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| Journal of the New Zealand Medical Association,
26-September-2003, Vol 116 No 1182
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Glenda Northey
Sport and Recreation New Zealand’s 2001 data stated
that horse riding and equestrian sport and leisure activities in New Zealand had
a participation rate of 5% over a 12-month period for New Zealand
adults,1 and 9% for those aged 18 to
24.2 During 2001, 133 400 adults participated
in a horse-related activity and horse riding was included in the list of top
sports and activities undertaken by New Zealand
women.1
However, death and injury from horse-related activities in
New Zealand have not been well documented, and consequently injury prevention
opportunities have been limited.
Buckley and colleagues investigated injuries due to falls
from horses for the period 1977–1986. Findings suggested that most
horse-related injuries involved a fall that resulted in head injuries, thus
indicating a need for helmet use and safe riding
practices.3 Furthermore, while young people
were most likely to experience severe injuries, they were not over represented
within participation rates. Buckley and colleagues concluded that the rate of
hospitalisation due to falls from horses was comparable to the rate of injuries
from playing rugby. Numbers of horse-riding claims to the Accident Compensation
Corporation in 2001/2 were approximately one thirteenth of rugby claims.
However, the long-term costs of horse-riding claims were higher, with ongoing
claims for horse-riding injuries averaging $16 582 per claim, while rugby
injuries averaged $13 516 per claim.4
A recent examination of New Zealand recreational and
adventure tourism injuries found that ‘of the commercial adventure tourism
activities, horse riding and cycling were the only significant contributors to
overseas visitor injuries’.5 It suggested
that there was a need to focus industry attention on standards of safety for
horse-riding participants by the introduction of regulatory codes of
practice.
Informed by a desire to improve horse-related injury
prevention opportunities, the aims of this research were to: (1) examine the
extent of equestrian injuries in New Zealand; and (2) recommend a range of
appropriate countermeasures based on current recommendations from published
research.
MethodsMortality data for the period
1993–1999 and morbidity data for the period 1993–2001 were sourced
from the New Zealand Health Information Service (NZHIS) Minimum Data Set.
Records were selected using the ICD-9 (Ninth International Classification of
Diseases) codes 827 ‘Animal-drawn carriage’, 828 ‘Accident
involving animal being ridden’, and 829 ‘Other road vehicle
accidents’, where the injured person was the rider of the animal or
occupant of an animal-drawn carriage. While these codes may include incidents
involving animals other than horses, these records are assumed to be
minimal.
Morbidity records relate to those patients hospitalised
for three hours or more with a primary diagnosis of injury. Records were only
included if the person survived the injury, and if the record was the first
admission for the injury event. Data were grouped by age: 0–9 years,
10–19 years, 20–29 years, 30–39 years, 40–49 years,
50–59 years, and 60 years and older. All data were analysed using SAS
Version 8.1 for Windows.
Ethnicity data were examined only for the period
1996–2001 as changes were made to the definition of ethnicity in 1995.
Consequently, 1996 was the beginning of a new time series for ethnicity
data.
An evaluation of the findings of recent studies on
equestrian injuries, both national and international, was also
undertaken.
ResultsAnalysis of NZHIS data for
1993–1999 found that 16 people died following horse-related injuries. For
the period 1993–2001, 5613 people were hospitalised for horse-related
injuries. Females accounted for 69% (n = 3893) of injuries and 56% (n = 9) of
deaths. Those most at risk of horse-related injuries were young females between
the ages of 10 and 19 years, who accounted for 35% of these injuries. Nearly
half of the total injuries sustained (46%) were to those under 19 years of age.
Those aged between 10 and 29 years received 55% of horse-related injuries. In
those aged 50 years and above (9% of all patients), males were more at risk than
females although the injury numbers for this age group were low (2.5% of all
injuries) (Figure 1).
An examination of the data on ethnicity indicates an
interesting trend relating to Maori (the indigenous people of New Zealand) when
results are juxtaposed with those of other ethnic groups (Figure 2). The
majority (88.6%) of those injured were NZ Pakeha/European/Other; 11% were Maori
and 0.4% Pacific. Within Maori those most at risk were Maori males.
Approximately two thirds (67%) of injuries to Maori were to males, compared with
26% to NZ Pakeha/European/Other males. Maori females accounted for 33% of
injuries to Maori, while NZ Pakeha/European/Other females sustained 73% of
injuries to NZ Pakeha/European/Other. In the age group 60 years and over, all
Maori injuries were to Maori males. Injuries to Maori were highest in the
regions of Bay of Plenty (30%), East Coast (21%) and Northland (17%).
Figure 1. Hospitalisation numbers for horse-related
injuries by gender and age
 Figure 2. Hospitalisation numbers for horse-related
injuries by ethnicity, age and gender (NZ/O = New Zealand
Pakeha/European/Other)
 Data indicated that the major injury site was the arm (28%)
(Figure 3). This included fractures and dislocations. Arm fractures and
dislocations increased from 186 (26%) in 1993 to 206 (31%) in 2001. Head
injuries accounted for 25% of injuries. However, the number of head injuries
decreased from 175 (25%) in 1993 to 134 (20%) in 2001. Leg injuries accounted
for 15% of injuries. Leg fractures and dislocations also decreased from 145
(20%) in 1993 to 100 (15%) in 2001.
Between the ages of 0 and 9 years, 68% of injuries were to
the arms. Between the ages of 10 and 19 years, head (30%) and arm injuries (33%)
were almost equal in numbers. Head injuries and fractures/dislocations of the
neck and trunk increased for those aged 30 years and over. Between 50 and 59
years, neck and trunk injuries were most common (31%).
A regional comparison of injury rates revealed that Greater
Auckland sustained the highest number (600) of horse-related injuries. However,
the region’s injury rate was one of the lowest (10 per 100 000). The
highest injury rate was recorded on the East Coast (32 per 100 000) followed
closely by the Bay of Plenty (31 per 100 000), Northland (28 per 100 000) and
Manawatu/Taranaki/Wanganui (21 per 100 000) regions. The lowest rates were in
regions that have significant urbanisation, although Greater Auckland and
Wellington/Wairarapa (8 per 100 000) include urban and rural areas (Figure
4).
Figure 3. Hospitalisations for horse-related injuries
by injury site
 Figure 4. Hospitalisation rate for horse-related
injuries by region
 Farms (15%) and places of recreation and sport (15%) were
the most predominant locations at which injuries occurred. Injuries were also
sustained on streets and highways (3.5%) and at home (5%). The location of more
than half of all horse-related injuries was unspecified (55%).
The majority of injuries (85%) were sustained while riding;
25% were sustained during non-riding activities (including tacking up or
grooming). An analysis of NZHIS free-text data shows that a significant number
of riding injuries were the result of a fall, while injuries on the ground were
often the result of being crushed between the horse and an object or being
stomped or trampled.
DiscussionThis research has identified that
young females aged 10–19 years sustain the highest number of horse-related
injuries and fatalities. An investigation of health-harming behaviours amongst
New Zealand youth found that many young people engage in high levels of
risk-taking behaviours such as not wearing a helmet in recreational
activities.6
To find causation in relation to the findings for ethnicity
a variety of issues would need to be explored such as the significant number of
Maori living in rural areas where riding behaviour may differ extensively from
general sport and recreational use of horses. A comparison of horse numbers and
injury numbers on a regional basis provided little insight into
causation.
Research into participation time and the purpose for riding
may identify areas at which interventions could be targeted. Where riders are
involved in work-related activities helmet wearing and protective measures might
be better advocated as an occupational health and safety issue.
A large number of injuries were the result of a fall from
the horse. A recent Australian study also found that 77% of injuries were the
result of falls in urban and rural areas.7 A
pictorial examination of falls from horses showed why a significant number of
injuries were sustained either to the head (27%) and arms (28%), as most riders
who fall from a horse are projected head forwards and
downwards.3 Roe and
colleagues8 state that when seated on a horse
the rider’s head can be up to 4 m above the ground and evidence indicates
that a fall from as little as 60 cm can cause permanent brain damage.
A study by Chitnavis and colleagues, which compared injuries
sustained in an earlier study in 1971 with those sustained during 1991, found a
near fivefold (p <0.001) decrease in head
injuries.9 The authors suggest that significant
decreases in serious head injuries can be mainly explained by the increased use
of improved helmets. Further support comes from a recent study, which indicates
a lower level of head trauma among those falling from a horse while wearing
helmets.10 This indicates the continued need to
promote the wearing of standard approved safety helmets.
An increase in injuries to the upper limbs was found by Moss
and colleagues, who suggested that while protective equipment has concentrated
on the head and body to date, this should now be extended to the arms,
particularly the wrists. The acceptability of wrist guards has been examined in
other sports.11 However, as wrist guards are
likely to hamper the delicate wrist movements needed by the rider to direct the
horse, other authors suggest that interventions should concentrate on the
instruction of falling techniques.10
An Australian study examined the frequently reported
locations for horse-riding injuries as fields/paddock (29%) and public roads
(16%).7 New Zealand data has shown that
injuries sustained on the roads are much lower (3.5%). However, because of the
high number of locations that were not specified (55%), this number could be
much higher. Better practice in the collection and recording of data at
hospitals and emergency departments could provide a fuller picture of the
locations in which injuries occur. These locations could then be targeted for
prevention strategies.
Past studies have suggested that up to one third of
horse-related injuries are received while on the ground around
horses.12 A recent Queensland study has
identified 16% of injuries to have happened when the patient was not mounted on
the horse,13 while the data analysed in this
research indicated that in New Zealand 25% of injuries were sustained during
non-riding activities. Education on horse behaviour for those spending time
around horses, whether riding or working is important. A recent Australian
investigation found that in all but 15 cases out of 1034 the horse receiving a
‘fright’ was the factor precipitating the injury
event.7
Unanticipated horse behaviour was a factor in 61% of the child cases (under 15
years old) and 39% of the adult cases (over 15 years old) reported in this
research.
All activities around horses, whether while riding or on the
ground, have their risks. Even a quiet horse can be ‘spooked’,
starting a series of events that can lead to an
injury.14 The key to safety is in protection
and awareness. The Hughston Sports Medicine Foundation suggests that an
equestrian may have a serious injury once every 350 hours of
riding.15 However, others suggest that the rate
of injury is considerably lower and may be as low as 0.06 per 1000 riding
hours.16 An evaluation of equestrian activities
and the participation time of each rider is problematic as activities range from
irregular sport and recreational use of horses to riding exclusively for work
and transportation.
Unfamiliarity with horses and horse behaviour is also a
major problem in the trekking environment.
Bentley and colleagues’ study of injuries to overseas
tourists in New Zealand suggested that horse riding should be seen as a high
‘actual’ risk activity and should have high standards of safety for
participants.5 They suggested a need for
standards and regulatory codes, which address level of training, qualifications
and experience required for guides, appropriate client–guide ratios,
equipment specifications and the use of personal protective clothing.
Bentley and colleagues also suggested that the provision of
footwear and clothing appropriate for the activity should be made mandatory in
adventure tourism. In the case of horse riding this would include the provision
of a standard approved helmet, which is fitted correctly, and the provision of
boots or shoes with smooth soles.
Data from the United States indicate that over one third of
horse-related injuries seen at emergency departments occurred during riding
lessons.17 To date no research has been done in
New Zealand in this area but interventions such as a code of practice for riding
establishments could have a significant impact on injury rates.
Queensland recently produced a code of practice for trekking
and riding establishments, which examines enforcement and also explores ways to
manage identifiable risk.14 The Code covers
instruction, environment and welfare, tack, evaluation of level skills, horse
behaviour, safety equipment, road safety, accidents and incidents. This document
could be examined and adapted for New Zealand riding establishments for the
safety of their clients. Horse riding can be an extremely rewarding and healthy
sport as long as riders adhere to safety measures.
Author information:
Glenda Northey, Manager, Information and Resource Unit, Injury Prevention
Research Centre, University of Auckland, Auckland
Acknowledgments: I
thank Dr Sara Bennett and Rhonda Hooper for their input. The Injury Prevention
Research Centre acknowledges the funding support it receives from the Accident
Compensation Corporation, the Health Research Council of New Zealand and the
Ministry of Health.
Correspondence:
Glenda Northey, Injury Prevention Research Centre, University of Auckland,
Private Bag 92019, Auckland. Fax: (09) 373 7057; email: g.northey@auckland.ac.nz
References:
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