CaseUpon completion of this article, you will be able to:
CaseMr. Roberts, who is 74 years old, owns a small farm by Texas standards, working a mere 200 acres with four seasonal hired hands and his wife. He has been a farmer all of his life, like his father before him, and has had his share of accidents. On the morning of March 3, he decides to get the plowing out of the way early and starts up his tractor, attaches the disc harrow, and takes off for the back field. It is his habit to start at the most distant field and work his way back home over the course of his day. When he finally arrives, over a mile from home, he lowers the discs and begins the day’s work.
It is not long before the discs create huge clods that clog the discs and force him to stop. He puts the tractor in neutral, engages the brake (he thinks), and climbs down to kick the clods loose. As he kicks the dirt free, the old tractor shifts into gear and lurches forward, knocking Mr. Roberts to the ground and pulling the implement across his lower legs. A disc harrow is made of heavy, sharp blades designed for tearing up earth. They tear through tissue and bone as easily as they tear up earth. The discs completely sever his right leg and most of the left, mangling both legs beyond recovery. Mr. Roberts is alone, over a mile from home, with both legs rudely detached from his body. Although bleeding profusely, he retains enough sense to call for help on his cell phone and then fashions crude tourniquets from his shirt and belt.
Approximately 1,783,000 full-time workers were employed in production agriculture in the U.S. in 2009. During this same year, 440 farmers and farm workers died from a work-related injury for a fatality rate of 24.7 deaths per 100,000 workers. Of the leading sources of fatal injuries to youth on U.S. farms, 23 percent involved machinery (including tractors), 19 percent involved motor vehicles (including ATVs), and 16 percent were due to drowning.1 The response to farm accidents and emergencies has developed over time. Nevertheless, EMS responders in America’s farming communities still face many unique challenges. This article discusses many of those challenges, many of the dangers on the farm, special response and treatment requirements, and the need for planning and communication among responding departments.
There are more than 2.2 million farms and ranches in the United States, ranging from small one-man operations to huge conglomerates spanning thousands of acres and employing hundreds of workers. Approximately 10 percent of the farms produce more than 75 percent of all U.S. agricultural products. Farming has always been a huge part of the American lifestyle, going back to the Native Americans, who taught the colonists how to work the ground in the New World. At first, farmers relied on manpower and animal power to break ground, sow seeds, and harvest crops, which limited both the size of farms and production. The Industrial Revolution of the nineteenth century introduced machines that could do the work of entire crews, allowing more ground to be opened up, more goods to be produced, and more income to be earned.
The number and size of farms and ranches in America exploded in the nineteenth and twentieth centuries, leading to more and bigger machinery and chemical fertilizers and pesticides to help the farmers and ranchers with their hard work. As the industry grew and spread out across the country, patterns of injury and exposure started to become apparent, presenting emergency responders with several layers of new problems.
Farms and ranches can be dangerous places for the people who work on them. Farming is an industry where children work alongside retirees, who work alongside casual workers. Regulations regarding workers are somewhat more relaxed than they are in many other industries. Farming employs migrant and seasonal workers with little to no training. Farming is one of the only industries where the entire family can work and live on the premises. People both very young and very old operate large machinery, handle dangerous chemicals, and control large animals.
The age of workers plays a major role in the safe operation of a farm or ranch. Most surveys point out that the majority of accidents and injuries on the farm or ranch occur to people under the age of 15 and over the age of 65.2 Inexperience is a major factor in injuries to young workers, but at the other end of the age scale is the older worker. Advanced age brings medical conditions such as diabetes, hypertension, deterioration of eyesight and hearing, and a host of other problems that affect the efficiency and abilities of the older farmer. The long hours in the outdoors that farming requires, in all kinds of weather, can exacerbate pre-existing medical conditions.
Farm or ranch emergencies create unique challenges for responders. Responders need to overcome long distances, remoteness, and terrain that affect response times and transport; acquire specialized knowledge of farm chemicals—both manufactured and natural—and their effects on the human body; contend with and sometimes control large animals; and establish relationships with a variety of agencies across a range of jurisdictions.
Also unique to farming and ranching is the variety of hazards causing injuries to workers, as well as the types of injuries. The three most common classes of injuries on farms and ranches, large or small, are:
By far, the most common type of injury facing farmers and ranchers is mechanical trauma. This broad category lumps together injuries from heavy and light machinery, falls, blunt force trauma, and penetrating trauma from farm or ranch animals. In this category, you can also include insect bites and attacks from wasps, bees, and snakes.
Most farm or ranch injuries come from large equipment hazards. Injuries usually encountered with farm equipment include crushing, amputation (complete or partial), burns, lacerations, and degloving. Hazards come from machines such as tractors, combines, hay bailers, mowers, plowing systems, front-end loaders, and fertilizer spreaders. Each piece of equipment has a different purpose, and several pieces of equipment are usually found on the same farm. To make matters worse, new farm machinery is sometimes cost prohibitive, forcing farmers and ranchers to work with older machinery often designed with fewer safety features. As with any machinery, as it ages, the risk of malfunctions increases. Brake failure, electrical fires, fuel leaks, and flying sharp instruments are some of the hazards facing operators of older farm equipment.
Of course, one does not have to be up in a tree for chainsaws, scythes, or even garden hoses to pose a danger. In 1999, there were more than 28,000 chainsaw accidents in the United States, 36 percent of which endangered the femoral artery.3 Another tool commonly found not only on farms but also in tool sheds in town is the rear tine tiller. Rear tine tillers are generally more productive than their front tine counterparts, and are often the tiller of choice for anything beyond a small garden. This type of tiller uses rotating steel blades attached to the back of the machine to break up ground for planting. These steel blades, spinning at several hundred RPMs, are just in front of the operator’s legs, forcing the operator to walk directly toward the blades. Furthermore, even though power equipment has been invented for almost every chore on the farm, there are still many hand tools with blades and edges often swung by children and teenagers. Lacerations, removal of fingers and toes, and penetrating and blunt force trauma are common injuries seen from the mishandling of hand tools.
| The Fair Labor Standards Act prohibits anyone under the age of 16 to operate or to be a passenger on any powered equipment over 2 hp, with some exceptions. This prohibition, however, is often ignored on the farm. |
Tractor accidents are the most common cause of death on American farms, with 110 people killed each year on average.4 Most tractors are powerful, slow-moving machines that operate differently than the family car, requiring special training to manipulate the correct levers and knobs to get the job done. Such training is often overlooked or is insufficient. These machines are usually powered by large diesel engines, generating lots of torque and horsepower, and have superheated surfaces that may or may not be shielded or even labeled.
Be extra careful on rescues around tractors. Be aware of equipment that still has the power on. Your top priority is to find someone with the expertise to kill the motor and engage the braking system before you attempt a rescue or treat an injured patient.
Tractors are often attached to other equipment. The main attaching device is the power take-off (PTO) shaft, a fast-spinning shaft extending horizontally behind the tractor to power attachable equipment. The PTO shaft can be attached to augers, mowers, fertilizer spreaders, and combines. It is a common accident site for farmers, and it can be a dangerous area for responders if the tractor is on. Be careful of exposed belts and rotating blades or spinners. Most new tractor models use a double-clutch system, allowing the PTO shaft to turn when the tractor is in neutral.
Be aware also that the rear tires on tractors are usually filled with a solution of calcium chloride and water for extra weight. The solution may contain as much as five pounds of calcium chloride per gallon of water to increase the tractor’s weight and to provide freeze protection. As an example, a 20.8-38 tractor tire will hold 140 gallons of water, an added weight of 1168 pounds. A solution of five pounds of calcium chloride per gallon of water will require 114 gallons of water and 570 pounds of calcium chloride. This solution adds 1521 pounds to the weight of each tire and remains slush-free up to -53˚F. This makes the tires dangerously heavy. Rear tractor tires should be handled with a forklift, loader, or hoist to prevent injury.
Losing control of large equipment on a farm is a common way of getting hurt. Farm and ranch fields tend to follow the lay of the land. Plantings are sometimes done on grades or slants, requiring the operator to traverse uneven terrain. Mix natural forces, such as gravity, with a large weight load, and the potential for rollover accidents is great. According to a U.S. Department of Labor survey, 2914 deaths related to tractor accidents occurred between 1992 and 2002,5 with an average of 124 per year specifically attributed to rollover accidents.
Most tractor rollovers occur to the side. Typical causes include the operator hitting an obstacle, operating on steep slopes, using a front-end loader, and driving at excessive speeds. In most side rollover cases, you will find that an implement was attached to, or was being towed by, the tractor. This attached equipment increases the severity of the accident and complicates rescue operations.
Rear overturns are less frequent than side rollovers but are more likely to be fatal. The operator has a greater opportunity to jump or be thrown clear in a side rollover. In a rear upset, however, the operator rarely has sufficient reaction time to jump and nowhere to go if he does have time. Typical causes of rear overturns are hitching to a point other than the drawbar, going up steep slopes, and trying to free another stuck tractor.
In rear upsets, the tractor usually crushes the victim against the seat and steering wheel. Fractured hips and pelvises, ruptured organs leading to internal bleeding, and pneumothorax are the most common injuries in such cases. Always suspect spinal injury and maintain cervical spine restriction during rescue.
Response to Tractor Rollovers
When medical problems and heavy machinery are combined, remember scene safety by powering down equipment and using appropriate extrication devices and personnel.
The U.S. Department of Agriculture (USDA) passed legislation that requires farm tractors produced after 2000 to have a rollover protection system (ROPS) that includes a roll bar over the cab of the tractor as well as seatbelts. These simple devices have been effective in reducing deaths from rollovers; however, safety devices can be considered a luxury item by some farmers and ranchers and might not be present.
CombinesAnother heavy machine found on large farms is the combine, or grain harvester, a machine invented in 1834 and improved over time to an almost fully automatic grain- and corn-harvesting device. These days it is usually a self-propelled device powered by a strong diesel motor and fitted with crop-specific heads or attachments. These heads pose the greatest danger. The standard head, or grain head, features a reciprocating knife cutter bar and a revolving reel that is comprised of metal or plastic teeth that draw the cut crop into the auger. Once on the auger, the crop is carried to the back of the machine through a series of belts to the threshing chamber, where the crop is stripped of leaves and straw, separated, and fed into a waiting bin either attached to the combine or pulled by a truck alongside it.
The combine poses several obvious hazards. First is the row of rotating blades attached to the front and extending out to both sides, which can run into unsuspecting workers walking alongside the equipment. A hazard unique to combine operation is the backfire. This is a result of overheated exhaust, belts, and threshing blades coming in contact with shredded straw and chaff (the dry, scaly, protective casings of the seeds) spewing out of the combine. Often unnoticed by the farmer until a full-scale grass fire is in the works, people can become trapped and isolated by the fire very quickly.
Visibility and blind spots are concerning factors in combine operation. The typical cab on a combine is placed high, accessible by ladder, in the center of the machine. It is designed to give the farmer a clear view of the crop rows in order to maintain a straight path. The position, however, cuts down visibility close to the combine. As operators attempt to maneuver this equipment without running over crops, they can forget about or lose sight of people nearby on the ground. The potential for injury increases when the operator is a juvenile and the people on the ground are small children.
Common injuries associated with the combine include lacerations, crushings, amputations, and deglovings. In 2008, in Polk County, Oregon, a 12-year-old boy was walking alongside a combine when the operator decided to turn, running the child down with the extended head and killing him. Another recent fatality involved a 50-year-old man in Madison County, Alabama, who was standing behind the combine when the driver shifted into reverse and unknowingly ran over him. He was pronounced dead at the scene.
Fruit and nut tree farms have their own set of hazards and problems. Harvesting of fruits and nuts is accomplished using simple ladders, complex rolling scaffolding, or hydraulic bucket lifts, along with tools such as sharp knives and chainsaws. Common injuries from the equipment and tools include fractures and brain injuries from falls, lacerations and amputations, and even electrocutions.
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According to the USDA, fruit and nut tree farms make up 13 percent of America’s farming community. That translates to many people working up in trees.6 |
During rescues in orchards, you might find that your patient is not only up in a tree, but was using tools such as chainsaws or sharp knives, leading to severe hemorrhaging and forcing treatment during extrication. Extrication is problematic at best with a patient trapped in a tree, which makes planning and coordination of rescue efforts vital. You might need special equipment, such as a ladder truck, cooperation from the local electric company, and extra personnel from various agencies.
In orchards, once again, it is a safe bet that the injured party is a minor, another case of combining dangerous conditions with youth and inexperience. In a report published by the National Institute for Occupational Safety and Health, approximately two-thirds of farm injuries occur to youths who live on the farm.7
Not only are large and small tools found on the farm but also large and small animals. Various types of livestock can be found on any farm, from horses and cattle to exotics such as buffalo and wild game. The USDA reports that one in every six injuries on farms and ranches is animal related.8 Between 2002 and 2007, there were more than 75,000 injuries and 375 deaths reported in the United States related to livestock. Common injuries from animals include dislocated and fractured bones, soft tissue trauma, concussions, and other brain injuries.
Domesticated as livestock may be, they are generally large animals weighing several hundred to more than a thousand pounds, with large hooves backed by robust legs that can do much damage to the human body. Most breeds of cattle also have large pointed horns capable of deep penetration trauma. This differs from stabbings because the head behind the horns is powerful enough to lift an adult male off the ground, thrash him about, and then propel him several feet.
Working around animals highlights the importance of planning. It is important to know which farms and ranches in your area have what kind of animals and in what numbers. If possible, arrange for animal control personnel to arrive either ahead of or concurrently with responding units. The livestock must be contained, and then the injured party should be moved to a safe area to prevent a second attack. When retrieving the patient, avoid entering pens with animals and always have an escape route planned.
Just like people, animals are different and have different triggers. Approach the animal slowly from the front or side, never from the rear. Cattle and horses have side-mounted eyes, giving them almost 360˚ of vision, except for a blind spot directly behind them. If you approach them from the rear, they will be forced to respond. Do not make sudden movements or threatening gestures or try to force them into a corner. Do not let yourself be backed into a corner or become caught between a large animal and a hard surface, such as a barn or tractor.
As ground is disturbed by the farmer or crops are harvested, another type of danger comes from wild animals, most notably snakes, wasps, and bees. The World Health Organization estimates that humans receive more than 300,000 snake bites each year, resulting in 94,000 deaths, mostly in regions with high rates of subsistence farming, such as Africa, South America, and the Middle East.9 The United States has its share of deadly snakes too. All over the world, remote rural locations and the unavailability of antivenin play a role in mortality.
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Hibernating reptiles often react dangerously when their den or nest is exposed during plowing or harvesting. Snakes nest in the fall, which is usually when harvest season begins. |
Wasps and Africanized, or killer, honeybees also present a huge hazard to the farmer. Both are territorial and aggressive and react in large numbers. Wasps tend to build large nests in trees, offering an unwelcome surprise to the fruit picker on a ladder several feet off the ground. Each wasp can sting multiple times, injecting poison each time. Killer honeybees are relatively new to the scene. Migrating across North America from Mexico, they are becoming increasingly common. These bees are usually dark in color, swarm in large numbers, and are extremely aggressive. They also have a wider alarm zone than European bees and a larger defense response.
Chemical Burns and PoisoningEvery farm or ranch has a store of chemicals. Consequently, chemical burns and poisoning are familiar occurrences on the farm. Some of the most common and easily recognizable chemicals are manure; various ammonia compounds; various organophosphates; and fuels such as diesel, gasoline, kerosene, propane, and natural gas. Two ammonia products are worth special mention: ammonium nitrate and anhydrous ammonia.
Ammonium nitrate, a chemical compound composed of 27% nitrogen and 8% calcium carbonate, has been used by farmers across the globe for decades. Usually found in granular form, it is inexpensive, readily available, and used year-round to replenish soil on any type of farm. It has been nicknamed “the silobuster.” Ammonium nitrate is stored in dry, well-ventilated rooms. It should be marked with flammable placards, although no regulations require any markings.
The main concern with ammonium nitrate is its volatility. It is not explosive by itself but when combined with any type of hydrocarbon, such as diesel or kerosene, and a detonation point, it is potent stuff. Ammonium nitrate is a preferred explosive in the construction industry because of its better yield and higher combustibility.10 In 1947, the cargo ship Grandcamp at port in Texas City was being loaded with 1900 tons of ammonium nitrate fertilizer when a fire in the hold ignited the chemical, causing an explosion that instantly killed everyone aboard; set fire to another vessel moored more than 8000 feet away; and knocked two planes out of the sky with a shockwave. In 1995, Timothy McVeigh detonated a mixture of ammonium nitrate and diesel fuel oil, killing 168 people and destroying the Alfred P. Murrah Building in Oklahoma City. This event drew greater attention to the use of ammonium nitrate as an explosive and prompted tighter regulations on its transport and storage.
Most problems from ammonium nitrate on the farm result from accidental inhalation, which causes coughing, a sore throat, irritated skin, and irritated mucous membranes. Treatment is continuous water flushing for at least 15 minutes, with care not to drown the patient.
According to the USDA, optimal results from ammonium nitrate require applying
between 50 and 250 pounds per acre, depending on the crop.11 Because huge operations work several thousand acres, the amounts of ammonium nitrate stored in any given response district can be staggering. Given these numbers, it would be wise to consider the presence of ammonium nitrate in your response planning. Details can include locations, prearranged response equipment, local on-site trained responders, and coordination with the local poison control center.
Another form of ammonia used in farming is anhydrous ammonia (anhydrous). Composed of one part nitrogen to three parts hydrogen, it is inexpensive and readily available. One of the most common soil enhancers used by farmers today, anhydrous is prized because it is a fast and cost-effective way to restore nitrogen to depleted soil. However, with all these advantages come some serious disadvantages. Anhydrous is difficult to store and transport, and, generally, to handle, and its caustic effects on biological tissue are devastating. It causes damage by burns. Treatment of significant exposure, after initial treatment with copious irrigation, is identical to treatment of severe thermal burns.
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Proper gear is needed when handling anhydrous: ammonia-rated safety glasses with rubber seals, a mask that protects both nose and mouth, rubber gloves with extended cuffs that can be rolled down to catch spills, and long-sleeved shirts or coveralls. |
In its natural state, anhydrous is a colorless gas with a sharp, pungent odor. To be used in farming, it has to be in liquid form, and this is where the trouble begins. To compress anhydrous into a liquid requires serious pressure, about 250 psi.12 It must be stored in specially designed tanks able to handle that kind of pressure load. Temperature plays a role in storage as well. With an ambient temperature of 50˚F, the pressure reduces to around 90 psi. However, on a 100˚F day, which is common in America’s farmlands, the pressure increases to over 300 psi.
The high pressure that anhydrous is stored under can weaken hoses, pressure valves, and transfer valves, which can lead to disaster when transporting from one tank to another. If there is a break in the closed system and pressure is released, anhydrous instantly returns to its natural gaseous state and expands forcefully, and can come in contact with any exposed body parts.
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A site contaminated by anhydrous is highly dangerous. Trained on-site first responders can keep people away from the contaminated site, help to minimize exposures, and give responding agencies an “eyes on the target” advantage. They can also remove victims from danger and provide basic first aid. |
Anhydrous ammonia exposure is considered lethal at a mere 300 ppm, with tissue damage possible with even the slightest contact. Fortunately, it has an odor threshold of 20 ppm, which gives people a chance to avoid exposure. According to the Occupational Safety and Health Act, there were 53 fatalities from 224 exposures to anhydrous ammonia between 1995 and 2004.13 Researchers at the University of Iowa hospitals found that 30 percent of the patients admitted to their burn center over a two-year period suffered chemical burns from the occupational use of anhydrous ammonia.
Theft adds insult to injury and complications to a very dangerous chemical. Anhydrous ammonia is used in the production of illicit methamphetamine. Anhydrous is essential to the production of a quality meth product and is readily available at the nearest farm. The problem arises when people with no experience or knowledge of the dangers involved work at night and in a hurry to siphon off anhydrous or steal outright an entire tank of a chemical that is instantly volatile and very deadly. In April 2000, the Centers for Disease Control (CDC) initiated a program called Hazardous Substance Emergency Events Surveillance, with the mandate to monitor and report incidents involving dangerous chemicals in the United States. From the time of inception to completion in 2004, there were 40,349 events involving anhydrous ammonia reported, with 1791 used in the manufacture of meth. Of the 1791 reported meth cases, 394 (22%) resulted in injury to the perpetrators, with 31 (8%) of those ending in death. Over half (54%) of the anhydrous stolen during this time was from agricultural tanks. Thieves preferred farms to commercial locations because of a lack of security and the usual remoteness of the rural location.14
Such thefts are also a source of danger to the victimized farmer. Thieves usually have only a vague idea of what they are doing, and they can damage hoses and valves. If the farmer is unaware of the theft and uses the tanks afterward, the risk for exposure is dramatically increased. A secondary danger involving the theft of anhydrous is the container in which it is siphoned into. Usually, the container is something makeshift, such as a propane tank from a barbeque grill that has been fitted with adaptors that connect to anhydrous tanks. These makeshift tanks are usually not properly sealed. When the ammonia leaks out, it travels upward because it is lighter than air, and, like any flammable gas that comes in contact with an ignition point, it explodes. This is the main danger of illicit meth production, according to the Environmental Protection Agency.15
Response to Anhydrous ExposureTypes of InjuriesAnhydrous means “without water.” When the ammonia comes in contact with moisture on the skin, eyes, or mucous membranes, it reacts immediately. This causes rapid dehydration of tissue, resulting in severe chemical burns. The respiratory tract is particularly vulnerable, given the “gasp effect,” with exposure resulting in complete constriction of the upper airway. Severity of symptoms depends on the degree of exposure. Mild or brief exposure results in minor skin irritation or rash, a sore throat, or exacerbated asthma. Prolonged or severe exposure results in burns that continue for 18 to 24 hours, especially in the eyes or the respiratory tract. Primary TreatmentThe first step is to remove victims from the source of contamination. Wear goggles and a mask that protects the nose and mouth or wear an SCBA. Once extrication is safely accomplished, flush with large quantities of water for at least 15 minutes. If exposure involves the upper airway, mouth, or nose, be careful not to drown the patient inadvertently during flushing. When flushing the eyes out, be sure to get underneath the eyelids, and remove contact lenses from the victim as soon as possible because they can collect minute traces that can continue damaging eye tissue. Advanced TreatmentAdvanced care requires active airway management. As with any type of burn, early intubation is recommended for patients with significant burns of the face or nasopharynx and for any patients with significant signs or symptoms of airway injury (loss of voice, stridor, hoarseness, wheezing, rales, dyspnea). Delayed damage is often seen in injuries involving the respiratory tract and eye tissue from inflammation caused by the caustic burns, so a high index of suspicion should be present in dealing with swelling around the mouth and nose, or hearing the patient wheezing or speaking in a high-pitched voice. Rapid transport to the closest burn center while administering supportive care and continuous flushing en route is the best treatment known to date. |
During emergencies on the farm, you might also have to contend with natural fertilizers. The waste from livestock penned in enclosed buildings or paved feedlots are normally collected and stored until they can be spread on the land as fertilizer. The most common method of storing animal waste is to flush it out and keep it in a lagoon (a pond), in pits beneath the animal pens, in underground tanks, in vaults, or in a covered pit called a “dry stack.”
Several dangers are associated with animal-waste facilities. One is drowning in the lagoon. The typical lagoon has steep sides, and a person can easily slip and fall in. Sometimes a mat of grass and weeds grows on the surface of the lagoon, which appears firm enough to walk on but a person who dares to do so can fall through.16
Another danger is being overcome by toxic gases from the pit. In Iowa, in 1989, a farmer went into a 10-foot manure pit to free a clogged agitator. While climbing out, he was overcome by toxic fumes and fell back into the pit. His 15-year-old grandson witnessed this, climbed into the pit, and collapsed beside his grandfather. One by one, others entered the pit to help—the boy’s father, a cousin, and an older brother—and all succumbed to the hydrogen sulfide fumes. Finally, the owner of a local farm implement business and two employees used ropes to rescue the victims without going into the pit itself. EMS arrived in less than 20 minutes after being activated, but all five members of the family died.
Explosion, fire, and toxicity are possible because methane gas and hydrogen sulfide are produced as the waste is broken down by bacteria. Methane is lighter than air and dissipates unless trapped in an enclosure. Hydrogen sulfide is heavier than air and cannot dissipate readily from low spots. Hydrogen sulfide is highly toxic and can kill a person with only a couple of breaths. It’s deadly toxicity is similar to hydrogen cyanide and involves disruption of cellular respiration at the mitochondrial level. Treatment is similar to treatment of cyanide poisoning. Both gases are flammable and should always be suspected in livestock enclosure facilities. Methane gas isn’t directly toxic, but it can exert toxicity as an asphyxiant by displacing oxygen. Do not allow any source of ignition in or near the entrance to manure pits or storage tanks.17
Treat manure pits and tanks as immediately dangerous to life and health. The levels of flammable and toxic gases will be highest during the process of agitating the waste for pumping out. This releases the bubbles of gases trapped in the slurry. Never enter an enclosed manure pit or tank without an SCBA, unless testing has indicated the atmosphere at the bottom is safe.
PesticidesAlong with fertilizers, you will find on the farm or ranch a range of chemical and natural pesticides. These are designed to keep bothersome bugs, bacteria, fungi, and weeds away from profitable crops, with little impact to the host plant. The most common type of inorganic pesticides is based on organophosphate (OPP) molecules. These compounds are cheap, mass produced, mostly unregulated, and easily available over the counter, despite being a significant cause of mortality. They are derivatives of phosphoric acid and can be found anywhere, from farm sheds to medicine cabinets.
The various levels of toxicity all lead to the same end, even if it takes different amounts to get there. They work by inhibiting the enzyme acetylcholinesterase in nerve cells, causing nerve and respiratory damage in insects. In humans, according to the CDC, OPP poisoning affects a large number of organs and physical processes. Following are the main signs and symptoms of OPP poisoning:19
A planned response is, again, a necessity with OPP exposure, where mere minutes can be the difference between toxicity levels. Be especially aware of which farms in your area have what types of pesticides and in what quantities. If OPP chemicals are present, consider the amount of atropine kept in stock, and share your findings with the local hospital or clinic. Trained first responders on site can remove the patient safely from harm and begin the decontamination process.
Several types of combustible fuels are usually present on farms and ranches. Gasoline, diesel, propane, kerosene, and natural gas can be found stored in above-ground or below-ground systems. Both types of storage present positives and negatives. The above-ground tanks are usually clearly visible and easily accessed for use and maintenance, but they are easy targets for thieves and vandals. In Dumas, Texas, in 1999, three men attempted to steal a 1200-gallon propane tank from the Rockin P Ranch. They improperly disconnected the fuel lines and then created sparks as they dragged the tank away, which caused an explosion that killed all three would-be thieves, destroyed the ranch’s stables, and started a fire that burned more than 100 acres. In March 2003, a farmer in Grayson County, Texas, was refueling his old tractor with kerosene from a neighbor’s tank when a cracked fuel line resulted in an explosion that threw him several yards away, killing him on impact and destroying the entire complex.
Below-ground tanks have their own set of concerns, such as improper maintenance, leading to leaky pipes and flooding that washes away fuel into reservoirs and destabilizes support systems. An explosion at a cherry tree farm resulted in the deaths of two young teenage boys when the farm truck they were driving backed over a pump. In 2005, methane fumes from a Jimmy Dean hog farm caused an explosion that killed four people and more than 300 hogs, and resulted in almost a half million dollars in damage to the facility.
Always keep in mind whether fumes from certain fuels sink or float. For instance, propane is heavier than air and runs along the ground, whereas methane is lighter than air and rises to the surface and floats down. Farmers are known to repair flat tires on equipment and vehicles with propane-based sealant, so always keep a high index of suspicion with farm equipment.
Humans have been working the earth to produce food since before recorded history. Although techniques to produce vast quantities of food year-round have improved over time, food production still highly depends on the variances of nature. In the United States, the majority of farms and ranches are in the heartland, or Great Plains. This center section of the country is home to the some of the largest farms and ranches and some of the deadliest weather patterns in the country, particularly tornadoes and storms.
Tornadoes are classified according to the the Enhanced Fujita (EF) scale rates which tornadoes between an EF-0 and EF-5 based on wind velocity associated with the resulting damage. On this scale, an EF-0 produces winds of 65-85 mph, which can cause shingles to be blown from roofs, young or weak trees to be uprooted, and minor damage to structures. On the high end of the scale, an EF-5 is capable of producing winds well over 200 mph, lifting homes from foundations, tossing cars up to a mile away, and leaving a path of established and incredible destruction.
In Greensburg, Kansas, in 2007, an EF-5 tornado bearing winds of around 300 mph destroyed this small farming community, killing 11 people and causing several million dollars in damage. In Snyder, Oklahoma, in 2005, a small tornado that witnesses say appeared out of nowhere touched down on a poultry farm, killing 14 people and scattering turkeys over a three-mile radius.
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Storms and tornadoes are not the only natural disasters farmers and ranchers face. As ground is cleared for planting, and natural barriers such as trees and dunes are removed, winds can create dust storms or intense blizzards, causing farmers and ranchers to lose their way and make errors in judgment. |
Flash flooding is another problem unique to the countryside. Flash flooding accounts for 40 percent of the natural disasters in rural America, according to the CDC.21 Texas experiences more than twice the number of flash floods than all the other 49 states combined. A mere six inches of moving water can knock a person down, and only two feet of water can float vehicles or equipment. According to the National Oceanic and Atmospheric Administration, during one recent 30-year period, the average number of deaths per year from flooding was 127, compared to 73 from lightning and 65 from tornadoes. One example: In Liberal, Kansas, in 1998, 12 inches of rain fell in under one hour, causing long-dried-up river beds to flood and trapping two farmers, eventually overwhelming their positions and washing them several miles downstream.
Inclement weather is not the only danger Mother Nature can produce. Farmers and ranchers work long hours, often 12 to 16 hours a day. Making the most out of the natural light, farmers and ranchers often work from before daybreak to after sunset. Long hours can lead to exhaustion, which in turn can lead to poor judgment. Tiredness, poor judgment, and heavy machinery are a lethal mix.
In addition, that much time in the sun, wind, or cold leads to such health problems as frostbite, dehydration, and heat stroke. Heat stroke, a prolonged increase in body temperature greater than 105˚F,22 is a prevalent condition that, according to the CDC, affected more than 200 farmers in 2009, a typical year, because of long hours spent in the fields. Symptoms of heat stroke include hot, red, dry skin; lack of sweating; tachycardia; tachypnea; altered or unresponsive mental status; and hypotension. In many cases, there may be no one around to call for help, and a victim might spend long hours in the field before rescue comes.
In rural communities, a proactive approach to emergency response is invaluable. A response plan, which includes a survey of the farms and ranches in your response district, better allows you and other providers to shave precious minutes when responding to an emergency.
Preparing a response plan takes time and effort. A well-thought-out plan helps you and other responders by:
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Often overlooked but vitally important is the condition of the ground around the patient. Will an ambulance or fire truck be able to make it to the emergency location? A request for special equipment should be made in the dispatch phase. |
Start your response plan with a mapping and general survey of the farms and ranches in your area. By either asking farmers and ranchers or making an on-site inspection, find out the following important facts about each farm or ranch in your district:
An important component of the response plan is a roster of people—volunteers and professionals—you can call on for assistance if needed. This group might include farm or ranch workers with special knowledge and skills, such as animal handlers; county extension agents; local volunteer firefighters; and responders from a nearby poison control center.
This is a good time to set up a person or group of people who can act as first responders on the site and points of contact for emergency responders. If possible, provide them with the following training:
During training sessions, make sure the farmers and ranchers and their employees are aware of the dangers involved in the chemicals they use. Remind them to make sure all hoses and connection points are in good shape, the dangers are clearly marked, and that everyone understands the importance of keeping 5 to 10 gallons of drinking water close to any containers of fertilizer or pesticides and its appropriate use for decontamination. Also remind them to take a cell phone with them when working in the fields and to check in with the home base from time to time.
This is also a good time for you to learn from the farmers and ranchers as well. Ask them to show you how to:
Once the farms and ranches have been mapped and surveyed, and you have identified your on-site responders, it is time to share that information with the various agencies and organizations—public and private—(and even businesses) that will be assisting in emergency response. You could include any or all of the following and share information on a need-to-know basis:
While sharing the information you have gathered, also find out about the resources available from cooperating agencies. You will want to know such things as:
Also consider that dispatchers might need to be trained to ask not only the physical address of the farm or ranch but also the location of the injured; whether they are trapped or confined; what, if any, special equipment is needed; whether animals are involved; and other information unique to farm rescues. At this stage of the call, it is important that all needed resources be dispatched to save time.
As for Mr. Roberts from the case study at the beginning of this article, once he arranged for help, he fastened tourniquets from his belt and shirtsleeve to stem the flow of blood from his mangled lower extremities. Then he waited. It took EMS and other responders almost 25 minutes to reach his side. Responders arranged for air transportation as soon as they made patient contact. Their initial assessment revealed severe volume loss, hypotension, and tachycardia. They started bilateral large bore IVs with 0.9% normal saline and applied mast trousers to control bleeding. They flew Mr. Roberts to the closest trauma center, more than 100 miles away in Dallas. Sadly, doctors pronounced him dead upon arrival from hypovolemic shock complicated by advanced age.
Farms present a unique set of challenges for responders across the United States. Farms of various sizes present unique combinations of equipment, personnel, animals, hazardous materials, and nature. Responders must be aware of potential emergencies and must adequately respond. Victims and hazards may be difficult to access and mitigate. Specialized equipment and resources may be needed to manage farm emergencies. Preplanning and training is vital to the successful outcome of a farm emergency.
Author Nate Anders, Copyright © CE Solutions. All rights reserved.
References
Image References
Image 1: Tractor Disc: Wikimedia Commons-Thurman Hinds. Image licensed via Creative Commons license. Accessed 12/01/2011.
Image 2: Combine, Image licensed ©iStockphoto/Wojitek Kryczka.
Image 3: Ammonium Nitrate: Wikimedia Commons-PI77. Image licensed via Creative Commons license. Accessed 11/18/2011.
Image 4: Anhydrous Ammonia: Wikimedia Commons-Andy Arthur. Image licensed via Creative Commons license. Accessed 11/18/2011.
Image 5: Tractor spraying field, Image licensed ©iStockphoto/Iain Sarjeant.