People use horses for work and recreational purposes on farms and ranches in Alberta, Canada. This retrospective descriptive review examines the records of all those people killed while around horses between 1975 and 1990. The intent is to ascertain features common to these injuries and to suggest prevention strategies. Records from the Office of the Chief Medical Examiner of Alberta revealed that 38 people were involved in horse-related fatalities between 1975 and 1990 and that 22 died of head injuries. All 38 deaths were classified as accidental. Some of these might have been prevented, or injuries might have been minimized by riders' wearing approved riding helmets. Public education encouraging the proper use of protective headgear is necessary if there is to be a reduction in the severity of these injuries.