened, surprised, or threatened. With the high numbers of accidents being seen in the D2 – C2 ratings, and especially at the D2 and D3 levels, we need to make sure that we are providing them with adequate supervision. The same need for some extra supervision applies to our children between the ages of 12 and 17.

In 2000, twenty-seven percent of the accidents resulted from ponies that threw their riders by either bucking or rearing. Another eleven percent resulted from ponies that spooked or shied, and five percent from ponies that kicked their children. This number is much higher than last year, and supports our need to continue to make sure that our children, especially less experienced children, are riding safe and suitable ponies. Addressing unsuitable mounts with parents can be a highly charged issue, but our pony club leaders and instructors need to be willing to be politically incorrect. Disobedient ponies put both their riders and the other riders around them at risk for injuries.

 

Laura Carr, RN, BSN
Safety Committee
United States Pony Clubs, Inc.
3186 Burnham Court
Lexington, KY 40503

Article courtesy USPC News


A note from the AMEA President

An Urgent Message

October 3, 2001. This is an urgent message to all members and potential members of the AMEA. The Board of Directors of the AMEA met tonight via conference call and needs you all to know the following:

Recent events, including the hideous 9/11 debacle and the resignation of our Executive Director, have forced the BOD to cancel the upcoming Annual meeting in February 2002 in Atlanta, Georgia.

We need to fill the position of Executive Director with a person who is dedicated to equestrian safety and has some connection with medical issues in order to continue the valuable work of the AMEA. WE hope to hear from any of you interested in leadership in safety with the AMEA. The job is not onerous but must be done with skill.

Many use AMEA Newsletters as the only resource for information on rider safety and equestrian sport medicine issues. We will print the next Newsletter in December thanks to the CHA, Carol Parker, Dr. George Koepke, Dr. John Stremple, and Dr. Doris Bixby-Hammett who continue to soldier on in the cause of equestrian safety.

We require funds to print th next Editions of the Newsletter if it is to continue as an educational and informative resource to the equestrian and medical communities. Membership dues for 2002 are due by December 15,2001 and without them we cannot produce the March Issue of the Newsletter. Please make sure your check is In the mall and encourage yours friends and colleagues to join if they are not members.

The BOD needs input from membership to delineate the role of the AMEA for the future. We have previously noted our role to be education, research and resource but perhaps there are other arenas In which we can fight the battle for safe riding. Some say we are a "helmet" committee but we have expertise in many other medical issues. We are prepared to support members In safety committees across North America and would welcome the opportunity to advise safety standards based on scientific medical research. Please take a moment to consider what information you need to see in the AMEA Newsletter and where you would like to see the AMEA focus in the future and send us a letter or e-mail today.

We apologize for the tardiness of the Newsletter and thank the CHA for it's continued support in getting AMEA through a difficult transition.

Yours respectfully,

Janet M. Friesen, MD
President
American Medical Equestrian Association

 


Question & Answer

Q:  "Can horses contract Lyme Disease? Is there an inoculation to prevent it?

Zhana M.

A: A serologic survey of horses in a highly endemic area of Monmouth County, N.J., and in a less endemic area of Pennsylvania has revealed that approximately 10%2of horses have serum antibody evidence of infection by Borrelia burgdorfei, the spirochete responsible for Lyme disease. The incidence is higher in 9 states i.e. Northeastern coastal areas including Assateague Island, MD., Cape Hatteras, NC and coastal portions of Virginia.3 It is essentially nonexistent in several other states. It is present among horses in the United Kingdom, Europe and Asia. Infected horses (serologic positive) may appear to be normal or may have dermatitis, swelling of legs or arthritis.4 The diagnosis of Lyme borreliosis in horses is difficult and confirmation relies on serologic testing or culture of the organism.

Successful vaccination of a horse against Lyme disease was described late in 1999 and again in January, 2000.5,6,7 A comparable vaccine became available commercially shortly thereafter, and is given by veterinarians to several mammals. It is recognized that it will not prevent disease among humans 15 to 70 years of age who already have unrecognized infections at the time of vaccination nor against other tick-born diseases.8,9 It is recommended for those at work or recreation in tick-infested areas. The efficacy in children under 15 has not been evaluated.

I am aware of but one report to verify the incidence of human infection acquired from a bite by a tick and in which a horse served as the host.12 Although there are approximately 15,000 new cases of Lyme disease reported to the U.S. Center for Disease Control each year, physicians and veterinarians are not uniformly agreed to vaccinate horses and humans. It is known that if the tick is removed from a person within 72 hours from the time that her (or she) is bitten, the overall risk of Lyme disease is but 3.2%.

Based on an assessment of the risks, consequences of Lyme disease, the adverse effects and efficacy of antimicrobial prophylaxis, a panel of the Infectious Disease Society of America recommended in 2000 that persons bitten by ticks should not routinely receive antimicrobial chemoprophylaxis.11 One wonders if the panel might reconvene to change their recommendation after considering data of more recent investigations and conclusions of researchers in the July 12, 2001 issue of The New England Journal of Medicine that a single dose of doxycycline for those over 15 years of age, is highly successful to provide prophylaxis for Lyme disease.10 Additional treatment is described by Steere for the several manifestation of Lyme disease that vary from skin disorders, arthritis, neurologic and cardiac disease.9

Conversations with qualified veterinarians in Ohio (where tick-born Lyme disease is seldom seen) brought mixed reactions about screening horses for Lyme disease infections. They admitted that they use comparable Lyme disease vaccine to protect dogs and other mammals. Perhaps a decision to test or to treat a horse for infection should vary with a history of exposure to ticks in known endemic areas and for possible signs of infection with Borrelia burgdorferi.

References:

1. American Association of Equine Practitioners (on line). Lyme Disease in Horses. Bushmick S L copyright 1996.

2. Cohen D et al. Epidemiologic studies of Lyme disease in horses and their public health significance. Ann N Y Acad Sci. 1988: 539:244-57.

3. Oliver J H Jr. et al. Ticks and antibodies to Borrelia burgdorferi from mammals at Cape Hatteras, NC and Assateague Island, MD and VA. J Med Entomol. 1999 Sep;36(5):578-87.

4. Parker J Letal. Lyme borreliosis in cattle and horses: a review of the literature. Cornell Vet. 1992 Jul: 82(3)253-74.

5. Chang YF et al. Vaccination against lyme disease with recombinant Borrelis burgdorferi outer-surface protein A(rOspA) in horses. Vaccine. 1999 Oct 14; 18(5-6):540-8.

6. Chang YF et al. Experimental infection of ponies with Borrelia burgdorferi by exposure to Ixodid ticks. Vet Pathos. 2000 Jan; 37(1):68-76.

7. Chang YF et al. Human granulocytic ehrlichiosis agent infection in a pony vaccinated with a Borrilia burgdorferi recombinant OspA vaccine and challenged by exposure to naturally infected ticks. Clin Diagn Lab Immunol. 2000 Jan;7(1):68-71.

8. Physicians' Desk Reference, Fifty Fifth Ed. 200-:3108-3111.

9. Steere, A.C. Lyme Disease. N Engl J Med.2001 Jul 12;345(2):115-123

10. Nadelman, R B et al. Prophylaxis with single-dose doxycyline for prevention of Lyme disease after an Ixodes scapulasis tick bite.N Engl J Me.2000 July 12;345(2):79-83.

11. Wormeser G P et al. Practice guidelines for the treatment of Lyme disease. Clin Infect Dis.2000;31:Suppl 1:51-514.

12. Marcelis L et al. Horse reservoir for Borrelia burgdorferi. Lancet. 1(8539):977.

George H Koepke M.D.

 

Q:  1 am a 57-year-old female rider with moderate osteoporosis and "attendant bursitis." I enjoy jumping with stallions and I am determined to ride against the advice of non-riding doctors. Where can I obtain more information on the subject?

A: Osteoporosis is a generalized and progressive decrease of bone density. In osteoporosis, the normal rate of bone resorption is accelerated over the rate of bone formation. This leads to the bone becoming less compact or less dense and to fracture with little or no trauma. Bone density is easily measured and can serve as a reliable predictor for fracture. This altered metabolism of bone is usually the result of altered gonadal hormones. Hormonal changes may occur with aging, diabetes, blood disorders, endocrine disorders, liver disease, kidney disease, rheumatoid arthritis, sarcoidosis, chronic obstructive pulmonary disease, cancer and the adverse effects of numerous drugs.

The primary goal is to avoid fracture and to treat the cause. The advice of your physicians to not ride is justified, in addition to the suggestions given in the Feb., 1994, Issue of the AMEA News, is to ask a hospital librarian for the opportunity to read articles on osteoporosis that are found In the textbooks of medicine and orthopedic surgery.

George H. Koepke M.D.

 


Children Deserve Better:  A Plea for "Grown-up" Behavior in the Helmet Debate

 

An "advertisement" against the Safety Headwear Rule Change appeared on page 23 of the August 31st issue of The Chronicle of the Horse. The unsigned piece used inflammatory, emotional phrases to present the argument that safe helmets should not be mandated until there were enough styles to basically ensure each child a custom fit. It ended by urging persons who agreed with the mystery author to contact USA Equestrian. Unfortunately, those of us who disagree with the writer are left no recourse, since the author lacked the courage to sign his or her name to the manifesto. Since The Chronicle will not accept Letters to the Editor in regards to Advertisements, I've chosen to "pay" to have a response published.

As a pediatric oncologist and hospice physician, I've witnessed this emotional, immature response many times when public safety standards are initially mandated. It's been hard for Americans to balance personal freedom with public safety, whether it has concerned seatbelts or public smoking.

However, the vast majority of Americans have always wanted to protect our children from harm with the safest products available. The mandated use of car seats, bicycle helmets and immunizations are examples. The regulated manufacturing of safer cribs, toys and sleepwear have improved the chances that each child born will live to a productive and happy adulthood.

Now, In the equestrian community, we are struggling to balance the science of protecting children's lives and brains with the traditions of appearance, fit and acceptance. While there is no scientific doubt that use of approved helmets saves lives and reduces the severity of head injuries, we can anticipate the need for continued improvement and "fine tuning" of both the helmets and rules. To do that, we in the adult community need to model cooperative decision-making and problem solving. This is not a time to take nameless potshots at efforts to save children's lives; It's a time to enter into open discussion about how best to accomplish what is surely our mutual goal.

Sincerely,

Kate Faulkner MD
Dover, MA. 02050

 

Editorial Note:

Dr. Faulkner stressed the importance of headgear for children. I want to stress the importance of all mounted riders wearing approved protective headgear. In the 51 North Carolina medical examiner horse related deaths during the years 1990 1999 (AMEA News. June 2000), 8 were below the ages of 19 in which 6 were head injury deaths (75%). However of the 31 deaths over the age of 18 year, 25 (80%) were head injury deaths.

It is important that the adults give children role models in wearing protective standard certified headgear, but it is for adults own lives. Their children will not grow up without a parent or a grandparent and the community will not lose a productive citizen.

Doris Bixby Hammett MD 


Horse and Rider Safety Committee Formed

 

Linda Mansmann, RN, has agreed to chair the new Horse and Rider Safety Committee of the North Carolina Horse Council. The purpose of the committee is to explore the prevention of injury and reduction of risk of injury to horse and/or rider.

Ideally, members of the committee should have experience In a medically related field: MD, RN, EMU Respiratory Therapist, etc. and thereby would have some experience with trauma, CPR and universal precautions. In addition, they should be a horseperson with first hand knowledge of sporthorse activities, have computer knowledge in order to communicate with committee members by email, willingness to work independently on projects and participate in bi-monthly meetings. They should also be a member of the North Carolina Horse Council.

The agenda for the committee will be to study and design recommended protocols for (1) Rider falls: when is it okay to get back on the horse? (2) Emergency response for horse and rider at public events equipment, level of training of emergency personnel. (5) Multiple trauma victim/collision: how to stabilize victims who must be moved to safety. (4) Schooling/ring safety recommendations. (5) CPR training for event personnel. (6) Accident review task force. (7) Target trainers as safely captains. (8) Barn safety recommendations.

Potential projects include: a safety helmet promotional program, data collection with resource list, rider safety promotion in North Carolina and a mock rescue project involving a horse rider trauma. Committee members will determine additional projects. The overall goal of the committee is public education through materials, videos, brochures, and the utilization of REINS volunteers.

Linda Mansmann
(919) 942-6341
fgfarm@mindspring.com



National Injury Data Reveals Details About Accidents

 

by Doris Bixby Hammett MD

Founder and Member of Board of Directors of American Medical Equestrian Association

[Reproduced from Spring 2001 Caution: Horses, Vol. 6, No 1.]

http://www.law.utexas.edu/dawson/safety/national.htm


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