1. Equestrian Injury is Costly, Debilitating, and Frequently Preventable: The Imperative for Improved Safety Awareness Kristi Guyton, Ellen Peck, Emily Houchen-Wise, John Mayberry MD

2. Equestrians in the Northwest Horses are integral to life in the Northwest 9.5 M horses in the US 1 30 M people ride horses yearly in US 2 Symbol of life in the West 1. UN Food and Agriculture Organization 2009 2. Loder. J of Trauma 2008

3. Equestrian Activity

4. Horses: Size, Speed and Power Size: 5-15x larger – 800 to 2,000 lbs – 4ft 3in to 7ft at the shoulder – Rider’s head ~10 ft off the ground Speed: 2x faster Strength: 20-40x stronger – Kick: 1 ton of force

5. Horses: Action and Reaction Horses are unpredictable – Herd mentality Horses in uncomfortable situations – We ask challenging things

6. When Things Go Wrong

7. Horses cause Injury Few injured equestrians require treatment 67,000 ER visits per year 1 ~300 people die per year in U.S. 2 Rate of serious injury per hours riding higher than motorcyclists 1 Fractures and traumatic brain injuries result in hospital admissions 1 1.Loder. J of Trauma 2008 2.Ball. Am J of Surg 2007

8. Study Objectives Circumstances of Injury Injury Patterns and Severity Cost Injury Prevention

9. Methods Retrospective analysis Trauma patients with horse related injuries treated at OHSU from 2001–2008 Trauma registry and chart review Survey

10. Injuries In 8 years 231 equestrians, 233 injury events Injuries ranged from mild to fatal – 35% have Injury Severity Scores >12 – Three patients died 25% of patients (59) required 84 surgeries – Orthopedic 33 (39%) – Laparotomy 15 (18%) – Spinal 12 (14%) – Facial 12 (14%) – Craniotomy 7 (8%)

11. Age and Gender Age Median: 43yrs Range: 2-75yrs Average: 38yrs

12. Body Regions Injured Head 96 (41%) – Intracranial Injury 79 (34%) Neck 20 (8%) Chest 58 (25%) Back 30 (13%) Abdomen 30 (13%) Pelvis 26 (11%) Extremities 26 (11%) Polytrauma 49 (21%)

13. Head Injuries 96 patients (41%) had LOC, skull fracture, or significant intra-cerebral injury 20% helmet use among mounted equestrians by EMS records 37% of serious head injuries were likely preventable with helmet use 2 deaths: neither wore a helmet, both likely preventable with helmet use

14. Survey Results: Experience Survey – 91 patients completed the survey – 66% of those successfully contacted Mode of Injury – 55% Fell or bucked off – 17% Kicked – 11% Stepped on

15. Survey Results Experienced Riders – 56% over 10 years riding experience – 73% formal instruction – 44% long-term training relationship Length of Horse Training – 59% had 2 or more years of training Location of accident – 89% familiar to the horse – 90% familiar to the rider

16. Results of Survey Injury Severity Score Equestrian Skill Level % of each Equestrian Skill Level

17. Survey: Preventive Measures Used 58% reported NOT wearing protective equipment 34% reported wearing a helmet at the time of injury 70% felt their protective gear helped prevent more serious injury

18. Results: Cost Average hospital charge: $29,800 – $3,000-$511,000 – Does not include any subsequent care Total cost: $6.9 million

19. Results of Survey 9% equipment failure 30% poor horse and rider pairing 40% environmental factors contributed 59% long-term disabilities

20. Checklist Check protective equipment – helmet, boots, vest Check horse tack – saddle, bridle Check environment Assess horses’ behavior Assess your own attitudes Consider steps to reduce risk

21. Limitations Retrospective Low survey response rate Survey response bias – Recall bias – Persistently symptomatic – Employed in horse industry

22. Conclusions Lack of helmet use remains prevalent Helmet use may prevent morbidity and mortality Equestrian injuries have financial and disability burdens Riding environment and horse and rider pairings contribute to injuries Potential for increased safety awareness even among experienced equestrians

23. Personal Experience One Month Post Op

24. Why we continue to ride…

25. Acknowledgements Dr. John Mayberry Ellen Peck and Emily Houchen-Wise OHSU Trauma Team My parents, Steve and Sigrid

26. Anything can scare a horse: children, cows, dogs, rabbits, flower pots Be aware of your horse’s reactions and adjust your behavior Practice everything at home: desensitize your horse Check your equipment yourself every time Be sure your position relative to the horse is safe Wear a helmet ALWAYS Survivor Wisdom