About Safety

Article by East Bay CDS Chapter Member Georgia Langsam

In August, 1969 at twilight, I fell off my horse while jumping bareback on a trail.  I wasn’t wearing a helmet.  No one wore helmets in 1969 except jockeys; we wore “hard hats” with elastic straps to show or hunt and we didn’t worry about it when we weren’t in a show.  There were no ASTM/SEI standards.

Anyway, when I fell, I flipped off the horse’s right shoulder, landed on my rump and then fell backwards and hit the back of my head.  Prior to falling, I was galloping at speed and I fell off a 16 hand horse.  The force of that fall ripped the seat out of my Levi jeans and caused me to fracture my skull and knocked a couple molars out of my jaw.  A bone chip from the skull fracture severed my middle meningeal artery and I was bleeding out into my brain.  Bone chips also severed my dura and lodged in my temporal lobe.  But I didn’t know any of that then, I only knew that my jeans were ripped and my horse had taken off and I had to catch him and walk home.  I had a date that evening.

I was one of the lucky ones.  My injury was serious enough to have left me unconscious or dead on the trail but miraculously didn’t.

After I got home, I took an aspirin for my headache and went to a party.  Because my head was hurting, at 10:30 p.m., I asked my mother to drive me to the emergency room because I’d fallen off and didn’t feel that well.  I was still conscious when I arrived at the ER but quickly lapsed into a coma.  That night I underwent 12 hours of emergency brain surgery.  Three days later I underwent another surgery that lasted longer.  I spent a month in a coma in the ICU and was expected to die.  My parents were prepared by the surgeons and nurses for my death or my survival as a severely brain damaged person requiring constant assistance.

For some unexplained reason, probably associated with my youth and the plasticity of my brain as well as the excellent medical attention I received, I survived and I overcame most of my disabilities.  I resumed riding 6 months after the accident and have never stopped.  I now, however, religiously ride in a helmet.  Had I been wearing a helmet when I fell that evening in August, I most probably would have escaped with a severe concussion, but most certainly would not have required extensive surgery, nor suffered the extensive brain damage caused by the fracture, shattering of my skull and massive bleeding.

Riding is dangerous. Head injuries account for approximately 60% of deaths resulting from equestrian accidents. Properly fitted ASTM/SEI certified helmets can prevent death and reduce the severity of head injuries sustained while riding.  Historically, head injuries constituted 18.1% of reported emergency room visits for injuries related to horseback riding in the period 1979-1981 and 16.1% of similarly reported injuries reported in the time period 2007-2008.

Although head injuries decreased during this 30 year time frame (presumably because of increased use of certified helmets), concussions increased from 3.6% of reported emergency room treatments to 4.9%.

The fact that concussions have been diagnosed more frequently in the past 30 years is not a condemnation of helmets.  Medical understanding of brain injury has increased in the last 30 years.  This fact has increased the diagnosis of concussion where it would have been missed earlier in time. Thirty years ago many concussions would be dismissed as “seeing stars” or a “ding”. Now more head injuries are recognized as concussions with medical consequences.  This gives a better understanding that although head injuries have decreased, the diagnosis of concussion has increased.

What is a concussion? A concussion is a type of traumatic brain injury. It may be caused by a direct blow to the head, face or neck, or a blow anywhere on the body with the resulting force transmitted to the head. Since a fall from a height of two to three feet has been shown to produce forces strong enough to cause a concussion, it is easy to understand why concussions are a common injury and are of great concern for all equestrian sport.

What are the signs and symptoms of concussion? Typically concussion results in signs and symptoms which reflect disturbances in the function of the brain as opposed to structural damage or injury.  This means that concussions often occur even when a CT or MRI shows no visible damage.  Signs of concussion can sometimes be detected by an observer. Such obvious signs include: loss of consciousness, unresponsiveness, convulsions, vomiting, and/or balance problems.  Often the symptoms of concussion are more subtle, and may only be detected by the injured person. The symptoms may include one or more of the following:

• headache (especially a headache that gets worse)

• feeling “pressure in the head”

• neck pain

• dizziness, nausea or vomiting

• vision problems

• hearing problems (ringing)

• generally not “feeling right”

• confusion

• drowsiness, fatigue or low energy

• feeling overly emotional

• combative behavior

• depression

• nervousness

• difficulty concentrating

• impaired memory

• sensitivity to light or sound

• slurred speech

• trouble sleeping

• numbness/weakness in arms or legs

Resolution of the signs and symptoms typically follows a sequential course, with 80-90% of concussions resolving over the course of seven to 10 days; in some cases symptoms may persist for months.

The Equestrian Medical Safety Association has produced a color brochure for easy reference regarding concussion:

http://www.emsaonline.net/pdf/Concussion-Brochure.pdf

A more detailed brochure has been produced by the EMSA for eventing which includes more detailed information about the grading of concussions:

http://www.emsaonline.net/pdf/ConcussionMgmtCard.pdf

Helmets save lives. There are many available models of helmets on the market.  Properly fitted ASTM/SEI certified helmets can prevent death and reduce the severity of head injuries sustained while riding.  For a current list of helmets certified by the Safety Equipment Institute to ASTM standard F1163, please go to http://www.seinet.org and click on “Certified Products”,  then click on Equestrian Helmets.

Bike helmets or ski helmets are not sufficient for equestrian activities.  The equestrian standard, F1163, tests helmets designed for equestrian pursuits on a flat anvil and a special equestrian hazard anvil which was designed to simulate the edge of a horseshoe and/or a jump standard.  Helmets designed for other sports are not similarly tested, so won’t necessarily provide the rider with the same protections that equestrians have been determined to need.

Equestrian Helmet Facts:

• Fact #1: Between 12 to 15 million persons in the United States ride a horse or pony every year.
• Fact # 2: Approximately 20 percent of horse related injuries occur on the ground and not riding.
• Fact # 3: Most riding injuries occur during pleasure riding.
• Fact # 4: The most common reason among riders for admission to hospital and death are head injuries.
• Fact # 5: A fall from two feet (60 cm) can cause permanent brain damage. A horse elevates a rider eight feet (three meters) or more above ground.
• Fact # 6: A human skull can be shattered by an impact of 7-10 kph. Horses can gallop at 65 kph.
• Fact # 7: According to the National Electronic Surveillance System figures the most likely ages for injury is at 5-14, and 25-44 years with each decade having about 20 percent of the injuries.
• Fact # 8: A rider who has one head injury has a 40 percent chance of suffering a second head injury. Children, teens and young adults are most vulnerable to sudden death from second impact syndrome: severe brain swelling as a result of suffering a second head injury before recovery from the first head injury.
• Fact # 9: Death is not the only serious outcome of unprotected head injuries. Those who survive with brain injury may suffer epilepsy, intellectual and memory impairment, and personality changes.
• Fact # 10: Hospital costs for an acute head injury can be in the range of $25000 per day. Lifetime extended care costs may easily exceed $3 million. There is no funding for rehabilitation outside the medical setting.
• Fact # 11: Helmets work. Most deaths from head injury can be prevented by wearing ASTM (American Society for Testing Materials), SEI (Safety Equipment Institute) approved helmets that fit correctly and have the harness firmly applied. Other types of helmets, including bike helmets, are inadequate.
• Fact # 12: Racing organizations require helmets and as a result jockeys now suffer less head injuries than pleasure riders. The US Pony Club lowered their head injury rate 29 percent with mandatory helmet use. Britain’s hospital admission rate for equestrians fell 46 percent after helmet design improved and they became in routine use.
• Fact # 13: The American Academy of Pediatrics, The American Medical Association through the Committee on Sports Medicine, Canadian Medical Association, and the American Medical Equestrian Association/Safe Riders Foundation recommend that approved, fitted and secured helmets be worn on all rides by all horseback riders.

USEF’s rule to protect equestrians from further head injury in competition[1]

In April 2009, the USEF “Return to Play” rule (GR1317) went into effect. This rule provides that any competitor who sustains a possible concussion or loss of consciousness during a USEF competition must supply the USEF with

medical release documentation.  The competitor may not compete again until this documentation is submitted to the USEF Steward or TD (if released during the same competition as the accident) or to the USEF office.

What factors affect Return to Play decisions?

Each person reacts differently to concussions. In some a slight blow may cause serious symptoms while in others a harder blow may cause mild symptoms. Loss of consciousness is not experienced by the majority who suffer concussions and is not an indicator severity.

Scientific evidence now shows the effects of repeated concussion accumulate and can affect intelligence, emotions and thinking ability for years to

come.  Even mild concussions, suffered repeatedly though separated by months or years, can cause problems.

A second trauma to an already injured brain occurring before the symptoms of the first have resolved can result in serious permanent damage

or even fatality (Second Impact Syndrome). It is crucial that the brain is given enough time to heal.

Many factors play a major role in determining the time needed to recover from a concussion.  These factors include the severity of the current injury, how long the symptoms persist, whether there has been prolonged cognitive impairment, whether there are any contributing cognitive impairment, whether there are any contributing factors in the genetic or medical history, whether the competitor has sustained repeated concussions (if so, the number, severity and

proximity to the current injury), whether repeated concussions are occurring with progressively less impact force and the age of the competitor.

For these reasons, Return to Play decisions can only be made by a medical professional who can exercise clinical judgment on an individualized basis.

Conclusion

Helmets can save lives and prevent catastrophic brain damage during routine falls from horses.  Many different models are now manufactured (there are even companies that will custom-make a “top hat” on a helmet – but they’re REALLY funny looking IMHO) and there are helmet sizes and shapes to fit every head.  Given the potential harm that can arise from failure to wear a helmet during all equestrian pursuits, everyone should wear a helmet.  If not for you, for your loved ones.