1. Horse Related Injuries Sonya Melville, MD University of Kentucky Chandler Hospital

2. Purpose To understand the incidence and prevalence of horse related injuries occurring in Kentucky and the U.S. To compare horse related injury patterns from the World Equestrian Games in fall 2010 to previous data. To identify injury patterns associated with horse related injuries. 2

3. Background 5,003 horse- related injuries in the United States 2002-2004. –Contusion/Abrasion 31% –Fractures 28% –Sprains/Strains 18% –Traumatic Brain Injury (TBI) 12% –Lacerations 6% (Loder, 2008) 3

4. Horse-related injury Fractures and TBI cause of hospital admission TBI most common injury when no helmet worn by rider Cost of TBI associated with horse related head injuries from $600,000 to 1.8 million (Mayberry et al., 2007) 4

5. Causality of Horse Related Injury Lack of protective gear- helmets in particular 27% of injuries to riders were due to demands the rider was placing on the horse - - that is asking the horse to perform a maneuver outside of its skill set Half of the patients in the study believed the injuries were preventable and were the fault of the rider (Ball and Ball, 2007) 5

6. UK Data Analysis Retrospective review using trauma registry data. IRB approval obtained 6

7. 7 Specific Aims: 1.Define the incidence and prevalence of horse related human injuries seen at the University of Kentucky. 2.Compare the UK incidence and prevalence of horse related human injuries to the United States incidence and prevalence. 3.Identify at least 2 strategies to reduce the incidence of horse related human injuries. 2

8. Sample All patients entered in the UK Trauma Registry Data Base from 2006-2008 with horse related injuries. All trauma patients 2006-2008 N = 8668 Horse related injuries 2006-2008 n = 223 (UK Trauma Registry, 2009) 8

9. 9 Patients Hospitalized at UK HealthCare First Seen in the Emergency Department for a Horse-Related Injury 2006 2007 2008 (UK Trauma Registry, 2009) 4

10. 10 Cause of Injuries of Patients Admitted to UK Hospital via Emergency Department (UK Trauma Registry, 2009) 5

11. 11 Examples of Typical Horse-Related Patient Injuries Requiring Hospitalization Crushed spine/spine fractures Broken shoulder blades Liver lacerated Bruised, bleeding, punctured lungs Right rib fractures Chest bone dislocated Collarbone fractures Broken/fractured arms, legs, hands, feet Traumatic brain injury (TBI) Fractured cheek Fracture eye socket Nose fracture Fractured jaw (UK Trauma Registry, 2009) 6

12. 12 Cause of Hospitalization of Patient with Horse-Related Injuries at UK (UK Trauma Registry, 2009) 7

13. 13 (UK Trauma Registry, 2009)

14. 14 Top Ten Sports for Traumatic Brain Injuries Percentage of emergency department visits for nonfatal traumatic brain injuries by activity: Horseback riding 11.7% Ice skating 10.4% All-terrain vehicles (ATV’s) 8.4% Sledding 8.3% Bicycling 7.7% Hockey 7.4% Playground 7.1% Moped/dirt-bike 6.6% Golf 6.6% Amusement Parks 6.5% (CDC, 2007) 3

15. Implications TBI risk increases without helmet. Protective Gear needs to be worn at all times by all riders. Injury Prevention Education essential. Equestrian professional associations must require appropriate protective apparel. 15

16. The WEG and Injury Concerns Simultaneous competitions Competitive venues with athletes from around the world Athletes had varying levels of skill Length of event had the potential to increase injuries seen What is different about an equestrian athlete? 16

17. The Equestrian Athlete Commonly exposed to repetitive trauma Head and back injuries very common. At least 13 riders in the past four years have been killed and several others seriously injured.

18. WEG 2010 18

19. History of the Games Prior to first WEG, each discipline held their own championships. –KY Horse Park hosted the Eventing World Championship in 1978. –The Championships were held every 4 years The concept for the WEG was first proposed in 1983 First WEG was help in Stockholm in 1990 –Six events: Jumping, Dressage, Eventing, Driving, Endurance and Vaulting –Reining was added in 2002 –Para Dressage is new this year to the competition This will be the first time the games will be hosted outside of Europe.

21. DRESSAGE

22. DRIVING

23. ENDURANCE

24. JUMPING

25. PARA DRESSAGE

26. REINING

27. VAULTING

28. EVENTING

29. Eventing All around test for the horse and rider Three Day Event comprises of –Dressage Test –Cross Country Test –Jumping Test (Stadium jumping)

30. Cross-Country Eventing 30

31. Injury Potential 31

32. Primary and Secondary Injuries 32

33. Chest and Spinal Trauma 33

34. Rider Outcome Open Mandible Fracture Rib Fractures with Bilateral Hemopneumothorax Scapula and clavicle fractures Facial Fractures Discharged home after 17 days Resumed riding shortly after injury 34

35. Protective Gear- Air Vest Ripcord tethered to horse- when rider ejected/separated from horse air vest deployed. Inflates when ripcord pulled from CO2 canister. Difficult for the rider to breath when the vest inflates- need to release vest clips as soon as possible. Example from Rolex 2010 – to follow 35

36. Inflatable Vest

38. Lessons Learned Main medical and satellite sites saw 956 patients- mostly minor complaints 37 transports- mostly spectators Trauma- spectator and athletes Cross- country eventing- 8 falls –3 athlete transports 5 total athlete injuries over course of event- all non-life threatening 38

39. 39

40. 40 References Ball, C. E., Ball, J. E., Kirkpatrick, A. W., & Mulloy, R. H. (2007). Equestrian injuries, injury patterns, and risk factors for 10 years of major traumatic injuries. The American Journal of Surgery, 193 (5): 636-640. Carrillo, E.H., Varnagy, D., Bragg, S. M., Levy. J., & Riordan, K. (2007). Traumatic injuries associated with horseback riding. Scandinavian Journal of Surgery,96 (1): 79–82. Centers for Disease Control and Prevention. (2007). Nonfatal traumatic brain injuries from sports and recreation activities – United States, 2001-2005. Morbidity and Mortality Weekly Report, July 27, 2007: 29. Ceroni, D. (2007). Support and safety features in preventing foot and ankle injuries in equestrian sports. International Sports Medicine Journal, 8(3):166-178. Loder, R. T. (2008). The demographics of equestrian-related Injuries in the United States: Injury patterns, orthopedic specific injuries and avenues for injury prevention. The Journal of Trauma, Injury, Infection and Critical Care, 65(2):447-460. Mayberry, J. C., Pearson, T.E., Wiger, K.J., Diggs, B. S., & Mullins, R. T. (2007). Equestrian injury prevention efforts need more attention to novice riders. The Journal of Trauma, Infection and Critical Care. 62(3):735-739. 17