First Aid for Equestrians

When accidents happen, it’s important to know what to do (and not to do). Photo by

These tips from an emergency medical technician and dressage pro could save someone’s life

By Jennifer O. Bryant

I keep an equine first-aid kit and reference book in my tack trunk. I have apps and websites at my fingertips that I can consult if a horse gets sick or injured. I’m sure you, conscientious horse owner, do the same.

But the first time that I watched a rider fall off and lie motionless on the ground as her loose horse raced around the arena, I felt paralyzed with fear because I didn’t really know what to do.

That rider wasn’t seriously hurt, but unfortunately that’s not always the case. Horse-related injuries are more common than we equestrians would like to believe, and riding is statistically among the most dangerous sports. If someone at your barn had a medical emergency, would you know what to do?

Helping equestrians be prepared for such an event was the goal of emergency medical technician (EMT) Gwen Ka’awaloa, who gave a talk on the subject at the 2022 Adequan®/USDF Annual Convention in Lexington, Kentucky. Ka’awaloa, a critical-care technician at Parker (Colorado) Adventist Hospital, is also a longtime dressage rider, judge, and trainer who received the 2022 USDF Volunteer of the Year award at the convention. Read on for the key things you need to know in case of a medical emergency.

Don’t move the person if you don’t know what’s wrong. You could make an injury worse.

When in doubt, call 911. EMTs have the training and equipment to deal with all kinds of medical emergencies, Ka’awaloa said. Plus, “They have pain medication!” she said.

Don’t assume that a person who looks OK on the outside is indeed unhurt. Internal injuries aren’t always obvious, Ka’awaloa cautioned. “Call 911. They have diagnostic equipment.”

“If you must drive the person, never bypass a fire department,” said Ka’awaloa. “They have paramedics.”

Know what you have on hand at the barn that can be used for first aid. “Polo wraps, or standing wraps with pillow wraps, are good for stopping bleeding,” Ka’awaloa said. A riding crop or shorter whip makes a good splint if you suspect a broken bone—but be sure to “apply with Vetrap; don’t use duct tape! Duct tape can pull the skin off when it’s removed, especially in older people.” You can also splint a limb by encasing it in a thick magazine and taping in place.

Although potentially harmful if used incorrectly, an emergency tourniquet can be an effective method of controlling severe bleeding, Ka’awaloa said. A stirrup leather can work well, as could a small halter or a lead rope tied over a polo wrap, she said.

EMT and dressage pro Gwen Ka’awaloa demonstrates how to use a crop or whip to splint a broken bone. Photo by Jennifer Bryant.

Add these to the list. “Trauma shears are excellent for cutting off bandages,” Ka’awaloa said. “Every horseman should have trauma shears in the barn.” They’re readily available from Amazon and other sources, she said.

Horse people may acquire inexpensive stethoscopes from various sources, but a decent one is much more useful, said Ka’awaloa. “Get a better stethoscope than the cheapo ones.”

Ka’awaloa also encouraged facilities to invest in automated external defibrillators (AEDs). These devices can deliver an electrical shock to restore the heart’s normal rhythm in the event of sudden cardiac arrest. They are extremely easy to use and can save lives, she said.

Know how to control bleeding. First, try applying pressure to the wound with your hands, Ka’awaloa said. Then apply a dressing to the wound and press. The most drastic means is an emergency tourniquet, as discussed above.

Recognize signs of concussion. If the person is unconscious after a fall, assume a traumatic brain injury (TBI). But even someone who remains conscious after an impact to the head may have sustained a concussion. Red flags, per Ka’awaloa:

  • Repetitive questioning. The person asks the same question multiple times, even after you’ve answered the question.
  • Inability to remember the incident. If the person can’t remember how they ended up on the ground, chances are they suffered a concussion.
  • Physical symptoms: Nausea or vomiting, a severe headache, dizziness, or vision problems.
  • Helmet damage. Scratches, dents, cracks, or breaks offer proof that the wearer’s head impacted the ground. However, cautioned Ka’awaloa, lack of obvious damage does not mean that the helmet did not sustain an impact. (And always replace a helmet after a fall, even if it looks OK on the outside.)

If there is any suspicion of concussion, call 911, Ka’awaloa said, because “the person needs a CAT scan” to determine whether brain damage occurred, and to what extent. And be aware that severe pain can make a person “track off’ and lose the ability to maintain a train of thought in conversation similar to that exhibited in a TBI.

Be aware of any preexisting health conditions. “If someone in the barn has a condition, such as a heart condition or a seizure disorder, everybody in the barn needs to know that,” Ka’awaloa said. “You need to call 911 for these people” if they get injured. And “know where their inhaler is” (or any other “rescue” medications or devices that they carry with them).

EMT and dressage professional Gwen Ka’awaloa recommends that trail riders and others wear US Eventing Association medical cards and armbands. USEA photo.

Inform and prepare. In the event of a medical issue, how easy would it be to locate the person’s emergency contact, health conditions, list of medications, and so on? Ka’awaloa recommends making a list of key information—names, birth dates, emergency contacts, known allergies, and medical conditions—and posting it “somewhere everybody can find.”

For occasions when riders venture outside the arena, they should carry this information with them. “My students wear US Eventing Association medical cards when they go trail riding,” Ka’awaloa said. The large cards are worn in armbands for visibility. Medical ID tags, such as Road ID wristbands or Medic Alert bracelets, “are good, but a card is best” because no cell-phone signal or internet connection is required to access the information. Similarly, “QR codes don’t always work” because they can become obliterated, she said.

Take a CPR course. CPR (cardiopulmonary resuscitation) is an emergency lifesaving procedure whose purpose is “to keep blood going to the brain” when the heart has stopped beating, Ka’awaloa explained. When CPR is performed until trained medical personnel arrive, the chances of successful resuscitation are increased. Find a course through the American Heart Association, she recommended.

Know your farm’s address. Telling the 911 operator to send the ambulance to ABC Acres won’t do much good. Make sure everyone knows the property’s correct, complete street address.

Silence the sirens. “Tell the 911 operator to have the ambulance come in silent if horses are present,” Ka’awaloa advised. “We don’t need to cause another accident.”

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