Chapter 103On-the-Track Catastrophes in the Thoroughbred Racehorse
Horses in racing and high-intensity training are subject to a variety of musculoskeletal injuries. For North American racing the overall incidence of musculoskeletal injuries ranges from 3.3 to 7.3 per 1000 starts, depending on variables such as reporting criteria and degree of follow-up. A much closer range of 1.1 to 1.8 injuries per 1000 starts is reported for horses with catastrophic injuries resulting in euthanasia.1 Catastrophic or fatal injuries are documented more reliably and are considerably less subject to bias or misinterpretation by the reporter. The rates for training injuries may be somewhat higher, although accurate acquisition and evaluation of these data is more difficult. To date, limited information is available regarding training injuries.1,2 Several factors cannot be controlled during training, making information obtained inaccurate and incomplete. The absence of a veterinary observer during most training sessions allows many lameness incidents to go unreported. Often only injuries requiring an ambulance come to the attention of a track veterinarian. During training, no standard exists for soundness, medication use, and exercise rider skill. Differences between training injuries and racing injuries are documented when they exist. In July 2008, the Jockey Club launched the Equine Injury Database (EID) to provide the racing industry with a national database for racing and training injuries. The purpose of the EID is to collect comprehensive data to serve as a resource for epidemiological study to improve safety and prevent injuries. Additional information on the EID can be found at www.incompasssolutions.com.
The official veterinarian and staff members at a U.S. Thoroughbred racetrack have many duties. The primary responsibility is monitoring the soundness of horses during racing and, to some degree, training. This task is accomplished by an efficient prerace inspection and observation of all horses before, during, and after a race. After the horse has been identified, a visual assessment is made of the overall condition and attitude, and vital parameters are assessed. Ideally the temperature, pulse, and respiratory rates are recorded, and the eyes and mouth are examined closely. The mouth should be free of any inflammation or lacerations, which the bit would aggravate, possibly causing control difficulties for the rider. The forelimbs and hindlimbs are palpated, and attention is paid to the type of shoes worn and the condition of the feet. When bar shoes, aluminum pads, or quarter crack patches are noted, closer inspection of the foot is indicated. A palmar digital neurectomy is permitted in most jurisdictions. The clinician must always check for a neurectomy to ensure compliance with the rules. Usually a horse that has undergone neurectomy must be reported to the track veterinarian and its name conspicuously displayed for claiming races.
Any horse determined to be sick or unsound for racing is reported to the track stewards and withdrawn from the day’s racing card. Only the stewards have the authority to officially scratch a horse, although in practice a track official rarely questions the veterinarian’s recommendation. The veterinary department must function as an independent authority, and neither management nor anyone connected to a horse should interfere with the veterinarian’s decisions.
Once withdrawn for a veterinary reason, a horse is usually placed on an ineligible list and requires further evaluation before being permitted to race again. Depending on the nature of the illness or lameness, the evaluation may involve only a quick check; if the condition is more serious, a monitored workout and thorough examination may be required. The importance of the prerace inspection and follow-up examinations of identified horses cannot be overstated. Evidence exists that horses with prior pathological conditions are at increased risk for recurrent or more severe injury, possibly career-ending or catastrophic.3,4
A veterinarian is present in the paddock, where horses are saddled, and at the starting gate. An injury or lameness requires prompt evaluation and contact with the stewards for a late withdrawal. The track veterinarian is the ultimate authority over all horses in the paddock and on the racetrack during racing and training.
Racing officials rely on the veterinarian for information and guidance. Objective data on injuries may assist the track superintendent to address concerns about the track surface and dispel rumor and exaggeration among horsemen. The stewards and judges need the veterinarian’s input regarding the use, safety, and validity of new equipment such as shoes, bandages, protective eye covering, bridles, and therapy modalities. The official veterinarian also can be an invaluable source of information on medication for private practitioners, horsemen, and racing officials.
A brief comment on managing spills is appropriate. A spill is defined as a sudden fall of horse and rider that usually causes other horses and riders to fall. Ideally, one may call for immediate assistance from other veterinarians and experienced track personnel to assess and attend promptly to more than one horse injured in the incident. Horses may rise after a spill, although seriously injured, and move to other areas on the racetrack, thus further complicating the situation. A prompt overall assessment of the number of horses involved, the location on the track, and the major injuries is essential to prevent misallocation of resources. Triage and communication, with preferably one experienced veterinarian coordinating the activities, are key to an efficient professional outcome.
Efficient management of an on-the-track catastrophe while maintaining the horse’s best interests is the primary objective. The key elements required include trained personnel, equipment, and communication.
Communication is critical to make the best use of available resources. The track veterinarian must be prepared to respond to the injured horse and direct support personnel and equipment at the scene. The injured horse is under the care and direction of the track veterinarians until it is moved to a clinic or stable to be attended by a veterinarian employed by the owner or trainer. A stable veterinarian may be called to the scene for severe injuries and if time permits. The track veterinarian acts promptly to attend to the injured horse on the track, thus facilitating an efficient transfer for further evaluation and treatment. Efficiency is important for the care of the injured horse and to allow the official veterinarian to be in position for subsequent races without undue delay. Ideally a communication network of two-way radios and mobile telephones works well to keep an orderly process in motion. Radio communication with track departments such as security is used to relay information as required.
The operator of the horse ambulance should have sufficient training to fully understand the ambulance features and how to use them. Knowing how to back up and position the loading doors properly is essential. Failure to accomplish these basic skills could cause further injury or delay proper treatment.
In most situations, track personnel are the first on the scene of the injured horse, but in some countries, such as those of the United Kingdom and Ireland, a veterinarian follows the race and would be on the scene immediately. Track personnel routinely are equipped with radios and are crucial for initiating communication with veterinarians and providing the immediate care. Knowing who and how to call for assistance can save valuable time and distress for all involved.
Those individuals should be instructed in the basics of emergency care. The track veterinary department should provide such instruction to ensure a defined, reliable standard, without confusion and delay. Topics such as restraint, controlling hemorrhage, support of an injured limb, and when to apply a splint are well worth the time. Most if not all persons are willing to do whatever may be required to assist an injured horse, but they are often reluctant for fear of making a mistake. These first-line providers of emergency care should be encouraged and recognized for their valuable assistance. Splint selection and application should be kept as simple as possible to avoid potential legal complications, which fortunately are uncommon. An overzealous and poorly trained person may assume too much responsibility, however, placing the horse at risk of further injury and subjecting track management to extensive liability. Outriders, who monitor training in the mornings, may be instructed in using a commercially available support, such as a Kimzey splint (Kimzey, Woodland, California, United States). The splint may be applied safely whenever loss of support in the fetlock joint is obvious, because the splint is simple, quick to apply, and generally well tolerated. Restraint is often a critical issue for horse and handlers’ safety. Usually keeping the horse quiet and still while supporting a distal limb injury is adequate until a veterinarian arrives to provide professional care. However, in some situations the horse is best kept recumbent (e.g., a horse with such a severe injury that it is unable to remain standing, even with assistance). Such horses may lunge repeatedly and fall, risking further injury and endangering all present. A fallen rider near the horse may be incapable of movement for several minutes while being attended, making control and restraint of the horse all the more imperative.
Substantial improvements in equine ambulance design have contributed to minimizing secondary injury and complications, increasing the chances of saving seriously injured horses. The ambulance should be partitioned, be well ventilated, allow ample daylight, and be equipped with interior lights. Sturdy, rubber floor matting and padded sidewalls, all easily washed, are required. A partition separating the horse holding area and a forward compartment provides a storage area and some protection for handlers. Ideally the ambulance trailer can be lowered hydraulically to facilitate loading of a severely injured horse and eliminating the need for a rear ramp. Side access doors with ramps provide convenient and safe off-loading, without having to back the horse up or turn it around. An extremely valuable feature is a movable middle partition, which serves as a squeeze chute to help support the horse during transport. A seriously injured horse will make excellent use of this feature by leaning on it or the wall when turning, thus drastically reducing lateral movement and unnecessary weight bearing. The Kimzey Equine Ambulance is an excellent example of such a fully equipped vehicle.
The ambulance should be well equipped with splints and bandaging materials. Splints to support the metacarpophalangeal (fetlock) joint are essential, as are compression boots in two or three sizes. Bandage material should include sterile pads, gauze and cotton bandages, and elastic and adhesive wraps. Sufficient material to make a modified Robert Jones bandage always should be available. Duct tape is an excellent means to secure a heavy support bandage or splint, preventing shifting and providing axial stability. Inflatable compression splints are sometimes helpful to stabilize carpal fractures, but application of a cotton-and-elastic bandage is often faster and more effective.
Some of this material can be kept in the equine ambulance, but space and security considerations require that most of the splints and medications are kept in a track vehicle that transports the veterinarians. Emergency supply bags can be equipped and organized to facilitate quick access at the location of the injured horse.
Although it is not frequently required, a portable oxygen supply with a simple flow delivery system and two endotracheal tubes should be readily available. A sling of suitable design to support a horse for extended periods is recommended (Liftex, Warminster, Pennsylvania, United States).
Security concerns may preclude keeping medications in the ambulance in some jurisdictions. An emergency bag with selected drugs is an efficient means to attend to an injured horse on the track and in the ambulance. A suggested inventory includes butorphanol, xylazine, flunixin meglumine, ketamine hydrochloride, detomidine, hydrocortisone sodium succinate, epinephrine, phenylbutazone, and euthanasia products. It should be noted that the American Association of Equine Practitioners Euthanasia Guidelines (2007) state that the sole use of skeletal muscle relaxants is unprofessional and inhumane; however, the guidelines do not preclude the use of these drugs as an adjunct to a barbiturate or other acceptable drugs to facilitate a humane procedure. These can be a valuable aid to safely manage an uncontrollable horse that cannot be removed from the racetrack for euthanasia. An assortment of syringes, needles, tourniquet, scalpels, scissors, hemostats, and blood collection tubes complete the emergency kit.
During morning workouts and gallops, horses are subject to the same injuries as those that occur in racing. A few injuries, such as humeral fractures, are not encountered commonly in racing, but they are often seen while horses are only galloping. For the reporting period of 1993 to 2000, 12 of the 15 humeral fractures observed occurred during morning training.5 Horses with spiral humeral fractures, with or without displacement, almost always are considered candidates for immediate euthanasia. The injuries usually involve the horse falling suddenly and remaining down, although some do rise. The rider may have no warning before the fall, but some horses may change leads and bobble or shorten the stride.
The diagnosis is straightforward if the horse is standing. The horse bears little or no weight, and the limb is in a hanging position, with the horse unable to advance the leg if encouraged to move. There may be obvious swelling of the area, and palpation or manipulation with auscultation often reveals crepitus. Horses that are down on the track when the veterinarian arrives are diagnostic challenges. They may make some attempt to rise, particularly with encouragement, but with the fractured humerus on the down side they are rarely successful. Rolling the horse over can be accomplished with at least two people and the use of shanks or similar equipment to avoid being kicked in the process. Once the horse is turned over, the fracture is often apparent and the horse may rise with the good forelimb down. These horses often fall dramatically when the fracture occurs and may be slow to recover because of the shock of both the fall and the fracture.
Although some injured horses may be loaded and transported to the stable, no treatment is recommended other than analgesia and physical support. These horses are extremely difficult to load without the assistance of capable and readily available personnel. Loading becomes substantially more difficult with time, and the increased swelling and pain make the horse reluctant to move at all after several minutes. A horse is best left supported on the equine ambulance until the stable veterinarian arrives to confirm the diagnosis before euthanasia. At the request of an owner, or to satisfy insurance requirements, radiography may be attempted to document the diagnosis, particularly for horses with minimally displaced fractures. For most horses with this severe injury, radiographs are obtained more humanely post mortem. Humeral and scapular fractures do occasionally occur during racing, and horses should be managed in the same manner.
Collision injuries usually are associated with training, because many horses are often on the track, exercising at various speeds, distances, and directions. Maintenance equipment and personnel moving on and near the training surface, open gaps permitting access to the track, and insufficient outriders to monitor and control the congestion all predispose to collision injuries with other horses and inanimate objects. Injuries may be of any type but include trauma to the head, axial skeleton, shoulder, and pelvis. Bruising and lacerations from impact are not uncommon. The severity can range from minor abrasions and contusion to severe, life-threatening fracture and hemorrhage.