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Equine July/August 2008 (Vol 3, No 6)

Guest Editorial — Catastrophic Injuries

by Scott Palmer, VMD

    Thoroughbred racing is an extreme sport. The fates of the horse and rider are inexorably linked the instant they break from the starting gate until the rider dismounts in front of the grandstand after the race. Reasonable expectations for the race are that one horse will win and the field will follow in its footsteps. No one expects the unthinkable: that horse or rider will die in a catastrophic moment during the heat of competition. Still, everyone knows there are risks. In no other sport does an ambulance follow human athletes around a track in case of injury. In addition, up to three crews of veterinarians, each with an equine ambulance, are stationed around the racetrack to come to the aid of an injured horse. For televised races, AAEP "On Call" veterinarians work with track emergency crews and are prepared to advise the announcers or go on camera to brief the public in the event of an injury. These veterinarians receive a standard greeting of, "We are glad that you are here, but we sure hope we won't need you!" Amen to that.

    In 2006, the media documented Barbaro's tragic injury and struggle for survival, highlighting owners' passion for their horses and showcasing advances in equine orthopedic care like never before. In a heartbeat, Barbaro's story crossed over from racing insiders to the general public. The Barbaro experience also set the world stage for the intensely emotional public reaction that followed the fatal injury of Eight Belles in the 2008 Kentucky Derby.

    At times like this, veterinarians are often asked to make sense of what looks to the casual racing fan like an epidemic of catastrophic injuries. Neighbors stop us on the street. Sometimes, the local paper calls for a comment, or radio and television reporters ask for an interview. The questions are always the same: why did this happen, and can't something be done to prevent it?

    Veterinarians are uniquely qualified to speak to this issue. Our education, postgraduate training, and volunteer service to horses set us apart. Equine practitioners have a long history of commitment to the welfare and safety of horses, including many decades of work in the particular areas of preventing, diagnosing, and treating injuries in racehorses. Veterinary research at universities around the world has helped us to understand the process of bone remodeling and to create training practices that have diminished the prevalence of stress fractures. We appreciate how maladaptive bone disease, subchondral bone remodeling, cyclic repetitive injury, and certain shoeing and hoof care practices can predispose horses to catastrophic injury. Veterinarians work in breeding sheds and nurseries throughout the world to provide state-of-the-art care for mares and foals. Attending veterinarians at racetracks provide top-quality daily health care to horses in competition. Veterinarians at referral hospitals work in concert with racetrack practitioners to provide a level of veterinary services that is not possible in shed rows. Racing commission veterinarians inspect horses during training and before racing and administer stringent medication testing programs. Other veterinarians serve as medical directors for racing jurisdictions, state stewards, or members of racing commissions. We serve organizations such as The Jockey Club and the Racing Medication and Testing Consortium to promote the health and welfare of horses in competition and to ensure the integrity of the sport.

    Many factors likely contribute to catastrophic injuries, including racetrack design, surface composition, and maintenance procedures; environmental considerations; the horse's conditioning, nutrition, medication programs, and shoeing; breeding for market factors such as precocious speed; and year-round racing schedules. All of these factors are currently being scrutinized. Veterinarians can serve an important role in explaining to the general public that although it's natural in times of tragedy to single out any of the above as the root of the problem, accidents, on or off the racetrack, usually involve an unlikely combination of factors. Oversimplifying the causes that lead to tragedy is a disservice to the victims and distracts us from appropriate and prudent analysis that can lead to meaningful answers.

    Because the causes of catastrophic injury are complex, it follows that there are no simple answers and no silver bullet that will fix the problem. The reality is that there will always be injuries in racing. However, it is our responsibility to reduce the prevalence of catastrophic injuries as much as possible. The good news is that there are opportunities for veterinarians to play a significant role in efforts to provide solutions. To make racing safer, we need the following:

    • A core value system that puts the safety and welfare of horses first
    • Evidence-based information to critically analyze current procedures and policies that may put horses at increased risk
    • The courage and determination to effect real change over time

    The Jockey Club Thoroughbred Safety Committee recently recommended that the racing industry do the following:

    • Institute an immediate ban on toe grabs higher than 2 mm, bends, jar caulks, stickers, and any other appliance worn on the front shoes of Thoroughbreds while racing or training on all racing surfaces
    • Adopt the Racing Commissioners International model rule on androgenic anabolic steroids, which effectively bans the use of all anabolic steroids in the race training and racing of Thoroughbreds
    • Support efforts by Thoroughbred sales companies to eliminate the use of anabolic steroids in Thoroughbreds intended for sale as weanlings, yearlings, and 2-year-olds in training
    • Revise the approved specifications and proper use of a riding crop in racing and training

    At the grass-roots level, equine practitioners can encourage decision-makers within their own racing jurisdictions to adopt these recommendations before the end of 2008. These are just a few of the initiatives that we need to support. They do not, by any means, represent the entire scope of changes necessary to accomplish long-term change, but they would be a very meaningful start.

    It is hoped that the Equine Injury Reporting System developed by Dr. Mary Scollaya will soon provide an appropriate sample size to help us make an informed decision regarding the relative safety of synthetic and dirt racing surfaces and identify markers for horses at increased risk of injury. To successfully minimize injury, all aspects of the racing industry need to be critically evaluated, including the impact of current juvenile sales policies and procedures as well as purse structures and racing schedules that influence market forces within the industry.

    In 1986, Dr. Jim Coffman, president of the AAEP at the time, spoke eloquently on the issue of value-based decision-making. His words are just as relevant to the current crisis in Thoroughbred racing as they were to the AAEP more than 20 years ago:

    We must take care to maintain a high level of awareness of why we exist as an organization, lest we lose our bearings in the midst of the rapid pace at which things are changing and increasing in complexity. I submit we as equine practitioners exist as an organization because of the horse and the medical and surgical needs peculiar to the species. I would argue further that this consideration serves as a virtually infallible standard against which to consider all AAEP policy. If thought through to its ultimate conclusion, whenever a question is answered based upon the welfare of the horse, the human principles involved are also best served in the long run. We are here for the horse; to the extent that we are responsible to that concept, we will prosper both as individuals and as an organization.

    Whatever your level of participation in or passion for Thoroughbred racing, I encourage you to help shape the discussion with these core values uppermost in mind, to shed light rather than heat on the issues using evidence-based information, and to help sustain the current momentum of racing's interest in making real changes to improve the safety of horses and riders.

    aEquine injury reporting system debuts at racetracks. Accessed June 2008 at www.avma.org/onlnews/javma/jul07/070715h.asp.

    References »

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