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Think Ahead... how it started

THINK AHEAD was set up to support and encourage equine vets, professionals, students and anyone who handles horses, to stay safe, be aware of the research and wear a safety helmet routinely.

More than 20 years ago, when I was just a student at the RVC, I saw an article about a young vet who had received head injuries when examining a horse for export. Amid much derision from my contemporaries, I had a letter published in the Veterinary Record, expressing surprise that vets don’t wear a protective helmet when examining horses, as was usual, for example, with stallion handlers. My interest was aroused because I was at vet school as a mature student and had qualified as a BHSAI in my career with horses before university. 


After graduation, this was forgotten as I made my way in small animal work, only developing an interest in equine behaviour latterly. The Society of Equine Behaviour Consultants is one of the few professional equestrian bodies to embed in their professional code of conduct that a helmet must be worn by the consultant and all helpers, and I feel this is a very good example to follow.


In 2014 Irish horse vet, Gerry Long, was killed by a kick to the head, and by co-incidence, just a few months earlier, my friend’s daughter, Bun, had a promising career as a show jumper cut short in the same manner, when she was turning out a horse. Luckily, she survived, but only because the horse was unshod. 


There is a saying; ’Making sense of your life is bringing the parts of it together’. Suddenly, I had a purpose. I began looking at research and trying to persuade anyone who would listen, in person and online, that they were statistically just as likely to be injured or killed by their horse on the ground, as mounted.


Being an equine veterinary surgeon is now recognised to be the most dangerous civilian occupation (BEVA 2014) and being a farm vet is risky too, but it seems that the only vets who currently wear a hard hat at work are the ones who have had a near death experience. It is inconceivable to imagine a fire fighter not donning their personal protective equipment, but a vet wearing a helmet is rare. Why? 


It may be that equine vets subconsciously do not want to acknowledge risk or appear afraid to onlookers. Ironically, wearing a hard hat can actually make the wearer feel braver, a little like the smug feeling you get when a snarling Rottweiler is safely encased in a muzzle. With practice, it starts to be completely natural and if your hat is forgotten, you suddenly feel as if your undergarments are missing. Indeed, one saucy approach in New Zealand has been to promote images of modestly naked, hat wearing equestrians, to make the point.


The equine world is changing, though, and many professional yards, such as BHS approved riding schools, are insisting on helmet wearing for yard staff, and the internet has pockets of enthusiastic groups promoting the concept. 


I am still in contact with the vet who survived the head injury, and she has had challenges, repercussions and stigma to cope with. She is still angry with the profession for putting her in a difficult situation in the first place: had she not entered that lorry, she would have risked a charge of false certification or her job. She would not be alone in finding the fear of litigation and claims of professional misconduct or negligence too much to bear.


As a profession, not many of us take enough steps to protect our mental health: we are resistant to change and afraid to show weakness. Is persistently stubborn refusal to wear a hard hat to protect our brain health a similar issue?


There are some lessons to be learned from military experience, where survival statistics are produced and analysed rapidly and simple changes save lives. During the Gulf war, soldiers were presenting at hospitals without their Kevlar vests: orders were issued and implemented, over-riding complaints of ‘too hot, heavy, uncomfortable’, and instantly the percentage of battlefield deaths dropped. Similarly, in the Iraq war, American trauma logs started to reveal a large number of blindings. It transpired standard issue goggles were ugly: as soon as cooler looking ballistic eyewear was introduced, the rate of eye injuries reduced correspondingly. 


Vanity, fashion and peer pressure are other reasons for disinclination to wear a hard hat, and here probably lies the key to changing minds.The younger generation of vets and nurses are more receptive to this than their predecessors, and we should help them not to feel foolish. They are the future of the profession, so let them take the lead with this and make helmet wearing both practical and attractive.


In my ideal world, images of large animal veterinary surgeons and nurses would always be with protective headwear, enabling the concept to permeate into the veterinary and general consciousness. It would also be helpful to refer to protective safety helmets or hard hats, rather than riding helmets, to emphasise that they are not just for mounted activities.


Vet Futures intends to identify challenges facing the profession: head injuries and personal safety are relevant and current, the knowledge is there, but the real challenge is to persuade people to change their behaviour. Think Ahead is a simple concept and if universally adopted, will ensure that some veterinary surgeons, nurses and horse handlers actually have a future and the accident survival statistics from 2015 to 2030 will have improved from pre 2015.      

Dr Jill Butterworth SEBC PTC BHSAI BVetMed MRCVS
Veterinary surgeon and equine behaviour consultant

This article was an Essay submission for the Vet Futures Veterinary Vision Competition 2015.
A simple idea that will transform the veterinary/veterinary nursing profession by 2030.




BEVA [2014] Equine Vets have the highest risk of all civilian professions.


On and off the horse: Mechanisms and patterns of injury in mounted and unmounted equestrians. Samuel P. Carmichael II, Daniel L. Davenport, Paul A Kearney, Andrew C. Bernard. Injury, Vol. 45 Issue 9, p1479-1483  April 3 2014


‘Better- A Surgeon’s Notes on Performance’ by Atul Gawande reporting on US Dept Defense weekly updates on American military casualties 


“Bun’s amazing recovery after her head injury led me to start the Think Ahead campaign. She was kicked in the head when just turning out a horse. This inspired me to encourage horse vets and handlers to wear protective helmets routinely.“ Dr Jill Butterworth MRCVS

Bun 2 years after her accident.

Think Ahead Campaign founder
Dr Jill Butterworth MRCVS


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