This article was originally published on Eventing Nation
It's hard to know where to start as I try to organize my notes and thoughts after a long, educational and sometimes emotional Saturday at the White Horse Tavern in the middle of the Wellington Showgrounds in Florida. Presented by the Succeed, sponsored by the USEF, and Troxel, Charles Owen, GPA, Tipperary, and Samshield Helmets, the goal of the Symposium was to make equestrian sport safer. FEI medical chairman and US Team Physician Dr. Craig Ferrell made sure the day ran smoothly and almost to time, no mean feat as he had to cope with last minute schedule changes due to weather and, sadly other issues. Lyndsey White was moved to found Riders4Helmets when her friend, dressage rider Courtney King-Dye, sponsored by her employer Succeed, suffered a serious head injury. Riders4helmets has helped to raise money through an online auction to help fund Courtney's medical expenses, and to encourage more riders to wear helmets. Courtney had hoped to speak at the Symposium, but after feeling unwell she was resting at home. Steffen Peters, a close friend of hers was teaching on her behalf, and had hoped to come also, but sent a personal message via Ken Braddick to stress his belief in the importance of helmets - nobody rides at his barn, or in his clinics without one.
A few days before the Symposium, Lyndsey had posted a poll online asking riders what stopped them from wearing helmets. From over 350 replies, nearly 90% said they think they're experienced enough not to need to wear one--that they don't think an accident will happen to them. This response was despite two high profile accidents to Olympic dressage riders Courtney and Guenter Seidel last year.
Kemi O Donnell was the first speaker on Saturday, and moved many of us to tears. In 1998 her 12 year old daughter was walking her horse when he spooked, causing her to fall off. She was wearing a velvet hard hat with a chin strap and died the next day. Kemi was under the impression that her daughter had been wearing an approved safety helmet; she told us it never occurred to her that she would be sold anything that wasn't a protective helmet, it looked exactly like one, she said, but actually was no more than a piece of apparel. Since the accident she went to her Senator, Senator Dodd, who sponsored a rule in Kristen's name to make it illegal to sell helmet's that aren't protective headgear, but the bill has yet to be passed.
USEF President David O Connor took the floor next, and vowed that the USEF will commit to support to making helmets mandatory at competitions. Personally he said he has been there for a while, but now as President he is ready to push it. If you have the technology, he argued, you have to use it, and the time is now. It absolutely is going to happen, he forecast, perhaps not in a year, but in 2, 5, or 7 years; it is going to happen, he said, so why not now? Understandably, he was proud of eventing for leading the charge, helped along by the cross country phase and adopting many of the safety standards from racing. He stressed that fashion and/or tradition is no longer a valid argument, and that watching the disciplines at the WEG in Kentucky he had been shocked by the riders who weren't wearing helmets while in the warm-up setting such a bad example, and finds it unacceptable and indefensible. He then had to rush off to Ocala Winter 1 Horse Trials, where he said he had a total of 32 horses running, and that the Canadians were all in good shape. Phew, I'm exhausted!
Dr. Allen Sills, a neurosurgeon from Vanderbilt talked about brain injuries, concussion (you don't have to lose consciousness to get a concussion), and recovery. Riding causes 11.7% of traumatic brain injuries amongst recreational sports--the highest percentage, and 15% of patients still have symptoms a year later. Dr. Sills explained that it's hard to diagnose concussion because sometimes even the worst cases will have a 'lucid interval', as was the case with Natasha Redgrave. There doesn't always have to be a laceration or even swelling to the head.
It's not always the direct blow that causes the injury but a biomechanical cascade of events that can take months or even years to mend, with symptoms including difficulty with memory retrieval and emotional learning. Imaging is not usually helpful, as an MRI or CT scan can look normal. However, computerized neurocognitive testing is becoming very popular in schools and colleges, especially ImPACT (ImPACT-Testing & Computerized Neurocognitive Assessment Tools
). This is the the kind of testing John talked about briefly from the USEA Convention whereby a rider might try and fake the Baseline test. Allison Springer asked about this, and they said they have internal controls and standards to "identify submaximal effort" so you can't game the system. There are also tests to measure balance and vestibular function, much like the DUI tests, or so I've been told. (!)
Then, Dr. Debbie Stanitski spoke with wit and candor about her fall 11 years ago. Despite wearing a safety helmet she suffered a cerebellum hemorrhage (on the back of the neck just below the helmet) and now competes her horse at First Level Dressage in both Para Equestrian and Able-Bodied Classes. She joked that the helmet probably saved her life, but a funeral would definitely have been cheaper! Walking with the aid of a stick, and with her speech affected she was forced to retire from her career as a pediatric orthopedic surgeon because she was seeing patients too "slowly". Head of the Equestrian Medical and Safety Association, she now takes a personal and professional interest in helmet and safety awareness. Although her own therapist stopped reporting any progress a year after her accident, Debbie said her dressage coach continues to see improvement through her riding, and although Debbie alluded to the frustration of not being able to do things she remembers before her accident, and "being normal" she joked again that her husband said she was never normal in the first place.
Do they taste good?
Dave Halstead, from Southern Impact Research (SIRC - Southern Impact Research Center
) spoke at length about the results of research. 1. Never let my son Harry play football. 2. Everyone agrees that helmets save lives. To break it down, there are two types of brain injuries: the first from linear acceleration ie. stopping on a straight line, and this is what helmets are so good at protecting our heads from--so good in fact that you'll often see football players lead into a collision with their heads and not their shoulders because their helmets are so effective. The second is rotational acceleration, and is a bit more of a mystery. These are more like the whiplash, or if you hit something and then bounce back in another direction, very simply put. You don't have to actually hit your head to get a concussion. These injuries are often mild Traumatic Brain Injuries, but they are much more difficult to prevent, and diagnose. To this end, Dave is hoping to receive a grant to conduct further research, especially with more emphasis on the neck.
After lunch, Tom Cafaro demonstrated a new substance, G Form (G-Form
) by dropping a bowling ball onto a concrete block. In between were some M & M's wrapped in tissue which were completely crushed the first time, when not protected by a lining of foam, but the second batch were protected by the thin layer of shock absorbing G-Form "magic" (!) and remained pristine and delicious - Lauren Sammis ate them! G-Form is thinner than old-school foam lining, and stiffens on impact to "decelerate" the load of the bowling ball or whatever it may be. Tom has also promised to put a link on the Riders4Helmets website of him dropping the bowling ball on his functioning IPad.
Beezie Madden and Lauren Sammis
Dressage rider Lauren Sammis, and legendary jumpers Beezie Madden and Anne Kursinski then changed the pace a little, talking about the responsibility and pride they feel as role models. Lauren talked about being a close friend of Courtney's and how she felt as if her accident had been akin to the 9/11 of the dressage world, and how she personally always wears a helmet, how proud she was to represent her country and would like to see the rules changed so that it's not an issue up for discussion any more. Both Beezie and Anne, Olympic medalists and vastly experienced, were humble and talked briefly. Sponsored by Charles Owen, they both wear helmets all the time. Ann discussed a period in the 80's after the L.A Olympics when she was forced to take a 6 month sabbatical from riding after a few too many concussions, (For the record, Dr Sills says one concussion is probably one too many but in reality we don't know) and wondered if she'd ever be able to ride again. Since then she has always worn a hat with a chin strap. Beezie's husband John, who sits on the FEI jumping committee, told us how he'd been inspired by Beezie to bring up a recommendation to make always wearing a helmet mandatory in Europe, and had met with no resistance or discussion. Beezie then had to rush off to Europe to look for her next superstar horse, while Anne has 14 horses here in Wellington for the season.
P.J Cooksey, America's third most successful female jockey, and now Marketing Director for the Kentucky Horse Racing Commission gave advice on changing regulations. Peter Rizzo, executive director of US Polo, gave some perspective from his sport which presents extra challenges due to the stick and ball impact issues.
Sarah Ike gave an interesting presentation on the history of the rules within the USEF across all the disciplines, and there seems to have been little rhyme or reason to them. For example, Driving introduced a compulsory helmet rule in 2000, let it go the next year, and then re-introduced it in 2005. However, it does seem almost certain that it will be passed within the USEA that helmets will become mandatory, and Carol Lavell seems convinced that US Dressage will do the same, and admitted that she has only started wearing a helmet herself these last couple of years due to peer pressure.
The helmet manufacturers all did brief presentations, as did Dean Moran with the Safety Equipment Institute (Safety Equipment Institute, Inc. (SEI)
). Then Dr. Sills and Dr. Ferrell spoke again before USEF CEO John Long wrapped thing up just in time for cocktail hour. Dr. Sills stressed the second impact syndrome--that we are far more likely to injure our brains if we return to play too soon after an initial injury, so we MUST avoid exposure to repeat concussion. This led to some debate, both in the group, and later in private about the 'one fall and you're out' rule. He discussed cumulative lifetime risks of three or more concussions, common in many footballers--17% reported memory loss. Dr. Ferrell also mentioned that eventing is setting the standards (again!) for physicians at competitions, by requiring that they should be qualified Advanced Trauma Life Support Physicians as standard.
USEF CEO John Long summed the day up for us nicely. We need more data and more science. We need more education for all our respective audiences, and we need to find a way to implement the rules so that it's no longer optional, and it's easy to regulate. Although there were plenty of suggestions for so many improvements that still could and need to be made, a real change is coming, albeit, baby steps at a time. As John said, "it is incumbent on my organization to get my house right to be a model for the more casual rider."
Everyone present agreed that helmets save lives. Everyone present would like to see rules passed to make wearing helmets mandatory. It was generally agreed that equestrianism as a sport is doing a good job in being pro-active to implement rules before the government steps in and does it for us. On a wish list: more research and answers into the rotational acceleration brain injuries, make wearing helmets "cool" and second nature whenever you're around or on your horse.
It was quite a day to have so many people from different perspectives gather together and work towards a common goal. From Olympic medalists Anne and Beezie, to eventers Allison and Jennie Brannigan, P.J Cooksey, and David O Connor, Racing, Polo, Dressage riders, surgeons, administrators, survivors, innovators, insurers, manufacturers.....Huge props to Lyndsey White and Dr. Craig Ferrell for dreaming it up and making it happen. Many thanks to the sponsors, and to everyone who attended, and thank you of course for reading. Strap one on, and GO EVENTING!
Videos of many of the speakers will soon be available on Youtube soon, and please check out the riders4helmets website here