If you were on social media the past few days, you may have seen the new data analysis study regarding air jacket safety. If not, see this link (be aware, this is the summary… you have to have a subscription for access to the full paper). Basically the authors analyzed FEI fall data, and from this data concluded that “Riders wearing an air jacket had 1.7 times (95%CI 1.14–2.64) increased odds of sustaining a serious or fatal injury in a fall compared to riders not wearing an air jacket.”.
While I’ve been questioning air jacket safety and the lack of research surrounding them for years, I think it’s important to recognize what this study is really telling us before anyone gets too up in arms or jumps to a conclusion about air jackets or the study. The conclusion of the study states:
Riders wearing an air jacket were over represented in the percentage of serious or fatal injuries in falls compared to riders who only wore a standard body protector. Further research is needed to understand the reason(s) for this finding. It is recommended that additional data on injury outcomes, rider characteristics and the biomechanics of falls be examined in future analyses, and that air jacket and body protector characteristics be further investigated.
So really, this study says “hmmm… we need to research this to figure out why we’re seeing this trend in the numbers.”. Which we do. While correlation does not equal causation, the data we do have definitely raises some questions and highlights the need for more and better data. There has been very little research done regarding air jackets as they relate to equestrian usage, and we really don’t know anything about failure rates, their influence on fall trajectory and direction of impact, potential destabilization of injuries, the risk of burst fractures, potential differences between inward inflation and outward inflation, any possible mental/risk-taking factors, other rider-related factors that might come into play with their use, etc etc. There are a lot of unanswered questions.
It’s also important to recognize that the FEI data itself is not very complete. Since it’s from FEI, it is all upper level competition data, but it’s not giving us particularly specific information about the types of injuries or how they occurred. I personally would be very interested to know what kind of body protector was worn under the air jacket in these cases, because it sure seems like people love to throw them over a 10+ year old cardboard-thin Tipperary and call themselves safe. (On my sandbox for a minute asking people to PLEASE invest in a good quality BETA 3 approved vest and replace it every 4-5 years, whether you wear an air jacket or not… we know for a fact that those work)
One of the authors of the study, Lindsay Nylund, commented on social media with a bit more information:
Thank you all for your comments and questions in relation to this study. I cannot respond to them individually as the debate has progressed, so I will try to address some of the major points raised. Firstly, the conclusion was, “riders who wear air jackets are over represented in the number of serious/fatal injuries in falls.” The results of the data analysis revealed a 1.7 times increase in relative risk. The probability that this finding was due to chance is less than 1 in 100 (p=0.009).
Nowhere does the study conclude that air jackets are the cause and no recommendation is made that riders should or should not wear an air jacket. Unfortunately the data available to the authors could not establish the reason(s) for the finding and hence why it is suggested that further research and investigation be carried out. The discussion section of the paper, explores some of the possible reasons for the finding to provide some focus on where future research efforts could be focused, but these should not be confused with the conclusions or imply causation. The reason(s) must either be due to air jacket characteristics (such as lanyard pull forces – reported in a Swiss study to be in the range of approx. 20 to 60 kg, or possible restriction of torso movement transferring injury risk to the head/neck, etc.), AND/OR due to rider characteristics (such as riders who wear air jackets having increased risk of injury in falls due to rider anthropometric characteristics or fitness levels, or pre-existing injuries, more rotational falls, etc.), that were different from the cohort of riders who fell not wearing an air jacket.
The analysis was limited to injury outcomes in falls (expected versus actual), not differences in fall rates for riders wearing/not wearing an air jacket – we did not have data on the number of starters wearing an air jacket. If 55% of the 3,305 riders who fell were wearing an air jacket, then you would expect 55% of serious/fatal injuries to be for riders wearing air jackets (if air-jackets were doing no good or no harm). While there may well be confounding factors that are unrelated to air jackets, the counter-intuitive finding in the data suggests that the matter needs to be investigated.
Indeed, the study raises more questions than it provides answers, however it does highlight the need for further research and investigation. It is up to each rider to decide whether they think the benefit of wearing an air jacket outweighs the potential risk that it may be increasing their overall serious injury risk, but wouldn’t you prefer to know that there may be a problem and make your own decision? It is fine to speculate about possible reasons and this can assist researchers to identify the data that needs to be collected and analysed. Important questions which need to be answered are: What are the rider, air jacket, and body protector characteristics that we need to collect data on? What is the best way to collect this data? How and when can it be obtained? How can we as riders, instructors, and industry bodies support the research that is needed to understand the reason(s) for the finding? What is it going to cost and how can it be funded? How quickly can further research be carried out? Thanks again for your comments and questions.
It has always bothered me how our industry has swallowed this item as a safety revolution, hook line and sinker, without having any actual research to back that up. It also concerns me that it seems as though most people think that the air jacket is more important than the body protector underneath. Or that the large majority of wearers do not follow the recommended service, maintenance, and inspection protocol. For example, Point Two’s policy says “We recommend you have your vest or jacket serviced yearly or after six inflations. Your safety depends on it.”. I don’t think I know anyone who actually does that. Some companies don’t even offer any kind of servicing or maintenance protocol. If you like wearing an air jacket, by all means please use it. But understand what it’s meant to do, what it’s not meant to do, and understand how to care for the equipment properly. And, ya know… put a good quality body protector underneath.
So why, in this FEI data, do we see such a disproportionate number of injuries with riders wearing air jackets? We don’t know. Could be so many reasons. Maybe air jackets are safer in some instances or not others. Maybe they have an effect that we don’t know about. Maybe there are other factors at play that would change the data completely and show that air jackets really do help prevent injury. The bottom line is that we have no idea. This data analysis just illustrates how little we DO know, and how much we need some solid research into the air jacket safety equipment so that we can understand how/if it really works. The next question is: how do we get those answers?
breedrideevent.com 
Interesting results; definitely more research is needed. I appreciate that the author took the time to respond to the social media comments in a thoughtful, thorough manner. I have the full paper if you want to see it (I’m not clear on whether you were actually able to read the whole thing or only what was in the link you shared).
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I have the full paper too, just don’t know the legalities around whether or not I’m able to share it in its entirety.
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I work in academic research, if you don’t want to share it, I will. I am the go-to for a lot of my friends without major university access to scientific literature. What can I say, I like to live dangerously.
I understand the benefits of having a paywall for peer reviewed research, but I wholly disagree with it. Knowledge and information should not have a for-profit gatekeeper. Plus, a lot of the time if you contact the author directly they’ll send you the paper.
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I’m happy to share the full paper if I’m allowed to, I just don’t know the “rules” regarding that and don’t want to step on anyone’s toes or get myself in trouble. I have a pdf file that I’m more than happy to send anyone if they’re interested. There aren’t a lot of pertinent details that people are missing from the full paper, mostly because the FEI data that it’s based on is not detailed in the least.
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It’s true. After reading the whole paper, the only thing you’re missing is the boring, very simplistic statistical analysis.
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My library spends a fortune on journal subscriptions/licenses but to provide access, if you come to our building? you can access every single one of our subscriptions so we provide a lot of access to a lot of people that way. I like open access journals, but they do hurt researches too with publishing fees… So many young (ie: new, up and coming) can’t afford to publish in open access due to the fees so they publish in paywall journals. You can’t win, right?
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My opinion here is sharing things for PERSONAL use is OK as long as you aren’t posting the article publicly (like was done briefly on COTH last night) — that violates copyright (think photographs). But sharing among friends privately? It’s fuzzy and you can probably make a fair use argument if need be…
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I wonder if there’s a component of “lack of risk avoidance” in riders that wear air vests.I can’t think of a good way to study that, but it’s an interesting psychological factor that isn’t considered in this paper.
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There are a ton of factors that aren’t considered in the paper since it’s based on data provided by the FEI, and the FEI does not do a good job of gathering much useful data.
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Disclaimer: I am not an eventer and have very limited knowledge of the sport.
I have to admit, my first thought was that the data may be skewed due to who is buying and using an air vest. From what I know, it is an expensive piece of equipment, and my guess is that, if I personally were to event at the lower levels, I would not invest in an air vest because it’s “just” the lower levels. I wonder how many people would think similar thoughts.
Personally, I would think that, as the levels rise and the technicality increases, my perceived level of risk would increase and I would be more likely to think an air vest was then needed.
Interesting study. I hope they do further research and go further with the data.
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FEI is all upper levels, so all of the data is from the upper levels.
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I am not an eventer…can anyone tell me what the benefits of air jackets are supposed to be (anything specific regarding certain kinds of falls or something like that?) and if this study disproves these benefits?
Or was this more of a “Hm, what kind of expensive equipment can we sell upper level eventers? Oh hey, a wearable airbag would be kinda cool” thing? Without any extensive research before?
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It’s supposed to provide extra cushioning and protection for the ribcage/spine in the case of a fall. This study doesn’t prove anything, really, aside from the fact that according to the FEI data, riders wearing an air jacket were 1.7 times more likely to sustain a serious or fatal injury in a fall compared to riders not wearing an air jacket. That data itself is not very specific or inclusive, so it’s impossible to garner more than that. It mostly just raises questions and shows that we need better data collection and more research.
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The fever for air vests started in April 2010 after Oliver Townend had a horrifying rotational fall down the 2-step bank at the Rolex KY 4*. He and the horse rolled together down both steps and it looked as if it would be hard to survive. But the air vest inflated, and Oliver was discharged from the hospital the following day with broken bones in his upper body, but nothing life-threatening. He credited the air vest with his narrow escape from something far more critical.
So many people watched that play out, and discussed it later on social media, because it was the KY 4* (now 5*).
That was the moment from which so many ammys and juniors had to have one. The demand skyrocketed as ammys and juniors jumped on board. Previously only some of the pros were willing to heft the price tag on an air vest.
So now hear we are, years later, still with no really definitive studies showing that air vests get it right.
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Very interesting. The woman who owns the ranch where I board my two horses INSISTS that air vests are the way to go. Interestingly, she is a very timid trail rider who admits to a medium level of anxiety. She hasn’t out and out criticized me for NOT wearing an air vest (I am a dressage rider), but I know she thinks I am foolish for not donning one. My first thought when I saw the data you shared was that a rider is more likely to suffer an injury while wearing a vest because more timid riders are more likely to wear an air vest than are more confident riders. No data suggest this of course, but my ranch owner has taken a number of very hard falls due to a lack of ability and confidence. My suspicion would be that the increase in injuries might be related to rider attitude more than the functionality of the vest.
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I am very much NOT on the air vest bandwagon, due to the lack of appropriate research yet to come out and the number of riders I have seen seemingly end up with more issues from their use (a rider at Melbourne on Sunday was stuck on course winded for some time after the air vest was activated – and the cause of the winding was stated to be the air vest itself rather than the accident).
Throw in the high cost, constant service requirements and the fact I will MOST DEFINITELY activate one by forgetting to detach when dismounting and I can’t justify this.
If research was to come out and state that it unequivocally provides a better level of protection than a standard safety protector, then I would be all for it. Until then, I’ll pass.
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I truly appreciate that you, Amanda, are always willing to “go there” — seeking information and truth Please don’t ever stop.
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I can tell you as an equestrian and a scientist that this is not a well designed scientific study. The dataset used in this publication has biased in it that were not addressed. The authors acknowledge the limitations in the discussion section of the actual publication but realistically most people on social media won’t read the full article. Statistically, you must remove biased if you want to do a direct comparison. In eventing, falls from all disciplines were included in the comparison but really the majority of air vests are only worn in the XC section, which is where the most serious falls happen and rather benign falls are experienced in the dressage and SJ section where no vests are worn. Sad that this will not be noted by most readers and this is how false rumors start that air vests are proven to be bad. Urgh
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