The Change Ahead: After Years Of Advocacy, Concussion Screenings On The Way For All Jockeys - Horse Racing News | Paulick Report
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The Change Ahead: After Years Of Advocacy, Concussion Screenings On The Way For All Jockeys

Viewers of the recent Cazoo Derby at Epsom got an unexpected bit of drama when Blue Trail broke from the gate without jockey William Buick. Video from a camera mounted in the starting gate showed what had happened – as Buick and Blue Trail were waiting for the start, rival Approachability in the stall to their right reared up and leaned over, flinging his head back and smacking Buick hard in his right temple. The video shows a stunned Buick crumpled at the back of the gate holding his head as his horse breaks out from under him as starting gate crews attend to him.

 

When Buick got out of the starting gate, he was checked out by medical personnel on the ground, which would have been the norm at most American racecourses too. But according to a report from Sporting Life, he also needed to get medical clearance before he was allowed to ride the remainder of the racecard. At some American racetracks, even years into the national discussion around concussions in sport, there isn't someone tasked with checking to see whether a rider in this kind of situation has a concussion and if it's safe for them to ride.

Advocates for jockeys are hoping that the coming implementation of the Horseracing Integrity and Safety Act (HISA) will soon change that.

The current situation

Ever since the topic of repeated head trauma in football became a focus for mainstream media nearly a decade ago, people have been asking Dr. Kelly Ryan and others what should be done about concussion protocols for jockeys.

Ryan began work at MedStar Health after completing a fellowship there following medical school, and was brought on in part because the Maryland Jockey Club had expressed interest in engaging MedStar to begin concussion monitoring. Maryland has led the way in this area, contracting Ryan through MedStar not just to do baseline concussion testing and screening after a rider falls, but to do physicals for jockeys and exercise riders, coordinate communication with hospitals and specialists after a fall, and clear riders to return to the saddle when they're fully recovered (whether they suffered a head injury or not.)

As one of the leaders in the area, Ryan has been asked to speak on her program over and over through the years. Sometimes she finds herself giving presentations to racetracks that end up implementing a similar program – and sometimes, she has encountered what sound to her like a lot of excuses about why they can't.

Dr. Kelly Ryan

“[They'll say], well we only have emergency medical services at the track,” she said. “Why? Why don't you have a medical director? Or we don't have enough money, enough resources…

“To be honest I don't know why people won't adopt it. we've tried to give them different ways of doing this, but it's just not a priority.”

Read our award-winning reporting on the dangers of head trauma in jockeys from 2015 here.

After Maryland led the way, Ryan says Delaware Park hired an athletic trainer to perform similar duties to hers. Parx and Penn National also began using HeadCheck, a software program that administers concussion testing and keeps medical records, and Ryan regularly checks in with staff at Charles Town to ensure jockeys' records are up-to-date for those who commute to Maryland.

In 2017, Keeneland announced a partnership with the University of Kentucky, and now has its own on-site physician and its own information management system for rider health data. New York Racing Association tracks formed a partnership with the Center for Sports Medicine at New York Institute of Technology last year to develop return to ride guidelines, monitor riders and educate them about head trauma.

Emerald Downs and Indiana Grand have also made strides in jockey safety.

But while most professional sports have taken the step of implementing return to play protocols and hiring someone to enforce them, many racetracks still have not.

“Everyone kept saying we can't because of this, or we can't because of that,” Ryan said. “Or 'we don't have that many concussions.' Well, you don't have that many concussions because you don't have anybody to identify them. These riders are riding after hitting their head and being dizzy and coming back the next day with headaches because no one was able to assess them or properly evaluate them … and there's nobody telling them they can't.”

For Ryan, the question isn't just what tracks are willing to do to monitor riders with concussions; she's seen situations where fallen riders can't communicate their medical histories or allergies to paramedics, and feels strongly medical personnel at the track should be able to access that information.

“Do I think the baseline concussion tests are an end-all, be-all? No,” she said. “Do I think the industry is really focusing on baseline concussion testing when jockeys don't even all have physicals done? Yeah. I'm much more concerned that a jockey has a good medical history in [records] than they have baseline concussion tests done.”

What HISA will do

According to the racetrack safety regulations that are due to go into effect July 1, covered racetracks will need to have a medical director who will be tasked with care and organization of medical needs for jockeys. The medical director may be a licensed physician or an athletic trainer. Jockeys will also need to show proof of a physical exam completed in the prior 12 months, as well as the results of a baseline concussion test.

The medical director will be in charge of organizing baseline concussion testing to establish what is “normal” for a rider and making sure a test is given to riders after a fall. They will also be responsible for reporting rider injuries, organizing emergency response teams' plans for injuries, clearing a rider to return after an injury, and oversee concussion protocols and requirements for an annual physical.

That doesn't mean the solution is perfect. Sources we spoke with voiced concern about whether a national record-keeping system of jockey health information would be HIPAA-compliant, and whether all tracks will implement the same software to share data on a rider's status post-accident. If tracks use different systems to flag a rider as being shelved for a head injury, or to store/transmit physicals, there are going to be records that don't get where they need to go.

There's also going to be a learning curve among the riders who haven't had to submit their medical information into a database before or who have never undergone baseline concussion testing.

“The first challenge that I had was getting the jockeys to see we were working in their best interest vs. trying to prevent them from working,” said Jamie Callard, a paramedic serving riders at Finger Lakes. “I believe that over time this has been accomplished as we have helped to get them connections needed for faster clearance.”

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Some riders may be suspicious the baseline cognitive testing they'll be asked to do by July 1 is meant to qualify or disqualify them to ride. This is a common misconception. Baseline testing is used as a comparison to test results after a fall, and is designed to help medical personnel detect changes in memory and balance within an individual. Surprisingly, Ryan said some jockeys perform poorly on balance tests used for baseline concussion testing, but that's good for her to know. Otherwise, seeing a jockey struggle with the balance test after a fall could lead them to be held out of races unnecessarily.

There's also a wide variety within the community of American jockeys in terms of education, income, and awareness of some of these new safety regulations and their purpose.

“I think for a lot of them it will be easy, and some of them it will be difficult. Some of them don't even have an iPhone or an email,” said John Velazquez, Hall of Fame jockey and member of HISA's racetrack safety standing committee. “Those are the guys who are going to need a lot of help.”

Ultimately, advocates for jockeys are hopeful the new requirements will result in injury reduction for riders. For years, the onus has been on riders to keep up to date with the latest research on safety vests and helmets, to educate themselves about the signs of a concussion and to proactively seek out treatment to prevent further injury. Terry Meyocks, executive director of the Jockeys' Guild, recalls working on the Jockey Health Information System as far back as 2008, trying to rally stakeholders to track injuries in a Jockey Injury Database in 2010, and has worked with medical researchers to create return to ride protocols for many years, too. The Guild walked away from the NTRA Safety and Integrity Alliance in 2018 when the group felt accredited tracks weren't upholding rider safety standards. In some ways, it feels like he has been saying the same things for many years with mixed response.

Jockey John Velazquez speaking with owner Will Farish

Meyocks reports 159 riders have died since 1940, though the rate has slowed significantly over the past 15 to 20 years. An average of two are paralyzed or permanently disabled each year.

“It's not new to us, but it is to track managers and regulators who ask why we're doing this,” Meyocks said.

He and Ryan both say such policies aren't just beneficial for riders – horseplayers are impacted if a jockey rides while impaired; horses are at a higher risk of injury when piloted by a jockey battling pain or concussion, and racetracks can ultimately reduce liability if they can improve safety figures.

For Ryan, it shouldn't be a question of who else benefits from improving rider health – the needs of the athletes should be reason enough for tracks to make the change.

“These are human beings who are riding on top of horses, but clearly the focus is the horse,” she said. “But there are people on the horse who have families and lives and are significantly impacted by these injuries. Coming from a medical world where people value healthcare, it's very frustrating the excuses people will make for why they can't implement a program.”

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