Alcohol Use and Horseback-Riding-Associated Fatalities -- North Carolina, 1979-1989

In the United States, an estimated 30 million persons ride horses each year (1). Total injury-related morbidity and mortality associated with horseback riding in the United States is unknown; however, during 1976-1987, 205 such fatalities occurred in 27 states (2). Even though alcohol use is a risk behavior for many types of injury, its role in horseback-riding-associated deaths has not yet been established. This report summarizes a study by the North Carolina Office of the Chief Medical Examiner (OCME) to characterize all horseback-riding-associated deaths during 1979-1989 and to determine what proportion of riders had used alcohol before death.

Thirty horseback-riding (including mule-riding) -associated deaths were identified; on average, one to three occurred each year. Sixteen (53%) decedents were male. Decedents' ages ranged from 7 to 68 years (median: 33.5 years).

Twenty-five persons were mounted on a horse at the time of the fatal event; four persons were trampled or kicked; and for one person, rider status was unknown. Twenty-one (70%) riders died when they fell or were thrown from the horse. Twenty (67%) riders died following head injuries (including one rider who drowned after striking his head, losing consciousness, and rolling into water); nine (30%) riders died from internal chest or abdominal injuries; and one rider drowned when he rode his horse into a lake.

Of 18 decedents tested for blood alcohol, six (33%) had detectable blood alcohol concentrations (BACs) of 0.6-3.6 g/dL (Table 1, page 341). Of 13 decedents who fell or were thrown from their horses, five (39%) had detectable BACs; none of the four decedents who were kicked or trampled had detectable BACs; and the rider who drowned had a BAC of 0.9 g/dL.

Reported by: DB Hammett, MD, American Medical Equestrian Association, Waynesville; TB Cole, MD, Injury Control Section, JD Butts, MD, Office of the Chief Medical Examiner, JN MacCormack, MD, State Epidemiologist, North Carolina Dept of Environment, Health, and Natural Resources. Unintentional Injuries Section, Epidemiology Br, Div of Injury Control, National Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: Although estimates of the proportion of horseback-riding-associated injuries related to alcohol use have not previously been reported, the proportion of horseback-riding-associated deaths related to alcohol use in this report is similar to that for other unintentional injury-related deaths in North Carolina and in other locations. For example, in North Carolina during 1973-1983, alcohol was detected in 48.6% of all persons who died from unintentional injuries (including those caused by motor-vehicle crashes) and who were tested for alcohol as part of the OCME's system (3). In Sacramento, California, during 1967-1969, 37% of persons who died from falls and 26% of those who died from fire-related injuries had consumed alcohol before death (4).

The findings in this investigation are subject to at least two limitations. First, complete information on the circumstances of the fatal event (e.g., risk factors and use of protective equipment such as helmets) was not available. Second, these findings may not be generalizable to horseback riders elsewhere in the United States because no comparable baseline information (e.g., hours of riding, hours of safety courses taken by decedents, and helmet use) is available.

Horseback riding requires coordination, timing, and communication of physical signals between horse and rider (5); alcohol use may impair equestrians, as it does operators of motor vehicles, by adversely effecting coordination and judgment and by lengthening reaction time (6). An alcohol-impaired rider may be unable to adjust to the horse's movements and may frighten the horse by unfamiliar actions. As with other transportation and recreational activities, use of helmets can prevent or reduce head injuries to persons riding horses (7,8), regardless of alcohol use. Horseback riders should wear a properly secured hard shell helmet lined with expanded polystyrene or similar material.

References

1. Bixby-Hammett DM. Accidents in equestrian sports. Am Fam Physician 1987;36:209-14.

2. Bixby-Hammett D, Brooks WH. Common injuries in horseback riding. Sports Med 1990;9:36-47.

3. Smith SM, Goodman RA, Thacker SB, Burton AH, Parsons JE, Hudson P. Alcohol and fatal injuries: temporal patterns. Am J Prev Med 1989;5:296-302.

4. Waller JA. Nonhighway injury fatalities -- I. The roles of alcohol and problem drinking, drugs and medical impairment. J Chronic Dis 1972:25:33-45.

5. De Benedette V. People and horses: the risk of riding. Physician Sports Medicine 1989; 17:250-4.

6. Maull KI. Alcohol abuse: its implications in trauma care. South Med J 1982;75:794-8.

7. CDC. Injuries associated with horseback riding -- United States, 1987 and 1988. MMWR 1990;39:329-32.

8. Grossman JA, Kulund DN, Miller CW, et al. Equestrian injuries: results of a prospective study. JAMA 1978;240:1881-2.

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