ed5 - agricultural health

7/29/2019 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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Machinery (cont.) Hydraulic injection

Pressure Temperature

Pinch points


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Animal injuries Aggressive animals

New mothersAdolescent malesAdult males

Size difference

2500 pound bull 75 pound child


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Animal injuries (cont.) Spooked animals

Wild animals Startled animals

Other

Working/processing animals Needle sticks

Stupid tricks


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Confined spaces Grain bins

Engulfment hazards Quicksand

Bridging

Avalanche

Grain vacuum

Suffocation Hypothermia


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Confined spaces (cont.) Silos

Conventional Mechanical hazards

Nitrogen dioxide (silo gas)

Falls

Oxygen limiting Reduced oxygen Mechanical hazards

Falls


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Confined spaces (cont.) Manure pits

Hydrogen sulfide (H2S) Drowning

Tanks

Assorted hazards


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Agricultural chemicals Pesticides

Herbicides Insecticides Rodenticides Fumigants


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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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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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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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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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What do you tell them? What all would you suspect?

How do you want this patient transported?


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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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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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What might be going on with this patient? What additional treatment do you want?


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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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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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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



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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



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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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Dyspnea worse with dust exposure Fever and flu-like symptoms

Moving and sortinghogs a challenge

Hog flu


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Cleaning out grain bin Used disposable respirator

Took respirator off brieflyduring work

No symptoms during work or immediately

after


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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

ed5 - agricultural health

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