emergency services at steeplechase and

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Proceedings of the54th Annual Convention of

the American Association of Equine Practitioners

December 6 – 10, 2008, San Diego, California

Program Chair : Harry W. Werner

ACKNOWLEDGMENTS

Dr. Stephen M. Reed, Educational Programs Committee ChairCarey M. Ross, Scientific Publications Coordinator

Published by the American Associationof Equine Practitioners

www.aaep.org

ISSN 0065–7182

© American Association of Equine Practitioners, 2008



Emergency Services at Steeplechase and

Cross-Country Hunter Events

R. Reynolds Cowles, Jr., DVM

Author’s address: Blue Ridge Equine Clinic, PO Box 278, Free Union, VA 22940; e-mail:

[email protected]. © 2008 AAEP.

Veterinary services at steeplechase and cross-coun-

try hunter events present many challenges to theattending veterinary practitioner. The veterinar-ian must be familiar with the requirements of theevent, the obstacles encountered, and the expecta-tions of the participants and the event organizers.Each location dictates different approaches to careof the horses, and the layout of facilities is critical tothe proper approach.

Steeplechase racing is concentrated in the Mid- Atlantic and southeastern states. Hunter pacesand cross-country competitions occur throughoutthe country. Steeplechase racing is regulated bythe National Steeplechase Association (NSA) at li-censed meets and at flat tracks. Point-to-point rac-

ing is largely unregulated except by the hunt clubsthat organize them. They are usually loosely affil-iated in regional groups and usually have presiding officials. The average licensed hunt meet underrules will have 70 –75 horses competing. Point-to-points will vary greatly but may have similar num-bers. These races will be on the flat, over brush orartificial hurdles, or over solid timber fences. Someraces are mixed hurdles and timber. The “nationalfences” are an artificial hurdle made of a metalframe and the “brush” is plastic branches with afoam roll in front. These hurdles are 4 to 4.5 ft

high, but the brush is soft and horses jump through

the top. Natural hurdles vary from soft cedar tofirm brush oxers. Timber fences vary from 3 to 4.5ft and may be very solid to very open post and railand may be vertical or slanted. Most poles on tim-ber fences are notched at the post to allow the pole tobreak away when hit with force. Timber races areusually the longer, slower races, and fatigue is oftena major factor. Horses hitting solid fences may be amajor factor in injuries. The shorter hurdle racesare run at a faster pace, and speed may be a factor ininjury.

The average horse starting in jump racing is 6.4 yrof age and starts three times a year. In one studya

of starts in 2000, hurdle starts resulted in falls 2.6%

of the time, and timber racing resulted in 7.3% of falls. Falls are not common in hunter pace events.Courses vary greatly from irrigated well-main-

tained turf to point-to-points run over pastures andhunter paces competing over “fair hunting country.”The NSA conducts course inspections on their li-censed meets. Flat tracks that conduct steeple-chase racing run these over the turf course that, inmost cases, is a well-maintained surface. Commonwisdom states that course conditions are a majorfactor in injuries seen at these competitions. Hardsurfaces in drought conditions seemingly lead to

AAEP PROCEEDINGS ր Vol. 54 ր 2008 153

IN-DEPTH: EMERGENCY CARE AT EQUINE EVENTS

NOTES

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Proceedings of the Annual Convention of the AAEP - San Diego, CA, USA, 2008



more soft tissue injuries, but no data are available tosupport that statement. There is an effort to cor-relate course inspections with injury data that theNSA is accumulating under support of the NationalSteeplechase Foundation.1 These data are com-piled by epidemiologists at the Marion DuPont ScottEquine Medical Center of the Virginia-Maryland

Regional College of Veterinary Medicine.Providing veterinary care for such events is muchmore than showing up with a practice vehicle.Preplanning is essential to affect timely and appro-priate care. The veterinarians should meet withcourse officials and management before race day.This meeting should cover the number of veterinar-ians needed, the ambulance service to be on course,the position of veterinarians during races, how com-munications will be handled—radios, cell phones,etc., who is responsible for handling communica-tions with the press regarding any veterinary situ-ation, and how the on course security people willintegrate with veterinarians. A minimum of two

veterinarians should be on course at all times, andthe layout of many courses requires more. Most of this goes well but requires much discussion. TheNSA has suggested protocols to handle these situa-tions, and they can be adapted to local needs.2

The nearest referral hospital should be identifiedand contacted before race day to facilitate anyneeded referrals. An on-site veterinary treatmentstall or area should be provided to facilitate treat-ment in the barn or van area. Adequate electricityshould be available to operate imaging equipment.

At cross-country events, this may not be practical,and a portable generator may be useful.

As an attending veterinarian, you may be asked toconduct a pre-race examination on horses compet-

ing, particularly at licensed hunt meets. This examwill consist of proper identification of the animal,observation of the horse trotting, and visual exam of the limbs and the horse’s condition. Palpation of obvious abnormalities is advised. Any findingsthat may significantly affect the safety of the animalare reported to the presiding stewards. These ex-aminations should be conducted in a quiet areaaway from other participants and should include atleast two practitioners that have no conflicts of in-terest with the participants. A horse may be pre-

vented from competing based on your examination.This will often be disputed by the trainer and callsfor strict adherence to ethical principles and what is

best for the horse under the conditions.The horse ambulance is a vital component in

emergency care at an event. “Ambulances” varyfrom standard horse trailers to well-equipped pro-fessionally operated vehicles. The horse ambu-lance may be regionally available at a cost to themeets. The ones in use in the Mid-Atlantic andsoutheast are very good vehicles and are highly rec-ommended.3 These ambulances should beequipped with the means to load a down horse—power sleds, tarps, winches, and appropriate ropes.

Ice or cold water should be on board. Misting fansare desirable. Bandage material and splints maybe on board or at the ready. Experienced personnelare probably the number one requirement. A downor struggling horse can be dangerous to attendants,and their safety is paramount. The ability toquickly and safely move an injured animal off course

is in the best interest of the animal and minimizespublic reaction. Pre-planning as to the handling of such incidents is critical and should be well commu-nicated to all personnel.

The attending veterinarian must be equipped tohandle the range of emergencies that arise. In ad-dition to the equipment listed in the ambulance, thepractitioner should have good portable radiographicand ultrasonographic equipment, adequate equip-ment to handle lacerations and musculoskeletal in-

juries, IV fluids, Kimzeyb splints3 or other PVC typesplints, material for Robert Jones splints,4 extrabandage material, casting materials, endoscopicequipment, and of course, euthanasia solution.

In the hunt meet or cross-country situation, accessto the animal often becomes problematic to provid-ing care. The veterinarian must await instructionfrom race officials to move on to the racing course.This is coordinated with security personnel and withthe action of animals still competing. Vehicles thatcan get over rough ground are needed. In a truecross-country race, access must be planned ahead.

The common injuries that occur in these eventsinclude but are not limited to the following: falls;fractures; soft tissue trauma; soft tissue break-downs; overheating and exhaustion; lacerations;metabolic conditions; and exercise-induced pulmo-nary hemorrhage. These conditions will often dic-tate varied methods of care but all must be

incorporated with accurate observation and diagno-sis, careful management of attending people as wellas the horse, and common sense approaches to thecare of the horse.

The most common scenario in steeplechase racing is the down horse after a fall. In most cases, theanimal will rise in a short time after lying for a fewminutes. These are tense minutes because the as-sessment of the down animal is difficult.4 Thehorse is respiring rapidly, it may be exhausted orhave suffered neurologic trauma, and may have afracture that is not readily evident. In addition,the animal may be struggling and presents an un-safe situation for those trying to assist. When the

animal is not struggling excessively and can be ex-amined, it is best to free the girth as quickly aspossible, either by unbuckling or cutting the overand under girth. This is often all that is needed forthese horses to take a deeper breath and rise.

Evident fractures call for decision making in con-sult with the owner or trainer as to how to proceed.In many cases, it is obvious that euthanasia is re-quired at the time. In other less severe or lessobvious fractures, sedation, stabilization, and re-moval to an area for further examination is re-

154 2008 ր Vol. 54 ր AAEP PROCEEDINGS






quired. When dealing with an exhausted, painfulhorse, the animal should be adequately sedated be-fore applying splinting. Some horses will accept asplint readily, whereas others may become excitedand over-react. Care should be taken not to rushthe application of a splint until the anxious animalis sedated. Xylazine (0.2–1.0 mg/kg, IV)3 and deto-

midine (0.005–0.02 mg/kg, IV)4

are the preferredsedatives and may be combined with butorphanol(0.005– 0.01 mg/kg, IV).4 Stabilization on course isoften accomplished with the use of a Kimzey or clamshell–type splint, especially for lower limb frac-tures.3,4 Adequate soft tissue protection is essen-tial, using soft bandages and support under thesplint. Robert Jones bandages may be applied forhind limb fractures if appropriate. At all times,safety of the attendants is paramount. Loading asupported horse requires adequate manpower andgood horsemanship. With a down horse that is tobe moved off course, very deep sedation or short-term anesthesia should be used. The use of apower sled or tarp is the easiest way to load such ananimal.When on-site euthanasia is required, the publicshould be screened off from the animal with screenson the ambulance, and security should maintaincrowd control. The attending veterinarian musttake control of the situation under the protocolsestablished before the race. As in any euthanasiasituation, the safety of those in attendance should beconsidered. Euthanasia of an excited animal issometimes difficult, and sedation may be requiredbefore the euthanasia solution is administered.The pressure to remove an animal from a racecourse should not supersede the needs of the horse.It is advisable to pre-load large volume syringes

with euthanasia solution to facilitate quick actionwhen needed. Large-bore 14-g catheters are usedto administer the euthanasia solution.

Central nervous system trauma is not uncommon.Fractures of the poll or cervical vertebrae do occur.Cranial head trauma will require careful assess-ment and often considerable time at the site to sta-bilize before sedation and moving the animal off course. Cervical fractures at the atlanto-occipital

junction or distal cervical vertebrae are not uncom-mon.4 These types of injuries are challenging todeal with. Obvious spinal fractures generally re-quire on-site euthanasia but may be very difficult toassess and to differentiate from concussions, which

often carry a decent prognosis. Seizure activitymay be controlled with diazepam (0.03–0.5 mg/kg,IV).5 If general anesthesia is needed to move suchan animal, short-acting barbiturates are generallythe choice to not increase seizure activity.5 If thesebarbiturates are not available, a combination of di-azepam (0.05–0.44 mg/kg, IV) and detomidine(0.5–40 g/kg, IV)5 is often the choice to sedatethese cases, and ketamine (1.0–2.2 mg/kg, IV)5 canbe used after good sedation is established. Ket-amine may increase intracranial pressure and can

increase seizure activity.4 Using the power-oper-ated sled to load such a horse is often the onlyrecourse.2

Lacerations occur from interference at fences, hit-ting fences at speed, falls, and common over-reachinjuries. The most common lacerations are of thelower limb and are managed with routine wound

care techniques. Severe degloving wounds are notuncommon but seem to have been reduced with theelimination of toe grabs on the shoes of competing horses. Soft tissue injuries vary from simple bowedtendons to complete soft tissue catastrophic break-downs. Bowed tendons are common,6 and manyhorsemen are reluctant to transport these horses off course in the ambulance. This should be encour-aged, and the ambulance should be used in the bestinterest of the horse. Support bandages may beapplied on site, and a splint should be used if com-plete rupture has occurred. These injuries are bestaddressed in the stable area and should be stabilizedbefore the horse is shipped back to the home stable.Because increasing soft tissue swelling is common,rigid support is to be avoided in favor of firm supportbandages.

At events conducted in warm weather, overheat-ing is common.1 Ice and cold water should be avail-able at the finish line at all such meets and plentifulin the barn areas. If misting fans are available,they are preferred. At races in conditions of hightemperature and high humidity, mandatory cold wa-ter hosing after pulling up at the finish is advised.This has prevented many of these horses from suf-fering exhaustion while walking back to the stablearea. Such horses will stagger when pulling up andeven go down repeatedly while struggling to stay ontheir feet. This is another dangerous situation for

the handler, and if these animals can be cooled downand sedated quickly, they recover quickly. Strug-gling, overheated horses should not be loaded on anambulance until they are quiet. Repeated cold wa-ter or ice water application and sweat scraping isused to facilitate evaporation.7 Flunixin meglu-mine (1.0 mg/kg, IV)8 is indicated, and sedation withxylazine (0.2–1.1 mg/kg, IV)8 or detomidine (0.5–40g/kg)5 will manage the anxiety of these cases.

Most other metabolic conditions such as exercise-induced pulmonary hemorrhage or exertional rhab-domyolysis are handled in the stable area. Insevere cases of “tying up syndrome,” IV fluids maybe needed, but this is uncommon in most cases be-

cause sedation and anti-inflammatory drugs oftenmanage the acute case. Electrolyte depletion mayoccur, and asynchronous diaphragmatic flutter isseen uncommonly. Adequate rehydration after therace is usually managed orally, and all horsesshould have access to clean drinking water in plen-tiful amounts managed carefully over the hours af-ter the race.

Although veterinary services at these events canbe stressful and require a lot of effort, with properplanning, personnel, and equipment, the results can

AAEP PROCEEDINGS ր Vol. 54 ր 2008 155






be very positive in the care of the horse and satisfy-ing for the equine practitioner.

References and Footnotes

1. Stephen J, White N, McCormick WH, et al. Incidence of injuries in Virginia Steeplechase Association races 1996–2000. J Am Vet Med Assoc 2003;223:1788–1790.

2. Protocol for emergency management of injuries to horses rac-

ing over jumps. Elkton, MD: National Steeplechase Asso-ciation.3. Swor T, Watkins JP. Adult orthopedic emergencies. In:

Orsini JA, Divers TJ, eds. Equine emergencies, 3rd ed. St.Louis, MO: Elsevier, 2008;286–287.

4. Williams J, Dyson S. Management of a recumbent horse.In: A guide to the management of emergencies at equinecompetitions. British Equine Veterinary Association, 1996;58–63.

5. Clark-Pierce S, Divers TJ. Anesthesia for field emergenciesand euthanasia. In: Orsini JA, Divers TJ, eds. Equine

emergencies, 3rd ed. St. Louis, MO: Elsevier, 2008;667–668.6. Williams RB. Racehorse injuries, clinical problems and fa-

talities recorded on British racecourses from flat racing andNational Hunt racing during 1996, 1997, 1998. Equine Vet J 2001;33:478–486.

7. Taylor P. Heat stroke, exhaustion and synchrous diaphrag-matic flutter. In: A guide to the management of emergen-

cies at equine competitions. British Equine Veterinary Association, 1996;102–113.

8. Robinson NE. Table of drugs and appropriate doses. In:Current therapy in equine medicine, vol. 5. St. Louis, MO:Elsevier, 2003;862–869.

aWhitcomb MB. Unpublished data, 2000.bKimzey Legsaver Splint, Kimzey, Woodland, CA 95695.

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