TRAUMATIC INJURIES IN AGRICULTURE David L. Hard John R. Myers Susan G. Gerberich.

TRAUMATIC INJURIESTRAUMATIC INJURIESIN IN

AGRICULTUREAGRICULTURE

David L. Hard

John R. Myers

Susan G. Gerberich

Traumatic Injuries in Traumatic Injuries in AgricultureAgriculture

• NCASH Report (1989)

• NCASH Report (1989)– Epidemic of traumatic death and injury in

American farming

American farming– Traumatic death and injury due in large part to

farm machinery—primarily tractors

farm machinery—primarily tractors– Inadequate farm building design and livestock

handling

farm machinery—primarily tractors– Inadequate farm building design and livestock

handling– Affect youth (<16) and elderly (65 and older)

• History of Fatal Occupational Injury– National Safety Council (NSC)

• 1930’s to present

• History of Fatal Occupational Injury– National Safety Council (NSC)

• 1930’s to present• Farm Safety Quarterly• Accident Facts• Injury Facts

• History of Fatal Occupational Injury– National Safety Council (NSC)– NIOSH--National Traumatic Occupational

Fatalities (NTOF)--1980

• History of Fatal Occupational Injury– National Safety Council (NSC)– NIOSH--National Traumatic Occupational

Fatalities (NTOF)--1980• Census of work related deaths• 16 years of age or older• External cause of death

• History of Fatal Occupational Injury– National Safety Council (NSC)– NIOSH--NTOF– BLS--Census of Fatal Occupational Injuries

(CFOI)--1992

• History of Fatal Occupational Injury– National Safety Council (NSC)– NIOSH--NTOF– BLS--Census of Fatal Occupational Injuries

(CFOI)--1992• Multiple records used to determine work-relatedness• Details often better than from death certificates• No age limit for inclusion

• History of Non-fatal Occupational Injury– National Safety Council (NSC)--1970’s-1980’s

• National survey of agriculture production injuries• 3 personal interviews with farm operator—1 year

• National survey of agriculture production injuries• 3 personal interviews with farm operator—1 year • Standardized instrument—utilized volunteers

• National survey of agriculture production injuries• 3 personal interviews with farm operator—1 year • Standardized instrument—utilized volunteers• 1982—31 states• 1985—35 states

• National survey of agriculture production injuries• 3 personal interviews with farm operator—1 year • Standardized instrument—utilized volunteers• 1982—31 states• 1985—35 states• Not sustainable

• History of Non-fatal Occupational Injury– NSC--1970’s-1980’s– Olmsted Agricultural Trauma Survey (OATS)--

1987• Both fatal and non-fatal• Telephone interview-based survey of farm operators• 1 year recall

• History of Non-fatal Occupational Injury– NSC--1970’s-1980’s– Olmsted Agricultural Trauma Survey (OATS)--1987

• Both fatal and non-fatal• Telephone interview-based survey of farm operators• 1 year recall• Used USDA/NASS list frame of farms• Comparison made with medical records at Mayo• Results were found to be realistic and effective

• History of Non-fatal Occupational Injury– NSC--1970’s-1980’s– Olmsted Agricultural Trauma Survey (OATS)– Regional Rural Injury Study (RRIS-I)--1990

• Both fatal and nonfatal• 5 states (MN, NE, ND, SD, WI)

• History of Non-fatal Occupational Injury– NSC--1970’s-1980’s– Olmsted Agricultural Trauma Survey (OATS)– Regional Rural Injury Study (RRIS-I)--1990

• Both fatal and nonfatal• 5 states (MN, NE, ND, SD, WI)• Sampling frame USDA/NASS• Recall period reduced to 6 months

• History of Non-fatal Occupational Injury– NSC--1970’s-1980’s– Olmsted Agricultural Trauma Survey (OATS)– Regional Rural Injury Study-I (RRIS-I)– Regional Rural Injury Study-II (RRIS-II)--1998

• Similar methodology • 4,000 farm households; 17,000 persons; 8,600 <20

• History of Non-fatal Occupational Injury– NIOSH Traumatic Injury Surveillance of

Farmers (TISF)--1993-1995• National survey of non-fatal production ag injuries• Random sample of farms• Sampling frame USDA/NASS• Recall period of 1 year

• History of Non-fatal Occupational Injury– NIOSH Traumatic Injury Surveillance of Farmers

(TISF)--1993-1995• National survey of non-fatal production ag injuries• Random sample of farms• Sampling frame USDA/NASS• Recall period of 1 year• TISF conducted over 3 years; allowed national estimates

and regional/state estimates• Total of 36,270 farms participated

• History of Non-fatal Occupational Injury– NIOSH Childhood Agricultural Injury

Prevention Initiative--1997• Develop ag. injury surveillance systems for youth

living, working or visiting farms in U.S.

• History of Non-fatal Occupational Injury– NIOSH Childhood Agricultural Injury

Prevention Initiative--1997• Develop ag. injury surveillance systems for youth

living, working or visiting farms in U.S.• 3 separate surveys conducted:

-1999 farm operator survey (USDA/NASS)

-1999 NAWS (USDOL)

-Case series follow-back (CPSC/NEISS)

• Current Status of Agricultural Injuries

– Both national and regional data used

– Limited to production agriculture

• Current Status of Agricultural Injuries– CFOI (1992-1998)

1,0001,5002,0002,5003,0003,5004,0004,500

Crop Livestock Ag. ProdTotal

Production Agriculture Occupational Injury Deaths, 1992-1998, CFOI

1992 1993 1994 1995 1996 1997 1998 Avg.

Crop and Livestock Production Injury Deaths, 1992-1998, CFOI

CropLivestockAg Production

1992 1993 1994 1995 1996 1997 1998

Crop and Livestock Production Injury Deaths, 1992-1998, CFOI

CropLivestockAg Prod.

Production Agriculture Occupational Deaths and Average Annual Fatality Rate, per 100,000 Workers, 1992-1998, CFOI

I n d u s t r y

D e a t h s

R a t e

C r o p

2 , 7 0 2

3 7 . 9

L i v e s t o c k

1 , 2 2 8

1 4 . 1

U n k n o w n

A g P r o d u c t i o n

T o t a l

4 , 0 8 2

2 5 . 8

5.2 5.2 5.3 5 4.8 4.8 4.6

1992 1993 1994 1995 1996 1997 1998 Total

Production Agriculture and Private Industry Fatality Rates, 1992-1998, CFOI

CropLivestockAg Prod. All Industry

104132166

408577578

0200400600800

100012001400

<1515-19

Production Agriculture Deaths by Age Group,1992-1998, CFOI

Ag Prod Deaths

Production Agriculture Deaths and Average Annual Fatality Rates per 100,000 Workers by Age Group, 1992-1998, CFOI

A g e G r o u p

D e a t h s

R a t e

* * * 1 5 - 1 9

1 0 . 2

2 0 - 2 4

1 4 . 7 2 5 - 3 4

1 4 . 1

3 5 - 4 4

1 7 . 1 4 5 - 5 4

2 1 . 2

5 5 - 6 4

3 1 . 9 6 5 +

1 , 3 6 3

6 5 . 9

T o t a l

4 , 0 8 2

2 5 . 8

P r o d u c t i o n A g r i c u l t u r e D e a t h s b y S o u r c e o f I n j u r y , 1 9 9 2 - 1 9 9 8 , C F O I

S o u r c e o f I n j u r y D e a t h s

P e r c e n t

T r a c t o r s

1 , 5 1 0

3 7 T r u c k s

H a r v e s t i n g m a c h i n e s

M o w i n g m a c h i n e s

A n i m a l s

3 . 5 O t h e r a g . m a c h i n e s

G r o u n d

3 . 0 B u l l e t s

L o a d e r s

1 . 8 T r e e s , l o g s

A l l o t h e r s o u r c e s

1 , 1 9 4

2 9 . 3

P r o d u c t i o n A g r i c u l t u r e D e a t h s b y T y p e o f I n j u r y E v e n t , 1 9 9 2 - 1 9 9 8 , C F O I

T y p e o f I n j u r y E v e n t D e a t h s

P e r c e n t a g e

O v e r t u r n i n g v e h i c l e / m a c h i n e

1 , 0 5 1

2 5 . 8 F a l l f r o m & r u n o v e r b y v e h / m a c h .

C a u g h t i n r u n n i n g e q u i p m e n t

6 . 8 S t r u c k b y f a l l i n g o b j e c t

R u n o v e r ( p e d e s t r i a n )

5 . 2 F a l l t o l o w e r l e v e l

S t r u c k b y r o l l i n g o b j e c t s

3 . 3 A s s a u l t b y a n i m a l

S u i c i d e

2 . 2 C a u g h t i n c o l l a p s i n g m a t e r i a l

L e a d i n g S o u r c e s o f F a t a l I n j u r y i n P r o d u c t i o n A g r i c u l t u r e a n d t h e P r o p o r t i o n o f D e a t h s t o W o r k e r s 5 5 Y e a r s o f A g e a n d O l d e r , 1 9 9 2 - 1 9 9 8 , C F O I

S o u r c e o f I n j u r y

F a r m i n g D e a t h s A l l W o r k e r s

F a r m i n g D e a t h s 5 5 a n d O l d e r

P e r c e n t o f D e a t h s 5 5 a n d O l d e r

T r a c t o r s

1 , 5 1 0

T r u c k s

4 3 H a r v e s t i n g M a c h i n e s

M o w i n g M a c h i n e

A n i m a l s

Nonfatal Injury Frequencies and Rates per 100 Workers for

Agricultural Production Sectors, 1993-1995, TISF

Employment

3,025,876 Injury

232,546

7.7 Livestock

Employment

3,855,526 Injury

286,357

7.4 Ag Prod.

Employment

6,881,403 Injury

518,903

N o n f a t a l I n j u r i e s i n A g r i c u l t u r a l P r o d u c t i o n b y A g e G r o u p , 1 9 9 3 - 1 9 9 5 , T I S F

A g e G r o u p

A v g . E m p l o y m e n t

A v g . I n j u r y

R a t e *

4 , 6 0 0

1 5 - 1 9

1 9 1 , 3 5 9

5 , 8 6 0

3 . 1 2 0 - 2 9

3 4 2 , 3 8 0

2 6 , 5 4 1

3 0 - 3 9

4 9 4 , 2 5 6

3 8 , 9 0 4

7 . 9 4 0 - 4 9

4 4 0 , 4 2 1

3 1 , 3 8 7

5 0 - 5 9

3 6 3 , 4 5 6

2 9 , 5 6 9

8 . 1 6 0 - 6 9

2 9 6 , 1 4 9

2 2 , 7 9 9

1 6 6 , 7 8 1

1 2 , 2 7 9

7 . 4 U n k n o w n

1 , 0 2 1

T o t a l

2 , 2 9 3 , 8 0 1

1 7 2 , 9 6 0

7 . 5 * P e r 1 0 0 w o r k e r s

• TISF--Persons incurring injuries on farms– Farm operator or family member (61%)– Hired labor (29%)– Partners or their family members (6%)

• Majority of injuries temporary (95%)

• Most sought medical attention (80%)

• TISF--Most injuries in months– August, July, June, and November

• Type of work activity at time of injury– Livestock handling (29%)– Farm maintenance (17%)– Field work (16%)

• TISF--Leading sources of injury– Machinery & Livestock (19% each)– Working surfaces and non-powered hand tools

(8% each)

• TISF--Leading sources of injury– Machinery & Livestock (19% each)– Working surfaces and non-powered hand tools (8%

• Most common type of injury events– Struck by or against an object (15%)– Fall from elevation (13%)– Contact with sharp object (11%)

• Most common body part injured– Leg, knee or hip (17%)– Back (15%)– Finger (12%)

• TISF--Leading nature of injuries were– Sprain or strain (26%)– Fractures (18%)– Cuts (17%)

• RRIS-I– 3,939 households; 13,144 persons

• RRIS-I– 3,939 households; 13,144 persons– 1 in 5 farms had farm-related injury;1 in 17

persons– 764 farm-related injuries– Non-farming injuries reported 1 in 6 farms; one

in 17 persons

• RRIS-I Gender issues– Males had a rate of farming related injury 3.5

times greater than females (8.7 vs. 2.5/100 persons)

– Males 30-39 had the highest rate (15.8/100 persons)

– Females 25-29 had highest rate (5.4/100 persons)

• RRIS-I Gender issues– Denominator-- hours worked– Male high rates were 5-9 and 10-14 years (11.0

& 8.0/100,000 hours worked)

& 8.0/100,000 hours worked)– Female high rates were 10-14 and 25-29 years

(7.0 & 8.0/100,000 hours worked)

& 8.0/100,000 hours worked)– Female high rates were 10-14 and 25-29 years

(7.0 & 8.0/100,000 hours worked)– Overall rates equivalent between males and

females (5.0/100,000 hours worked)

• RRIS-I Source of injury– Livestock (30%)

– Machinery--other than tractors (20%)

– Tractors (9%)

• RRIS-I Injury treatment/disposition farm-related injuries – 6% hospitalized– 80% treated by health care professional– 37% restricted for 1 week; 19% month or more– 25% resulted in permanent disability

• RRIS-II• 4,037 households • 16,759 persons (8600 children-51%)

• RRIS-II• 4,037 households • 16,759 persons (8600 children-51%)• Youth: 207 farm operation injuries

– Animals (36%)

• RRIS-II• Youth case/control found increased odds for

– Horses (2.7 OR, 95% CI=1.88-3.96)– Beef cattle (2.2 OR; 95% CI=1.62-3.08)– Operating tractors (2.2 OR; 95% CI=1.60-3.02)– Riding on tractors (2.2 OR; 95% CI=1.61-3.04)– Machinery (2.1 OR; 95% CI=1.50-3.00)– Swine (2.0 OR; 95% CI=1.27-1.42)– Dairy cattle (1.8 OR; 95% CI=1.20-2.64)

ConclusionsConclusions• Traumatic injuries still leading cause of

death and injury for production agriculture

death and injury for production agriculture• Main concerns identified in 1989 NCASH

continue:– Tractors leading cause of farm death; mostly

overturns

overturns– Older farmers at highest risk for death

overturns– Older farmers at highest risk for death– Traumatic injuries still concern for youth

ConclusionsConclusions• Fatality rates fairly constant in 1990’s

ConclusionsConclusions• Fatality rates fairly constant in 1990’s• Do not have a national non-fatal injury

surveillance system in place

surveillance system in place• Surveillance is key element for assessing

magnitude of the problem, details, and effectiveness of interventions

surveillance system in place• Surveillance is key element for assessing

magnitude of the problem, details, and effectiveness of interventions

• Effective interventions imperative to alleviate this public health problem

TRAUMATIC INJURIES IN AGRICULTURE David L. Hard John R. Myers Susan G. Gerberich.

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