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Bull Riding-Related Brain and Spinal Cord Injuries -- Louisiana, 1994-1995

Rodeos are popular sporting events in the southern and western United States, and bull riders sustain 37% of all rodeo-related injuries -- more than participants in any other rodeo event (1,2). During 1994-1995 in Louisiana, five cases of central nervous system trauma associated with riding bulls in rodeo events were identified through the Louisiana Central Nervous System Injury Registry, a statewide, population-based surveillance system addressing brain and spinal cord injury incidence, etiology, and outcome. To further characterize these injury events, the Office of Public Health, Louisiana Department of Health and Hospitals, conducted chart reviews and follow-up telephone interviews with the five injured persons or their parents and interviewed rodeo organizations about rules, regulations, and membership. This report summarizes the investigations of these five cases and recommends use of protective equipment to reduce the risk for such injuries.

In November 1995, the Louisiana division of the National High School Rodeo Association (NHSRA) listed 67 high school students who were registered to compete as bull riders in Louisiana (F. Hinton, Louisiana division, NHSRA, personal communication, November 1995). Because other rodeo associations exist and riders frequently have membership in multiple associations, the number of bull riders cannot be accurately estimated.

Case 1. A 28-year-old man with 15 years' riding experience was thrown to the ground while riding a bull and suffered a fracture of the fifth and sixth cervical vertebrae and an incomplete * spinal cord injury. He had not been wearing any protective equipment (i.e., mouth guard, helmet, or protective vest). Emergency medical service (EMS) was not present at the event; the time between the call for an ambulance and its arrival was 45 minutes. He was hospitalized for 9 days; at discharge from acute care, he was unable to function independently in activities of daily living (e.g., eating, dressing, and walking) and was considered to have a severe disability. He had impaired movement below the level of the injury.

Case 2. A 14-year-old boy who had ridden a bull three times previously was thrown to the ground while riding; he struck his head and was then trampled by the bull. He sustained a brain stem contusion and an incomplete C2 spinal cord injury and was unconscious for 16 days. No information was available about the use of protective equipment or EMS response. He remained in a persistent vegetative state (i.e., dependent and no meaningful responsiveness) on discharge from the reporting acute-care facility 24 days after he was injured.

Case 3. A 26-year-old man with 2 years' riding experience struck his head against a bull's head while riding. He sustained a concussion with brief loss of consciousness, multiple facial bone fractures, and a trimalleolar fracture of his leg. He was wearing a protective vest. EMS was not present; the patient was transported to a hospital in a private vehicle by a family member and was in acute care for 2 days. He recovered with no reported functional limitations.

Case 4. A 15-year-old boy with 2 years' riding experience was thrown from and then trampled by a bull. He sustained an incomplete T10-T11 spinal cord injury, multiple rib fractures, a tension pneumothorax, and a splenic injury. He was not wearing protective equipment. The time between the EMS call and arrival was 10 minutes. Although at the time of discharge from acute care 17 days after he was injured he was reported to have no major deficits, he is no longer able to do heavy manual labor or compete in athletic events.

Case 5. A 17-year-old boy with 3 years' riding experience struck his head against a bull's head while riding. He sustained a brain injury and multiple nasal fractures and was unconscious for 5 days. He was not wearing protective equipment. EMS was present at the rodeo. After 40 days in acute care, he had pronounced cognitive and behavioral impairments.

Reported by: LI Gibbs, MPH, DW Lawrence, MPH, BA Reilley, Disability Prevention Program, Injury Research and Prevention Section, Office of Public Health, Louisiana Dept of Health and Hospitals. Div of Acute Care, Rehabilitation Research, and Disability Programs, National Center for Injury Prevention and Control, CDC.

Editorial Note

Editorial Note: In competitive bull riding, the rider holds with one hand a length of braided rope wrapped around the bull's midsection. The rope is not tied in any way; only the force of the rider's grip on the rope keeps the rider on the bull. Riders must remain on the bull for 8 seconds, during which their free hand cannot touch the bull, themselves, or the rope (3,4). Because riders and bulls are matched by random draw, injuries are more likely to occur when a younger, less experienced rider draws a high-spirited bull. Bull-riding schools for experienced riders exist but are not widely used. For developing basic skills, riders practice on mechanical bulls, calves or young steers, and barrels suspended from ropes (K. Henry, Professional Bull Riders Association {PBR}, personal communication, January 1996), although mechanical bull riding also has been associated with injuries (5).

The findings in this report document severe bull riding-associated brain and spinal cord injuries and permanent disability among young males. The number of such injuries may increase directly with the popularity of rodeo sports -- from July 1992 to July 1995, membership in the Louisiana division of the NHSRA increased 47% (F. Hinton, NHSRA, personal communication, November 1995).

Protective head gear designed for bull riding has not been developed or recommended by rodeo organizations. Protective vests designed for bull riding are required for youth competition but not for professional competition (3,4,6). Use of protective head gear recommended to prevent horseback-riding-associated traumatic brain injuries (7) may decrease the risk for brain injury in bull riding but has not been assessed for that use. Potential barriers to using protective equipment include cost and a perception that some protective equipment detracts from the desired rugged, western appearance (K. Henry, PBR, personal communication, January 1996; T. Corfield, National Intercollegiate Rodeo Association {NIRA}, personal communication, November 1995).

Timely transport by EMS providers to definitive care should decrease the severity and improve the outcome of injuries (8). EMS availability depends on which rodeo organization, if any, sponsors the event. For example, the Professional Rodeo Cowboys Association requires the onsite presence of an emergency medical technician and an ambulance; if the ambulance leaves to transport an injured rodeo participant, the rodeo is to be suspended until another ambulance arrives (4). Rodeos sponsored by college and high school associations require the presence at all times of an emergency medical technician with a suitable conveyance (3; T. Corfield, NIRA, personal communication, November 1995). At least three of the five injuries described in this report occurred at nonsanctioned rodeos.

The cases described in this report indicate the need for assessing the effectiveness of existing equipment, recommendations for its use in bull riding, and the need for new equipment; graduated competition; and matching the bulls with the skill levels of riders. To reduce the impact of injuries, adequate emergency medical care and transportation should be required for all rodeo events. The Louisiana Office of Public Health is working with the Louisiana Sports Medicine and Safety Advisory Committee (a group initially formed in 1990 to address spinal cord injuries among high school football players), the Tulane Institute of Sports Medicine, the Louisiana Sports Medicine Alliance, and the Louisiana High School Rodeo Association to increase participant awareness of the risk for injury related to bull riding and to develop prevention strategies.

References

  1. Justin Sportsmedicine Program. Ten year injury report. Grapevine, Texas: Justin Sportsmedicine Program, 1995:1-9.

  2. Griffin R, Peterson KD, Halseth JR, Reynolds B. Injuries in professional rodeo: an update. Physician and Sportsmedicine 1987;15:105-15.

  3. National High School Rodeo Association. Rules, constitution and by-laws, 1995-1996. Denver, Colorado: National High School Rodeo Association, 1995:72-5.

  4. Professional Rodeo Cowboys Association. Rulebook. Colorado Springs, Colorado: Professional Rodeo Cowboys Association, 1995:R10.6.1-R10.6.7.

  5. McConnell RY, Rush GA. Mechanical bull syndrome. South Med J 1982;75:681-6.

  6. National Little Britches Rodeo Association. Official rule book, 1995-1996. Colorado Springs, Colorado: National Little Britches Rodeo Association, 1995:58-9.

  7. Anonymous. American Academy of Pediatrics Committee on Sports Medicine and Fitness: horseback-riding and head injuries. Pediatrics 1992;89:512.

  8. McSwain NE Jr. Emergency medical services. In: McSwain NE Jr, Kerstein MD. Evaluation and management of trauma. Norwalk, Connecticut: Appleton-Century-Crofts, 1987:43-53.

    • A spinal cord injury resulting in any preserved motor or sensory function below the level of the injury.




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