University of Vermont AAHS


Doris Bixby Hammett, MD
Member, Board of Directors
American Medical Equestrian Association

[reproduced from Winter 2000 Caution:Horses, Vol. 5, No. 4]


The American Medical Equestrian Association obtains figures of horse related incidences by three different measurements: deaths, injuries, and accidents.


Deaths can be divided into those resulting from injuries from mounted accidents, those while on the ground, those resulting from pulled vehicles/equipment, and those involving vehicles hitting horses, both under rein and loose.

Deaths involving a horse, but not related to action of the horse: Drive by shooting of a rider, rider on a moped racing a horse.

Complications resulting from injury: i.e. septic shock, pulmonary or fat emboli, those associated with high spinal injury.

Some medical examiners report only immediate deaths from horse related injuries. Others report deaths that occur not only with the injury but resulting from the injury. Some report only mounted deaths, while others include all horse related deaths from motor vehicles, crushed and kicked while on the ground, driving a horse in a carriage or a farm team.


Injuries can be divided into:

Minor injuries, requiring no treatment or only first aid: i.e. checking, cleaning, Band-Aid, cool pack.

Intermediate injuries requiring advanced first aid, bandaging, packing, first responders evaluation and observation.

Injuries requiring EMT evaluation and treatment.

Injuries requiring physician evaluation and treatment on site

Injuries requiring transfer to private physician, free standing clinics, or hospital emergency rooms.

Each study or survey has different definitions of an injury. Some activities only report injuries of riders, some report injuries only during events, and some report both mounted and unmounted injuries. The definition of injury ranges from a scratch or bruise to only those requiring transport to. emergency rooms.

The National Electronic Injury Surveillance System (NEISS) provides the only national figures available for horse related injuries.


All accidents have potential for injury and death. However, horse related accidents whether or not an injury occurs has the most vague definition.

The United States Pony Clubs defines an accident as any event which causes concern of the parent, instructor, club official, or the child. This results in some of the over 400 clubs reporting everything, and some clubs overlooking everything in which there is not an injury.

Some horsemanship classes define a accident as any time a rider is separated from the horse whether an injury occurs or not. This misses some accidents which can be severe in which the rider remains mounted or is on the ground in horsemanship activities. These figures are of great assistance to an organization who is studying its activities for safety.


North Carolina has a state medical examiner system, in contrast to those that have county or regional medical examiner systems in their state.

This paper reports the findings in 22 years of horse related deaths as recorded by the North Carolina State Medical Examiner.


North Carolina has an excellent medical examiner system which reports all horse related deaths as well as deaths from complications during treatment for a horse related injury, deaths of persons in vehicles and those in which a vehicle hits a loose horse or a horse drawn vehicle.

These medical reports are available from 1978. The years 1980-1989 and 1990 - 1999 have been reported in the AMEA NEWS (November 1991 and June 2000). During these years;85 horse related deaths have been recorded.

These findings are reported in this paper. In seven instances, two body parts were listed, either of which could have caused death.

Table 1
Cause of Death: Body Parts

Cause 78-89 % 90-99 % Total %
Head 21 57 30 55 51 55
Chest 7 19 7 13 14 15
Abdomen 5 13 4 7 9 10
Multiple 1 3 6 11 7 8
Neck 1 3 0 0 1 1
Spine 1 3 2 4 3 3
Medical 0 0 5 9 5 5
Other 1 3 1 2 2 2
Total 37 101 55 101 92 99

Note: The total of 92 is greater than the number of deaths (85) because multiple body parts were sometimes recorded in causes of death. 

Head injuries cause 55% of the horse-related deaths, with chest (15%) and abdomen (10%) following. Medical complications causing death subsequent to the injury are involved in 5 % of horse-related deaths.


Table 2

Gender 78-89 % 90-99 % Total %
Female 15 44 16 31 31 36
Male 19 56 35 69 54 64
Total 34 100 51 100 85 100

Males account for almost twice as many of total deaths as females (64% vs. 36%) with the males increasing from 56% to 69% and the females decreasing from 44% to 31% in the last 10 years.

The NEISS injury figures show that more females are injured then males.

Table 3

Mounted 78-89 % 90-99 % Total %
Yes 27 82 34 67 61 73
No 6 18 17 33 23 27
Total Known 33 100 51 100 84 100

Note: Only 84 total deaths are reported since in the 78-89 reports, the mounted/unmounted status of one case was unknown.

Deaths of persons mounted on the horse accounted for 73% and those not mounted for 27% of the deaths. The mounted deaths decreased from 82% to 67% and the non-mounted deaths increased from 18% to 33% during the last ten years.

Two reasons are possible for the increase in non-mounted deaths. First, the Medical Examiner System may be more alert to horse related deaths and may therefore report some unmounted deaths as horse-related that earlier would not have been so reported. Second, as more of the nation moves to the city, those who are around horses do not have the knowledge gained by repeated exposure in the rural farm community. These persons arrive in the horse community without essential knowledge of safety.

When the rider was mounted, death resulted from a fall in 85% of the cases (52 of 61). During the last 10 years, this percentage has increased, from 85% (22 of 27) to 88% (30 of 34). 

The 15 percent mounted who did not die from a fall (9 of 61), died from the following causes: hit by car while riding horse; gunshot; horse spooked into large truck, went through windshield; galloping and hit telephone pole; rode horse into guywire, horse fell on her; hit by vehicle; hit by vehicle; and drowned from riding horse into deep part of lake; horse reared hitting deceased’s head.

Of the 23 unmounted deaths, 9 were caused by the horse, 4 by motor vehicles, 3 in horse-drawn vehicles 3 from loose horses, 2 while leading a horse and 2 from medical causes. The means by which these deaths can be prevented is education of the horse community for the changes that need to be made in each situation.

Table 4

Age 78-89 % 90-99 % Total %
0-4 0 0 4 8 4 5
5-14 6 18 3 6 9 11
15-24 5 15 6 12 11 13
25-44 18 53 20 39 38 45
45-64 4 12 15 29 19 22
65+ 1 3 3 6 4 5
Total 34 101 51 100 85 101

In the four deaths under 5 years of age during the last 10 years, only one fell from a horse. One was in a pasture and was trampled by horses, one was in a multipara whose mother was kicked by a horse and delivered a premature child who died, and one was in her mother’s lap when the car in which they were riding struck a horse.

The ages 5-14 years deaths have the greatest decrease during the last 10 years from 18% to 6%. This decrease is the largest seen (two-thirds) and may be the result of education--both of the parents, the children themselves--and increasing mandates for safety in the youth activities.

Deaths in the 15-24 year olds deaths have decreased from 15% to 12%.

The ages of 25-44 years have the highest number of deaths but the percent of these deaths have decreased from 53% to 39%. Evidently, information concerning safety is reaching this age group.

The deaths in ages 45-64 years have increased from 12% to 29%. This marked increase in deaths may be because these persons are traditionalists 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 recommendation for safety This is the age of the baby boomers and we may be having an increased number of participants in this age bracket.

The ages of 65 and older have doubled their percentage of deaths. This figure relates to the small numbers involved, but may be related to the reasons of the increase in the ages 45-64 years.

Table 5

Ethanol 78-89 % 90-99 % Total %
Elevated 6 43 13 43 19 43
Not Elevated 8 57 17 57 25 57
Total Reported 14 100 30 100 44 100

In the horse related deaths over the age of 17 in which blood was drawn, 43% had an elevated blood alcohol. That has not changed in the last ten years. These figures are a condemnation of those who feel that drinking while riding does not interfere with the performance of the horse. These figures shout: "Do not drink while riding or working with a horse."


Of the 51 deaths from head injuries, 7 were under the age of 15. Of those, two were 4 years old, two were 7 years old, two were 9 years old, and one was 11 years old. Of these, one four year old and seven year old were kicked while on the ground, but all others were mounted.


The horse-related chest fatalities have the greatest incidence in ages 25-44, with 45-64 years ranking second. Six of the 14 deaths occurred when the deceased was not mounted.

Recent ASTM/SEI standard protective vests have raised the question whether the use of a protective vest might have improved the survival rate. The North Carolina horse-related deaths do not support this opinion. Of the 14 chest injury deaths, two were the result of collision with a motor vehicle, one was thrown from a horse-drawn vehicle, one was trampled by a mule team, one died when a horse fell on the deceased, two fell from horses, one died while hitching a horse to a carriage, two rode their horses into trees, two were kicked on and stepped on by a horse, one hit a telephone pole, and one was stepped on by a horse.


The Medical Examiner figures do not give causes. These must be determined by the horse community. In North Carolina there were 85 deaths, giving an average of 4 deaths a year. Head injuries cause 55% of these deaths. The percent has not changed from 1978-1989 to 1990-1999. None of the deceased was wearing protective headgear. Headgear prevents or reduces the severity of head injury. Until we convince riders to use ASTM SEI protective headgear at all times when mounted, we cannot hope to change these figures. Chest and abdominal deaths both have decreased. As standardized protective vests have just recently become available, vests were not a factor in this decrease nor in the decrease of abdominal injury deaths. Better emergency medical care is available over the nation which might have improved the survival of chest and abdominal injuries while head injury care has not had the same medical advances.

The study of horse-related deaths can be a guide to the areas in the horse community which can be changed to improve safety and reduce risk.


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