It is estimated that up to 30 million people in the U.S. ride horses, although most ride infrequently. The rate of serious traumatic brain injury for horse riders is about 7 times greater than for motorcycle riders and racecar drivers (MMWR, 1988). Head injuries are the most frequent cause of horse-related deaths (Nelson & Bixby-Hammett, 1992). Head injuries account for over 25% of the total rider death (Bixby-Hammett & Brooks, 1990; Anthony-Tolbert, 2002; Sports-related head injury, 2005).

The annual combined costs of horseback riding injuries and fatalities are estimated at $89.7 million (SSN EDARC,1999-2003). The annual cost of non-fatal horse-related injuries to youth age 0 – 19 years of age treated at emergency departments is estimated at $945.6 million with females age 10 to 19 years accounting for $443.7 million of that total (MMWR, 1990).

Use of Riding Helmets greatly reduces these risks. However, only about 50% of youth who ride horses believe that a helmet increased their safety, even though about 21% reported having received a riding-related head injury. Only 20% of youth horseback riders report that they wear an approved equestrian helmet each time they ride (McKee & Brady, 2004).  The Heather on Horseback simulation and Cost Tools demonstrate safe riding decision making and show the high costs to everyone when a rider is injured.