 Horse-related activity HRA can be risky. The National Electronic Injury Surveillance System NEISS estimated that in 2006, 68,060 Americans went to a U.S. emergency room with horse-related injuries HRI, of which 5,676 were hospitalized. However, Thomas et al estimated that 102,904 people each year from 2001 to 2003 were treated for HRI in emergency rooms nationwide. In Oregon, horses are the leading cause of animal-related fatalities in Oregon and Oregons annual death rate from animals is 45 higher than the national rate. In a survey of 679 Northwest equestrians in Oregon, Washington, and Idaho, 81 riders reported at least one injury during their career, and 1 in 5 equestrians required hospitalization, surgery, or sustained permanent disability as a result of a HRI. 