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falls in warmup ring

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  • falls in warmup ring

    At the event I was just at a kid in our aisle had a fall in the warm-up ring. Nasty pony move, pony reared and then leaped out, and then did the same thing a second time ejecting the kid over backwards. Kid hit her head fairly hard and the first thing she said was that her head hurt. EMT asked her a few questions, she didn't seem disoriented, so they cleared her to ride. She ended up winning her division, but as she was stabled next to me I overheard her saying her head was still was sore the next morning before cross country. Now I'm not a fan of the one fall and you are out rule, but head impacts seem more serious to me. Maybe it's because I recently had a mild concussion, and the ER doc I talked to was very adamant that you don't need to get knocked out or even be disoriented to have damage. In my case I was not disoriented, but the headache was a dead giveaway that things weren't quite right. I'm sure we are all familiar with the Natasha Richardson tragedy last year, and by all accounts she was not disoriented, yet the consequences were lethal. Particularly where a kid smacks their head and is complaining that their head hurts, I'm not sure letting them back on to do show jumping is the best idea. The consequences of two mild concussions in short succession can be much worse than the sum of their parts, and my doctor was fairly adamant about having at least a week headache free before I got back on the horse. I'm not sure why we treat falls in warmup so differently, but I thought the situation was a little worrisome.

  • #2
    Kids have parents. Let them parent.


    • #3
      I believe that is the official process--if you appear injured you have to be cleared by the EMTs, and it sounds as though she was.

      Parents or trainer could have jumped in if they felt EMTs were not cautious enough, but perhaps she looked as fine to them as to the EMTs in the moment.

      I think I the idea behind the warm up rule is that there are likely to be areas of the warm-up unsupervised and if someone falls in the parking lot, or not during show hours, just really hard to regulate.

      . . .

      Without knowing how she would feel the next day, not sure how the EMTs do it exactly--the one time I visited with EMTs post concussion (not horse related) they asked me some questions (who are you, what are you doing here, etc.) as well as spent a lot of time looking at my eyes, follow the light, etc. Sadly I "failed" so even the above account might be imperfect.


      • #4
        I have a hard time with the fact that you posted earlier (about this same show), complaining that someone reported you to the TD that you were over-riding your horse, when you knew you were fully within the rules.

        ...And yet, it is perfectly okay for you to butt into someone else's business (who was fully following the rules and procedures set forth) and post a private conversation that you were listening to (uninvited) on a public bulletin board and then speculate about it. Hmmmm....

        Last edited by SevenDogs; Oct. 5, 2009, 10:50 PM.


        • #5
          I hope the trainer or parents replaced the helmet before allowing the kid to get back on. Any fall that causes a headache can make the helmet lose its effectiveness at protecting from the next impact. Of course, most people don't carry an extra helmet.

          Letting the kid ride after the fall is in the gray area. If she didn't seem to hit her head hard in the fall, seemed totally normal and didn't have a headache after the fall, I can understand the parents, trainers and EMT letting her continue. If she had a headache, she should not have been allowed to continue. Hopefully, they watched her closely after the fall.

          My limited (and possibly incorrect) understanding of the Natasha Richardson injury is the she had an epidural hematoma. I heard that she was not acting normally after her fall, although was conscious and talking. Epidural hematomas can be rapid bleeds that necessitate quick access to a neurosurgeon and a good hospital. People can look relatively ok for a time after their fall and then develop severe symptoms. Unfortunately, she was not close to a hospital that could provide neurosurgery, so when she deteriorated, there was no one to provide the care she needed. Natasha Richardson's injury wasn't the typical minor head injury. It does illustrate that rapid access to a good hospital is essential in some circumstances.


          • #6
            I could be wrong, but I *think* the OP is questioning the actual fall rules...not the rider, parents, emt or trainer. She never said that they did anything illegal...I think she's just questioning our current system.

            However, I think Beam Me Up hit the nail on the head:
            I think I the idea behind the warm up rule is that there are likely to be areas of the warm-up unsupervised and if someone falls in the parking lot, or not during show hours, just really hard to regulate.


            • #7
              Some very good questions here.

              I'm an EMT, licensed in two (very) different states and certified by a national board as a Wilderness EMT.

              The notion of being 'cleared' by an EMT doesn't really fit with the scope of practice of an EMT. If an EMT sees you hit your head or witnesses see you hit your head or you say you hit your head, then we'll do an assessment and offer to transport you regardless. After all, you hit your head and EMTs were called to the scene.

              When we assess you, we ask you your name, where you are and what day it is. If you can do this successfully, you are called 'A&Ox3' (alert and oriented, times 3) and can consent to or refuse medical treatment. If you are A&Ox2, we can treat you under the assumption of implied consent -- if you were A&Ox3, you would want to be treated.

              If you are A&Ox3 and allow us to treat you, we'd ask you a few questions about what just happened out there because amnesia -- retrograde or anterograde -- is an important criteria for determining a TBI. It's actually more important than whether or not you were unconscious (briefly unconscious, that is, <5 minutes). You can be knocked out and be just fine; you can remain conscious and be in rough shape. We also take into consideration the mechanism of injury: the speed you were traveling, the height of the fall, the surface you landed on, what landed on you (like your horse) etc. We'd also be looking for any changes in your level of consciousness during our assessment, which means our questions might get repetitive.

              (If you say your head hurts, that's also a significant finding. If you're a parent and your kid says their head hurts, call it a day.)

              However, if you are A&Ox3, you can refuse treatment and/or transport. Even if your arm has fallen off. If you choose not to be transported, you will have to sign a waiver/release of liability. If you are a minor, your parent or guardian will have to sign.

              The EMTs may also ask you to sign a statement that you are declining transport/treatment/examination against medical advice (AMA). Sometimes, they might do this because they think you are injured; other times, they'll do this because their EMS agency or ambulance company requires it for CYA in all non-transport cases.

              And how does all this apply to eventing?

              According to the eventing rules:
              EV113 Medical Requirements.
              a. In the event of an accident in which a competitor is apparently injured or concussed, they must be examined by designated medical personnel to determine if they may take part in another test, ride another horse or if they are capable of leaving the grounds.
              Refusal to be examined shall be penalized by a fine of $100 (Payable to the Organizing Committee) at the discretion of the Ground Jury.
              b. Competitors who fail or refuse to follow the advice of the medical personnel regarding treatment following such a fall may be subject to disqualification at the discretion of the Ground Jury.

              If you refuse to be examined, you might -- at the discretion of the GJ -- be fined $100. It does NOT say that you can be disqualified for refusing to be examined.

              Potential disqualification only applies to those who 'fail' (WTF? 'fail' in general or 'fail' in attempting to follow medical advice?) or 'refuse to follow' medical advice.

              But how will the GJ know if you fail or refuse to follow medical advice? Who is going to tell them?

              The Ground Jury, all-powerful though they may be, is not exempted from following HIPAA laws. HIPAA applies to all EMS patient care documentation to protect the patient's identity. If you sign a waiver or an AMA, it falls under HIPAA and an EMT cannot discuss this with a member of the general public.

              The PGoJ can ask the patient about what happened with the EMTs. The patient can say whatever he/she feels like saying. If the PGoJ asks the EMTs, the EMT is bound by HIPAA. The PGoJ might surmise that the patient is declining transport because the ambulance isn't leaving but the EMT can't discuss why the patient is remaining on the grounds. If the rider goes AMA, the EMTs can't discuss it with the GJ. If the rider is 'cleared', the EMT really can't discuss that either.

              Oh well.


              • #8
                Originally posted by JER View Post
                The PGoJ can ask the patient about what happened with the EMTs. The patient can say whatever he/she feels like saying. If the PGoJ asks the EMTs, the EMT is bound by HIPAA...

                Oh well.
                At the end of the day it is a sport and we are on our honor and only our honor to follow the rules. It isn't any difference than many of the rules out there, whether is drug rules, truthfulness on medical armbands or a host of other things.

                Ultimately we must not only be responsible for ourselves, but also give other people the dignity to be responsible for themselves. There are not enough rules that can be written to protect stupid people from doing stupid things--at some point we have to accept that not only can we not legislate every detail, we shouldn't.

                I'm sure there are plenty of you out there that want the whole nanny state concept to become nanny sport governance, but I'm not one of them. It's why I event instead of knit.


                • #9
                  Thank you SubK!!!


                  • #10
                    Originally posted by SevenDogs View Post
                    Thank you SubK!!!
                    Your're welcome...can you tell I'm a tad cranky today? Sorry.


                    • Original Poster

                      Well, one is a safety issue, and as a parent and former instructor, I don't think questioning the action of a TD in one situation makes it hypocritical for me to question the interpretation of another rule. I don't think it's like Republican vs. Democrat, i.e. you are either pro rules or against rules. In some ways they are flip sides of the same question, how we interpret ambiguous rules and how we ensure safety without succumbing to a complete "nanny state" as one of the other posters referred to it. I'm probably influenced by the fact that one of the junior riders from our barn had a bad head injury at an event in April and remains in a coma, following another earlier head injury. The kid that fell this weekend was a student who takes lessons with a good friend who trains with the same trainer I do, so in sense we were all in the same "barn" or at least the same team. My friend and I were competing in the same division and ride with the same trainer, but she also has a couple of beginner novice students that she boards horses for, and I know both the pony and the family. Many of us were a bit astonished that the kid hadn't gone to the ER, considering how hard she hit and the fact that she was complaining her head hurt, but kids have a pretty strong desire both to avoid doctors and to get back on the pony. Had I not just been educated on this subject a month ago I doubt I would be as familiar with the topic, since I honestly don't think most people are aware that brain trauma can include injuries where you aren't disoriented. I always assumed that if you didn't lose consciousness or at least get disoriented it wasn't a concussion, but it turns out that is incorrect. Most of us of a certain generation grew up with the idea that you get back on the horse no matter what, but head injuries can be tricky.

                      It's funny, I was thinking earlier this afternoon that this topic illustrates something I've noticed before on this board, that you can post something that is anti-rule and get tons of support, but heaven forbid you ever post something that suggests that a rule might not be adequately protective. The last time I got flamed on this board was back in April, when I posted something on the board related to the young rider from our barn who was a very serious accident.
                      Last edited by vali; Oct. 6, 2009, 12:30 AM.


                      • #12
                        Originally posted by vali View Post
                        It's funny, I was thinking earlier this afternoon that this topic illustrates something I've noticed before on this board, that you can post something that is anti-rule and get tons of support, but heaven forbid you ever post something that suggests that a rule might not be adequately protective. The last time I got flamed on this board was back in April, when I posted something on the board related to the young rider from our barn who was a very serious accident.
                        I think your concerns are very valid and I hope I didn't come off as flaming you in any way.

                        I think the rules, as written, are meaningless and unenforceable in any meaningful way.

                        If the one-fall rule is to function as a safety rule, it has to apply to all falls, regardless of location on the grounds. You fall, you're out. And no riding any of your other horses.

                        But that's never going to happen.

                        Should it? Statistics show most falls are harmless. This is why BE repealed the one-fall rule last year. But allowing one fall or falls on the flat or falls in warm-up involves some degree of judgment on the rider's part -- and while this will function perfectly well most of the time, there's always going to be some odd cases. The question is where the line is drawn between individual assumption of risk and a sport organization's responsibility for the safety of its participants.

                        However, the one-fall rule (the total version) might make sense if applied to minors. There is plenty of science showing the extra dangers of TBI to young brains and the severity of second impact syndrome to that age group. With the one-fall rule in place (again, the total version), there'd be no need for parental consent, waivers or other liability issues after a competitor falls.


                        • #13
                          SubK -- you're not being cranky at all. You are making a lot of sense.


                          • #14
                            Originally posted by vali View Post
                            It's funny, I was thinking earlier this afternoon that this topic illustrates something I've noticed before on this board, that you can post something that is anti-rule and get tons of support, but heaven forbid you ever post something that suggests that a rule might not be adequately protective. The last time I got flamed on this board was back in April, when I posted something on the board related to the young rider from our barn who was a very serious accident.
                            I really did mean anything as a "flame."

                            A singe anticdote--prejudiced by other personal experience--is not a very compelling arguement. If someone came here and actually presented evidence that individuals who fall off in warmup then proceed to compete have a significantly higher rate of serious injury then I'd probably have a different attitude. Might or might not agree, but I'd certainly view the whole thing in a more serious light.

                            Maybe you get the response you do to expanding the coverage of rules is that for the last few years every time someone gets a notion or a knee jerk we get a rule change that isn't backed up by any data. Some of those new rules (think long format) are literally killing our sport. It makes us cranky.


                            • #15
                              Originally posted by vali View Post

                              It's funny, I was thinking earlier this afternoon that this topic illustrates something I've noticed before on this board, that you can post something that is anti-rule and get tons of support, but heaven forbid you ever post something that suggests that a rule might not be adequately protective. The last time I got flamed on this board was back in April, when I posted something on the board related to the young rider from our barn who was a very serious accident.
                              I read the thread that you are talking about. I was saddened by this young person's accident and have followed her progress since then. What you refer to as "being flamed" was actually people objecting to the fact that you felt the need to point out that the rider was on a young TB without a trainer, as if she brought the accident on herself and, IMO, made your post feel more like gossip than concern. Extraneous information such as the rider being there without a trainer, or the fact that the rider that fell this past weekend went on to win her class, makes me extremely suspect of intentions of the post (perhaps warranted or perhaps not).

                              If you had concern for the rider this past weekend that you seem to know so well (part of your barn, etc.), perhaps it would be more appropriate to approach them (or their trainer) personally rather than reporting an overheard conversation on a public bulletin board.

                              "Keeping your eyes on your own paper" goes both ways and the person that reported you to the TD for over-riding your horse would also claim that they just had the best interest of the horse in mind when they spoke to the TD. By the way, I think the TD had the obligation to check out the report and it doesn't sound like he/she did anything wrong to me that warranted your post about it.

                              I also don't think those of us that feel our current rules are adequate (that making rules just to make rules is wrong) makes us "anti-rule". It just seems like the same names pop up on this board over and over with "issues" at shows, with officials, etc.

                              Hmmm... SubK... I might just be the cranky one!


                              • Original Poster

                                Well Seven Dogs, you are making a lot of assumptions here, and making this more personal than it needs to be. Why do you assume that I'm "butting" in where I don't belong, or that I haven't talked to the parent? And why should that preclude a discussion here of why we have somewhat random distinctions between falls in warm-up and falls on course, when a more sensible distinction might be between falls where there is clearly no harm (most falls) and falls where there are symptoms of a possible head injury? The USEA guidelines for falls says that one of the questions to ask before clearing a rider to continue is whether the rider has a headache. The risks of second concussion syndrome are very documented and are described further in the USEA pamphlet on concussions.

                                And it's nice that you've followed the progress of the other young rider from our barn, but what else have you done? Her insurance has now run out, and while lots of people were interested in fundraising for Darren Chiacchia, not that many people seem to be that interested in helping her and her family out. If you have been actively involved in helping her family then more power to you, since I have no clue who you are, but if you haven't then you might want to invest your energy in that instead of attacking other people on a bulletin board. Both the Martinez Horseman's Association and our barn (Hossmoor) have been organizing fundraising efforts, and some of us are also trying to get Kaiser to do more to provide coverage.

                                Finally, many of us have been bothered by some of the hastily made rule changes, but there are constructive and non-constructive ways of handling those concerns. When the rules were first changed to require 4 qualifying Training events for Prelim the requirements were initially worded so that they would all have to be made in a set time period to mirror the requirements for Intermediate and Advanced. Many of us wrote detailed letters to the Rules Committee articulating why it made more sense to have the qualifications stand without a set time restriction, and the Rules Committee changed it. I also wrote letters to the Rules committee and the USEA President objecting to the one fall and you are out rule, but we obviously lost on that one. I hope you have been doing more than simply complaining here about proposed rules changes, because discussions here, while occasionally entertaining, don't do much to influence the Rules Committee.


                                • #17
                                  I've got to compliment JER on her analysis of the rules as currently written and their interaction with HIPAA. Really very interesting that what we so often assume can be done and may be done isn't the case at all.

                                  I've had waaay too many concussions over the years, including 5 within a 6 month period. The one thing I can state from my personal experience is that any degree of TBI impairs judgement to some degree. It may be so subtle as to be unnoticeable and inconsequential. It may be significant enough that an idiot seeing stars, experiencing tunnel vision with a bleeding scalp laceration drives her truck and trailer home, takes care of the horse, unhitches the trailer and then drives herself to the ER. (Any guesses who that idiot was?) I still have nightmares about what could have happened when I was driving that day.
                                  They don't call me frugal for nothing.
                                  Proud and achy member of the Eventing Grannies clique.


                                  • #18
                                    I am not sure how I feel about more rules that tell us when we can or can't compete. Common sense and self preservation has to kick in at some point. If everything is going to be regulated as to the riders health for competition then why not a complete medical exam on the eve of the competition to "catch" any riders that may have fallen at home before coming to the show? Also what about all the non horse accidents that can happen that would effect the riders ability. I, being a bit of a clutz and somewhat accident prone, ran head first into the bucket of a backhoe Don't ask how it happened, but I sure as #$@ rang my bell. And since there was no horse involved I sure wasn't wearing a helmet. I took it upon myself to scratch since I didn't really feel quite right.


                                    • #19
                                      But plenty of falls don't involve the head AT ALL.

                                      Do you really want to eliminate the rider for "horse stopped, rider didn't, rider landed on feet" in the warm up?

                                      chief feeder and mucker for Music, Spy, Belle and Tiara. Someone else is now feeding and mucking for Chief and Brain (both foxhunting now).


                                      • #20
                                        If they are cleared by a medic and the parents okay it let them go. I was bucked off in warm-up at richland for stadium. I had the wind knocked out of me hard but no head problems. Medics looked at me said I was fine. I have had 2 concussions and both times I was scrambled. I knew I did not hit my head so my parents let me finish the event. I did have a member from the ground jury watching my round though to make sure I was "safe".

                                        It is up to the parents to decide if it is safe not more rules!!!