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

2. Traumatic Injuries in Agriculture NCASH Report (1989)

3. Traumatic Injuries in Agriculture NCASH Report (1989) –Epidemic of traumatic death and injury in American farming

4. Traumatic Injuries in Agriculture NCASH Report (1989) –Epidemic of traumatic death and injury in American farming –Traumatic death and injury due in large part to farm machinery—primarily tractors

5. Traumatic Injuries in Agriculture NCASH Report (1989) –Epidemic of traumatic death and injury in American farming –Traumatic death and injury due in large part to farm machinery—primarily tractors –Inadequate farm building design and livestock handling

6. Traumatic Injuries in Agriculture NCASH Report (1989) –Epidemic of traumatic death and injury in American farming –Traumatic death and injury due in large part to farm machinery—primarily tractors –Inadequate farm building design and livestock handling –Affect youth (<16) and elderly (65 and older)

7. Traumatic Injuries in Agriculture History of Fatal Occupational Injury –National Safety Council (NSC) 1930’s to present

8. Traumatic Injuries in Agriculture History of Fatal Occupational Injury –National Safety Council (NSC) 1930’s to present Farm Safety Quarterly Accident Facts Injury Facts

9. Traumatic Injuries in Agriculture History of Fatal Occupational Injury –National Safety Council (NSC) –NIOSH--National Traumatic Occupational Fatalities (NTOF)--1980

10. Traumatic Injuries in Agriculture 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

11. Traumatic Injuries in Agriculture History of Fatal Occupational Injury –National Safety Council (NSC) –NIOSH--NTOF –BLS--Census of Fatal Occupational Injuries (CFOI)--1992

12. Traumatic Injuries in Agriculture 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

13. Traumatic Injuries in Agriculture 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

14. Traumatic Injuries in Agriculture 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 Standardized instrument—utilized volunteers

15. Traumatic Injuries in Agriculture 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 Standardized instrument—utilized volunteers 1982—31 states 1985—35 states

16. Traumatic Injuries in Agriculture 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 Standardized instrument—utilized volunteers 1982—31 states 1985—35 states Not sustainable

17. Traumatic Injuries in Agriculture History of Non-fatal Occupational Injury –NSC--1970’s-1980’s –Olmsted Agricultural Trauma Survey (OATS)-- 1987

18. Traumatic Injuries in Agriculture 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

19. Traumatic Injuries in Agriculture 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

20. Traumatic Injuries in Agriculture 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)

21. Traumatic Injuries in Agriculture 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

22. Traumatic Injuries in Agriculture 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

23. Traumatic Injuries in Agriculture 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

24. Traumatic Injuries in Agriculture 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

25. Traumatic Injuries in Agriculture 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.

26. Traumatic Injuries in Agriculture 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)

27. Traumatic Injuries in Agriculture Current Status of Agricultural Injuries –Both national and regional data used –Limited to production agriculture

28. Traumatic Injuries in Agriculture Current Status of Agricultural Injuries –CFOI (1992-1998)

29. Traumatic Injuries in Agriculture

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

33. Traumatic Injuries in Agriculture

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

36. Traumatic Injuries in Agriculture

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

42. Traumatic Injuries in Agriculture 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%)

43. Traumatic Injuries in Agriculture 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%)

44. Traumatic Injuries in Agriculture TISF--Most injuries in months –August, July, June, and November

45. Traumatic Injuries in Agriculture 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%)

46. Traumatic Injuries in Agriculture TISF--Leading sources of injury –Machinery & Livestock (19% each) –Working surfaces and non-powered hand tools (8% each)

47. Traumatic Injuries in Agriculture TISF--Leading sources of injury –Machinery & Livestock (19% each) –Working surfaces and non-powered hand tools (8% each) Most common type of injury events –Struck by or against an object (15%) –Fall from elevation (13%) –Contact with sharp object (11%)

48. Traumatic Injuries in Agriculture Most common body part injured –Leg, knee or hip (17%) –Back (15%) –Finger (12%)

49. Traumatic Injuries in Agriculture 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%)

50. Traumatic Injuries in Agriculture RRIS-I –3,939 households; 13,144 persons

51. Traumatic Injuries in Agriculture 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

52. Traumatic Injuries in Agriculture 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)

53. Traumatic Injuries in Agriculture 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)

54. Traumatic Injuries in Agriculture 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)

55. Traumatic Injuries in Agriculture 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)

56. Traumatic Injuries in Agriculture 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) –Female high rates were 10-14 and 25-29 years (7.0 & 8.0/100,000 hours worked)

57. Traumatic Injuries in Agriculture 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) –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)

58. Traumatic Injuries in Agriculture RRIS-I Source of injury –Livestock (30%) –Machinery--other than tractors (20%) –Tractors (9%)

59. Traumatic Injuries in Agriculture 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

60. Traumatic Injuries in Agriculture RRIS-II 4,037 households 16,759 persons (8600 children-51%)

61. Traumatic Injuries in Agriculture RRIS-II 4,037 households 16,759 persons (8600 children-51%) Youth: 207 farm operation injuries –Animals (36%)

62. Traumatic Injuries in Agriculture 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)

63. Conclusions Traumatic injuries still leading cause of death and injury for production agriculture

64. Conclusions Main concerns identified in 1989 NCASH continue: –Tractors leading cause of farm death; mostly overturns

65. Conclusions Traumatic injuries still leading cause of death and injury for production agriculture Main concerns identified in 1989 NCASH continue: –Tractors leading cause of farm death; mostly overturns –Older farmers at highest risk for death

66. Conclusions Traumatic injuries still leading cause of death and injury for production agriculture Main concerns identified in 1989 NCASH continue: –Tractors leading cause of farm death; mostly overturns –Older farmers at highest risk for death –Traumatic injuries still concern for youth

67. Conclusions Fatality rates fairly constant in 1990’s

68. Conclusions Do not have a national non-fatal injury surveillance system in place

69. Conclusions Fatality rates fairly constant in 1990’s Do not have a national non-fatal injury surveillance system in place Surveillance is key element for assessing magnitude of the problem, details, and effectiveness of interventions

70. Conclusions Fatality rates fairly constant in 1990’s Do not have a national non-fatal injury 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