Only falls and horses: accidents and injuries in racehorse training
M. Filby1, C. Jackson2 and M. Turner3
1Racing Welfare, Robin McAlpine House, 20b Park Lane, Newmarket, Suffolk CB8 8QD, UK, 2Birmingham City University, School of Social Sciences, Perry Barr, Birmingham, West Midlands B42 2SU, UK, 3British Horseracing Authority, 75 High Holborn, London WC1V 6LS, UK.
Correspondence to: Craig Jackson, Head of Psychology Division, Birmingham City University, School of Social Sciences, Perry Barr, Birmingham, West Midlands B42 2SU, UK. e-mail: [email protected]
Background The horseracing training industry has largely been ignored in terms of active occupational health research.
Aims To provide baseline statistics on the specific nature and type of accidents that occurred in English horseracing stables during 2008.
Methods All 716 training yards/stables registered with the British Horseracing Authority were contacted in April/May 2009 to complete the Racing Injury Accident Statistical Survey. The survey asked re-spondents to detail all recorded accidents and injuries during 2008.
Results Two hundred and fifty-six yards (36%) provided usable responses. The proportion of different-sized yards was highly comparable with the sizes of yards in the national population. Employees per yard ranged from 1 to 121 (mean = 9 ± 14), with a total of 2293 employees (30% of the total 7558 UK yard staff). At the point of survey, participating yards housed between 0 and 243 horses (mean = 6 ± 32), with 6420 horses covered in this survey. One hundred and thirty yards (51%) reported no accidents. Of the remaining 126 yards, 665 accidents were reported, ranging from 1 to 58 accidents per establishment, equalling 5 accidents per yard (± 7) or 3 accidents per yard for the entire sample. There was a mean of 53 horse-related accidents per month, and 96% were horse-related. Medical treatment was required for 50% of accidents.
Conclusions This representative sample covers the broad range of hazards, accidents and injuries in this difficult-to-access but unique industry. Recommendations for the management of accidents are made.
Key words Accidents; horses; horseracing; injuries; stables; yards.
Introduction
Everyday work with thoroughbred horses is widely acknowledged to be hazardous, but the risks can be mod-erated through the skill, aptitudes and experience of staff and employers. These attributes and personal character-istics can also magnify such risks. The horseracing indus-try relies on controlled risk management when handling horses and livestock, in all conditions and throughout the year. Despite increased focus on risk perception and assessment in workplaces, working with animals will always afford an element of unpredictability [1]. As sum-marized by Fleming et al. [2] horseracing and training is a hazardous activity as horses are unpredictable and emo-tionally labile. They are large powerful animals weighing on average 500 kg and reaching speeds of up to 60 km/h. Furthermore, the kick strength of horses has been esti-mated to be 400 J (four times the test impact load of most
equestrian helmet standards), which can easily result in a skull fracture or intracranial haemorrhage. Finally, as riders are elevated with their heads up to 3 m above the ground, and in a head-forward position with no restrain-ing device, there is an increased risk of ejections or falls.
There is limited information in the UK on workplace accidents in this industry, and the difficulty accessing workers in the horseracing industry may have prevented previous research [3]. Paradoxically in the UK, more information is known about the type of accidents suffered by professional jockeys during racing than in other groups within the racing industry that have a greater exposure to horses and longer ‘riding-hours’ than jockeys [4]. Injury rates of jockeys are so well recorded that it is possible to make comparisons between countries [4] in terms of accident severity, financial compensation [5], or even their health trajectory in retirement [6], but no such data exist for stable staff. For those who work in training stables, research
involving them is often limited to forensic or surgical case studies following extreme injury [7,8] rather than prospective widespread data collection. The risk of career-ending decisions following accidents causing fractures or neurological injury to the head or spine is known to be high in jockeys [9], but no such evidence exists for stable staff.
A national comprehensive study of professional jock-eys and injuries in the USA [10] used a postal survey to measure the types of injuries sustained and health-related issues. Over 1700 injuries were reported by 706 jockeys. Fractures accounted for 64% of injuries, mostly from jock-eys being unseated and then the horse falling. Crucially this study found an interesting relationship between seri-ous injuries following prolonged periods of not riding. Similarly, a cross-sectional study of around 200 accident injury claims involving falls from horses among jockeys and trainers in Australia [11,12] found the most com-mon injury to be fractures (46% jockeys, 45% trainers) and then bruising (18% and 15%, respectively). However, almost 30% of stable staff experienced lower limb injury compared with 23% of jockeys. For stable staff, 16% injured their backs, compared with only 9% of jockeys. The Australian study was similar in some respects to a UK review of recreational riding accidents among young peo-ple [13], finding that long bone fractures and head injuries were the most commonly reported injuries. Interestingly, the study also found that although most injuries occurred during recreational riding, approximately 15% of injuries occurred in non-riding/ground-level activities such as feeding, handling, shoeing and saddling. The finding con-cerning long bone fractures and head injuries was found a decade earlier by a German study [14], which also con-cluded that helmet improvements and equestrian safety training were crucial factors in accident reduction.
Lack of detail concerning the thoroughbred racing industry is not restricted to the UK as other countries too share increasing concerns about the lack of accident data [11,12]. It has been observed that a wider body of research knowledge exists concerning the deaths of racehorses than for the staff who train them [15]. As shown in previous stud-ies [4], there are different styles of racing between countries such as the UK, Australia and France, and as such, the style of training involved may also differ, hence data from foreign studies of stable staff cannot solely be relied on to provide data of use to the UK training industry. The aim of this cur-rent national survey of training yards was to provide base-line data on the nature and causes of workplace accidents in the training of racehorses, as opposed to jockeys.
Methods
The accident survey was developed in consultation with a small number of racing secretaries and yard owners. Horse-training industry literature, magazines and safety publica-tions were inspected in order to provide further areas of investigation by the current survey. The self- completion
survey was based on a questionnaire designed and used in a pre-training yard and was brief and easy to complete for most people, assuming an average reading age. Initial versions of the Racing Injury Accident Statistical Survey (RIASS) were piloted on six racing secretaries, and feed-back from these led to reiterations and further development of the RIASS used. The survey asked for demographic details about the yard/stable as well as a list of accidents and associated factors from 2008, which could easily be extracted from accident log books. Completion time var-ied depending on how many accidents were recorded, but for those respondents reporting no accidents, completion time would have been less than 5 min.
As this was a survey of healthy volunteers who would be responding to an anonymous survey, no formal eth-ical review was needed. The British Horseracing Authority provided their support to the study, as long as anonymous sampling was adhered to. The names of all 716 yards in operation in the UK in April 2009 were obtained from the British Horseracing Authority, and a survey pack was posted to all the yards. This mailing was repeated again in June 2009. The survey pack contained a letter to yard owners, the two-page RIASS and an addressed business reply enve-lope for the return of the survey. An e-mail address was provided for any respondents who wished to complete the RIASS electronically and return it to the researchers. The integrity of the data was double-checked by randomly sam-pling 10% of the dataset and comparing the entered data with details recorded on the RIASS surveys.
Results
Of the 716 yards contacted, usable responses were received from 256 (36%). Of these, 198 (88%) operated as yards only; 2 as studs; 24 combined studs/yards; and 32 were unknown. Licence holding ranged from 1 to 46 years with a mean of 13.5 years (± 11). Licences were flat only 23 (10%); national hunt only 11 (5%); combined 148 (62%); and permit holder 56 (24%). Licence type was unknown for 18. Yards were categorized by staff size (unknown for n = 7) shown alongside the relative percentage of yard sizes in the national racehorse industry, in Table 1.
The data collected represented a total of 2293 employees (30% of the total of 7558 racing staff in 2008). Each yard employed a mean of 9 staff (± 14) with the number of horses ranging from 0 to 243. The survey covered 6420 horses, giving an average of 26 horses per yard (± 32).
A total of 665 accidents were reported by 256 yards (range 0 to 58), with 130 yards (51%) accident-free. Of the yards in the survey, the mean accident rate was three accidents per yard (± 6). Including only the 126 yards reporting accidents, the accident rate was 5 per yard (± 7). Of 665 accidents, 640 (96%) were horse-related accidents (HRAs), equalling a mean of 2.5 HRAs from those ‘acci-dents yards’. Of all the HRAs, only 2% were viewed as hav-ing ‘complex causes’. Treatment was required for 50% of
M. FILBY ET AL.: ACCIDENTS AND INJURIES IN RACEHORSE TRAINING 345
those HRAs; 71% went to hospital accident and emergency departments, 20% were administered first aid, 9% had non-emergency GP visits and 4% had paramedic treatment.
About 51% of the HRAs involved male staff, and 89% involved full-time staff. Ages ranged from 15 to 70, with a mean age of 30 years (± 11). About 83% of involved staff were UK nationals. Core stable staff (grooms, stable lads/lasses, staff riders) were involved in 82% of accidents, with non-core stable staff involved in 18% of accidents. There were no significant differences in accident types, locations, injury sites or treatment requirements between core and non-core staff. Differences found between the two groups were related to gender (core = 48% male; non-core = 66% male; χ2 = 11.4, P < 0.01); age (core = 28 years ± 10; non-core = 37 years ± 13; F = 51.1, P < 0.01), and UK national status (core = 81% UK; non-core = 90% UK; χ2 = 5.52, P < 0.01).
For HRAs the occupations and locations of those involved are shown in Table 2. The mean frequency of HRAs was 53 per month, with no seasonal variations observed. Fewer than average accidents occurred in February, May, June, October and December. HRAs were either riding accidents (fall from horse, rolled on/fall with horse, equipment failure and foreign body) or
Table 1. Comparison of survey sample and national training yard population
ground-level accidents. About 53% of HRAs were rid-ing accidents (53%) and 47% ground-level accidents. Accident types are shown in Table 3, and a comparison of the important accident factors made between riding accidents and ground-level accidents is shown in Table 4.
The variety of injuries sustained in HRAs is shown in Table 5 (injury type was not disclosed for 35 accidents). There were no significant differences between the sexes concerning any injury type or injury locations.
About 261 (41%) accidents resulted in sickness absence, ranging from 1 to 365 days, representing a total of 7431 sick days. The mean duration of sickness absence for HRAs was 12 days (± 37). Including only those accidents resulting in one or more days of sickness absence, the mean number of sickness days per absence was 28.5 (± 53). It must be noted that some staff did not return to work by the time of data collection and that this may bias the absence data (Table 6).
Horse-to-staff ratios were calculated for 247 yards and ranged from 1:1 to 20:1 (mean ratio 3.4:1), although the
correlation between horse-to-staff ratio and the number of accidents recorded by yards was a weak negative one. Staff size was significantly correlated with the number of acci-dents (R = 0.71, P < 0.01) as was the number of horses per yard/stable (R = 0.72, P < 0.01). The age of staff involved in recorded accidents was significantly negatively correlated with the number of accidents (R = – 0.79, P < 0.01). The number of years of holding a training licence was not cor-related (R = 0.09) with the number of recorded accidents.
Discussion
This cross-sectional survey of the horseracing training industry reveals that just under half of the yards sampled reported at least one accident per year, with a mean of five accidents per year. Of those, the majority were horse-related riding accidents, although a large proportion was ground-level accidents. Half of all accidents required medical treatment. Given the methodological limitations of studies such as this [16], the survey can be argued
Table 4. Accident factors split by ground-level accidents and riding accidents
M. FILBY ET AL.: ACCIDENTS AND INJURIES IN RACEHORSE TRAINING 347
to broadly represent the UK yard population. Data were derived from just over one-third of the UK training population, and if no problematic responder bias influenced such results, it could be estimated that the findings herein are representative of a severely accident-prone industry, suggesting that more attention should be given to safety awareness and care provision for staff involved in accidents. The authors have carefully underscored the nature of the sample as self-selecting, and sensible caution should be exercised in generalizing results to the population group [17]. Demographic characteristics suggest that the sample is not widely at odds with the population of training yards.
It is notable that 51% of respondents had no accidents to report, although the accident numbers may have been under-reported. Data suggest that measures of staff size and horse numbers are both independently associated with accident rates. The horse-to-staff ratio failed to cor-relate with accident numbers. This may be because this ratio included all yard/stable staff and did not focus solely on core stable staff dealing with horses on a daily basis. It is not clear why larger training establishments have a higher accident rate than smaller yards, given that there
appears to be no relationship with the ratio of employees to horses, and intuitively there is no reason to assume that the larger yards are relatively more poorly staffed than smaller yards; the reverse would seem more likely to be the case. This finding may be an artefact of the likelihood that larger yards have more developed management and administrative resources with better reporting procedures.
Given the acknowledged hazards in training thor-oughbreds, consideration should be given to the main-tenance of standardized accident books in all yards as a rule of racing. Small employers may not welcome such requirements, although were the employers’ organization or regulatory authorities to provide working guidelines, such misgivings could be overcome. While cooperation from employers has been good, this industry is averse to surveys, and small employers are generally not enthused with requests for information. Therefore, consideration might be given to alternative ways of measuring acci-dents. A consistent message from the findings is that given the large number of accidents reported, formal systems of accident recording need to be adopted as in other countries [11]. One possibility is to use a panel/spotter method (similar to the UK reporting schemes
Table 5. Type and location of injuries sustained in HRAs
Injury type No. of accidents (%) Prevalence ratioa
of The Health and Occupational Research network in which a sample of core yards representative of the national sample could be recruited to provide ‘observa-tories’ on accidents, involving annual summary reports from the accident book). Consideration should be given to establishing such a system in the near future, perhaps using online anonymous reporting as trialled in Australia [18]. A high-trust and no-blame culture for participants would, however, be necessary.
In terms of protecting yard staff from injury, systems could be put in place to reasonably enforce the wearing of protective equipment. Given that 17% of injuries were to the head/face, a system requiring the wearing of helmets at all times when within a yard (not just when riding) could be beneficial. This has been noted with jockeys [9] where head injuries are the most common career-ending injuries, and counter measures such as personal protect-ive equipment are seen as important.
The majority of recorded accidents (60%) resulted in staff taking no sickness days, suggesting that at any one time there are a significant number of ‘walking wounded’ at work, perhaps reflected by the number of soft tissue injuries reported. Workers in the industry seem to be resilient and durable, and this may be associated with an unwillingness to go off sick and a collective attitude to ‘not let the team down’. However, this may not be help-ful in particular cases as a partial loss of flexibility or full mobility may increase the likelihood of risk of injury in some activities, and uncared-for strains and bruises could lead to later musculoskeletal problems. In view of this coping behaviour, developing and providing some tar-geted advice for staff and employers regarding self-care of soft tissue injuries may be beneficial. Furthermore, it is possible that many staff lack the resources or social, practical and emotional support to manage their reha-bilitation and relationship with health professionals in the context of more serious injuries. They may therefore benefit from proactive advocacy in their ‘patient expe-rience’ and steps to facilitate support and advocacy for individuals from an appropriate third party.
Although the notion of cause was used here to iden-tify the immediate context of accidents, the larger causal process involved in incidents leading to an injury can be complex. An example is the lower-than-average number of accidents occurring in February, May, June, October and December; although the exact mechanisms are not understood, it could be posited that weather conditions, temperature and daylight hours could play a part. The breaking-in of yearlings and the ‘riding away’ are tradi-tionally done in January, which could explain why above average accident levels were seen at the start of the year. After a steady decline in accidents from March to June (a possible ‘practice effect’), numbers rise in July and peak in August when the horse population is at its highest, with many national hunt flat racing horses returning to the stables fresh from a short summer break. There is
scope to research the level of pre-employment screen-ing and quality of on-the-job training offered to yard employees, as well as at the national Riding Schools and the National Vocational Qualification process, as this may also hold the key to understanding some of the acci-dent data more clearly.
This survey adds to the limited literature available on horse-related injuries in the training industry, not least by highlighting the need for reliable accident data collection. The results also provide as many questions about the specific mechanics of HRAs as answers. Given a smaller-than-ideal response rate, the data suggest that the industry has a disproportionately large accident rate relative to its size. The results are similar to those found in Australia [11,12] by using accident claims. Horse-related injuries are a significant aspect of the workplace experience in the UK training industry.
Funding
This work was supported by the British Horseracing Authority Welfare and Training Group and Racing Welfare.
Acknowledgements
The authors would like to acknowledge Mr Andrew Spence (Health and Safety Manager, Darley Stud) for the development of the original questionnaire that was used in this study.
Conflicts of interest
None
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• Just under half of the yards sampled reported at least one accident per year, with a mean of five ac-cidents per year.
• The majority of horse-related accidents were rid-ing accidents (53%) and a large proportion was classed as ground-level accidents.
• Medical treatment was required for 50% of all accidents, with accident and emergency depart-ments used for 75% of those requiring treatment.
M. FILBY ET AL.: ACCIDENTS AND INJURIES IN RACEHORSE TRAINING 349
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