American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Farm Injury Prevention

The farm as a workplace remains dangerous with high morbidity and mortality from injury to the worker and often to observing family members. While fatal injury has decreased, nonfatal injuries have increased annually, and long-term disability is significant.1,2,3,4 Multiple factors contribute to the development of and subsequent poor outcome from these injuries with most being amenable to prevention programs. Examples are:

Environment

  • Animals. Agricultural animals pose threat because of size and unpredictability resulting in a high incidence of injury. Animals also pose problems with swerving of cars or equipment at night.
  • Falls. Often working unprotected at heights.
  • Weather. Impaired visibility, cold distraction, and equipment malfunction.
  • Suffocation. Silos and pits present common risk.
  • Delayed discovery. Often working alone at a distance from help or traffic.

Equipment

  • Tractors. Overturns are common cause of severe injury with TBI, SCI, and major thoracoabdominal injuries predominating.
  • PTO (power take off). These devices deliver energy from the tractor to run other machines. The protective housing is often removed or becomes jammed, providing a site for entanglement.
  • ROPS (rollover protection structures). Often lacking or removed to provide access in low clearance situations.
  • Chemicals. Pesticides and fertilizers use is common with protective gear use as low as 8 percent in a recent interview study.5
  • ATVs. Often used on farms, and common cause of injury.

Human Factors

  • Age. Extremes associated with increased injury.
  • Fatigue. Long work hours with backup support unavailable or too costly.
  • Experience. Unfamiliarity with equipment or the environment increase risk.
  • Drug or alcohol use. Impaired worker at high risk.

Many of the machinery and environmental problems will improve with ongoing input from the industry. Improvements in ROPS,6 supplemental restraints, and retrofit safety devices for older equipment are needed. This needs to be encouraged as a matter of public policy and should include financial incentive for development and implementation. Educational programs that emphasize the proper use of protective equipment need local support. Accurate population-based data will be necessary to gauge effectiveness of intervention. The National Trauma Data Bank (NTDB) may be a resource for this on the national level but requires more universal submission of data.

The key to the development of an effective farm safety program is a community-based multidisciplinary program that deals with a problem identified locally. Essential to the process is evaluation and measurement of effectiveness, ideally over time to measure duration of effect. Multiple resources are available to develop solutions to the locally identified issues. These include:

A recent review of farm safety intervention programs indicates that most programs have design limitations that make interpretation of effectiveness difficult.7 The Agriculture Disability Awareness and Risk Education (AgDARE) program attempts to resolve this with a control group and delayed observation of behavior following the program.8 Initial results indicate that this program may be an appropriate tool to use in teaching farm safety in high school agriculture classes. Similar programs need to be developed and their effectiveness measured in a randomized controlled study.

References

  1. Rivara FP. Fatal and nonfatal farm injuries to children and adolescents in the United States, 1990-3. Injury Prevention. 1997;3:190-194.
  2. Rivara FP. Fatal and nonfatal farm injuries to children and adolescents in the United States. Pediatrics. 1985;76:567-573.
  3. National Safety Council. Injury Facts: 2000 Edition. Itasca, IL: National Safety Council; 2000;44-66.
  4. Bull MJ, Agran P, Gardner H, et al. Prevention of agricultural injuries among children and adolescents. Pediatrics. 2001;108(4):1016-1019.
  5. Perry MJ, Marbella A, Layde PM. Compliance with required pesticide-specific protective equipment use. American Journal of Industrial Medicine. 2002;41(1):70-73.
  6. Powers JR, Harris JR, Etherton JR, et al. Preventing tractor rollover fatalities: performance of the NIOSH autoROPS. Injury Prevention. 2001;7(Suppl 1):154-158.
  7. DeRoo LA, Rautiainen RH. A systemic review of farm safety interventions. American Journal of Preventive Medicine. 2000;18(4 Suppl 1):51-62.
  8. Reed DB, Kidd PS, Westneat S, Rayens MK. Agricultural Disability Awareness and Risk Education (AgDARE) for high school students. Injury Prevention. 2001;7(Suppl 1):159-163.