University of Vermont AAHS

February 1998, Vol. IX, Number 1

 Table of Contents

 Accidents Make Us More Aware
 Dru Malavase Responds
 Equestrian Helmet Testing
 Head Protection Research Laboratory
 Editorial Comment
 USCTA Annual and Safety Committee Meetings
 Energy Cost of Riding
 Presidential Address
 A Personal Experience of Thirty Years of Riding Accidents
 News Items
 Educational Material Available to Order

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Denny Emerson

At the Blenheim CCI*** (England) on September 4-7, Sam Moore from Ireland was killed in a cross-country fall. The following weekend at the Burghley CCI*** (England) American team riders Karen O'Conner was knocked out for a brief time and Canadian team rider Chaire Smith was hospitalized with a serious head injury. The following weekend, at the Fair Hill Horse Trails (MD) Amanda Warrington was sent to the intensive care with head injuries. (Ed. Note: She died.) At the Bromont Horse Trials (Quebec) on September 26-28, where I was competing, these accidents were the main topic of conversation.

It is not possible to have such a spate of serious accidents without casting a pall of sorrow and worry over an entire sport. Eventing has never been, nor can it ever be, a risk-free sport. No sport that involves galloping and jumping horses over fixed obstacles can be completely safe, but that doesn't mean that it can't be made safer.

Eventing is not going to get substantially safer though, unless a number of different constituencies work together toward that objective. These constituencies include riders, coaches, parents, event organizers, technical delegates and officials, and a small but highly visible group of "famous riders."

Here are some questions that members of each of these groups who are interested in safety might ask themselves. (I am well aware that there are quite a few high-risk personality types in eventing who won't think much about safety so they won't think that this "questionnaire" is relevant to them.)

Questions For Riders:

1. Am I physically fit, am I pretty weak, or am I somewhere in between? Tough agile, wiry people are much more likely to stick on over fences and are much more likely to be able to help a tiring horse keep his own balance.

2. Am I riding at my competence level? One way of really asking for trouble is to try to move up the levels of competition before being adequate at preceding levels.

3. Am I riding at my comfort level? A rider may be physically competent to ride at preliminary, for example, but may simply feel too nervous and scared to succeed. The kind of fear that is debilitating is not simply pre-competition nerves, which everyone feels, but real fear of physical injury.

4. Am I riding a good horse? Horses that rush or hang their knees, or quit and spin out the last second, or rear or buck, greatly increases a rider's chances of injury.

5. Do I wear a properly affixed helmet whenever I get on a horse? Injuries to most parts of the body can usually get fixed, at least to some extent. Many head injuries leave people permanently changed.

6. Do I school over fences alone or do I make sure some one is available to get help in case I have a wreck?

7. Do I have a clear understanding of galloping techniques and can I ride competently at speed?

8. Does my trainer emphasize safety? Does he/she insist that I wear a helmet? Does he or she set an example by practicing safety procedures himself or herself?

Questions for Trainers:

1. Do I insist that my riders always wear protective headgear? Do I have them wear body protectors when jumping cross-country?

2. Do I set a good example by doing so myself?

3. Do I try to explain to them and, if relevant, to their parents how crucial it is to have the right horse?

4. Do I try to make sure that my students are riding at the levels for which they are confident and capable, or do I let them (or their parents) push to levels above their abilities? 5. Do I talk with the technical delegate at an event if I see what I believe is a truly dangerous fence? Or do I "not make waves" and just hope nothing goes wrong?

Questions For Parents:

1. Do I insist that my child gets lessons from a competent instructor?

2. Does that instructor practice safety habits such as insisting that my child always wears appropriate headgear while riding? Does the trainer himself or herself set a good example in that regard?

3. Do I support what the instructor tells me about the suitability (or unsuitability) of my child's horse, or do I let my child make that decision, even though my child's opinion may be based more on emotion than on reason?

4. Do I support what the instructor believes to be the appropriate level of competition for my child, or do I let my child have his or her own way if she/he wants to ride at a higher level than that for which the instructor feels she/he is ready?

Questions for Event Organizers:

1. Is safety a major concern, pervading many of the decisions I make concerning the conduct of my event?

2. Does my course designer share my commitment to safety? Does he or she use ample ground lines and build inviting fences, or is he or she known for creating difficult, vertical, trappy questions?

3. Do I cooperate with safety requests from my technical delegate, such as placing a row of hay bales in front of a table? Or do I resist this kind of pressure and decide that next time I will find a tame T.D. who won't hassle me?

Questions For Technical Delegates and Officials:

1. Do I rate safety a highest priority?

2. Do I insist that dangerous or overly difficult fences either get modified or removed from the courses, or do I avoid creating extra work for my employer, the organizer?

3. Do I listen with an open mind to concerns of coaches or competitors regarding safety issues, or do I feel that they are being overly cautious and frequently deny their request for fence modifications?

4. Do I accept the designation that has been placed upon me, as a technical delegate, as "the last line of defense for the horse and rider?"

Questions For Famous Riders:

1. Do I feel that my high visibility and the support I may receive from the U.S. Equestrian Team or the Canadian Equestrian Team places me under any obligations as a role model?

2. Do I practice safety, especially in public, such as wearing approved helmets whenever riding?

3. When I am teaching clinics, or teaching at home, do I insist on safe procedures?

Famous riders are role models to youngsters, whether they accept or reject that designation. Some of our top riders are very conscientious in this regard, but an even larger number are not.

I never used to give safety a thought. I've probably ignored every safety-related suggestion I've made here at some time in my eventing career. I even used to school alone over cross-country fences without a helmet on bad horses; and at the time, I considered it normal practice.

Several factors have changed my attitudes about safety. One is that I have gotten older. At 20 or even at 30, your immortal. You don't think it can happen to you. I heard a statement from a woman at a clinic that related to how your attitudes change. "If you're over 40, and you wake up in the morning, and nothing hurts, you're dead!"

Another thing that has made me much more aware of safety is having my own children, who are now adults. All parents know how vulnerable they are to anything that threatens their children. Also, too many of my friends have had serious riding accidents, and I don't like that. I've had some riding accidents myself, and I like that even less.

And finally, serious accidents wound eventing as a sport. Collectively we have made great progress toward making eventing much safer for both horses and riders. This latest serious of incidents, though, shows us that there is never an appropriate time to become complacent about making eventing a safer sport.

The questions I've asked here are only the ones that several other trainers and I came up with at Bromont. I am sure there are may others that are equally important.

It is one thing, or course, to ask the right questions. It is something else to come up with the right answers, and that can only be achieved through collective effort.

Reprinted by permission from The Chronicle of the Horse: October 17, 1997.

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Denny Emerson emphasized wearing "a properly affixed helmet", "protective headgear" and "approved helmets". However, it is really prudent to make certain that the helmets worn by eventers are certified to meet the highest available standards, since the nature of the sport coupled with the speeds required assure that there will be many falls with head and face impacts every year.

Of the injured riders mentioned in Denny Emerson's article only Claire Smith, a Canadian, was wearing an ASTM/SEI certified helmet (made in 1991 according to her father). From their photos, the others, like the majority of our U.S. top level eventers (including several who have sustained severe head injuries during the past year), chose to wear helmets made to the 1988 BS4472 jockey helmet standard, now obsolete in the U.K. and no longer permitted by our National Steeplechase Association.

The USCTA news of November 1995 gives a thinking rider all the ammunition any rational person needs to change to more protective helmets from the BS4472. Unfortunately Mr. Emerson is right; too many "top" riders apparently believe themselves to be above the need to protect their heads.

In England, the Mark Davies Injured Riders Fund has commissioned independent research which compares the British PAS 015 standard (far, far more protective than BS4472 or the new ENl384 for Europe and the U.K.) directly with ASTM/SEI. As reported in HORSE AND HOUND (see article in this AMEA NEWS), this study found that the tested ASTM helmets passed all of the PAS requirements, but that two of the four PAS helmets failed certain ASTM requirement. Because of my known bias (not based on fashion, history or prejudice, but rather on research and study) toward ASTM/SEI, I'm not asking anyone to take my word for this. Call Jane Davies of MDIRF at 011 44 1483 268623 and ask her. Or call MAXPRO engineer Claran J. Costello in Ireland at 021 772459 for his report on the EN 1384 helmets. The Irish racing industry has many misgivings about the new EuroStandard, and some good suggestions for improvement to all riding helmets.

Our event riders are exposed to peer pressure and advertising which falsely claims that a certain EN1384 helmet "offers maximum protective available". At last one British helmet manufacturer claims to have a product which meets ASTM F1163, but without complete impartial testing (such as is supervised by SEI) how can a rider know this is true? More than one U.S. manufacturer of ASTM/SEI helmets has presented products for BS4472 and EN1384 certification, but to date the British manufacturers have not approached SEI to do the same. Certainly if the Australian manufacturer of ASTM/SEI products can pass U.S. standards, the British could do the same, and we would be assured of what we are getting when we buy their products.

There are two groups Mr. Emerson neglected in his list of constituencies which need to work together to remedy the current sad situation. They are the USCTA, which could improve its reporting system for accidents to provide a broader and more meaningful sample including helmet manufacturer, and the AHSA, which has always had the capability to REQUIRE the use of superior headgear, but continues with its lame excuse that it is too legally dangerous to inspect helmets at competitions. Under eventing rules, it would be a simple matter to have the phase stewards check helmets as they do bits, whips, and spurs. Pony Club has managed to do this for years without fuss.

The nice thing about ASTM/SEI helmets is that they are REQUIRED to disclose their manufacturers, models, sizes, when and where they are made, and several other important points on permanent labeling inside. This label can also give a rider an idea as to when a helmet is coming near the end of its useful life, which generally occurs at about the five year mark if the helmet is worn frequently without the impact of a fall during those years.

The USCTA Safety Committee Chairman is quoted in the Fall 1997 Riding Instructor magazine (ARICP) as believing that "the only jumping helmets available now from most tack shops are ASTM helmets," and that even without... a mandate the marketplace has done it for us. More riders now are ...using ASTM helmets than in 1990, 1991, or 1993." Certainly there are more new riders each year who make an enlightened choice of a helmet, but sadly for eventing they are not the ones who are the role models who get the sponsorships, product endorsements, and are in major demand at clinics. In my area, there are as many "item of apparel" helmets in stores as there are ASTM/SEI, and many catalogs sell these and the British helmets, sometimes with deceptive text and sometimes with small print notices that they are not considered protective. .

This fall's horse press has also given some terrible examples to our young--and not so young--riders. George Morris in the September SPUR says he prefers "Any Good old- fashioned hard hat !" which to me (and to him if his pictures do not lie) means an unharnessed "item of apparel" hat. In the same article steeplechase trainer Gerald Oxley prefers the "old-style Callente", helmets without the crushable liners which make helmets effective in absorbing energy. Other steeplechasers voted for the "New-style Champion jockeys' skullcap" (EN1384, used by 70% of steeplechase riders) and "old-style Champion jockeys' skullcap" (BS4472).

The September AHSA HORSE SHOW presented us with a puff-piece entitled "The Search for the Ultimate Hunt Cap" which sings the praises of the overpriced (and underprotective) made-to-order British Lock fashion leader. This hat is used by several of our Olympic medalists, and appears in their endorsement ads. I am sure the writer's helmet looks properly high domed and back curved, and probably feels worth all the bucks she paid for it. I just hope she isn't wearing it when she rides!

The same Chronicle which carries Mr. Emerson's article also shows several pictures of adorable junior riders wearing "item of apparel" helmets with retention systems so loose that the helmet would eject from the child's head in a fall. Can it be that the coaches and parents of these talented children care more about their perceived appearance than their safety? Some priorities!

Every ASHA rules change year since the late 1980's I have written to the appropriate committees asking for saner and safer rules. Last year I received my first response, from the former AHSA Executive Director Eric Straus. Although the decision was made to continue the status quo, at least I believe that someone actually considered my proposals. Of course I don't delude myself that I carry the clout of the USCTA members of AHSA committees, or former USCTA or ASHA board of directors chairman. Back in 1978 an article by then USCTA board member Clark Cassidy retarding Caroline Treviranus' terrible head injury was the impetus behind the convening of an ad hoc committee on equestrian protective headgear. Those of us who attended that committee's first meeting (convened by the USPC because nobody else was brave enough to do so) have seen many changes for the better over the ensuing years, but if the "right people" don't use the resulting helmets and encourage others to do so, it may well be that there will be fewer manufacturers of ASTM/SEI helmets, and fewer good choices for riders. As Mr. Emerson has pointed out, head injuries can be forever. No helmet can protect a hundred per cent in every kind of fall, but it would be nice to know that people with intellects worth protecting are using products worth wearing.

Drusilla Malavase
2270 County Road 39, Rt. 3, Bloomfield, NY 14469

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Transport Research Laboratory, England

A number of standards for horseriding helmets exist internationally and in the UK alone the consumer is offered helmets which conform to a number of these standards including the British PAS 015, the American ASTM F1163 or the European EN 1384. This makes choosing a helmet a very difficult issue for the customer who is ignorant of the differences in terms of protection between helmets.

In order for a helmet to be approved to a standard, it must be shown to comply with all of the many requirements included in the standard. One of these requirements is based on the impact performance of the helmet, which is determined from a series of impact tests. To determine which standard is the most stringent, and hence which helmets may offer the best protection, is a highly contentious issue. It cannot be resolved by a mere perusal of the requirements included in the standard because different Standards prescribe different test procedures with different criteria and limits.

At the request of the Mark Davies Injured Riders Fund (MDIRF), the Transport Research Laboratory (TRL) has undertaken a program of research to investigate and compare the impact requirement of two prevalent standards for equestrian helmets; the UK PAS 015 and the USA ASTM F1163. The strategy for this project was to test helmets which were already certified to one or other of these standards, in accordance with the specified procedures of both standards. Subsequent analysis of the results enabled an objective evaluation of the two standards to be made. The MDIRF kindly supplied twelve different models of horseriding helmets for this study. In total, 50 tests were conducted, each using an appropriately instrumented headform. The use of instrumentation and data processing enable the impact performance of the helmets to be determined as required by the standards.

The main conclusions were that all of the ASTM certified helmets were able to conform to the impact requirements of the PAS Standard, particularly the PAS frontal impact. However, two of the four PAS helmets failed the ASTM tests in the temporal region. The PAS and ASTM standards specify different areas on the headform to which the helmet is subject to impact tests. The PAS includes a region at the front which is not included in the ASTM whereas the ASTM includes a region at the rear which is not included in the PAS. However, it was established that the ASTM helmets could be positioned on the test headform such that they conformed with the PAS coverage requirement. This was achieved simply by tilting the helmet forwards. Similarly, the PAS helmets could be positioned on the headform such that they conformed with the ASTM coverage requirement. This was achieved by tilting the helmet rearwards.

Regarding tests in the temporal region, TRL's research identified that the ASTM standard was more stringent than the PAS standard. And accordingly, TRL found that the ASTM helmet provided a higher level of protection than the PAS helmets in this area. The protection in the crown and the rear regions was found to be similar for both ASTM and PAS helmets.

This work has identified that all of the ASTM helmets included in this study, provided impact protection above that which was required by the PAS standard, and therefore ASTM certified helmets should not be considered inferior to those helmets certified to PAS.

Transport Research Laboratory, Old Wakingham Road, Crowthornre, Berkshire RG45 6AU England.

EDITORS NOTE: The last statement should read: This work has identified that all of the ASTM helmets included in this study, provided impact protection above that which was required by the PAS standard, and therefore ASTM certified helmets should be considered superior to those helmets certified to PAS.

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University of Colorado Health Sciences Center
Jeff Beel, Ph. D.

So many biomechanical variables are involved in head injury that it is not reasonable to expect that any protective headgear would be capable of preventing head, brain injury or death in all accidents. It is assumed that users of a standard recognize that reducing the probability of sustaining a traumatic brain injury depends on precautionary measures beyond just wearing protective headgear. Many of these measures are the responsibility of the user. Factors such as proper sizing and fitting of the helmet, proper use of the retention system in securing the helmet to the head, and proper care of the helmet are extremely important and contribute substantially to the total degree of protection of the user. It is also important that visual inspection of a helmet be made prior to use in order to detect any damage incurred during prior use. If damage is observed or if damage is suspected (e.g. after sustaining any type of impact), the user should not use the helmet again until the helmet is either reconditioned by the manufacturer or replaced.

Proper training in any sport is of extreme importance in injury prevention and is especially so in horseback riding. Training should include not only basic riding skills, but also proper falling techniques, animal and equipment care, protective equipment use, and observational skills. The riding environment should also be considered carefully by riders of different skill levels. Riding on paved roads or through rocky or wooded areas, or riding at high speeds present greater risks to the rider. Arena riding and racing present another set of physical hazards that require proper equipment (including quality safety railing, jumping fences, and other equipment), proper grounds maintenance, and proper training to help reduce the potential for injury. All riders should pursue formal training that addresses every aspect of equestrian safety.

General Notes on Traumatic Brain Injury and Headgear

Injury Mechanisms

Four distinct mechanism associated with common sports activities can cause traumatic head injuries: penetration of the brain, deformation of the skull, translational acceleration of the brain and rotational acceleration of the brain Penetration of the brain by an object, e.g. due to falling onto a sharp object (tree branch, rock, or sharp metal object) causes direct damage to the brain by tearing and cutting tissue.

Deformation of the skull can be caused by an object striking the head, by the head striking an object, or by crushing the head. The injuries that can result from skull deformation include skull fractures, epidural hematomas, intracerebral hematomas, and cerebral contusions. Aside from fractures, these contact injuries occur because the soft brain tissue is compressed inside the skull at and around the point of contact, at the opposite side of the skull from the contact point, or at points located away from the impact site. This can result in damage to the neural tissue and blood vessels in the brain due to the mechanical stresses that are generated in the affected areas. Torn vessels allow blood to escape into the brain tissue and spaces around the brain. These injuries can result in excessive pressure inside the skull since the skull cannot expand to accommodate increase amounts of fluid - the increased pressure is turn causes more damage and can eventually result in death.

Translational acceleration of the brain is caused by increasing or decreasing the translational speed of the head. This type of acceleration occurs during head impact. Translational acceleration of the head also occurs for conditions that do not involve head impact, e.g. during deceleration of the body with the head unrestrained as when impact occurs to the body only. Injuries that can result from large translational accelerations include subdural hematomas, brain contusions and concussions. These problems result from the compressive and tensile stresses that develop within the brain tissue and vessels during acceleration.

Rotational acceleration is caused by motion of the head or skull relative to the neck or body, as, for example, when the head swings forward or backward (as nodding or whiplash), or drops to the side (as in tilting the head), or turns to the side (as in looking over the shoulder). Injury occurs from rotation when the rotation is very rapid and often happens in high-speed accidents, e.g. motor vehicle accidents. Head impacts that cause the head to rotate obviously generate this type of acceleration.

Rotational acceleration injuries occur especially in activities or sports involving motions and impacts at greater than average speeds. The injuries that can result from rotational acceleration are different than those that result from purely translational acceleration. The injuries from rotational acceleration include diffuse axonal injury (DAI) in which individual nerve cells are disrupted by shear forces.. Contusions can occur due to the brain gliding over rigid protrusions on the inner surface of the skull during rotation. Subdural hematomas can occur near the surface of the brain due to the tearing of bridging vessels. Also, concussion can be caused by rotational acceleration, which may actually be responsible for those concussions thought to be caused by translational accelerations. Many impact situations probably generate some combination of translational and rotational accelerations.

All of these types of injuries can have serious consequences for the victim including death or permanent mental and physical disability. Even concussion, which is one of the mildest medical problems associated with head injury, can result in permanent mental problems for the victim.

Protective Headgear In order to prevent traumatic brain injury or to reduce the chances of injury, the use of quality protective headgear is crucial in order to absorb as much of the impact energy as possible. Numerous experts in the area of brain injury prevention advocate the use of quality headgear for activities where there is an increase risk of head injury. Analyses of many activities have noted that substantial reductions in the numbers of head injuries occur following the requirement of headgear use. However, four important facts regarding headgear and injury prevention should be understood. First, headgear can only help to prevent those injuries associated with head impact that are caused by translational acceleration, skull deformation or penetration. Helmets function by absorbing impact energy, sometimes through destruction of the helmet itself, and by stopping sharp objects from piercing the skull. Injuries caused by rotational acceleration and non-impact translational acceleration cannot be prevented by wearing helmets since helmets (at least current models) cannot prevent the head or brain from rotating or moving during this type of motion.

It is possible that helmets absorb some of the impact energy such that rotational accelerations are decreased at impact for low-speed situations (high speed impacts would not be affected significally by the helmet). However, at present, helmets are not considered to be useful for the prevention of rotational injuries.

Second, headgear cannot prevent injuries in all cases, including cases in which the accident conditions are within the limits of protection specified for the headgear or specified by any headgear standard. There are too many variables involved in the generation of a brain injury to expect that headgear would be able to prevent injury in all accidents. Although there exists a considerable amount of information regarding impact biomechanics of the head, the information available is by no means comprehensive or complete even within a specific area. Most of the available impact biomechanics data encompass only a very limited number of impact conditions with regard to velocity, mass, direction and point of impact, duration of impact, material, size and shape of the impacting object. In addition, only some of these studies have involved actual human test materials and the actual full body motions involved in accidents. And, people exist in a variety of sizes, shapes and susceptibilities to traumatic injury which further complicates the research efforts. Therefore, much of the information necessary to design an ideal helmet to prevent injury in all circumstances does not exist.

Third, although obvious, headgear cannot prevent injuries due to impacts to areas that are not covered by the headgear. For example, without a face shield, facial injuries (lacerations, fractures) and brain injuries due to impact accelerations cannot be prevented.

Finally, headgear cannot be expected to prevent injuries for conditions that are in excess of the performance capabilities of the headgear. There are a number of reasons that limitations in headgear performance exist including 1) technology limitations (in current materials, biomechanical data, design, manufacturing problems and expenses), and 2) user- influenced design limitations (problems of esthetics, comfort, expense, and aerodynamics).

From: 1995 Standard for Protective Headgear for Equestrian Sports, Horse Racing, and Western or Recreational Horseback Riding.
Jeffey A. Beel, Ph.D.
University of Colorado Health Sciences Center
Division of Neurosurgery
4200 East Ninth Avenue, Denver, CO 80262

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The salient points in this article support the use of helmets while riding. Nevertheless, it must be understood that although helmets lessen the risk of head injury the possibilities are not eliminated completely. The potential of sustaining injuries to the head and/or brain as the result of contact or impact is reduced as discussed. However, those brain injuries which result from rotation of the brain and/or brain stem within the skull may not be significantly altered. Unfortunately, it is these forces ( inertial ) which impart catastrophic brain injury, e.g. diffuse axonal injury. Horseback riding is the archetypal sporting activity that presupposes those conditions which gives rise to rotational forces; e.g. falling to one side or frontal from a horse poised 9 -12 feet above the ground concurrent with speeds up to 26 MPH. Reduction of the injurious forces attendant with impact is helpful; thus wearing a helmet at all times when mounted on a horse is strongly recommended. Nevertheless, all riders should be aware of those forces generated during a fall from a horse that are minimally, if at all, reduced. It is hoped that methods to test for these forces and lessen their effects will become available as technology advances. In the meanwhile, wear your helmet each and every time you ride.

William H. Brooks, MD
Lexington Neuroscience Center
152 West Zandale Drive, Lexington, KY 40503

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The USCTA Meeting and Safety Committee Meeting
by David McLain, M.D.
Safety Committee Chairman

The USCTA Annual Meeting was held in Minneapolis, Minnesota, on December 3-5, 1997, and had the largest attendance in USCTA history (440)! The meeting featured several sessions on safety including one each on "Improving Your Odds", "Emergency Equipment", and "Protecting Your Bottom Line." The "Improving Your Odds" session featured Denny Emerson (USET rider, coach, and former President of the USCTA), Debbie McKenzie Wilson of United States Pony Club, and Dr. David McLain. This session follows a year in which the Eventing world has had two deaths (Blenheim and Boekelo) and two serious head injuries in Advanced Level riders (See lead article). Denny Emerson started the session and presented anecdotes and historical perspective of how a rider at Rolex fell and a photo caught a picture of her helmet falling off her head as she was about to strike the ground. Denny said that episode triggered the "chin strap" rule where every rider must wear a helmet secured by a chin strap.

Denny stated that the AHSA was "gutless" for not requiring stricter regulations for helmets. Debbie Wilson presented information regarding barn safety. David McLain presented the USCTA statistics and a discussion of helmet evolution, head injury mechanics, and consequences. A lively discussion with the audience ensued. Jim Graham (USET rider) related that he always rides and schools in a helmet (Jim is sponsored by Troxel) and stated that he requires all riders in his clinics to wear helmets on the flat or while jumping. Jim recalled that at one clinic two women refused to wear helmets. Jim stated that he told them they "could get a HELMET or a REFUND" but he wasn't going to teach them without a helmet. (The audience applauded Jim.) Jane Savoie (alternate Dressage rider, Barcelone Olympics and noted author) was in the audience and stated that she always wears a helmet when schooling but noted that many dressage riders do not. Denny recalled when Robert Dover was at the ARICP meeting and the members of the audience asked Robert why he didn't wear a helmet when schooling. Denny stated that Robert's only defense was "Do any of you smoke?"

The USCTA audience also discussed tooth guards. One rider stated she was a model and wanted to protect her teeth. She said she was using a football tooth guard but that it was large and made breathing difficult. A woman dentist said riders should see their dentist or she would be glad to make tooth guards for anyone interested (See AMEA NEWS May 1994 4:2). These guards do not have to be large and should not effect breathing. A neurologist's wife said her husband had seen two riders at the Mayo Clinic who had what they thought were minor head injuries and were found to have subdural hematomas. She recommended that anyone with a head injury be checked by a physician, even when seemingly minor. The session was a good interplay of safety information showing the strong interest in safety among the rank and file USCTA members. Representatives of the Mexican Federation were also at the meeting and were eager for safety information.

Brian O'Connor, an announcer at many USCTA events and brother of Olympic medalist and Badminton winner David, co-chaired a session with course builder Pete Costello on Emergency Equipment for cross country incidents. A session was held on "Protecting your Bottom Line" with David McLain, M.D., John Hart of American Equine Insurance Group, and Katherine Bloomquist, an attorney that has an interest in Equine Law. This session dealt with safety, barn rules (including a helmet rule), limited liability statutes, and oral agreements. Dr. David McLain suggested a barn safety program using the AMEA Rider Safety Video and "Every Time, Every Ride." John Hart said this was a great idea and said his company gives 10% discounts for bonafide safety programs.

The AMEA was represented at the meeting by an exhibit with the newly formed Injured Riders Fund. The AMEA Rider Safety Video as well as the "Every Time, Every Ride" video were shown continuously. A Christopher Reeve Trophy was inaugurated and the first recipient was Christopher Reeve. The trophy, a bronze, featuring all three phases of 3 day competition, is to be presented for individuals displaying courage in the face of adversity.

The USCTA Safety Committee met and deliberated on several items of interest. First, the newly developed USCTA Incident Report form was modified and approved. The form is to be sent back to Mona Weiss, a professional safety consultant, for correction and then sent to the USCTA Board for approval. Ritch Temple, safety committee member, course designer, and AEIG representative, said the forms will be used at all USCTA Schooling Days even before Board approval. He said the forms were great! Howard Simpson, a USCTA Vice President, said the forms "lead the person through all the steps of accident investigation" and heartily endorsed it. The new forms are to replace TD forms that are presently used for statistic gathering. The present forms are mostly blank and require the TD to "start from scratch". The new forms have many entries that allow the TD to check off the proper answers and a diagram to document the site of injuries. The USCTA Safety Committee also recommended two controversial measures-the mandating of ASTM helmets for USCTA recognized events and proposing a rule to suspend riders who suffer a head injury until cleared by a physician to return to competition. The mechanics of this latter rule are yet to be worked out. In England, where this rule IS in effect, there is a physician at every event who examines any rider who has had a head injury. A rider is suspended until cleared to return by a physician. In the US where an injured rider is likely to be taken to the ER and the ER doctor is likely to know little about the sport of eventing or even horseback riding, it is not clear how this rule would be upheld. One suggestion was to suspend any rider who was transported to the hospital until cleared by a physician to continue. It was thought that this would result in riders refusing to be transported. Any suggestions from AMEA members on this subject would be appreciated.

Dennis Glaccum, organizer of the Fair Hill International Horse Trials, related two events to me that need to be recognized. First is the fact that Body Protector Vests need to be worn OVER the clothes. Dennis noted that Amanda Warrington, who suffered a severe head injury at Fair Hill (she subsequently died) and who was at fence three and close to the ambulance team, had a shirt over the vest. It took the paramedics several precious minutes to cut the shirt off before they could get the vest off. Riders need to be cautioned to always wear their vest on the outside of their clothes. Dennis also told of how the paramedics, unfamiliar with the newly mandated medical card, cut it off and put it aside. Dennis had to tell them its purpose. Organizers and technical delegates need to brief the paramedics on the purpose of the medical identification cards. At the USCTA meeting, a number of the board members wore the medical cards on their arms to highlight the mandate, which began on December 1st. The meeting highlighted the importance of safety in the life of the USCTA. Safety should play an important role in many equine organizations.

David A. McLain, MD
Chairman USCTA Safety Committee
Board of Directors AMEA
6225 Cahaba Valley Road, Birmingham, AL 35242

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Johanna Harris

Everyone wants to know – how hard is horseback riding? Is riding a horse as taxing as riding a surfboard or skateboard? Do we use as much energy riding and cleaning stalls as playing tennis and mowing the lawn? Well, it depends. We can make the energy cost, or energy demand, of riding as high or as low as we want, to a certain extent.

All good discussions about energy begin with food. The energy you need to groom, ride, and clean stalls comes from food and it's right there on the box – 350 calories per serving. The caloric content, or energy value, of food is determined by measuring the amount of heat generated when it's burned in a calorimeter. Each kilocalorie, or calorie, equals the amount of energy needed to raise the temperature of a kilogram of water by one degree Celsius.

Determining the energy expenditure of athletes is not easy in equestrian sports, nor is it easy in most other sports. Polo players do expend more energy than trail riders do, but competitive cyclists expend more energy than recreational cyclists and steep hills demand more energy than slight hills. When you think about the differences caused in energy expenditure by tire characteristics, snow conditions, water currents, and court surfaces, you see that most athletes are all in the same game. The energy demands of a sport constantly change according to the nature of the event, skill and motivation of the athlete, environmental conditions, and characteristics of equipment being used. It's just that for us, the horse's level of training and state of mind are also important factors.

Even if we forget about the fact that the energy demands of a sport are constantly changing, it's still hard to determine how much energy an athlete has to expend. It's hard because there is no easy way to measure the amount of heat the body generates during an activity – the most direct method of measuring energy. So instead, we resort to a less direct method, one that measures energy expenditure by calculating the amount of oxygen an athlete uses during an activity. This works because the body uses oxygen at a fairly constant rate to convert the food that's eaten into useable energy (it takes roughly one liter of oxygen to burn five calories).

Now that we know that there's a relationship between calories consumed and oxygen used, we can look at the calories an athlete burns during an activity and estimate its energy demands. The energy demands of horseback riding, as well as other physical activities, can then be easily classified according to the number of METs, or Metabolic EquivalenTs, required. A physical activity that is 6 METs requires that an athlete use six times more oxygen for energy than when he/she is resting quietly.

Using the chart below, you can see how much physical exertion is required for an activity of a certain MET level:

Using a caloric expenditure chart and the results of a 1983 European study of elite and advanced riders, I put together the chart below. From this, you can see that equestrians never venture beyond optimal physical exertion. (The numbers below are based on a 150 pound person.)

Calories burned and METs used by an average 150-pound (68-kilogram) person during various activities.

The European study also found that:
1. The sitting trot was more demanding than the posting trot.
2. Experienced riders used 60 to 90% of their maximal oxygen consumption (or V02max*) during trotting and cantering.
3. Elite riders only used 38 to 58% of their V02max while trotting and cantering.
4. Two riders jumped a course of 10 jumps in less that one minute and used 73 and 78% of their V02max.
5. One experienced rider rode a 10-minute, upper-level dressage test and used 40% of his VO2max.

*VO2max is expressed as the number of liters of oxygen consumed per kilogram of body weight per minute. (Westerling, D. (1983) A study of Physical Demands in Riding. European Journal of Applied Physiology. 50:373-382) METs classified according to the amount of effort required.

The only problem is that the amount of energy you use to catch "Sunny", tack him up and gallop off into the sunset, is a very personal figure. It depends on your body weight, the smoothness and efficiency of your movements, how hard you work to control his movements, and, of course, what you're doing at the time. Heavy set equestrians expend more energy catching their horses than slender equestrians do; novices expend more energy balancing themselves at the sitting trot than Olympians; trainers expend more energy cantering green horses than nonchalant pleasure riders on well-schooled mounts; and, quick-maneuvering polo players expend more energy than sightseeing trail riders. But even with this personal stuff aside, we can still come close to determining the energy costs of riding by using a caloric expenditure chart and making adjustments for body weight (see chart).

To find how many calories you burn, add 10% for every 15 pounds you weigh over 150 pounds or subtract 10% for every 15 pounds you weigh less than 150 pounds (add or subtract 10% for every 6.8 kilograms you weigh under or over 68 kilograms). For example, a 135-pound woman burns roughly 405 calories an hour at the sitting trot [450 – (450 X .10) = 405].

So exactly how hard is it to ride and take care of horses? After all of this, we can still say that it depends. And surfers and skateboarders can say the same thing. But, we can also say that the energy we expend is rarely more than an optimal amount. Perhaps that's why so many people enjoy horseback riding.

Johanna Harris
118 Lower Sand Branch Rd. Black Mountain, NC 28711

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William Lee, MD

It is with great honor that I start the two year term as president of the American Medical Equestrian Association. The AMEA is of importance to me at several levels. We are all drawn to horses either by genetics and/or a spouse or child. Like all sports, as a physician, there is worry about injury in the sport. This becomes more acute, in my case, when you have a wife and three children who ride. Unfortunately we are not a nation now where people are raised around horses. As a result, when a child wants to ride, the parents don't have the experience to recognize what is right and/or safe..

My background was working at a stable and with a rodeo stock contractor in grade school and high school. The sport is important enough to me that I chose an internship in Phoenix, AZ, so I could keep my horse. My wife put up with the pack trips and mule racing, but finally got me into running and jumping so we now event and ride jumpers.

I feel strongly about the AMEA and the great group of individuals who make up the membership. I benefit from communicating with them and sharing information about an activity we all love. The AMEA is maturing and now has an Executive Secretary, Mike Nolan, who brings expertise and connections in the horse world. But we have keep our "soul" -- Doris Bixby Hammett, MD, to keep urging us forward.

The AMEA can meet yearly and talk about the statistics and mechanisms of injury till we are "blue in the face" but we won't make an impact until we get to the rank and file rider. We have a vehicle -- the Neil Ayer Rider Safety video tape. We need to be a source to prevent all injuries. I'd like to get the video tape to Pony Clubs, 4-H, show management, horse clubs, tack stores and catalogs. Help from anyone with horse connections and leadership roles would be appreciated.

Once we get the video tape in the horse community, I want a "ACLS/ATCS" like course that any one with some medical experience could give. I would develop the manual and slides and start with a few trial courses. Thus instructors and participants would give valuable feedback. I would target two areas: the general horse riding community and the trainers/coaches. We might work with the equestrian insurance organizations so that if the program used the tape and course, the barn would be a discount on insurance premiums.

We all, for various reasons and from various backgrounds, are into horses, medicine and safety. The AMEA is a great vehicle for all of these. I encourage everyone to get involved -- talk about AMEA what it is, what it does and can do. Use the AMEA brochures. Mention safety at the barn, point out practices you see that are not safe. You will save someone from a severe disabling injury.

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

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Richard Nicholson, FRCS
Consultant Orthopaedic Surgeon, Pontefract

The following is from a presentation at the spring meeting of the Medical Equestrian Association, England, at Stamford and Rutland Hospital

To deal with the most serious outcomes first, death due to a riding accident has three main causes:

1. Head Injury - remember the words of Hippocrates "No head injury is so slight that it should be neglected, or so severe that it should be despaired of."

2. Upper cervical spine injuries.

3. Crushing of the rider under the horse.

The most serious injuries are produced when a horse leaves a leg behind at a solid fence and cartwheels onto the fallen rider. The following are notes on some of the regions injured.


Existing spinal conditions: Lumbar spondylosis - the symptoms are made worse by riding but may be helped by the use of a corset and NSAIDs. The beneficial effect of a corset is not due to direct support of the spine. It works because it provides a firm container for the abdominal contents. These normally behave as a fluid but when bounded by a firm container they are able to support part of the weight of the upper body and so take some of the stress from the spine. A discectomy is not a contraindication in continuing riding.

Upper Limbs:

Clavicle - fractures are common. Acromion - clavicular dislocation have a 50% chance of becoming comfortable without surgical treatment. Sterno-clavical joint dislocation are uncommon. Shoulder dislocations often occur. Elbow fractures are uncommon. Wrist - sacaploid fracture are usually due to a fall on the outstretched hand but the speaker has never seen a scaploid fracture out hunting, probably because most riders have learned to curl up when they fall. Metacarpal fractures are usually due to direct trauma. Digital - the commonest is disruption of the ulnar collateral ligament of the first metacarpophalangeal point. If a bone fragment is detached this is treated satisfactorily by immobilization in plaster. If no bone is detached operative treatment is required. The little finger is frequently injured when a horse refuses at a jump probably due to twisting of the finger by the reins. Hand injuries are common stable yard injuries - never wrap leading ropes around the hand.


Fractured ribs are common - a tension pneumothorax is the most serious complication.


Acetrabular fractures are not infrequent. Dysostosis of the symphysis pubis may appear on x-ray to be an insignificant injury but that is not so because it is accompanied by severe damage to the muscles of the pelvic and to the muscles of the pelvic floor and to the sacro-iliac joints. Pelvic injuries bleed. If the pelvis is moveable or if a pelvic fracture is suspected give intravenous fluid. Before intra-venous drips were used pelvic fractures had a 50% death rate.

Lower Limbs:

Adductor tendonitis at the origin of the adductor magnus tendon is a painful when the rider adducts or squeezes - leading to failure to grip and an insecure seat. Soft tissue injuries are common - often due to a kick. Apply direct pressure to reduce hemotoma formation. Femoral fractures are not common. Knee - cruciate ligament injury is not common. Tibia and fibula - often fractured in collisions in the hunting field due to the hind leg of the horse in front going back onto the victim. Spiral fractures of tibia may occur while mounting. Ankle - injuries very from sample ligamentous to severe fracture dislocations. Leave (expensive) riding boots in place until they can be removed in the hospital by carefully cutting the stitching in the back seam. Foot: the commonest injury is to the first toe - these injuries usually take nine months to recover.

Copied by permission from the M.E.A. NEWSLETTER
Hon. Secretary, Dr. R. Marshall
Raybarrow Farm
Nettleton, Chippenham, Wilt. SN14 7NN

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A SAFETY SUMMIT, being organized by the American Medical Equestrian Association, will involve equestrian educational programs, schools, and certifying organizations, breed registries, racing, rodeo, show and event sanctioning organizations, manufacturers, distributors and retailers of equine products, liability insurance underwriters, horse media, equestrian lawyers and equine-related trade publications. The purpose of the Summit will be to identify methods of increasing the safety of riders and other involved with horses through improved equipment, rule changes, and education. The SUMMIT is planned for June 17 and 18, 1998, in Louisville, KY. The meeting was scheduled to coincide with Equitana, an event which attracts a wide spectrum of horse sports and disciplines.

For information contact Michael Nolan, 4715 Switzer Road, Frankfort, KY 40601, Phone/FAX 502-695-8940 e-mail .

42rd Annual Convention Phoenix, Arizona
William Lee, MD

I was fortunate to attend the American Association of Equine Practitioners as representative of the American Medical Equestrian Association. Mike Nolan, the AMEA new Executive Secretary, had arranged for Norm Luba of the North American Equine Ranching Information Council to show me around and introduce me to various people in the AAEP.

The meeting was quite large and the largest held to date with greater than 4,000 persons in attendance with 250 trade show booths. These booths fascinated me as a "wanta-be Vet." The scientific sessions covered foal care, tendon injuries and new orthopedic ways to manage splints. The new president is Dr. Gary Norwood, a race track practitioner from Louisiana. Controversies were in regards to the management of race horses and race horse injuries: first response and EMS if you will. This all has to be done under the scrutiny of spectators.

I see the American Medical Equestrian Association in a parallel role with the AAEP. With 40% of horse related injuries on the ground, our friends, the veterinarians and farriers, are at high risk for injuries and can use our support. I would like our AMEA membership to let their own vet and farrier know that the AMEA exists and see if we can help in the education of horse owners. I see the AMEA in the role of prevention and education.

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


The 1998 AMEA annual meeting will be held November 6-7, in Durham, NC. The exact site is still under negotiation. Denny Emerson will speak, and will be presented with the inaugural Ayer-Hammett award presented by the AMEA to recognize outstanding achievements in promoting safe horsemanship. Sessions are planned on practical preparation for safety aspects of horse events, improving teaching/coaching for equestrian activities, therapeutic riding programs, rider fitness, and epidemiology and mechanisms of horse related injuries.

There will be a group outing to the featured Friday night jumper classes at the Duke Childrens' Classic Benefit Horse Show. For information contact AMEA Annual meeting chairman, Maureane R. Hoffman, MD, Chairman AMEA 1998 Annual Meeting, 5408 Sunny Ridge Drive, Durham, NC, 27705, E-mail

Maureane R. Hoffman, MD
Chairman, AMEA 1998 Annual Meeting
Associate Professor of Pathology, Duke University

Maureane Hoffman was born and raised in northern New Mexico. She began riding as a child, first Western gaming events and reining, then junior jumpers and eventually combined training. She received her BS in Animal Science from New Mexico State university, and also enough good advice to steer her away from the tough life of a veterinarian. Maureane and one horse then traveled to the University of Iowa, where they survived on her graduate student stipend until completing an MD and PhD in Pharmacology/Toxicology. During this period, Maureane acquired another horse and a husband, Steve Richardson.

The whole crew moved to North Carolina, where she completed residency training in Anatomic and Clinical Pathology at Duke University Medical Center. She was Associate Director of the Transfusion Service at the University of North Carolina Hospitals for four years; then returned to Duke where she is currently Director of the Hematology` and Flow Cytometry Laboratories at the affiliated Durham VA Medical Center.

She is a member of numerous professional organizations and serves on the Scientific Subcommittee on Platelet of the International Society on Thrombosis and Hemostasis, and on the National Heart, Lung and Blood Institute Program Project Review Committee. She has published over 50 scientific articles, written chapters on Immunology and on Blood Coagulation for medical textbooks, and been an invited speaker at research meetings in the US, Europe and Israel.

Livestock holdings have increased to three: the 21 year old semi-retired thoroughbred TB who moved from Iowa with her, a 10 year old thoroughbred cross mare she competes in Preliminary level horse trials and dressage, and the 2 year old son of the above mare who (like all young horses) is just full of potential.

Maureane R Hoffman, MD
Chairman AMEA 1998 Annual Meeting
5408 Sunny Ridge Drive Durham, NC, 27705

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Proceedings 1997                   $10.00
Proceedings 1996                    10.00
Proceedings 1995                    10.00
Proceedings 1994                    10.00
AMEA News 1993                       5.00
AMEA News 1994                       5.00
AMEA News 1995                       5.00
AMEA News 1996                       5.00
AMEA News 1997                       5.00
Planning Event Coverage              1.00
When Can My Child Ride a Horse?    no charge        up to 25
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No Accident                        no charge        original to copy
Do I Need to Wear an Equestrian
  Helmet?                          no charge        original to copy
Horseback Riding Safety:
  A Rider's Responsibility         no charge        original to copy
Rider Safety Video                  17.00            3.00 S/H
Every Time, Every Ride
  Video brochure*                  no charge
Ground Handling Horses Safely
  Video brochure**                 no charge

*To order video: Washington State 4-H Foundation, 7612 Pioneer Way, Puyallup, WA 98371; $15, if 5 or more are ordered at the same time the cost is $11.00

**To order video: Attn: Betsy Greene, Washington State University, Clark Hall 126, Pullman, WA 99164: $19.95 plus $5.00 shipping charge for the first tape.

To order products available from AMEA, send order with your check to

American Medical Equestrian Association
4715 Switzer Road
Frankfort, KY 40601.

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