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]
The American Medical Equestrian Association believes that records of horse-related accidents provide means to learn about these accidents, how they can be prevented and/or their severity reduced.
Accident records present many problems.
1. Most activities do not keep records of injuries, reporting that their activities do not have accidents or injuries.
2. Most accidents are in recreational leisure riding, not shows, events, clinics, or classes.
a. This means by which these can be tabulated is through the emergency room records. The medical personnel may not know or be interested in the events involved in the injury, only the medical~spectss of the injury.
b. Another means of tabulation is through surveys, but the replies do not give an unbiased
3. Each study seeks different information with no agreement of what should be reported. Reports are difficult to be compared.
The National Electronic Injury Surveillance System (NEISS) provides the only national figures available. The NEISS is a division of the US Consumer Products Safety Commission. Through the National Injury Information Clearinghouse, NEISS provides figures on horse-related injuries that go to hospital emergency rooms over the nation.
NEISS changes the base figure as indicated by opening of new hospital emergency rooms, closing of some hospital emergency rooms and changes in the caseload in other hospital emergency rooms. This base figure was changed in 1990 and again in 1997 to reflect the most current figures from hospital emergency rooms in the United States. The 1997 sample update took into account changes between the 1985 and 1995 sampling frames. From these reports, NEISS projects national figures. These figures omit injuries not treated, treated on site, by private physicians, in free standing clinics or resulting in death without emergency room admission.
NEISS statistics for horse related injuries (product 1239) became available to the American Medical Equestrian Association (AMEA) in 1979 and continued until 1982. At this time, NEISS discontinued keeping figures on product 1239 as this was the time of federal budget cutting. With requests from the AMEA and the American Society for Testing and Materials (ASTM), the figures for horse related injuries was reinstated in 1987. The first report to the AMEA was in the was in the AMEA News Vol. 1, #2 May 1991.
The article in the AMEA NEWS 1991 compared the figures for the four years 1979-1982 with the years 1987-1990 as no figures were available for the years 1983-1986. These years, 1979 to 1986, were the years in which protective headgear was being introduced to the horse activities. The head had a decreasing percent of injuries during this period and there was an increase in the percent of injuries to the trunk. During these years we saw the beginning of the increase of injuries to the older riders, but the "older riders" were those in the age bracket of 25-44 years of age.
Females began to increase in the percent of those injured. Accidents at home increased, with those in supervised sports decreased. The editorial note stated the marked increase in injuries at home would seem to indicate that riders may use helmets and safety procedures at organized events, but at other times do not, which would explain the increase in injuries at leisure.
The figures beginning in 1991, according to Vicky Leonard, Technical Information Specialist, Consumer Products Safety Commission, National Injury Information Clearinghouse (NEISS), can be compared. The total figures for these years are:
Total Injuries Reported
During the years 1995 to 1996, we felt that the horse community was making progress in safety and that the total number of injuries were decreasing. However, the years of 1997 - 1999 have increases which should alert those in the horse community.
WHY? NEISS figures do not tell us the cause of any change. NEISS figures are simply observational statistics. The horse community can deny that NEISS figures are correct. The other alternative is to assume these figures are correct and attempt to see possible causes.
A possible reason for the increase in horse-related injuries is that persons are going to the emergency rooms with less severe injuries which increase the number of visits. Another reason is that greater numbers are participating in horse activities. The American Horse Council and the Horse Industry Alliance believe this is so. Conflicting information comes from horse tack, equipment and apparel manufacturers who report decreased sales.
Two influences can be seen that might cause a trend for an increase in the number of persons in horse activities. The first is that Americans have more time and money to spend on recreational activities, including equestrian sports. The second is that the baby boomer generation is continuing its active life style as the members grow older, while previous generations reduced their riding as they matured. This may be increasing the number of persons riding horses.
Body Part Injured
The most frequent area injured is the lower trunk, followed by the head and the upper trunk. [Table Two] Injuries to the lower trunk have had a gradual increase over the years 1991 to 1999, with no sudden increases or decreases. [Table Two]
Unlike injuries to the lower trunk, the number of head injuries has varied. In 1997 we felt that we were making advances in reducing head injuries, but the horse related head injuries have increased during the last two years. We can take comfort in the fact that although the total number of injuries has increased during the past two years, in 1999 head injuries were fewer than the previous years of 1992, 1994 and 1995.
Head Injuries as Percent of Total Injuries
Percent of Total
Since 1991, there has been a variance of the percent of head injuries to the total number of injuries with the smallest percentage in 1993, increasing to 1995, with a two-year decrease to 1997, with the highest percent of head injuries in 1998. In 1999, the percent is below the high of 1995, making it the third highest of the years recorded.
Face injuries have varied over the years 1991 through 1999. [Table Two] Except for polo, where face masks are sometimes used, no face protection has been available to equestrians. We have the fewest number of face injuries in 1997, with the number increasing in 1998 and 1999. However, unlike head injuries, the numbers are below that of 1991 and 1992. We do not have the answer to why face injuries have decreased more than head injuries.
The upper trunk (chest) has the third largest number of injuries. [Table Two] 1997 had the lowest number of injuries and 1999 the highest. These same increase is seen in the total number of injuries as well as in head injuries. If there has been increased use of protective vests in 1999, these figures do not show any decrease that might have been the result of this use. The horse community beginning this year has an ASTM standard vest. Previously, the body protectors were industry certified, varied in the padding, the area of body covered, and claims for protection.
Type of Injury
Contusion/abrasions understandably are the most common injury. Following closely is fracture with sprain/strain considerably less. Concussion is a far sixth, following internal injuries. Many concussions never arrive at the emergency room, and if the concussion is mild and associated with other injury, such as fracture, laceration or internal injury, the concussion may never be entered on the discharge diagnosis.
The total number of fractures had the lowest figure in 1997 and the highest figure in 1999. The same trend is also showing in the United States Pony Club accident study.
Fractures of the upper trunk would include rib, clavicle, shoulder and thoracic spine. These fractures have the lowest figure in 1997, but have increased in the last two years. The figures in 1998 and 1999 are below those of 1995 and 1996.
We know that vests will not prevent fractures of the spine. As most of the clavicle fractures are from forces transmitted from the upper extremity these would not be prevented by a protective vest. The only fractures of the clavicle that would be prevented would be those from a direct blow, and these might only be prevented by the use of properly located shoulder pads. Rib fractures from crushing or the body hitting an object or from the horse falling on the rider would not be expected to be reduced. To date we have not seen a study of rib fractures that might be reduced by a protective vest.
The greatest increase in the number of fractures is in the lower trunk. [Table Five] This would be the pelvis, hip, coccyx and lumbar spine. These fractures have increased more than those of the upper trunk. Prevention of the lower trunk fractures has not been addressed specifically. Orthopedists and physiotherapists should look for training procedures to reduce these fractures.
Wrist and shoulder fractures have both decreased. [Table Five] As riders fall on their outstretched arms, they are taught to keep their hands turned in. This tends to keep the elbows flexed and provides more give in the arm. With the hands turned outward, the tendency is to lock the elbow in extension, making the arm rigid and more likely to fracture. Vaulting and practicing the emergency dismount teaches this skill.
Females have more injuries than males in horse activities. Females had more injuries in 1999 that in any previous year except 1992. Although males had fewer injuries in the years 1996-1998 than 1999, 1999 had fewer injuries than the years 1991-1995
|1991||38 %||62 %|
If in place of numbers, we look at percent of male-females, the year 1991 has the same percent of male-females as 1999. The smallest difference in percent was in 1996.
The number of horse related injuries relating to age has changed during the nine years of NEISS figures. During this time, the injuries to the 0-4 year old have decreased. This would indicate that parent education and supervision has improved during these years.
Injuries to the 5-14 year old have decreased. This is the result of education both of the parents, the children themselves, and increasing mandates for safety in the youth activities.
An increase in injuries is also seen in the horse community 45-64 years of age. These are the traditionalist who feel that their experience has prevented an accident and they do not need to make any changes in their riding habits or respond to the recommendation for safety. As mentioned under the increase of persons in the riding community, this is the age of the baby boomers and we may be having an increased number of participants in these years. It is possible that each one is having no more accidents than previously but as a group the numbers show an increase.
The ages of 65 and older have a projected varied number of injuries, which relates to the small numbers. The figures would indicate that there has been little change in the absolute numbers, but with the increase of all injuries, their proportion of the total injuries would have decreased.
The figures on location of the horse related injury proposes other aspects for consideration. After the decrease through 1997, injuries at home have increased, but these figures are at or below those of 1991 and 1992. We believe that injuries at home are related to education and role models for those riding. At home there are no mandates for safety. These figures are encouraging.
NEISS defines as public lands those lands that are not streets or highways. This would include city, state or federal trails, arenas, show rings, parks and forests. Injuries on public property which after a high figure in 1995 and the lower figure in 1996, have increased above the figures of 1991-1994. Until public facilities determine that it is within their interests relating to legal liability to mandate safety measures, this figure may continue to increase.
The greatest increase has been in sports activities. These are the activities that could change their rules and procedures to those that have been shown to increase safety. This is a condemnation for every activity, administration and governing board. The first step would be for the organization to appoint a safety committee, conduct a study of the organization's activities to determine where, when and what type of injuries are occurring in the activities. With this information, recommendations should be made by the study/safety committee, and these recommendations followed by the governing board.
Horse related injuries have increased.
The most common body parts are the lower trunk, the head, and the upper trunk. Lower trunk injuries have had a gradual increase during the years of 1991 to 1999. In 1999 lower trunk injuries exceeded head injuries by a fourth and upper trunk injures by a third. The number of head injuries has varied greatly, with the highest number in 1994 and the lowest number in 1997. The numbers have increased both in 1998 and 1999. Upper trunk (chest) injuries have increased, having the highest number of injuries in 1999.
The highest injury type is contusion/abrasion. The second in frequency is fracture, with the third sprain/strain. The most common fracture is of the upper trunk, second is the lower arm and the third most common fracture is the wrist.
Females have more injuries than males with the spread increasing in 1999. The ages 25-44 years have the greatest number of injuries, but the greatest increase in the number of accidents has been in the years 45-64. The number of accidents in the ages 0-4, 5-14 and 25-44 years have all decreased, with the greatest percent increase in the 15-24 years age group.
Injuries in sports have increased, while at home and on the farm they have decreased.
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