The preliminary level adult professional rider came to the “destination event” with four horses and a couple of working students. On cross-country day her first horse had an excellent round, but her second horse was fractious in the warm-up area and she fell, taking a hard blow to her helmeted head.

Since she bounced right up onto her feet and seemed fine she was allowed to remount.

Halfway around the course the horse was right on optimum time, but as the pair made an abrupt left turn on a slope the horse lost its footing and the rider fell again. Because there was no fence near the turn, no one was close enough to get to her immediately, and again she popped right up and remounted.

At the top of the hill, the pair took the first two elements of a combination and then abruptly pulled up, stopping in front of one of the cross-country crew who was there to make sure the footing was holding up. His radioed message to the safety coordinator was delivered in a stressed-out voice: “Rider number XXX is here with me and she says she can’t see her next fence; what do you want me to do with her?”

An EMT also heard his call and intervened immediately. The rider showed several key symptoms of concussion, had a severe headache, continued to have visual disturbance and began to insist that she was fine and should be allowed to continue on course, especially since she had two more horses to ride. The EMT explained that her “time out” was being recorded but that because of her symptoms she needed to be observed for 15 minutes. The rider became extremely irritable, another key sign.

The warm-up steward and the fence judge closest to the turn where her second fall had occurred radioed in. But ironically, the rule which eliminates the rider from continuing after two falls doesn’t come into effect when falls are not associated with a fence.

At the end of the 15 minutes, this rider’s symptoms had not improved, and she was transported by ambulance to the parking lot, where she flatly refused to be transported to the hospital. Her husband took charge of her at this point, signing a release form with the ambulance crew. The next day she show jumped the horse who had completed cross-country and stoutly denied that she had given anyone any kind of argument the previous day. The organizers didn’t know whether she was checked out by a physician, but since there was no rule to require that, she was entitled to ride.

When Is It OK To Ride Again?

In contact sports of most kinds, there are “return to play” rules that come into effect after a participant is injured. Although equestrian sports aren’t always thought of as contact sports, it has been well documented that about 20 percent of horse-related injuries are to the head and the face, and that one can get a concussion from a hard fall where the head is not actually impacted. In the past couple of years it has also been documented that during the recovery period from concussion, athletes are at risk for additional injury, since even a mild concussion can affect reaction time and judgment.

Until all the symptoms of a concussion have disappeared, a second impact from any source, not just the original sport, can be extremely dangerous, even fatal. Unfortunately, an injured rider may believe he or she is thinking clearly, when it is clear to others that this is not the case. Because of the nature of concussion, it’s far better to let the “return to play” decision be made by someone impartial and medically trained. Evaluations are made in many ways, including everything from brain scans, observation, physical testing, and computer analysis, which compares the way the athlete answered questions before and after the concussion.

The U.S. Eventing Association’s Safety Committee has been working on fair and sensible rules to address this common problem, with the Concussion Task Group doing a major amount of research over the better part of two years. The result is an education program that addresses all concerned groups and that should enhance rider safety at events.

The U.S. Equestrian Federation’s brochure, “Wake Up To Concussion,” gives more detail, as will the U.S. Eventing Association website, that will list physicians’ recommendations for recovery after a concussion.

New Guidelines

The new guidelines go into effect for eventing on July 1, 2005. There are three levels of action that will be taken after a fall or other injury that results in concussion symptoms. These include “seeing stars,” memory loss, headache, loss of balance, dizziness, confusion, fuzzy/blurry vision, poor concentration, no ability to follow simple instructions, drowsiness/fatigue, nausea/vomiting, poor memory for routine, irritability, and unusual aggressiveness. Almost all mild concussions occur WITHOUT any loss of consciousness.

If riders immediately remount and proceed with no apparent problem, there will be no interference by any official. Fortunately most falls come under this category. Where the rider remains down or is showing symptoms, these are the recommended guidelines:

LEVEL ONE: If the rider shows some or all of the concussion symptoms, he or she will be held for 15 minutes and asked some very specific questions. If the symptoms are gone in that period and the answers are satisfactory, the rider will be given the choice to continue. Since the medical “time out” is recorded, he or she may do so without time penalties.

LEVEL TWO: If the symptoms do not resolve after 15 minutes, the rider will be offered a ride in the ambulance, or he or she can take the required paperwork back to the barn and then go to a doctor. The rider should be accompanied by someone responsible and should not be driving. Level Two riders will not be permitted to compete for at least five to seven days after all symptoms have disappeared. A physician must sign their Return to Play paperwork.

LEVEL THREE: If symptoms get worse after 15 minutes or if the rider has lost consciousness, even momentarily, he or she will be transported by ambulance according to local medical protocols. As in level two, the rider may not compete for a minimum of five to seven days after symptoms have all resolved, and he or she must have written physician permission to compete again.

If the rider has a previous history of head injury, the waiting period may be longer, since reactions to injury are not standard; diagnosis can only be made by a medical professional.

Although head injuries are usually mild in equestrian sports, they have the potential to be life threatening in someone who has a prior head impact. Brain cells do not regenerate. Even a mild first concussion can affect a rider’s reflex time, vision and judgment. If he or she returns to ride on the same day of showing concussion symptoms, there is an increased risk of another fall, which could be extremely serious.

Studies have also shown that it is common for an injured rider to suffer a second injury during the year after the first one; this includes all kinds of initial injury, including concussion.

Event riders are generally brave, tough and very competitive, but what ribbon or prize is worth suffering a life-altering injury? RTP improves the odds that you will return to compete another day.