Evaluation of agricultural rescue course by providers.

STUDY OBJECTIVE: To assess the characteristics of rural emergency medical services providers involved in the prehospital care of victims of agricultural injuries and determine which aspects of an agricultural rescue course were perceived as most useful. DESIGN: A questionnaire was sent to participants of a course designed for agricultural prehospital providers who had attended a farm accident rescue course between 1986 and 1993. SETTING: A rural referral center in central Wisconsin. PARTICIPANTS: The questionnaire was sent to all persons who had participated in the course. Respondents to the questionnaire characterized their service experience and rated the topic areas in usefulness and whether the subject should be included in future courses. RESULTS: A total of 459 surveys (44% of potential respondents) was returned. Of the respondents, 316 (74.4%) were men, and the mean age was 39.4 years. There were 247 (60.8%) who were volunteers, and an additional 126 (31%) were paid, on-call workers. There were 232 (56.4%) basic providers, and 365 (87.5%) were from a rural area. Many (n = 149; 36.9%) had not responded to farm accidents during the past year. Training course topics rated most useful were machinery extrication, tractor overturn, and enclosed-space rescue. CONCLUSIONS: Respondents to an evaluation of an agricultural rescue course primarily were rural, basic providers. Future development of courses for emergency medical technicians involved in agriculture rescue must account for this level of training. Such courses should be short and modular with an emphasis on continuing education, practice, and focus on the identified needs of the participants.

The relationship of farm residency status to demographic and service characteristics of agricultural injury victims in central Wisconsin.

This study performed a surveillance of a defined population in central Wisconsin during a two-year period that included six months of follow-up. The study included those who worked and lived on farms and those who only worked on farms. The injury rate for farm residents was 3.15 injuries per 100 persons per year. However, 195 of the 510 injuries (38.2%) involved persons who were not farm residents. For nonfarm residents, 88.7 percent of the victims were male, whereas for farm residents 79 percent of the victims were male. More than one half of the farm residents who were injured were the owners and an additional 21 percent were juvenile children. Of those aged 18 to 29 years, 51.3 percent were nonfarm resident victims and 15.2 percent were farm resident victims. Of nonfarm residents, 41.1 percent were married; of farm residents, 65.3 percent were married. More than one half of all injured nonfarm residents were seen within two hours of injury while one quarter of the injured farm residents were seen more than 24 hours after the injury. Only 4 percent of the injured farm residents were self-insured, but 15 percent of the nonfarm residents were self-insured. However, the time of injury, actual injuries, diagnoses rendered, and services received were similar for injured farm residents and injured nonfarm residents. Effective attempts to intervene on agricultural injuries will need to consider different risk factors for injuries for nonfarm residents as compared to farm residents.

Prehospital care of agricultural injuries.

In the United States, farming has become one of the most dangerous occupations. There are unique challenges for the providers of prehospital care to victims of agricultural trauma. The machinery and the work environment associated with agricultural trauma are different from those encountered in other occupations. The unique features of the machinery and risks are discussed. In addition, solutions unique to the problems of agricultural prehospital care are discussed. Effective care of the victims of agricultural trauma has a potential to reduce morbidity.

The spectrum of emergency care of agricultural trauma in central Wisconsin.

Agriculture is among the most dangerous occupations in the United States. When injuries do occur, the emergency department (ED) is the primary source of care. Over a 2-year period, the emergency medicine section of the Marshfield Clinic/St Joseph's Hospital, cared for 913 victims of agricultural trauma. Although 11% were initially admitted and 4% were later treated, the remainder received their care solely in the ED. Unlike most occupational injuries, people of any age may be involved in agricultural injuries; 27% in this series were less than 18 years of age and 5% were 65 years or older. Just over half of all injuries were from mechanical devices, including tractor and farm machinery. The remainder were from animals, falls, or exposure. Although several different types of injuries occurred, the most common diagnoses were soft tissue injuries and fractures and the most common procedure was diagnostic radiography followed by wound and fracture care. An ED in a rural setting should be prepared to deal with agricultural trauma.

Bilateral humeral fractures from electrically induced muscular spasm.

Various injuries have been attributed to electrical injury. Low voltage current, especially alternating current, can lead to sustained muscular contraction and subsequent fracture of adjacent bones or dislocation of affected joints. We present the case of a 57-year-old male who suffered electrical injury from hand to hand. He did suffer bilateral humeral head fractures but did not suffer cardiac or long-term neurologic injury. Failure to recognize that sustained muscular contraction can lead to fracture or dislocation can result in delayed diagnosis and inappropriate therapy. However, with prompt diagnosis and appropriate therapy, morbidity can be minimized.