ED5 - Agricultural Health
Transcript of ED5 - Agricultural Health
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FARMER SAFETY & HEALTH
LaMar Grafft
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Farmer-Specific Problems
Agricultural trauma Zoonotic exposures
Osteoarthritis in farmersAgricultural chemical exposures Cancer rates in the farming population
Noise induced hearing lossAgricultural skin diseases Behavioral health issues of farmers
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Agricultural Health Training
Program Enrichment training:
175:209 Rural Health and Agricultural
Medicine Spring semester on Monday night, or
Intensive course, June 11-15
MS, PhD programs
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Case Study
57 yo male arrives in your office/clinic C/O headache, fever, malaise x 3 days
What are your questions for him What exposures could cause these
symptoms
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AGRICULTURAL TRAUMA
Mechanics of agricultural trauma Tractors
Machinery
Animals
Confined spaces
Chemicals
First responder/EMS considerations
Prevention of agricultural trauma Case scenarios
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AGRICULTURAL TRAUMA
550 farmers die per year/US 8 times the occupational average
100,000 disabling injuries per year
30 farmers die per year/Iowa 1,000 disabling injuries per year
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AGRICULTURAL TRAUMA
Why? Stress
Long hours Solitude
Weather
Hazardous situations Familiarity
Tradition
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Mechanics of
Agricultural Trauma Tractors = 50% of farm fatalities
Overturns
High center of gravity/rough terrain 50% of tractor fatalities 97% male Side overturns = 85% of all overturns
Rear overturns, 85% of these are fatal Spinal injuries Crushing injuries
Long bone fractures
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Mechanics of
Agricultural Trauma Tractors (cont.)
Runovers
50% of these fall from tractor Children and other extra riders
27% are bystanders Bypass starting
Spinal injuries Crushing injuries Long bone fractures
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Mechanics of
Agricultural Trauma Tractors (cont.)
Roadway incidents
13% of tractor fatalities Wide loads Slow speed Inadequate lighting or marking
Slow Moving Vehicle (SMV) signs
Reflective tape
Left turns
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Mechanics of
Agricultural Trauma Machinery (cont.) Power Take Off shafts (PTOs)
1000 RPM (17/second) 540 RPM (9/second)Amputations Spinal injuries Long bone fractures
Stationary machinery Primarily PTO problems
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Mechanics of
Agricultural Trauma Machinery (cont.)
Augers
Hand/finger amputations Massive lacerations
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Mechanics ofAgricultural Trauma
Machinery Combines and corn pickers
Slips and falls Snapping rolls
23 feet per second
Belts and pulleys
EntanglementAugers Spinal injuries Lacerations
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Mechanics ofAgricultural Trauma
Machinery (cont.) Hydraulic injection
Pressure Temperature
Pinch points
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Mechanics ofAgricultural Trauma
Animal injuries Aggressive animals
New mothersAdolescent malesAdult males
Size difference
2500 pound bull 75 pound child
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Mechanics ofAgricultural Trauma
Animal injuries (cont.) Spooked animals
Wild animals Startled animals
Other
Working/processing animals Needle sticks
Stupid tricks
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Mechanics ofAgricultural Trauma
Confined spaces Grain bins
Engulfment hazards Quicksand
Bridging
Avalanche
Grain vacuum
Suffocation Hypothermia
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Mechanics ofAgricultural Trauma
Confined spaces (cont.) Silos
Conventional Mechanical hazards
Nitrogen dioxide (silo gas)
Falls
Oxygen limiting Reduced oxygen Mechanical hazards
Falls
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Mechanics ofAgricultural Trauma
Confined spaces (cont.) Manure pits
Hydrogen sulfide (H2S) Drowning
Tanks
Assorted hazards
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Mechanics ofAgricultural Trauma
Agricultural chemicals Pesticides
Herbicides Insecticides Rodenticides Fumigants
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Mechanics ofAgricultural Trauma
Agricultural chemicals (cont.) Fertilizers
Anhydrous ammonia (NH3) Hydroscopic -28F
Methamphetamine manufacture
Ammonium Nitrate Explosive when mixed with diesel fuelOklahoma City
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Case Study
57 yo male arrives in your office/clinic C/O headache, fever, malaise x 3 days
What are your questions for him What exposures could cause these
symptoms
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Case Study
Cold Flu
Pesticide poisoning ODTS Farmers lung
Brucellosis Hantavirus
Psittacosis Q fever Rabies
Rocky MountainSpotted fever Lyme disease
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Tractor Overturn Scenario
July 3, 1900 hours 76 YO male was using a tractor and bush
hog to mow ditchesAs he was mowing by the road, his lowerwheel dropped into a washout and thetractor rolled onto its side
Tractor was equipped with a weather cab He was not wearing a seat belt
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Tractor Overturn Scenario
The driver of an approaching car stoppedand called 911
He then assisted the elderly farmer fromthe tractor
The farmer complained of some neck and
back pain, along with LUQ tenderness
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Tractor Overturn Scenario
What should be the first treatment by theEMTs?
What type of injuries would you expect? How should this patient be packaged?
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Tractor Overturn Scenario
Ambulance arrived and started patientassessment
Vital signs: BP 158/96, P 98 strong andslightly irregular, R 28 and slightly labored
Patient refused treatment and transport,
just wanted a ride home EMTs call you for medical control
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Tractor Overturn Scenario
What do you tell them? What all would you suspect?
How do you want this patient transported?
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Tractor Overturn Scenario
EMTs convinced the patient to betransported to the ER
He c/o more pain to his neck and back, sothey use full c-spine precautions
SaO2 86% on room air, increasing to 92%
on 15 LPM/non-rebreather Patient stated he was a long time smoker,
but has since quit
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Tractor Overturn Scenario
Saline lock started Enroute to the ER, patient c/o increasing
tenderness to the LUQ Repeat vitals: BP 132/90, P 110 and
irregular, R 32 and labored
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Tractor Overturn Scenario
What might be going on with this patient? What additional treatment do you want?
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Tractor Overturn Scenario
Heart monitor attached showed a sinusrhythm with frequent multifocal PVCs
Patient states he has a history of heartproblems
Denies chest pain other than from the
trauma of being tossed around the cab IV LR established
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Tractor Overturn Scenario
Ambulance stepped up their transport toemergency
Patient states he is feeling dizzy and lightheaded
Vitals rechecked: BP 118/82, P 120, R 30
Patient c/o increased tenderness toabdomen
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Tractor Overturn Scenario
What do you suspect might be going on? What further treatment do you want
EMTs to provide? What tests will you order when the patient
arrives?
Agricultural Respiratory
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g p y
Diseases
Agricultural Respiratory
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Agricultural RespiratoryExposures and Illnesses
Respiratory illnesses: the most important healthcondition of farmers
Cause of greater disability in agricultural workerscompared to other work groups
>25% of workers in confinement animalproduction have chronic conditions
Agricultural (organic) dust: a universal exposure Gasses
Agents Causing Respiratory
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Agents Causing RespiratoryDisease in Agricultural Workers
Agricultural Dusts Gases:
Hydrogen Sulfide Ammonia
Anhydrous Ammonia Ammonia from livestock operations
Nitrogen Oxides (silo gas) Carbon Monoxide Carbon Dioxide
Pesticides Paraquat Fumigants
Infectious Agents At least 5 zoonotic infectious agents affect the respiratory tract
of farmers
Agricultural Respiratory
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Agricultural RespiratoryDiseases
Organic Dust Exposures Bronchitis Asthma-like condition
Mucus Membrane Irritation Organic Dust Toxic Syndrome Hypersensitivity Pneumonitis (Farmers Lung)
Bronchiectasis
Silo-fillers disease Acute Respiratory Distress Syndrome Progressive malignant pulmonary fibrosis Zoonotic infectious agents
A i lt l D t
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Agricultural Dust
Exposures throughout the industry
High content of organic materials
Much more widespread environmental
concern than hazardous inorganic dusts(i.e.. silica, asbestos)
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Components of Agricultural
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Components of AgriculturalDusts
Microbes
- bacteria
- fungi
Microbial Products
- endotoxin
- glucans
- mycotoxins
Insects
- mites
- roaches
Two Categories of
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Two Categories ofAgricultural Dust Exposure
1. Periodic high concentration (15-50 mg dust/m3) High microbe content (105-109 organisms/m3)
Risks = Organic Dust Toxic Syndrome (ODTS) andHypersensitivity Pneumonitis (HP) or Farmers Lung (FL)
2. Chronic lower concentration (2.5-10 mg dust/m3) Lower microbe content (103-105 organisms/m3) Risks = Bronchitis, Asthma-like condition, Mucus
Membrane Irritation
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Worker Health Issues
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Worker Health Issues
Bronchitis
Acute/Subacute (60%)
Chronic (25%)
Organic DustToxic
Syndrome (33%)
Upper Airways
Inflammation
Sinusitis (22%)
Irritant Rhinitis and
Pharyngitis (30%)
Acute Respiratory
Distress/Pulmonary
Edema(19 Deaths Reported)
Occupational Asthma
Chronic Inflammation(20%)
Allergic Mediated
(1%)
Asthma-Like
Syndrome (11%)Chest Tightness and
Cough on Return
to Work
The circles indicate overlapping symptoms and conditions. The percentages indicate
approximate rates of swine workers who experience these conditions.
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Respiratory Case History
68 year old farmer
Long history of tobacco use COPD ~ 5 years ago Mildly progressive dyspnea on exertion
Quit smoking ~ 20 years ago
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Respiratory Case History
Dyspnea worse with dust exposure Fever and flu-like symptoms
Moving and sortinghogs a challenge
Hog flu
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Respiratory Case History
Cleaning out grain bin Used disposable respirator
Took respirator off brieflyduring work
No symptoms during work or immediately
after
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Respiratory Case History
That night developed dyspnea, fever,muscle aches and malaise
No better in the morning Sought medical attention next afternoon On arrival in ER severely dyspneic, visibly
distressed and diaphoretic
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Physical exam in ER
T 38.2C RR 24 HR 65 BP 137/65 Chest Decreased breath sounds
bilaterally with prolonged expiratory phaseand diffuse expiratory wheezes
Abdomen Soft NT/ND
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Laboratory Results
Blood gas low oxygen saturation CXR Streaking in RLL no other
infiltrates CBC: Left shift with elevated total white
count 15.247
14.2 227
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Laboratory Results
All cultures (sputum/blood) negative Chemistry mostly normal
EKG Normal Pulmonary function: Low lung volumes
and flows, with an obstructive pattern
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Progress
Admitted Treated with abx./oxygen/steroids
Gradually improved and discharged 10days later
Persistent hypoxia and remained on O2
supplements for four months
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Our Differential Diagnosis
Pneumonia COPD exacerbation
Asthma Hypersensitivity Pneumonitis Organic Dust Toxic Syndrome
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Key Issues
History of similar problems with previousexposure
History COPD Obstructive physiology on PFTs No acute infiltrates
No growth in cultures
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CT Scan
Radiologists interpretation Scarring/streaky opacity in RLL
Bronchiectasis in RLL associated with areas ofscarring
Mildly enlarged precarinal lymph nodes
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Diagnosis:
Organic Dust Toxic Syndromecomplicated by COPD
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Organic Dust Toxic Syndrome
Respiratory problems have been known tooccur in farmers for hundreds of years
An influenza like syndrome, separate fromHP, in grain handlers and livestockfarmers has been recognized for 20-30years
Confused with HP / Farmers lung becauseof similar presentation in the acute phase