Equine-Related Human Injuries
- Oct 1, 2000
Like bicycles, skateboards, and dogs, horses supply fun and risk. Riding bikes or skateboards can lead to falls, and dogs can bite. Handling and riding horses can mean falls, bites, and kicks, but like other leisure pursuits, the pleasures outweigh the pitfalls. Associating with horses requires recognizing the hazards. When humans and horses interact, accidents can happen merely because of the animal's size. Another way mishaps can occur is through misunderstandings in interspecies communication.
Among companion animals, the horse's appeal is its size and power. Its behavior can threaten you because of its larger body mass. Even a newborn foal can outweigh many of the people it encounters.
"Be aware of your own limitations," said Julie Ballard, Chair of the U.S. Combined Training Association (USCTA) Safety Committee. "You deal with a large animal that can inflict injury, even if it doesn't mean to."
Besides the horse's size, its behavior compounds the dangers. Few horses deliberately attack humans. Horses tend to react suddenly and, to many people, unexpectedly.
That sudden motion can be dangerous if you're in close range. Here are a few real-life examples of collisions:
A handler leads a horse through a group of spectators, who line both sides of an aisleway. The horse bounds to the side in one jump, and steps on a bystander.
A horse flings up its head, and the top of its neck hits the rider in the forehead. The impact knocks the rider off the horse.
In an indoor arena, a horse bucks, and the rider's head collides with a wooden roof support.
You can call these "freak" accidents, but the possibilities always exist. Jan Dawson, President of the American Association for Horsemanship Safety, explained, "Most accidents seem to have their roots in the fact that most people do not understand that you cannot overcome instincts with training. The horse is always a horse, and he will be predictably unpredictable. Whenever the horse is under sufficient mental or physical pressure, the training will be gone and the instincts will kick in.
"At that moment the horse is just a horse. We often want to make the horse into something he is not. He has no human qualities, and even if he bonds with a human, his inherent characteristics are still there."
Even the most expert horse owners can become accident victims. Injuries and fatalities occur to Olympic-level riders and champion jockeys. At the highest level of competition, riders' decisions to "go for it" can increase the risk.
William Lee, MD, President of the American Medical Equestrian Association (AMEA), said, "Safety is a hard sell. Nobody likes to think about it." A rider himself, Lee sees the need to balance a love of horses with awareness of potential for injury.
Horses can kick, shove, stomp, shy, buck, and bolt. The effect on you can be soft tissue injuries (bruises, abrasions, lacerations), fractures, or blows that result in concussion.
Various organizations have collected injury statistics through emergency room reports. A survey from Victoria, Australia, noted that for children, riding was the third-highest recreational activity requiring hospital admission. For adults, it was the fourth-highest activity. Another Australian study placed riding as fifth in its injury rate, with 718 injuries to every million participant hours. (Cycle touring was most dangerous, with bungee jumping 10th.)
Falls account for about 80% of injuries. On a horse, your head is eight to 10 feet off the ground. If you fall, the force of deceleration upon impact can result in trauma. A Cambridge University study surveyed 1,000 riding accident hospital admissions. It showed these relationships between hours in the saddle and falls causing injury.
One injury for 100 hours of leisure riding;
One injury for five hours for amateur racing over jumps;
One injury for one hour of cross-country eventing.
In the United States, the National Electronic Injury Surveillance System (of the U.S. Consumer Product Safety Commission) reports injury type and body part. Of 64,693 equine injuries from 1998, most were contusions and abrasions (28.7%) and fractures (28.6%). The trunk was the most frequently injured body part.
The U.S. Pony Clubs has collected its own accident reports since 1979. Pony Clubbers in 1998 most frequently injured the ankle/foot/toe area.
Reported head injuries are less frequent, but more serious. Concussions range from 4%-8% of injuries, yet head injuries cause two-thirds of deaths. A concussion is any alteration in mental state after a blow to the head.
As examples of horse-related fatality rates, British Columbia, Canada, reported a rate of one in 10,000 riders. The Netherlands, with an estimated half-million riders, had five fatal riding accidents each year.
Where riding, the horse you ride, and your equestrian discipline can affect your chance of injury. In an Australian study, horse behavior was the highest cause of injury (39%). Jumping accounted for 16% of injuries. The 1998 Pony Club study reported primary causes as the horse falling or slipping (19.8%), bucking (16.5%), or refusing a jump (13.2%).
Ballard said, "Any time you get into jumping or cross-country, it is most hazardous. There is an increased risk once you go cross-country, or trail riding in remote areas." She added that other perilous actions involve trailering and ground handling.
Doris Bixby Hammett, a board member for the AMEA, reported, "The most hazardous activity involving horses is recreational pleasure riding."
Off the horse, you're at risk while leading, loading into a trailer, or grooming. The Australian study reported being kicked as the most likely ground injury (44%). Dawson considered the most dangerous equine profession as either the veterinarian or farrier.
"How dangerous the job becomes depends on whether the vet or farrier will deal with any horse, or is she or he more selective. Too often people make the mistake of expecting them to treat or shoe horses that are not sufficiently handled to be safe."
Are the number of accidents rising? Hammett says no. "The total number of injuries do not seem to show a trend, but the injuries are occurring less to the young riders and more frequently to the older riders. We believe that this is true because young riders are more willing to accept safety concepts and the older riders remain traditionalist, doing what they have always done."
The Netherlands report noted an increase between 1990 and 1995. The number of riders treated in emergency rooms escalated by 30%; the number of hospital admissions increased 41%.
The sport of eventing has recorded an increased number of fatalities in recent years. The Federation Equestre Internationale (FEI) formed a committee to investigate these deaths. From its recommendations, the FEI reported "Everything should be done to prevent horses from falling. This single objective should greatly reduce the chances of riders being seriously injured as well as significantly improve the safety of competing horses."
Besides the pain of injuries, accidents affect the horse industry. Professionals can lose valuable time when recovering from injury, and personal injury lawsuits increase costs.
As an equestrian, you assume and mitigate risks. You can make safe decisions when you interact with horses. Take these steps to prevent a wreck and increase your enjoyment of horses and riding.
Choose clothing to reduce the chance of injury. Personal Protective Equipment (PPE) can shield you from impact (such as helmets, safety vests, safety stirrups, etc). Consider PPE that is appropriate for the risk, fits you, and adequately controls the risk.
Wear sturdy footwear around horses. This is the first line of defense against being stepped on. When riding, choose boots with short heels to prevent your foot from sliding through the stirrup.
Protective headgear is for all riders, although especially important for jumping and racing. In today's riding helmet, an expanded polystyrene liner absorbs shock waves. A retention system keeps the helmet in place.
Helmets meet standards developed by the American Society for Testing and Materials (ASTM) or the European Union's Euro Norm (EN). Models are tested to uniform performance standards and certified to pass the tests. In the United States, the Safety Equipment Institute (SEI) certifies helmets by subjecting them to drop and crush tests.
Helmets can reduce the severity of injury, but none can guarantee complete protection. The FEI report mentioned the need for neck protection in cross-country riding, considered all but impossible by medical professionals.
Hammett noted, "Football has searched for years to find neck protection for the players, without success. There has been nothing developed that would allow the rider the movement that is necessary, and which would protect the neck in such a fall as Christopher Reeve suffered."
"Neck injuries are not that common," said Ballard. "Head injuries are much more common."
You also can choose to wear body protection, sometimes called "body armor." A protective vest covers your upper body, with high-density foam padding cushioning your breastbone, ribs, and backbone. It gives you protection against bruises. Bull riders wear Kevlar vests to help shield against bruising and the animal's horns.
As a safeguard, the vest is limited in its defense. It is meant to protect against blunt trauma of the internal organs and ribs. The body protector won't protect from spinal injury.
Gloves can protect your fingers and hands. A glove can act as a barrier against abrasion while you handle a lead rope, reins, or a rope while roping cattle. A long-sleeved shirt and chaps gives you some protection, as the fabric can shield your arms and legs from scrapes.
Whenever you are around a horse, stay aware of the animal's possible behavior and the surroundings. "Think about what can happen, and what can go wrong when you work around horses," advised Ballard. "The longer you are around them, the more chance you can get hurt."
Human error leads to many accidents. You can forget how to act safely, or intentionally decide to act carelessly. In addition, avoid excessive use of alcohol when working around horses. According to the AMEA, in a significant number of deaths with horse activities, the person had an elevated blood alcohol level.
Maintain a healthy respect for horses. When you attend to the horse on the ground, understand the vicinity that forms a typical "danger zone." The vicinity is most likely inches, but feet and yards also mark the range of potential contact. Have an escape route in case of emergency.
Develop a secure seat in the saddle, whatever your discipline. (If you drive horses, maintain your position in the vehicle and stay in control, whether standing or moving.)
Realize that falling is a real risk, and that all riders fall. Learn to fall safely. Keep yourself safe by guiding the horse so he remains upright. Watch where you ride, and avoid footing that can cause the horse to stumble and fall.
Stay especially alert on a public road, where horses will encounter traffic. Hammett noted, "In North Carolina, 20% of horse-related human deaths involved a motor vehicle, and 11% were in horse-drawn vehicles."
Have a plan to manage the worst-case scenario. To address those "what if" concerns, know how you will enlist assistance for human injuries. Such help includes a first aid kit containing basic supplies, and contact numbers for medical emergencies. When you and your horse leave the barn, report your itinerary and expected return time.
The USCTA has published a Safety Coordinator Manual. Ballard explained, "It is aimed at providing medical care at events. It applies to any type of event, for people to look at and think about what kind of medical services they need, and what services are appropriate." This comprehensive guide covers plans to respond to medical emergencies. Procedures detail all aspects of handling accidents. To purchase a copy for $10, contact the USCTA at 703/779-0440.
By alertness and safe practices, you reduce the chances of equestrian accident. Hazards never disappear, but you can savor the delights as you minimize the risk.
Riders continue to debate whether organizations--government or sport--should regulate individual behavior. Safety devices, like seatbelts and airbags in cars and helmets for cyclists, can generate either fear of further injury, or a false sense of security.
Government entities in the United States and Canada are beginning to draft regulations requiring certain riders to wear protective headgear. For example, New York State passed a law in 1999 requiring rental horse providers and trainers to supply helmets to beginning riders and those less than 14 years old.
For competition, U.S. associations have developed (and enforce) regulations about personal protective equipment. The U.S. Pony Clubs has been the most influential. Dru Malavase, former chair of the Safety Committee, started efforts toward helmet safety standards in the 1980s, and pushed for the first ASTM standard in 1988. A Pony Club rider may participate in mounted activities only when wearing an approved helmet. The National Steeplechase Association also requires a certified helmet.
The American Horse Shows Association recently modified its rules about required protective headgear. Previous rules required, then were modified to encourage, riders to wear ASTM/SEI helmets. The newest rule change now requires junior riders in Hunter, Jumper, and Hunter Seat equitation classes to wear headgear "passing or surpassing then current applicable ASTM/SEI standards with harness secured." AHSA also "strongly encourages" event riders to wear protective vests in the Endurance Test. Eventers must wear a Medical Card in an armband, which identifies the rider in case of an emergency.
Your first goal in any equestrian activity is self-preservation. Whether you deal with horses as work or sport, you want to maintain your well-being. You expect to end each session safe and sound, and be as healthy as when you approached the horse.
Recognize that the horse's instinct also is for self-preservation. Even the most gentle animal can be transformed by panic and will make every effort to escape a perceived life-threatening emergency. Jan Dawson of the American Association for Horsemanship Safety, advised, "Learn how horses view the world in which they live, and accept that."
When you find yourself in an emergency, first say to yourself, "Can you deal with a situation without harm to yourself?"
For example, you might discover a cast horse. You first think, "How can I get him free of the wall or fence?" Balance that thought with, "How is it safe for me to get the horse free?"
About the Author
Award-winning writer Charlene Strickland lives in Bosque Farms, N.M. She has published 8 books and over 600 magazine articles, and is a member of the International Alliance of Equestrian Journalists.
POLL: University Equine Hospitals