In summer 2017, a groom collapsed in the paddock at Laurel Park while leading a horse, stricken by a heart attack. While the people immediately around him panicked, racetrack security knew exactly what to do – they called for a medical doctor to the paddock, and Dr. Kelly Ryan of Medstar Sports Medicine responded. Ryan is contracted by the Maryland Jockey Club to provide sports medicine services to jockeys and backstretch workers at MJC tracks. She began performing CPR and called for emergency medical services, who arrived with a Automated External Defibrillator (AED). In less than two and a half minutes from his collapse, the man had medical attention and would later walk to the ambulance under his own power.
If not for good luck and good policy, Ryan says, the outcome could have been very different.
“You have to communicate effectively, and that's important – to make sure there are processes for when things go wrong. Seconds and minutes can decide whether or not someone lives or dies,” said Ryan, speaking at a continuing education event for the Racing Officials Accreditation Program in April. “That man lived that day because we were a well-oiled machine and we had practiced. That was a perfect situation, but it's not always perfect.”
It's critical for security and medical personnel at every track to have detailed plans for situations like this and to rehearse those plans. Those plans need to extend beyond downed riders on the track, as the Laurel incident demonstrated. Security and EMTs need to know where defibrillators are, where EMTs are stationed throughout the race card, and how to communicate with each other. Track officials – not just EMTs – should be trained in performing CPR. Everyone should know where the AEDs are on the property. A specific person should be assigned to call an outside ambulance if one is needed and communicate to that ambulance the nature of the trauma, especially if they're transporting a fallen rider. Ambulance operators use this information to decide whether to take a patient to a certified trauma center or a community hospital, which differ greatly in their ability to deal with jockey spills and looking for internal injuries.
“I get so many medical charts – I get charts back after a jockey has gone to the hospital – that just say 'Fall from horse,'” said Ryan. “No, it is not just a fall from a horse. It's not 'Oh I just got bumped off and landed on my butt.'”
But the details matter, too – for example, Ryan said the call she heard was 'Doctor needed in the paddock,' which isn't really specific enough at a facility where practitioners of human and veterinary medicine are often at work. The professionals called to the scene also need more information than the patient's species – where, within the paddock, is the person who needs help? Is this someone who has sustained a kick from a horse or someone who may be having a stroke? Is the person breathing, bleeding, have they suffered trauma? How old is the person? In a medical emergency where a rider or handler has fallen, outriders and security need to know if there's a loose horse to be dealt with.
Ryan is contracted via Maryland Jockey Club to provide sports medicine services to jockeys and exercise riders, including general physicals, assessment of riders after track injuries, coordinating concussion and return-to-ride protocols, and other health services for those on the backstretch. As such, she stays on the forefront of welfare and safety issues for riders and wants officials in other states to develop policies for potential issues before they become actual problems.
One of the other protocols tracks need to prepare, Ryan told the gathered racing officials: preparations for heat stress.
“Heat is not just a sports medicine thing,” she said. “It's an occupational hazard, too.”
Ryan has treated people at the Maryland tracks for heat stress in the summer. One of the most important things to note about a human suffering from heat stress, according to Ryan, is the need to cool the person's core temperature before they are transported to a hospital or clinic for further treatment. She suggests cold water immersion, like a baby pool with ice water in it, can accomplish this.
Ryan also has concerns about medication use in jockeys – both legal and illegal. Commonly-abused substances like alcohol, opioids, narcotics, and stimulants obviously have an impact on a rider's performance, but so do prescribed drugs like diuretics and beta blockers – all of these, she says, could impact emergency medical personnel's treatment of an injury and are banned in jockeys in Ireland unless the rider has a therapeutic use exemption. If and when marijuana use becomes legal in a given racing state, Ryan is concerned tracks could be subject to even more legal liability. Studies show people probably shouldn't drive under the influence of marijuana, and she worries riding while high isn't safe for a jockey, either.
“There are some things in here that I'm pretty sure riders in our country are riding with,” she said. “I hear a lot about [implementing World Anti-Doping Agency rules] for horses but I don't really hear about it that much for our riders and as someone who's concerned about their medical well-being overall, I do worry about a lot of these things.”
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