3/12/2017

1

Tim Perry, RN, NREMT-P, CMTE

Erlanger Life Force

Farm Emergencies and

Crew Safety Awareness

1. Identify Causes of Farm

Injuries

2. Recognize Risk to Rescue

Crews

3. Implementation of Basic

Rescue Techniques.

4. Recognize Patient Care Needs

Stats

Third Most Hazardous

Occupation in America

1300 Fatalities Per Year

25% Are < 15 Y/o

27% > 65 Y/o

Tractor Roll Over Account for

44% of Farm Fatalities.

Over 120,000 Reported Injuries

Per Year.

80% of Tractor Injuries Could Be

Prevented With ROP, Safety

Belts and PTO Guards

Highest Risk of Injury to Family

Members and Hired Help.

Number One Cause of Injury

“COMPLACENCY”

Goal: Make Life and Limb

Saving Decisions Without

Causing Harm to Yourself or the

Patient.

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Common Farm Accidents

Tractor Rollover

Tractor Implements

PTO Shafts and Augers

Grain Bin and Manure Pits

Large Livestock

Chemical

Others

Electrocution

Medical

Burns

Falls

Tractor Rollover Type Roll Over

Side to Side {80%}

End Over End {20%}

Key Points

Rescuer and Patient Safety

Always Approach a Overturned

Tractor From the up Hill Side If

on a Slope.

Secure Tractor With Cribbing,

Post, Cables or Ropes

Eliminate Fire or Burn Hazards

Including Fuel, Oil and Other

Chemicals

Turn off Ignition Key

Shut off Fuel on Diesel Tractors

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Rescue May Include, Hydraulic

Rescue Tools, Air Bags, Tractors

and Tow Trucks

If the Ground Is Soft, It May Be

Better to Dig the Patient Out

Rather Than Risk Lifting the

Machinery and Risk It Falling

High Occurrence of Crush

Injuries and Fractures to Include

Head, Chest, Abdomen, Pelvis

and Extremities.

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Comments / Questions

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PTO Injuries PTO Shaft with guard

High Incidence of

Fractures

Amputations

Lacerations / Avulsions

Death

Contributing Factors Leading

to PTO Injuries

Guard Removed From Shaft

Loose Clothing

Shoe Laces

Long Hair

Stepping Over or Standing

Close to an Engaged Shaft

PTO Shaft With Guard Removed

PTO Rescue

Block the Implement to Ensure

Firm Support During the Rescue

Attempt to Telescope the Two

Ends of the PTO Shaft Apart. It

May Be Necessary to Roll the

Tractor Forward After

Disconnecting the Shaft From

the Tractor.

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Telescoping PTO shaft

Shaft together Shaft apart

Single Piece PTO Shafts May

Have to Be Cut or Disassembled

at Either End to Free the Victim

It May Be Possible to Free the

Victim by Rolling the Shaft

Backward. NEVER Use Tractor

Power to Rotate the Shaft

Sometimes, It May Be Best to

Transport a Stabilized Victim

Still Entangled With Part of the

PTO Shaft. Extrication Can Be

Completed by a Surgeon Under

Trauma Center Conditions and

Preventing Further Neurological

Vascular Injury

All Amputated Tissue Should Be

Transported With the Patient

Spine Injuries Are Common in

PTO Entanglements. Apply Full

Spinal Immobilization

Cut Clothing off Patient If

Restricting Breathing

Augers

Same As PTO

Make Sure Power Is Cut to

Auger

Questions / Comments

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Tractor Implements Rotary Mowers / Bush Hog

Rotary Mowers / Bush Hog

Type Injuries

Run Over

Amputations/lacerations

Fractures

Crush

Thrown Objects

PTO Shafts

Death

Hay Bailer High Incidence of Extremity

Injury

Crush / Amputation

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Round Bales Can Weight

1200 + Pounds

High Risk of Crush Injury and

Death From Implement.

Combines and Corn Pickers

Risk of Bystander Run Over

Entanglement in Moving Parts

{Belts / Header / Cross Auger /

Snapping Rollers}

Carbon Monoxide

Fires

{Dust / Fuel Leaks / Over

Heated Bearings / Electrical}

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Injuries May Include

Fractures / Burns

Lacerations / Amputations

Crush Injury / Death

Entanglements May Involve Only

a Hand or Foot, or May Involve

the Entire Body.

Rescue Procedures Shut off Power and Block

Wheels to Prevent Movement.

If Header Is Involved, Support

the Header to Prevent Settling or

Lowering. A Header Can Weight

up to 6,000 Pounds.

Determine the Seriousness of

Injury and Plan Extrication.

Always Keep a Charged Fire

Hose and Extinguisher Ready for

Immediate Use.

Patients Entangled in a Drive

Belt Can Be Freed by Cutting the

Belt. If Clothing Is Caught in a

Shaft or Pulley, It May Be

Possible to Manually Reverse the

the Shaft or Cut Clothing Free.

If Patient Is Trapped Beneath the

Header, It May Be Possible to

Free the Patient by Digging. The

Header Can Also Be Lifted off

Patient With Air Bags or Jacks.

Use a Wide Base to Prevent

Jacks From Sinking Into the

Ground. Continue to Add

Support Cribbing As the Header

Is Lifted to Prevent Fall.

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DO NOT Raise the Header With

the Machines Hydraulics. The

Header Came Down on the

Patient for a Reason, Which

Might Be Faulty Hydraulics!

The Cross Auger Can Be

Manually Reversed by Removing

the Drive Belt or Chain and

Turning the Shaft With a Pipe

Wrench. The Shields Will Have

to Be Removed to Access the

Belt or Chain. The Auger Can Be

Adjusted Upward to Relieve

Some Pressure off the Patient.

Snapping Bars and Snapping

Rolls May Be Spread by

Loosening Them With Hand

Tools.Headers Are of Heavy

Construction, the “Jaws of Life”

Will Not Be Able to Spread

Rollers and Augers From the

Frame of the Header. Cutting Is

Also Very Difficult Due to the

Cast Iron Material Used.

Call the Local Equipment Dealer

and Request Assistance With

Disassembly of the Machine.

Consider Calling a Trauma

Surgeon to the Scene to

Amputate the Limb If

Appropriate to Save Life.

Insert Wedges Between Rollers

While Spreading to Prevent Snap

Back.

DO NOT Use Chains or Cables

in Attempt to Spread the Frame.

The Cables or Chains May Slip

or Break Without Warning

Causing Further Injury to Patient

or Crew.

Front Loaders

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Front Loaders con’t

• Risk for crush injury.

• Increase risk of tractor roll over with

elevated and unbalanced loads.

• May have multiple attachments.

• If patient trapped under loader, treat as if

hydraulic failure.

• May become pinned between loader and

tractor.

Modern tractor safety design

Questions / Comments Grain Bins / Manure Pits

Suffocation Is the #1 Cause of

Death Involving Grain Bin

Accidents.

Always Assume That the Person

Trapped in the Grain, Even If

Completely Submerged, Is Alive.

Accident Causes

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Accident Causes Con’t

Crust Bridges

Entering Grain Bin While Auger

Running

Carbon Dioxide

Dust Explosions

Rescue

If Completely Submerged, Rapid

Extrication Is Critical for

Survival.

Rapid Evacuation of Corn / Grain

by Cutting 3 Large Triangle

Shaped Cuts at Bottom of Bin at

120 Degrees for Even Fast

Removal of Contents. All 5 Feet

Above the Base.

An Air Chisel or Abrasive Saw

May Be Used. Use a Cutting

Torch As Last Resort Due to

Explosion Hazard.

If Partially Submerged,

Never Use a Rope to Remove

Victim If Submerged Above the

Knees, This Will Only Cause

Further Injury.

Cut Power to Auger

Turn on Dryer Blower and

Ventilation Fans to Move Fresh

Air Into the Bin.

Wear Mask or SCBA If O2

Deficient.

Wear Safety Harness If Entering

the Bin.

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Use Spine Boards or Other Wide

Material Across Top of Grain to

Move Across Grain to Victim to

Prevent Rescuer From Sinking.

Use a Drum With Both Ends

Removed to Place Around

Victim to Decrease the Force of

the Grain off Victim and Enable

Digging the Victim Out.

Manure Pits

High Risk of Toxic Gasses

#1 Is Hydrogen Sulfide

and Methane.

NEVER Enter a Pit Without

SCBA.

NEVER Lower a Fan Into a

Underground Storage Area for

Added Ventilation Because

Sparks From the Motor Could

Cause Methane Gas to Explode.

Questions / Comments

Large Livestock Injury

Bulls / Cows

Horses / Mules

Pigs / Other

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Cattle: High Risk of Crush Injury

Head / Chest / Abdominal

Death

Horses: High Risk of Riding

Injuries From Falls.

Spinal Injuries

Fractures

Chemicals

Anhydrous Ammonia

Gas / Diesel / Hydraulic

Solvents / Weed Killer and

Insecticides

Other

Organophosphates / Pesticides

• Most used because they are more

environmentally safe than DDT.

• Over 40 different brands on the market.

• Pathophysiology: Acetylcholinesterase

inhibiting. Increase in acetylcholine in

cholinergic synapses.

• Used in military nerve agents.

Organophosphates con’t

• The bond between organophosphates and

AChE become irreversible after 24 to 72

hours.

• Absorbed from the skin, lungs and GI tract.

• Increased risk of immediate toxicity,

increase risk for death.

• Reported over 1700 hospitalizations

annually.

Signs / Symptoms

• Respiratory depression, Bradycardia,

diaphoresis, diarrhea, urination, miosis,

emesis, lacrimation, salivation, weakness,

chest tightness, wheezing, seizures, head

ache. Hypotension.

• History of organophosphate exposure.

• Increase with patient with hx of low levels

of AChE.

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Treatment considerations

• Immediate airway control and ventilations

• Atropine 1-2 mg IV, IM, ETT

• Pralidoxime {2-Pam} 1-2 grams IV over 15

to 30 minutes.

• Decontaminate with soap and water.

• If intubated may require Lasix and PEEP

for pulmonary edema.

• Succhinylcholine contraindicated for RSI.

Crew protection

• Decontaminate patient and self as needed

with soap and water.

• Level “C” PPE should be utilized.

• Use rubber gloves, vinyl gloves provide no

protection against oganophosphates.

• Avoid contamination!

Dioxin / herbicides

• Not usually acute, absorbs over long time

exposure. Most common in industrial

exposure, heavy farm use, contaminated

foods.

• Increase risk of cancer.

• Most acute S/S are GI tract, nausea,

vomiting, diarrhea and abdominal pain.

• Treatment supportive.

Remove Patient From the

Environment

Remove Clothing

Decontaminate With Water If

Chemical Not Reactive to Water

Keep Warm

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Medical

AMI

CVA

Heat Stroke / Exhaustion

Diabetic

COPD

Anaphylaxis

Burns

Chemical / Thermal

Remove Patient From the

Environment

Remove Clothing

Stop Burning Process

Airway and Fluid Support

Dry Dressings

Farms are high risk for fires

Electrocution

Lightning Strikes

Falls

Electric fencing

Control unit

Multiple strand high tinsel

fencing

Falls

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A/ Airway / C-spine / ETT

B/ Breathing Rate / Depth

02 100% NRM / BVM

C/ Circulation /Crystalloids

/ Blood. 2 Large IVs

D/ Disability / LOC

E/ Expose / Cut Clothing

Extricate

F/ Keep Warm / Covered

Full Spinal Immobilization

Air Medical Transport /

Helicopter

Trauma Center

Debrief

Questions / Comments

timothy.perry@erlanger.org

Cell: 931-260-4661