Hippotherapy Safety & Horse Selection Note

Patient: [Patient name]  |  DOB: [Date of birth]  |  MRN: [Medical record number]

Date of Service: [Date]  [Start time]–[End time]

Location: [Facility name]; [Arena/area: indoor arena / outdoor ring / trail / other]

Service: [Discipline: OT / PT / SLP]; [Plan of Care reference]

Author: [Author name, credentials]

(Document observed facts and explicit decisions. When a standard protocol was followed, state completion and record only exceptions or abnormal findings. If session was unmounted or canceled, state reason in relevant sections rather than leaving blank.)

Pre-Session Patient Safety Screen

• [Interval safety-relevant history since last session] (Include new symptoms or events affecting mounted safety such as falls, seizures, syncope, pain, fever, or skin breakdown. If nothing new, state "no interval changes reported." If key information is unknown, state "unknown" and document mitigation decision.)
• [Medication changes affecting participation] (Include agents impacting alertness, orthostasis, photosensitivity, or coordination. If none, state "no medication changes.")
• [Behavioral changes affecting safety] (Include factors such as impulsivity, anxiety, sensory tolerance, or fear responses. If none, state "no behavioral concerns.")
• [Contraindications and precautions reviewed] (List applicable items. If none apply today, state "no additional precautions.")
• [Clearances obtained] (Document required clearances: physician clearance, vital sign parameters met, seizure-free interval per caregiver, or other. If none required, state "no clearances required.")
• [Baseline measurements] (Vitals, pain score, skin check at contact points if clinically indicated. If not indicated, state "not indicated today.")

Safety Team and Roles

• [Team members present] (List by name and role: treating therapist/team leader, horse handler, side-walker(s)/therapy aide(s), equine specialist if applicable.)
• [Role assignments] (Identify primary communicator to horse handler, designated first aid/CPR responder, environment scanner.)
• [Staffing level justification] (Briefly justify staffing based on patient needs.)
• [Safety commands reviewed: HOLD / STOP / EMERGENCY DISMOUNT] (Confirm review with all team members prior to session.)
• [Staffing deviations and mitigations] (If staffing differs from usual, document rationale and compensatory strategies. If none, omit this line.)

Environment and Facility Check

• [Weather conditions] (Temperature, wind, precipitation, lightning risk, heat/cold stress considerations as applicable.)
• [Arena readiness] (Footing condition, lighting, noise/distractions, gate/perimeter status.)
• [Emergency readiness] (Team aware of emergency action plan; first aid kit present; communication device accessible; emergency access route clear.)
• [Mounting area] (Ramp/block/lift condition; surfaces clear and stable.)
• [Identified hazards and mitigation] (Document hazard, mitigation taken, and decision: [proceed mounted / proceed unmounted / cancel]. If no hazards identified, state "no hazards identified.")

Horse Selection and Suitability

• Selected horse: [Name/ID] (If mounting did not occur, state reason horse selection was not performed.)
• Horse characteristics: [Height; build; temperament today using objective descriptors]
• Same-day health screen: [Soundness/lameness: yes / no] (If present, describe); [Back/skin condition]; [Behavioral stress indicators observed]
• Match rationale: [Clinical reasoning linking patient factors to horse selection] (In 1–3 sentences, connect patient factors—size, weight distribution, tone, head/trunk control, sensory tolerance, medical precautions—to horse movement qualities and session safety constraints. Avoid generic statements such as "appropriate"; state the specific reasoning.)

Helmet and Equipment Checks

• Patient helmet: [Type and standard per program policy]; [Size]; [Condition]; fit verified: [sits level / stable with movement / chin strap secured / no pressure points]
• Alternative helmet or omission: [Reason, risk/benefit analysis, and additional mitigations] (Include only if applicable.)
• Horse tack: [Tack type: saddle / surcingle]; [Pad]; [Girth condition]; [Adaptive equipment: handles / thigh straps / quick-release features / other]
• Tack check: [Standard tack check completed]; [Exceptions or concerns] (If none, state "no concerns.")
• Patient supportive devices: [Device, purpose, and restrictions created] (Include only if applicable.)

Mounting and Dismounting Plan

• Mounting method: [ramp / block / lift assist / wheelchair transfer / other]
• Assist level and positioning: [Staff positions for mount]
• Transfer safety devices: [Gait belt / handhold strap / other]
• Horse control during mount: [Horse at halt; handler cues; "ready" confirmation sequence]
• Planned dismount: [Method and location]
• Emergency dismount plan: [Trigger criteria]; [Command phrase]; [Role sequence and actions]

(If mounting did not occur, state "Mounting/dismounting not performed" with reason and omit above details.)

Safety Modifications

(List constraints in descending safety priority with brief justification.)

• Gait: [walk only / limited transitions / speed limit / duration limit]; [Rationale]
• Pattern: [straight lines / large turns / avoid corners / avoid obstacles]; [Rationale]
• Support: [Number of side-walkers, spotter positioning, therapist position]; [Rationale]
• Environment: [indoor only / avoid specific areas / weather limits]; [Rationale]
• Equipment: [Alternative helmet / added vest / tack changes]; [Rationale]

Safety Events

Classification: [no event / near miss / incident with minor injury requiring first aid / incident requiring higher level of care]

(If "no event," state: "No safety events or near misses this session." and omit details below.)

(If event occurred, complete the following. Document clinical facts only; do not speculate about fault.)

• Event narrative: [Sequence of observable events, location, gait, and activity at time of event]
• Immediate patient status: [Symptoms, consciousness, pain, vital signs if taken]
• Immediate horse status: [Observed behavior and control]
• Actions taken: [Emergency stop/dismount, who initiated, first aid performed, notifications made]
• Disposition: [returned to unmounted session / ended session / transferred to medical care]
• Follow-up plan: [Equipment inspection, horse rotation status, updated constraints for next session]

Post-Session Summary and Plan

• [Session progression] (Whether session proceeded as planned; changes made and reasons.)
• [Patient tolerance and safety-relevant responses] (Fatigue, anxiety, autonomic symptoms, sensory dysregulation, or other observations.)
• [Plan for next session] (Same or different horse with rationale; tack/helmet modifications; staffing changes; required clearances before next mount.)

Signature

Author: [Signature] [Credentials] [Date/Time]

[Additional contributors: name and role] (Include only if applicable.)

(Label any late entries as addendums with current date/time; preserve original content.)