Cowboy Up: EMS at Rodeo Events

EMS providers must prepare for any scenario that comes their way while on duty. This includes special events, such as rodeos, that can pose unique challenges and dangers for medical coverage. Even seasoned EMS professionals with experience providing medical care at rodeos can attest to the intricacies of delivering care in this high-stakes environment.

The Rodeo Culture

Rodeos are integral to American culture, attracting thousands of spectators and participants each year. The nature of the sport carries a significant risk of injury for participants. They put their bodies on the line to pursue glory and prize money. As such, there is a growing recognition of the need for adequate medical coverage at rodeos. EMS providers are often called upon to care for competitors and patrons in this fast-paced and dynamic environment.

As with any standby event, crews should always be on guard and prepared. EMS personnel should be in their assigned area and easily located before the event starts, and livestock has been unloaded. You don’t want dispatch calling you on the radio because someone’s been bitten or crushed, and they can’t find you because you’re getting a hot dog and coffee across the road.

One of the primary challenges of providing medical care at rodeos is the sheer size and scale of the event. While bull riding and other single events can be confined to small arenas, professional rodeos can cover many acres, and the crowds can number in the tens of thousands. Coverage requires a well-coordinated medical response plan, with EMS personnel strategically placed throughout the venue to ensure rapid response times. At most sanctioned events, at least one crew is dedicated to the rodeo athletes and those working the event; other crews must handle the care of spectators and workers outside the arena. The speed and unpredictability of rodeo events present unique challenges for EMS providers. The events can be fast-paced and intense, making it difficult for EMS personnel to reach the injured party promptly.

A critical challenge in providing medical care at rodeos is the dangers posed by the livestock involved in the events. These animals, such as bulls and horses, can weigh over a thousand pounds and cause severe injury or death with even a minor misstep. Scene safety is as important at a rodeo as it would be working a crash on an interstate highway. EMS providers must prepare to deal with the hazards posed by livestock, including the possibility of being crushed, kicked, trampled, or gored.

Patient Population and Common Injuries

Not all rodeo events are created equal. The professional rodeo events have a different class of competitor than the smaller local rodeos or single-event competitions, like bull riding. Rodeo paramedic Keith Ellis of Gray, TN, provides coverage at bull riding events. He emphasizes the significance of protective gear in reducing the risk of injuries. Ellis says, “The protective gear they wear has made a huge difference in the injuries we see. The protective vest provides unreal protection.” The National High School and National Intercollege Rodeo Associations require bull riders to wear helmets and vests. In smaller events, this could be optional. Ellis says that locally, the vest is required, though riders can sign a waiver and be allowed to opt out of wearing the protective helmet. Professional rodeos are a different beast; the competitors are independent contractors responsible for their safety. 

EMS providers need familiarity with rodeo culture and the attitudes of rodeo participants. Rodeo athletes are often independent, hard-working individuals with a strong sense of pride and a fierce competitive spirit. As such, they may hesitate to seek medical treatment for their injuries and prefer to “tough it out” and continue competing. Professional rodeo athletes are beginning to take better care of themselves, just as any professional athlete.

EMS providers must have a well-coordinated response plan to provide adequate medical care at rodeos. Such plans involve both the venue and rodeo committee, and include:

• Effective communication
• Teamwork among the EMS personnel on duty
• A shared understanding of rodeo participants’ unique needs and challenges
• Coordination and familiarity with the local EMS system

Pre-planning, including familiarization with the event site and venue layout, is also essential to ensure that the appropriate resources and personnel are in place to respond quickly and effectively in an emergency. Should a sports medicine team be involved, EMS will need to coordinate their actions with them.

EMS providers must also be aware of the socioeconomic background of competitors, as many are competing for more than a belt buckle. They use the only collateral they have to make money to get them through the season—their health.

Margarite “Maggie” Powell, a paramedic and trauma nurse from Johnson City, TN, highlights that most of their work at rodeos involves cuts, joint injuries, and riders having the wind knocked out of them. Powell adds, “pneumos (pneumothorax) are the biggest thing we usually fly out. Though we’ve only had one pneumothorax in the last three years.” Ellis points out that they see more head and neck injuries locally with barrel racers and saddle broncs, though they also get several ankle injuries from the riders.

Ellis says some young riders new to the sport may wear another person’s boots with the spurs fixed. These may not fit well and provide even less ankle support than traditional cowboy boots. This is less common in the pros unless someone has lost some luggage flying. Boots may be tied or taped onto the riders’ feet when riding bareback horses or bull riding to keep the footwear on the rider and should not be misconstrued as not fitting properly.

The Response Team

Larger rodeos or bull riding events typically have athletic trainers and physicians on hand who specialize in sports medicine. These professionals provide care outside the normal realm of EMS, treating sprains, strains, cuts, bruises, and dislocations, which may not require emergency medical intervention or hospitalization. They are specialists and are often more familiar with the riders and injuries sustained in rodeos. They can guide EMS providers in caring for patients at an event or assist with emergencies.

According to a June 2022 article published in the Kansas Journal of Medicine, head injuries are the largest severe injury group seen in hospitals, accounting for 54% of patients in a level 1 trauma center. Serious head injuries have occurred in rodeo athletes at a rate of up to 15 per 1,000 rides. In a ten-year study of injuries and specific rodeo events, bull riding is responsible for the most significant proportion of injuries (28-50% of all rodeo-related injuries). Saddle bronc and bareback riding events generate 20-23% of injuries, calf roping 3-12%, steer wrestling 8%, team roping 1-4%, and barrel racing 0-3%.

The protective gear worn during competition can make a significant impact, which is why the helmet and vest are essential. As with motorcycle and football helmets, use care when removing the helmet to evaluate and treat patients. The vest is easily removed with familiarity. However, there is resistance from rodeo cowboys. The riders comprise the voting body of the organizations making the rules and deciding on the use of protective headgear and lack of adherence to recovery guidelines, particularly in the case of concussions.

Rodeo is a high-energy sport with highly talented and tough athletes. However, the prevalence of injury is high, especially in rough stock events, which include bareback, saddle bronc, and bull riding. Bull riding has an incidence of injury reported at 32.2 injuries per 1,000 competitor exposures. While many injuries can occur during bull riding, concussions are often the most alarming. Nonetheless, rodeo athletes want to return to their sport despite injuries and rarely seek medical care. Arena-side health care is still utilized and appreciated by rodeo cowboys. It’s important to educate the athlete and their traveling partner/family about concussions—including things to watch for and when to seek further care.

In a survey of 180 participants in the Indian National Finals Rodeo in 2004, injury prevalence studies in rodeo athletes at the University of Washington. The response rate was 94%. The history of injury was variable according to the event. One hundred percent of bull riders had been injured, while only 24% of tie-down ropers had been injured. Twenty-six percent of the athletes had injuries that prevented them from working for an average of 3.2 months. This study also surveyed protective equipment, finding that 40% of athletes used protective equipment, primarily protective vests.

Providing medical care at rodeos is a unique challenge that requires a well-coordinated response plan and familiarity with rodeo culture and the attitudes of rodeo participants. Pre-planning and effective communication and teamwork among the EMS personnel on duty are essential to ensure that the appropriate resources and personnel are in place to respond quickly and effectively in an emergency. EMS providers must also be aware of the socioeconomic background of competitors and the unique needs and challenges of rodeo participants. Athletic trainers and physicians who specialize in sports medicine provide care outside the normal realm of EMS. EMS providers or even EMS volunteers may be the only medical care on hand in smaller events.

Protective gear is crucial in reducing the risk of injuries, particularly head injuries. EMS providers must become familiar with it to remove protective equipment to evaluate and treat patients safely. Despite resistance from rodeo cowboys and organization rule makers to the use of protective headgear and lack of adherence to recovery guidelines, concussions are one of the most threatening injuries that can occur during bull riding. Still, they may also be the most amenable to prevention.

Many competitors have been severely injured by torso and abdominal injuries. These injuries require rapid intervention when the scene is secured. Internal injuries and open wounds can both present themselves when dealing with livestock. Never let your guard down.

Those on stand-by at rodeos and rodeo-type events should be mentally and physically prepared to deal with bites, kicks, falls, crush injuries, head injuries, neck injuries, back injuries, and the snot and drool often seen in rodeo livestock as they get hot waiting to perform.

Keeping the Tradition Alive

In the end, rodeo is a thrilling sport that attracts highly skilled and tough athletes who put their bodies on the line in pursuit of glory. However, the high prevalence of injuries in rodeo events makes it essential for EMS providers to be well-prepared and knowledgeable about the unique challenges and dangers involved in providing rodeo medical care.

By understanding the rodeo environment, the attitudes of rodeo participants, and the need for effective communication and teamwork, EMS providers can ensure that they provide the highest quality care possible to those who participate in this beloved American tradition.

Resources

Campbell, R. (2022). Rodeo injuries and the physician’s role in caring for rodeo athletes. Kansas Journal of Medicine, 15(1), 21-24.

Johnson, K. (2020). Rodeo injuries: when the thrill of the ride ends in the emergency department. Emergency Nurse, 28(8), 22-27.

National Intercollegiate Rodeo Association. (n.d.). Health and safety. Retrieved from https://www.collegerodeo.com/about/health-and-safety

Rodeo Medical Director. (2019). Rodeo injury and medical protocols. Retrieved from https://rodeomedicaldirector.com/wp-content/uploads/2019/02/Rodeo-Medical-Protocols.pdf

John M. Dabbs is a consultant and investigator for the Northeast Tennessee Regional Health Office and a frequent contributor to EMS World.