Data from a health risks of Australian veterinarians (HRAV) study were reviewed to identify reported serious injuries incurred while working with horses and the factors associated with these injuries. Of the 2188 serious injuries reported in the HRAV study, 1583 (72·3 per cent) were associated with animals, and of these, 453 (28·6 per cent) involved horses. Most of them were sustained in stock or handling yards. Factors associated with an increased frequency of injury included activities such as suturing, wound care, tubing and drenching. The parts of the body most commonly injured were the head and face and the lower extremities. Fractures were the most common type of serious injury. The use of safety precautions at the time of the injury was reported by 70 per cent of those injured.
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VETERINARIANS have been observed to have a high prevalence of injuries sustained in the course of their work (Landercasper and others 1988, Poole and others 1999, Reijula and others 2003), and large animal practitioners are at highest risk (Fritschi and others 2006). Hospital-based research has suggested that veterinarians have up to a nine-fold relative risk of severe injury in work-related accidents than their medical general practitioner counterparts (Norwood and others 2000). Fritschi and others (2006) reported that 51 per cent of Australian veterinarians had sustained a serious work-related injury during their career, and 26 per cent reported having had at least one injury in the previous 12 months.
Recreational and sporting activities involving horses are associated with a higher risk of injury or death than football, motorcycle sports or automobile racing (Norwood and others 2000), and they are associated with specific risks, including the possibility of significant head injury and consequent neurological injury (Griffen and others 2002). Most horse-related injuries are reported in recreational settings (Johns and others 2004), but many are sustained in the course of employment and are of concern (Edixhoven and others 1981, Nienhaus and others 2005).
Several risk factors have been associated with the high incidence of injuries to veterinarians (Wilkins and Bowman 1997), but the specific risk factors associated with injuries received while working with horses have not been well described (Jeyaretnam and Jones 2000). This paper describes a study of the factors associated with horse-related injuries to veterinarians responding to a national survey of Australian veterinary school graduates.
Materials and methods
The methods used to identify a health risks of Australian veterinarians (HRAV) study cohort have been described in detail by Fritschi and others (2006). All the graduates from Australian veterinary schools between 1960 and 2000 were eligible for the HRAV study, and invitations to participate were sent to those for whom a current Australian address could be found. Participants who did not respond to the first invitation were sent a reminder.
The subjects were sent a questionnaire requesting their personal details and professional history since graduation, and they were asked whether they had ever had a serious work-related injury during their professional life. A serious injury was defined as one that resulted in hospitalisation, or in not being able to work for at least one day, or in not being able to work at their usual pace for five or more days. Work-related injuries included animal-related injuries, but also motor vehicle accidents when travelling for work purposes, falls, needlestick injuries and foreign bodies in the eyes, ears, and so on. For each respondent, up to two of the most serious injuries (those requiring admission to hospital or that caused the most lost work time) were included in the analysis.
The subjects were asked about their activity at the time of the serious injury, the treatment received, the major factors considered to have been associated with the cause of the injury, location of the injury on the body, the mechanism and the nature of the injury. They were also asked to record the time lost from work as a result of the injury, and the time during which they were restricted in their capacity to work normally.
Any safety precautions in use at the time of the injury were requested and classified according to a hierarchy of risk controls, ranging from the most desired control, that is, the elimination of the hazard, through hazard substitution, the use of engineering controls and administrative controls, to, finally, the use of personal protective equipment. The highest order control described as being in use at the time of the injury was used for the analysis. Frequencies and cross-tabulations were used to describe the data, which were than analysed by using the statistical package SPSS version 15.
Completed HRAV questionnaires were received from 2800 of the 5746 veterinarians for whom addresses could be found, a response rate of 48·7 per cent. A higher proportion of eligible women than eligible men responded (39·6 per cent v 34·9 per cent), and there were fewer responses from graduates in the 1960/69 decade than more recent graduates (30·9 per cent v 35·7 per cent, P=0·002). These differences were statistically significant but the actual differences were relatively small, suggesting that the respondents were reasonably representative of Australian veterinarians.
A total of 2188 serious injuries were reported by 1397 of the veterinarians. Of these, 1583 (72·3 per cent) were animal-related, and 453 (28·6 per cent) of these involved horses. These 453 injuries were reported by 384 veterinarians, 74 per cent of whom were men. The nature of practice employment at the time of the injury was identified in 96 per cent of the injuries and was described as mixed in 69·4 per cent, large animal in 16·3 per cent, small animal in 6·7 per cent and special practice (including academic practice) in 7·6 per cent.
Place of injury
One hundred and seventy-one (37·7 per cent) of the 453 horse-related injuries were sustained in stock or handling yards, 166 (36·6 per cent) were sustained in open paddocks and 71 (15·7 per cent) occurred in stables.
Activity at time of the injury
Two hundred and seventy-three (60·2 per cent) of the horse-related injuries were sustained in association with procedural activities (Table 1), which were categorised as surgical, medical, obstetric, anaesthetic and other activities, excluding vaccinations and sample collecting. Surgical and medical procedures accounted for 39 per cent of the activities. The most common surgical procedures were described as suturing or wound care, and gelding or castrating, and the most common medical procedures were tubing and drenching.
Use of safety precautions
Seventy per cent of those suffering a serious injury when working with horses had used some safety precautions at the time (Table 2). The most common safety precaution was some form of restraint of the horse (34 per cent), and reliance on hand-held physical restraints was reported in 9 per cent of the injuries. Twenty-three per cent of those who reported sustaining a head injury reported that no safety procedures were in use.
External cause of injury
Being kicked or struck by the horse accounted for 79 per cent of all the injuries, and being crushed by, pushed against or stepped on by the horse accounted for 12·3 per cent. Eleven bites were sustained during an oral examination or dental treatment, and 10 strain or overexertion injuries were also reported.
Nature of the injuries
One hundred and twenty-six fractures and 14 dislocations were reported, with facial (n=29) and thoracic/rib fractures (n=29) being the most common, followed by fractures to the hand (n=22), the lower leg (n=10) and the foot (n=8) (Table 3).
Site of injury
The lower extremities (33 per cent), head and neck (26 per cent) and upper extremities (20 per cent) were the body regions most commonly injured (Table 3). There were 43 head injuries, 26 of which were reported as concussion or intracranial injury and five as fractures. Of the 67 facial injuries, 29 were fractures and 24 were open wounds or lacerations. Of the 38 thoracic injuries, 29 were rib fractures.
Eighty-five (18·8 per cent) of the reported injuries resulted in admission to hospital, 79 (17·4 per cent) in attendance at hospital accident and emergency departments, 153 (33·8 per cent) in treatment by a general practitioner and 111 (24·5 per cent) were reported as self-treated. Of the remaining 25, 10 received treatment from a physiotherapist, six from specialists and nine were reported as treated by ‘other’ means.
Loss of working time
The period of absence from work as a result of the injury ranged from 0 to 180 days, with a mean of 7·4 days and a median of 0 to one day. Two hundred and seventy-two of the injuries (60 per cent) resulted in a day or less absence from work, and 50 (11 per cent) resulted in eight days or more absence. The period during which the injured veterinarian's rate of work was restricted ranged from 0 to 365 days, with a mean of 16·7 days and a median of seven days; 40 per cent of the veterinarians reported eight days or more of restricted work rate.
Work-related injuries in veterinarians are common (Landercasper and others 1988, Poole and others 1999, Reijula and others 2003, Nienhaus and others 2005) and pose a significant burden on the injured individual and the veterinary profession. The prevalence of injuries to Australian veterinarians appears to be similar to that in international studies (Jeyaretnam and others 2000, Fritschi and others 2006).
Seventy-two per cent of all serious injuries reported by the Australian veterinarians were animal-related, an observation comparable with previously published findings based on insurance claims (Nienhaus and others 2005), and horse-related injuries accounted for approximately 20 per cent of the total of all reported serious injuries. A serious injury in the HRAV study was defined as one that resulted in hospitalisation, or in inability to work for at least one day, or in not being able to work at the usual pace for five or more days. Although there may have been some misreporting of the severity of injuries, the severity of injuries observed in the results appears to be consistent with the definition criteria, with nearly 20 per cent of reported horse-related injuries resulting in admission to hospital. The periods of absence from work or restriction of activity at work also appear to be consistent with the definition.
Despite the increasing proportion of women in the veterinary profession in Australia (Jeyaretnam and Jones 2000), nearly three-quarters of all the horse-related injuries occurred in men, an observation consistent with the larger proportions of men working in large and mixed animal practices (Fritschi and others 2006).
In this study, the majority of the horse-related injuries were reported to have been sustained in handling yards and in open paddocks, as would be expected given the nature of Australian equine practice. Activities such as suturing, wound care, tubing and drenching were the activities most frequently associated with injuries.
The body regions most commonly injured were the head, face and the lower extremities, and 27 per cent of the injuries were fractures. The injuries appear to be consistent with previous observations of horse-associated injuries (Bixby-Hammett and Brooks 1990, Griffen and others 2002, Thomas and others 2006). The common mechanisms of injury specific to large animals, namely being kicked or struck, affect the relative frequencies of the observed injuries (Johns and others 2004). Occupational incidents including large animals also tend to be associated with more severe injuries because of the animals' size and the forces involved (Nienhaus and others 2005).
Forty-three head injuries were reported by the veterinarians, 26 of which were reported as either concussion or intracranial injury and five as fractures. Twenty-three per cent of those reporting serious head injuries reported that no safety procedures were in use when the injury was sustained. Although these results may have been influenced by recall bias, the use of safety measures by veterinarians working with horses appears to be less than optimal. Thirty per cent of the veterinarians reported that no safety precautions were in use, and less than 10 per cent applied the isolation/enclosure measures usually considered to be the more desirable control method in the hazard control hierarchy.
The inadequate use of safety equipment associated with horse-related injuries has been reported by Chitnavis and others (1996) and Thomas and others (2006), and may be partly due to the confidence of experienced veterinarians. The risk of injury, however, has been suggested to be more a function of cumulative exposure, and reliance upon experience has been reported to be unprotective as a risk minimisation measure (Kriss and Kriss 1997). Awareness of the proper use of established techniques for handling large animals has also been suggested as a positive means of reducing the incidence of injuries (Grandin 1999).
These results add to the evidence that horse-related incidents are a serious source of traumatic injuries to veterinarians. Efforts are needed to improve veterinarians' awareness of safe handling practices and the use of appropriate safety precautions.
This study was funded by the Cancer Council of Western Australia and the University of Western Australia Research Grants. The authors would like to thank the alumni organisations of Queensland University, Murdoch University and the University of Sydney for providing lists of graduates, and the Australian Veterinary Association, the New Zealand Veterinary Registration Board and the veterinary registration boards of the Australian states for their assistance. L. F. and L. D. are supported by the National Health and Medical Research Council.
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