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USPA Player Injury Report
(For injuries which took place in 2021)
*
1.
Gender
(Required.)
Male
Female
Other
*
2.
Age at time of injury
(Required.)
18 & Under
19-25
26-35
36-45
46-55
56+
3.
Describe the injuries (ex. ‘I had swelling to my knee and I had a laceration to my arm that required sutures in the emergency department, had x-ray of my arm and knee but no broken bones’ and ‘I fell and had residual back pain and saw my primary care doctor, who ordered an MRI. I went to physical therapy’)
4.
Describe the scenario leading up to the injury (ex. ‘Another player’s mallet struck my arm during ride off’)
5.
When did the injury occur?
Riding/exercising
Stick and balling
Practice
USPA Tournament Game
I/I Game/Tournament
Club/League Game
Other (please specify)
6.
In what setting did the injury occur?
Grass Field
Arena
Track/Riding Area
Other (please specify)
7.
Did your injury require medical attention?
No
Yes, I was seen in a clinic or urgent care setting only
Yes, I received on-site medical attention, but did not got to the hospital
Yes, I was transferred to the emergency department but discharged from the emergency department
Yes, I was admitted to the hospital and stayed overnight for an admission
8.
If admitted to the hospital, how many days where you admitted?
Not admitted
1
2
3-5
6-10
11+
9.
What safety equipment were you wearing at the time? (check all that apply)
Helmet
Goggles/Glasses
Helmet mounted eye protection
Other (please specify)
None of the above
10.
What brand/model of helmet where you wearing?
11.
Was your horse injured?
No
Yes (please specify)
12.
What was your USPA Affiliation at the time of injury?
Registered Player Member (US Citizen)
Affiliate Player Member (Non- US Citizen)
Social Non-Playing MEmber
Not a USPA Member
Other (please specify)
13.
Number of years playing polo at time of injury
0-5 years
6-10 years
11-20 years
21-30 years
31-40 years
40+ years
14.
How many hours do you play per week on average
0-5 hours
6-10 hours
11-20 hours
21-30 hours
31-40 hours
40+ hours
15.
What level of polo were you playing at the time of the injury?
Junior Polo
Intercollegiate/Interscholastic Polo
Outdoor (0-4 Goal)
Outdoor (6-8 Goal)
Outdoor (10-14 Goal)
Outdoor (16-20 Goal)
Outdoor (22+ Goal)
Arena (0-3 Goal)
Arena (3-6 Goal)
Arena (6-9 Goal)
Arena (12+ Goal)
Other (please specify)
16.
Are you willing to be contacted to discuss any other injuries?
No
Yes (please provide email address)
