Safety: The dark side of farming
The statistics on fatalities and accidents reflect the ever-present workplace dangers for farmers
A farmer is eight times more likely to die in his or her workplace than a worker from the general population. It may be shocking but the statistics don't lie.
Thirty people lost their lives on Irish farms in 2014 - the highest number of deaths in over 20 years. The number so far this year is 16, according to the Health and Safety Authority (HSA) figures.
More than 200 people, including 25 children, have died on Irish farms in the past decade.
According to the HSA, farming as an industry has been accountable for more than half of all workplace related fatalities and accidents in this time.
Workplace deaths on Irish farms stood at 15.9 per 100,000 population in 2013, compared with an average of 2.1 fatalities per 100,000 in the general working population.
Over the years, July has consistently proven the most dangerous month on a farm, coinciding with a busy time for machinery activity.
The extraordinarily-high fatality rate associated with Irish farming has quite rightly come under the spotlight in recent years in terms of media campaigns and safety initiatives.
However, I would argue this is only half of the story in terms of the dark side of Irish farming.
Each year there are about 2,500 non-fatal farm accidents reported. These can be really life-changing injuries such as losing a hand or a leg as a result of a power take-off entanglement.
Each year the National Rehabilitation Hospital in Dun Laoghaire, Dublin, sees a stream of farmer inpatients get fitted for a prosthetic leg or arm in a bid to learn how to adapt to life after a serious accident.
While loss of life might be avoided, the cold truth is that these are the kinds of injuries that can effectively end a farming career.
As a medical student, one of my rotations was in the National Rehabilitation Hospital, a place full of inspirational survivor stories. Talking histories on the wards, I remember being struck by meeting so many inpatients with farming backgrounds who would vividly describe to me how their accident happened.
Machinery came up again and again as the cause for lots of below-knee amputations, fractures and de-gloving injuries, where skin is torn off from underlying tissue.
It was inspiring to see the drive these patients had when faced with such a defining moment in life, but I couldn't get away from the uncomfortable reality that farming as an occupation was heavily over-represented.
Mechanism of injury
Teagasc conducted a national survey of farm injuries in 2011. John McNamara, author of the paper and safety officer with Teagasc, found that the number of farm injuries had increased by 35pc over the survey's five-year period from 2006 to 2010, with 2,459 injuries per 100,000 farms reported for year 2010 compared to 1,815 injuries for 2006.
The vast majority, around 95pc, of reported injuries required medical treatment. Of these, 49pc required hospital inpatient treatment and 36pc required hospital A&E treatment.
Unlike other professions, farmers often tend to work in isolation and have no co-workers in their immediate vicinity to alert emergency services when something goes wrong.
This simple fact unfortunately means an injury, which with even basic medical intervention would not usually be life threatening, such as direct trauma to an upper limb as a result of coming into contact with the tractor's power take-off shaft, can quickly deteriorate and become fatal.
In the absence of any form of assistance or method of calling help, uncontrolled bleeding will lead to shock, hypotension and loss of blood, leading to death. The upper and lower limbs tend to be most vulnerable, especially when the victim is wearing loose-fitting clothing.
Invariably, tractors and machinery are the single biggest cause of farm fatalities and accidents each year. Tractors overturning, leading to serious chest-abdominal and head injuries, and/or death, are very common. Rolling and crushing injuries, where the farmer is rolled over by a tractor or trailer, are also common.
The second biggest cause of farming accidents and fatalities is livestock. The type of tissue and bone injury seen in livestock-related accidents are mostly crush injuries, but also abdominal injuries and injuries to the upper and lower limb.
Death and organ failure often results from extensive internal bleeding. Farmers who survive a livestock attack tend to have had a family member nearby when the attack occurred.
For such a lonely profession as farming, perhaps this one fact underlines the importance of carrying a mobile phone at all times.
All-terrain vehicles (ATVs) are very common on Irish farms. Unlike tractors, and to the dismay of many health campaigners, these vehicles are not yet legally required to have rollover protection bars fitted.
The result is that when an ATV overturns, there is no cab or support structure to protect the driver's head and upper body.
Whether wearing a helmet or not, this means the driver's head and spinal column are at major risk of serious injury on overturning.
Such has been the widespread and serious nature of injuries sustained from ATV accidents, leading spinal surgeons across the globe have called for reform of the legislation surrounding the use of ATVs.
A 2008 US study found the main mechanism of spinal cord injury from an ATV related accident is an axial compression-type fracture. In this type of injury, excessive vertical force is placed on the spine, forcing pieces of broken vertebrae to move outwards in a horizontal direction.
The injury location is usually between C1 and C5 level of the spine, a crucial area, with long-term neurological damage highly likely.
Apart from spinal injuries, other common injuries sustained from ATV accidents include facial lacerations and fractures of the skull or facial bones.
Elderly farmers comprise the biggest share of both accidents and fatalities on Irish farms every year, with a high proportion occurring in the winter months.
This is due in part to the absence of proper succession planning for younger family members taking over.
What can be done?
At farm level, the most simple and readily-fixable advice for farmers is to always carry a phone.
Where possible, let someone know where you are going and when you will be back so help can be raised if you don't return.
At a national level, I strongly feel it is time to start delivering more shocking messages along the lines of the road safety campaigns.
Farmers need to see the types of injuries sustained every week in Ireland. What might this involve? Whatever must be done to catch attention should be done.
The Road Safety Authority's strategy of shocking TV ad campaigns have been an unequivocal success in terms of reducing deaths on our roads. I can't think of any reason why it wouldn't work for farm deaths and injuries as well.
Derek Casey is a junior doctor in Orthopaedics in University Hospital Waterford
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