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Kristi Guyton, Ellen Peck, Emily Houchen -Wise, John Mayberry MD

Equestrian Injury is Costly, Debilitating, and Frequently Preventable: The Imperative for Improved Safety Awareness . Kristi Guyton, Ellen Peck, Emily Houchen -Wise, John Mayberry MD . Equestrians in the Northwest. Horses are integral to life in the Northwest

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Kristi Guyton, Ellen Peck, Emily Houchen -Wise, John Mayberry MD

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  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 US1 • 30 M people ride horses yearly in US2 • 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 year1 • ~300 people die per year in U.S.2 • Rate of serious injury per hours riding higher than motorcyclists1 • Fractures and traumatic brain injuries result in hospital admissions1 Loder. J of Trauma 2008 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 Median: 43yrs Range: 2-75yrs Average: 38yrs Age

  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 % ofeachEquestrian SkillLevel 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. Survivor Wisdom • 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

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