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Table of Contents
Introduction: This research profiles equestrians injured in accidents that occurred “at home” (defined as the place where the rider or handler keeps/boards/leases his/her horse or horses) in understanding the feeling states and responses of these equestrians. Previous studies indicate that over 27,000,000 people participated in equestrian activities each year in the U.S.[1] Of those, 92,000 annually require some form of medical care. After a riding accident, the bond between human and horse may be temporarily or, at worst, permanently disrupted. Depression, nervousness and anger can replace the positive feelings and benefits.
Participants
and Procedure: the editors of several
nationally known horse magazines (The Chronicle of The Horse, Equus, and
Dressage Today) and by two local equine papers (Maryland and Pennsylvania) as
well as on the researcher’s Web Site advertised the study. Data from
equestrians whose “at home” riding accidents were serious enough to required
medical attention/treatment from a trained medical professional (doctor, nurse,
dentist, physician’s assistant) either in a private office or in a
hospital/emergency setting) were used.
Five hundred and two people responded to the Equestrian Injury Questionnaire (see below). Four hundred and fifty two of the respondents used the Internet to answer and to respond to the questionnaire. The remaining 50 participants requested, received and returned copies of the questionnaire through the mail. Responses were collected throughout the fall of 2000 and the Winter/Spring 2001. Of the 502 responses, 44 came from observers of equestrian accidents. Information from 8 participants could not be used either because they did not fully answer the questionnaire, or because their accident happened at a show and not at home, or because they were from a foreign country. The final sample of injured riders/handlers (actors) was 450. All responses were anonymous.
An “Equestrian Injury Questionnaire” was developed containing 28 items. Part A included questions on age, gender, income, educational level, style of riding, description of the accident and the injuries received, importance of riding to the respondent, self ratings of severity of the injury/injuries received, number of riding accidents sustained while riding throughout the years, whether visible signs of the injury persisted after the accident, number of horses owned, now long he/she had ridden the horse involved in the accident, number of hours per week horses are ridden or handled, whether the horse(s) owned by the participants were kept at home or boarded, self rated level of riding skill (beginning, intermediate, advanced, part time profession, professional) etc. Part B asked respondents to assess 15 causes (riding ability, effort, bad luck, could have happened to anyone, something in the physical environment, interference from others, personality factors, attitudes toward riding, reasons or motives for riding, divine intervention, ability level of the horse, training of the horse, soundness of the horse, tiredness of the horse and finally, the horse’s disposition or personality) for their riding accidents. The statement of each cause was followed by a 5 point rating scale (very true of me, true of me, somewhat true of me, not true of me and very untrue of me). Respondents first rated these causes by reflecting on how they felt immediately (within twenty four hours of the accident). Then, respondents re-rated the 15 causes by analyzing how they felt now, at the time they were answering the questionnaire, about these same causes. Because time since the accident varied from “approximately one month” to “20 years”, respondents were rating their post accident attributions at very different time intervals. Statistical techniques (partial correlation and ANCOVAs [2] were used to help to eliminate the influence of time since the accident on post accident attributions.
This
research also questioned participants on their depression, nervousness and
anger, within 24 hours of the accident and at times subsequent to the accident.
Again, these “times since the accident” varied depending on how long
it was between answering the questionnaire and the date of the
equestrian-related accident. Participants also indicated how long each one of
these feelings lasted.
RESULTS
Table
I
The 450 participants ranged in age from 9 to 80 years. (Average age = 39
years).
Table II
Ninety
five percent were female and five percent male. Their income ranged from $1600 a
year for students and younger participants to $250,000, with an average of
$58,200 per year. Twenty seven percent of this sample made more than $70,000 per
year.
Respondents have ridden an average of 20 years but this varies from a few
months to 76 years. All participants who were 18 or older at the time of the
survey had completed high school. Most respondents (47%) have had some college
or completed college, though 20% are still in school and 33% have completed some
graduate level training, including the MBA, MSW, Ph.D., MD or JD degree. They
rode or handled horses an average of 14 hours per week and owned an average of 3
horses at the time of the accident. Fifty one percent kept their horses at home,
11% boarded at a small, private boarding facility with five or fewer horses or
at a friend’s farm, 26% boarded at a large private facility (six or more
horses) and 11% kept their horses at a lesson or boarding barn at the time of
the survey. The remaining 1% boarded at a large public facility. Eighteen
percent of the respondents did not own a horse at the time of their accidents.
They were either leasing one at the time of the accident or the accident
happened on a school horse. Four percent had the accident while trying out a
horse for purchase.
Part I: Psychological Aspects of an Equestrian Injury:
(A). Attributions from the Injured Equestrians:
In general, riders and handlers made stronger attributions to external causes for their accidents than to internal causes. This was true both at the time of the accident (within twenty-four hours) and at various post accident intervals. Specifically, riders and handlers and drivers rated two causes as most important in their analyses of their accidents: could have happened to anyone (M=3.22) and the attitude/disposition/personality of the horse (M =3.09).
A few rider characteristics related to how attributions were made. Older riders attributed less to bad luck as a cause of their accidents than younger riders (p < .05). The more years of formal schooling, the less the riders attributed their equestrian mishaps to “could have happened to anyone” (p < .05). The longer they had ridden and the higher their own self assessed skill level, the less they saw ability as a cause in their riding accidents (p< .05). There were no other statistical differences (p > .05) in any of the 15 attributions for income level, for horse’s activity or behavior at the time of the accident, for the gait at which the accident occurred, for riding style (English Hunt Seat, Dressage, Western, Bareback) for single versus multiple injuries or for body region injured. This was true for participants’ responses to how they assigned causality immediately after the accident (within twenty-four hours) as well as at post accident intervals.
In addition to finding out how injured equestrians responded to a standard attribution questionnaire, the research also asked which causes participants would select from a list of eight causes. There were also places in this question for riders to add to the list of possible causes. Participants were asked, “When you think about this riding accident, whom/what do you feel is responsible?” Beside the causes listed respondents were free to list as many causes, as they felt applied and to add their own. Fifty four percent selected only one cause. The remaining 46% checked multiple causes. Of those who selected only one cause for their accident, a significantly larger percent of the respondents, as indicated by Chi Square tests for independence, attributed the accident to rider error (37%), to the horse misbehaving (25%) or to extraneous causes such as loose dogs (19%) than to any of the other causes.
How do riders’ and handlers’ attributions differ from observers? The observers did not witness the accidents described by the riders or handlers. The riders/handlers and observers are not making attributions for the same accidents. The sample of observers was also much smaller. Forty observers’ responses were usable. These forty observers were matched in terms of age, education level, income level, and frequency of religious participation and self-assessed riding skills with forty riders/handlers from the sample of 450. All data for this stage of the data analysis came from females. Regardless of the type of equestrian accident, observers rated rider ability (M=2.94) and rider effort (M=1.89) as significantly stronger causes of the equestrian accident than did actors (M =1.63 (ability) and M= .83 (effort)). On the other hand, just as attribution theory would predict, the riders/handlers rated “could have happened to anyone” (M =3.22) and the horse’s personality/disposition as significantly (M=3.09) stronger causes of the accident than did observers (M=1.93 for “could have happened to anyone”) and (M= 2.02 for horse’s attitude, personality/disposition).
(B). Feelings after a Riding Accident:
Immediately after a riding accident (within 24 hours), 24% reported no depression, 24% reported no nervousness and 39% reported no anger. These are not necessarily the same riders reporting no anger, no depression and no nervousness. For example, some riders may have felt no depression but a great deal of nervousness and moderate anger, etc. Approximately 40% within each one of the emotions rated slight to moderate feelings of depression, nervousness and anger. On the other end of the emotional spectrum, 29% reported that they were very depressed, 35% very nervous and 23% very angry. These are not necessarily the same riders reporting high levels of depression, nervousness and anger. However, analyses did indicate statistically significant correlation (relationships) among the three emotions, both at the time of the accident (within 24 hours) and at the various post accident intervals. This means that within twenty-four hours of the accident, the more depressed a rider, the more nervous (rp(431) =.444, p=.000). It means the more depressed a rider, the more angry (rp (430)= .446, p=.000). And, the more nervous the rider, the more angry he or she is likely to be (rp (430) =.160, p=.000). Similar significant correlation was also obtained at post accident intervals. These intercorrelations tell us that the feelings are occurring and are staying together. However, the statistical technique does not permit us to discuss cause and effect.
All three emotions, rated within 24 hours, were significantly correlated (p< .05) with these ratings of emotions at post accident intervals. Time since the accident was partialed out statistically. This means the more depression retrospectively reported within 24 hours of the accident, the more depression retrospectively reported at post accident (rp(421) = .322, p= .000). The same was true for nervousness within 24 hours and at post accident (rp(423) = .371, p=.000) and for anger (rp(420) = .421, p=.000). In general, the findings also tell us that the stronger the feelings of depression, nervousness and anger at the time of the accident, the longer these feelings were reported to persist post accident (p < .05).
When all the various riding styles/disciplines were included, for those who did suffer depression, nervousness and anger, they lasted for 4.67 months, 8.7 months and 5.73 months respectively. Depression at the time of the accident and length of time anger lasted were related to severity of self-assessed injury ratings (p<.05). This means the more severe the rider viewed his/her injuries, the higher the level of depression (p<.05) and the longer the anger lasted (p<.05). The majority of riders reported that any depression (93%), nervousness (79%) and/or anger (89%) that they felt dissipated with time and even disappeared. By post accident intervals the ratings of all three emotions were at “one” or “zero” on a five-point scale. These participants were rating the three feelings as not occurring or as very slight. The emotion, which persists the longest and the strongest for most styles of riding and for all age groups involved, is nervousness.
There were statistically significant relationships (p <.05) between the three feeling states of nervousness, depression and anger and certain attributions. The more nervous the injured equestrian at the time of the accident and the longer that nervousness lasted, the stronger the attributions to rider’s effort, to the ability level (actually inability) of the horse, to the horse’s lack of training and/or to the horse’s tiredness as causes of the accident. Higher levels of self rated depression at the time of the accident and at post accident intervals as well as length of time the depression lasted were related to attributing the accident to “Divine Intervention” and/or to the horse’s unsoundness. Higher anger ratings were related, both at the time of the accident and at post accident intervals, to beliefs that the horse’s unsoundness, and/or the horse’s tiredness and/or “ Divine Intervention” caused the accident. These relationships require more in-depth study in subsequent analyses.
(In the next report on this research, the physical injuries sustained in the sample of “at home” riding accidents will be considered along with safety precautions reported both before and after the accident. And, in the third report, coping strategies and enjoyment levels after the injury as well as some vignettes provided by the participants will be discussed. Conclusions will also be presented in Part III.)
[1] Nelson DE, Rivera FP, Condie C: Helmets and Horseback Riders. AmJPrevMed 1994;10(1).
[2] ANCOVA: Analysis of covariance. If a third variable (unwanted variable or confounding variable) is influencing the relationship between the dependent variable and the independent variable there is a statistical procedure that takes the influence of this covariate (Confound) out and gives you a better result (meaning a less confused look at how the independent variable is influencing the dependent variable).
A recent article on bicycle helmets caused me to pause and reflect on equestrian helmets once more. I believe the outcomes of helmet use in other sports, from car racing, motorcycles, bikes, football, hockey, baseball batters to skateboards, etc., can be extrapolated to outcomes for helmet use in equestrians. We have no prospective studies, randomized and double blinded to support the contention that equestrian helmets prevent injury and death. To do so would be unethical. We cannot randomize riders to a study arm in which so much collateral data indicates that they are at increased risk of injury. Unfortunately, riders still elect to enter the "no helmet" arm of the equation and put themselves at risk.
The
BCMJ and more recently the CMAJ have published follow-up reports on legislated
bike helmet laws and their results after 2 years. Five of the ten
provinces have bike helmet laws. The review in CMAJ Mar 5 2002; 166(5) by
LeBlanc et al reports an increased use of helmets from 36% to 86% and subsequent
50% reduction in cyclist head injuries. This law was enforced by the
police and no mass education was carried out since 1997. One of the
editorial comments noted that similar results were found in Australia and New
Zealand. One of the detractors noted that the result of the law was a
decrease in cyclists.
Bicyclists now include those who are on roadways, back country and racing. Except for those on the roadways it is difficult to believe the police could enforce such a law and, indeed, many have been warned or fined and still do not comply. It appears from the statistics that having the law "on the books" does increase the use of helmets and a subsequent very significant drop in head injuries. Initially, education was used but did not have the tangible outcome that resulted from legislation. I hope to see data from New York, Florida and Ontario regarding the results of their helmet laws. It is too early to retrieve this data and we will have to wait. Changes in head injury incidence have been shown in the US Pony Club since enforcement of their helmet policies.
I
personally would prefer education to laws but I wonder how many need to suffer
from head injury before riders are convinced by education alone?
Janet
M. Friesen
President, AMEA
Since last edition, I have been very busy. Being Medical Officer at the Foxhall Cup (Eventing’s National Championship), attending the Kentucky Derby, putting the finishing touches on the safety portion of the USEA’s Instructors Certification Program and just day to day business has kept me on my toes, not to mention my real job and family duties! Another computer crash slowed me down and now I am in the recovery mode. My deepest apologies if technical difficulties have slowed down our response to you.
The AMEA is moving right along and I still have some goals to achieve including membership. We are way behind in membership dues and I appeal to you to please send in your 2002 dues. Reminders will be mailed soon. Man can not live by bread alone and neither can the AMEA! Another goal is to solicit corporate sponsorship to help our mission and offer our corporate, safety minded friends more exposure through the AMEA. If you have any suggestions of potential corporate partners or sponsorship, please contact me. Individuals wishing to be sponsors are welcomed also. Donations are tax deductible.
If you don’t know, the AMEA does more than publish a newsletter. Please see, “AMEA to the Rescue”, in this edition. In the near future, I would like to establish a list of members or member’s facilities that specialize in the treatment and rehabilitation of those injured while riding to help us refer requests to the appropriate treatment centers.
This month’s News contains a few new items. Thanks are in order for Ms. Jan Dawson, a long time friend of the AMEA, who will begin a column to address legal issues relevant to members of the AMEA. Also, a member spotlight column will begin to highlight members and introduce them to us. This issue will highlight our two new Board members. Please submit your suggestions for who can be profiled in this interesting column.
In closing, I would again like to say thanks to the many people that help the AMEA and me personally on a daily basis. Without the support and advice that is given by our many friends, we could not survive. The AMEA is definitely making a difference within our sport and I am proud to be associated with such a fine organization. I hope you have a safe and happy summer.
Rusty
Low-Level
Falls Can Cause Greater Pediatric Brain Injury Than Previously Thought
Dr. Michael Y. Wang
American Association of Neurological Surgeons
Children
who fall from heights of less than 15 feet can develop intracranial bleeding or
blood clots that may not be apparent on external examination.
The researchers of Children’s Hospital of Los Angeles performed a
retrospective analysis of patients younger than 15 years old with fall related
trauma between 1992 and 1998. Cases,
excluding suicides, were identified through the hospital database.
Complete records were available for 729 patients.
Boys were slightly more than half of the children. The median age was 2
years. Low level falls involved 396
patients (54.3%). The commonly used guideline to gauge the severity of injury
and emergency care of an injured child is a 15 feet fall.
Dr. Michael Y. Wang said that low-level falls have been largely ignored as a public health issue, and emergency medical services triage criteria dictate a lower urgency for low-level falls. All deaths occurred in children younger than 9 years of age. The only cause of mortality from low-level falls was intracranial injury.
www.medscape.com/viewarticle/431503
Editorial Note:
Physicians and medical personnel who see young children who have fallen from a horse must be aware of the high danger of intracranial injury that does not show symptoms at the time of the fall. These children must not remount and must be under careful observation by qualified personnel.
Doris Bixby Hammett, MD
The AMEA has recently received some interesting requests for assistance. When a request is received, I attempt to triage the situation and forward the request to the appropriate person (s) or organization (s) that can most appropriately handle the request. As you will see, these requests can involve teamwork from many people!
These are only a few of the noteworthy requests received by the AMEA. We will provide assistance within reason for any equestrian issue that is safety related. The AMEA provides this assistance in good faith hoping to continue making our sport safer. For assistance, we can be reached by our e-mail address, fax or toll-free number.
Special thanks should be given to our members and friends who provide assistance to the AMEA with these requests. As stated previously, the AMEA provides assistance at no cost to the requester. We simply ask for a donation.
Rusty
Lowe, EMT-P
Executive Director
Vital
Statistics 1995-1998
Centers of Disease Control 1999
TABLE I
Animal Related Deaths
|
Code |
83-94 |
Deaths/Yr |
|
1995 |
1996 |
1997 |
1998 |
Total |
Deaths/Yr |
Percent |
|
|
|
83-94 |
|
|
|
|
|
|
95-98 |
|
|
E813.5 |
74 |
6 |
|
3 |
6 |
7 |
8 |
24 |
6 |
3.7% |
|
Motor vehicle involving collision with |
|
|
|
|
|
|
|
|
|
|
|
animal ridden/animal-drawn vehicle |
|
|
|
|
|
|
|
|
|
|
|
E827 |
69 |
6 |
|
8 |
9 |
6 |
6 |
29 |
7 |
4.4% |
|
Animal
drawn vehicle |
|
|
|
|
|
|
|
|
|
|
|
E828 |
1218 |
102 |
|
86 |
87 |
76 |
91 |
340 |
85 |
52.1% |
|
Animal
being ridden |
|
|
|
|
|
|
|
|
|
|
|
E906.8 |
852 |
71 |
|
51 |
75 |
70 |
63 |
259 |
65 |
39.7% |
|
Other injury caused by animal |
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
2213 |
185 |
|
148 |
177 |
159 |
168 |
652 |
163 |
|
The animal related deaths for the years 1983 to 1998 are listed in Table I. As noted in the AMEA NEWS November 1997 there are no inclusive figures for horse related deaths. Motor vehicles causing deaths of riders of animals and occupants of animal drawn vehicles are included in E813.5. Animal drawn vehicles, E827, are mostly horses, but again bovine, dogs, elephants and other animals can draw a vehicle. The chief classification is E828 “animal being ridden”. Other animals are ridden; bulls and cows in rodeo, elephants and camels for example. “Other injuries caused by animals” is the last category included (E906.8). This includes deaths from kicks, crushing, dragging and bites not only from horses, but injuries from dogs, bears, sharks and other animals. The National Center of Health Statistics coding does not separate the animals, which cause death.[1]
GENDER (Table II)
TABLE II
Animal Related Deaths 1995-1998 Gender
|
|
1995 |
1995 |
1996 |
1996 |
1997 |
1997 |
1998 |
1998 |
Total |
Total |
TOTAL |
Percent |
Percent |
|
|
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
|
Male |
Female |
|
E813.5
|
2 |
1 |
2 |
4 |
4 |
3 |
6 |
2 |
14 |
10 |
24 |
58.3% |
41.7% |
|
E827 |
7 |
1 |
8 |
1 |
5 |
1 |
5 |
1 |
25 |
4 |
29 |
86.2% |
13.8% |
|
E828 |
49 |
37 |
51 |
36 |
49 |
27 |
48 |
43 |
197 |
143 |
340 |
57.9% |
42.1% |
|
E906.8 |
39 |
12 |
53 |
22 |
50 |
20 |
48 |
15 |
190 |
69 |
259 |
73.4% |
26.6% |
|
Total
|
97 |
51 |
114 |
63 |
108 |
51 |
107 |
61 |
426 |
226 |
652 |
65.3% |
34.7% |
|
TOTAL
YR |
|
148 |
|
177 |
|
159 |
|
168 |
|
|
|
|
|
In E813.5 (motor vehicle involving collision with animal ridden/animal-drawn vehicle) males have a higher percent at 58.3% than females at 41.7%. If we can accept that females ride horses more frequently than males and that the NEISS figures (AMEA NEWS December 2001) are correct giving more female horse related injuries than males, we must assume that males may be more risk takers with animals than females. (AMEA NEWS May 1995) Jill M. Ryder of The Carriage Association of America[2] states that no data on the gender of drivers of horses exists.
E828 (animal being ridden) although the total figure of 340 deaths in the four years are much higher, they give very similar percent figures to E813.5 motor vehicle deaths, again bringing up the question relative to male risk taking.
Although E906.8 (other injury caused by animal) is included, it is unknown relative to the part horse related injuries share in these figures. Again males dominate the fatalities.
AGE (Table III)
TABLE III
Animal Related Deaths 1995-1998 Age
|
E813.5 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Motor vehicle involving collision with |
|
|
|
|
|
|
|
|
|
|
|
|
|
animal ridden/animal-drawn vehicle |
1-4
yr |
5-14yrs |
15-24yrs |
25-34yrs |
35-44yrs |
45-54yrs |