1. AgriSafe Health Services: An Innovative Occupational Health Model Denise Andress, RN West River Health Services Hettinger, ND Phone: 1-701-567-6177 Email: denisea@wrhs.com www.wrhs.com

2. Mission The Mission of the Network is to support a growing network of trained agricultural health and safety professionals that assure access to preventive service for farm and ranch families and the agricultural community.

3. Vision We envision a day when farmers and ranchers across the country have access to highly trained AgriSafe clinicians. They will provide superior disease management and prevention services to match the farmer and rancher specific exposures.

4. Why AgriSafe? Agriculture is the nation’s most hazardous occupations Even though mining death rates have decreased in the past 20 years, Ag has been consistently high 55 deaths per 100,000 workers in the past year 45 injuries per 100,000 workers in the past year Over 44% U.S. farmworker households have at least one disabled member Cost of disabling injuries in agriculture exceeded 2.7 billion in 1990 alone!

5. Why AgriSafe? Health Insurance Workman’s Compensation Regulatory Agencies Barriers Prevention Services

6. Unique Occupational Health Needs Farmers and ranchers suffer from an increased incidence of: respiratory diseases zoonotic diseases skin cancer chronic back pain musculoskeletal disorders arthritis hearing loss depression disabling injuries occupational fatalities

7. AgriSafe Model Serves as an early point of entry into the health care system before serious conditions develop.

8. AgriSafe Model Menu of services: –Occupational health screenings –On site farm site evaluations –Personal protective equipment (PPE) sales and education –Educational programs

9. AgriSafe Service Locations Commodity Groups Meetings/conferences Pesticide Applicator Training Farm Association Meetings/conferences Grain Elevators County Fairs Seed Dealers Stockyards Machine Dealerships

10. Agricultural Occupational Health and Safety Training Target audience –Practicing health professionals serving rural areas –Nurses and other health professionals intending to establish AgriSafe Clinics –Health professional students intending to practice in rural areas –Health professions graduate students including veterinarians intending to enter public practice.

11. Collaboration - Referrals Family Physicians –Nurses Hospitals Public Health Specialists –Ear/Nose/ Throat –Pulmonologists –Audiologists Chiropractor Mental Health Services Pharmacists Social Services Occupational Health Parish Nurses

12. Agricultural Respiratory Diseases Agricultural dust exposure Toxic fumes Agricultural chemicals Infectious diseases Prevention –Environmental assessment –Personal protective equipment

13. Agricultural Skin Diseases Contact Dermatitis Sun and heat induced dermatitis Anthropod induced dermatitis Plant induced dermatitis Infectious dermatitis

14. Agricultural Pesticides Organocholorines Organophosphates Pyrethoids Neonicodenoids Herbicides Fumigants

15. General Environmental Hazards Water pollution Air pollution Solid waste Confined animal feeding operations

16. Musculosketal Diseases Pain Chronic pain Acute pain Injuries ERGONOMICS!!

17. Physical Factors Affecting Health in Agriculture Heat injuries Cold injuries Vibration injuries Noise induced hearing loss

18. Psychosocial Condition Social structure of farming and ranching communities. The sources and pychophysiopathology of stress. Anxiety disorders Depression Screening, treatment and prevention of stress-related disorders Suicide and prevention

19. Acute Agricultural Injuries Injury statistics Special medical considerations of agricultural injuries Injury scenarios and prevention

20. Hazards of Pharmaceuticals Veterinary biologicals of human health importance Needle sticks Antibiotic; individual health risk and risk of resistant microbes Health hazards of growth promotants –Estrogenic compounds –Progesterone compounds –Bovine growth hormones –Oxytocin –Prostaglandins

21. Rural Zoonotic Infectious Diseases General epidemiologic characteristics of zoonoses Summary of zoonotic diseases associated with the production of: –Swine –Dairy cattle –Sheep and goats –Poultry General environmental reservoirs

22. Prevention Regulations Engineering Education Personal Protected Equipment Ergonomics

23. Health Promotion in the Farming Community Social Services Schools Churches Health Systems Government Insurance/ Business Mental Health Providers AgriSafe Clinic Universities

24. Community Linkages Think beyond the provision of direct clinical services. AgriSafe providers can be the link to other health professionals to get them on track with the latest agricultural health and safety information.

25. Occupational Health Services Agricultural Specific Screening Services –Occupational History –Lung Function screening –Hearing Test –Skin Cancer Screening –Back/Spine Lifting Safety Assessment –Cholinesterase –Tetanus Immunization General Health Screening Services –Height/weight evaluation –Blood Pressure –Cholesterol Referral to Health Care Providers

26. Client Consent & Orientation Pulmonary Function Testing Cholesterol and Cholinesterase Screening Blood Pressure Height-Weight Evaluation and other Vital Signs Hearing Testing

27. Identification of High Risk Areas Health and Safety Education Specific to the farmer’s needs and the needs of their spouse, children,other family members. REFERRALSPLANNING

28. Personal Protective Equipment Fit, Education and Sales Farmer, ranchers and their families, local businesses, vendors, and media Respirator Fit Testing

30. Farm Site Evaluation

31. A collaborative research project between Iowa’s Center for Agricultural Safety and Health (I-CASH) at The University of Iowa and the AgriSafe Network PROGRAM OBJECTIVE: to improve the health and well-being of farmers and their families by offering an innovative incentive package from public and private sector partners

32. –This model uses theory from the fields of epidemiology, engineering, industrial hygiene, ergonomics, and regulation. –Includes education based on a combination of applied theories from safety education, social psychology, and public health. –Inclusion of health and safety in the management of the farm operation is crucial. Certified Safe Farm (CSF)

33. Remove or modify on-farm work hazards Preventive health screening services to detect and prevent high risk health conditions on the farm Identify informational needs and provide educational material Evaluation of data, including: Illness, injuries, fatalities, PPE usage, modification of work hazards, and Insurance costs and coverage.

34. CSF Focus Group Responses January 2006 Question: Have you changed any of your health habits as a result of being in the CSF program? Carry earplugs at all times Began wearing sun safe hats, use sun-screen more often Began wearing dust masks more often Made diet changes and try to exercise more Began wearing gloves when mixing chemicals; let the elevator do chemical application

35. Safety Improvements (1998-02) 1,292 improvements reported including: 207 SMV signs, 60 PTO master shields 32 driveline shields 77 machine guards/shields, 83 lockout/tagout items, 35 fire extinguishers 139 lighting and marking items 6 tractor ROPS, 3 skid steer loader cages Total value ~$70,000 or $650 per farm

36. Network Expansion

37. Must complete the 40 hour agricultural health training provided by Iowa’s Center for Agricultural Safety and Health (I-CASH) at the University of Iowa. Must pass I-CASH course exams. Maintain annual.5 CEU requirements. Must adhere to the Network’s Operations Manual and the affiliation agreement. Required Professional Standards of AgriSafe Clinic Providers

40. Summary The AgriSafe approach to health care delivery reflects innovation in bringing the best preventive services to the farming and ranching population. AgriSafe health professionals should be considered as a “dissemination arm” to bring information directly to farmers and other health professionals. AgriSafe members receive multiple benefits including technical assistance in the development of clinical and educational services.

41. Contact Information Denise Andress, RN Community Health Manager West River Health Services Hettinger, ND 58639 Phone (701) 567-6177 denisea@wrhs.com