Tractors and rollover protection in the United States

Tractor Injuries in the Upper Midwestern United States: a retrospective analysis of four trauma centers

OBJECTIVES

The purpose of the present study was to characterize the incidence, injury characteristics, and outcomes of patients presented to four trauma facilities located in the upper Midwest with tractor-related agricultural injuries.

METHODS

We performed a retrospective review of the facility level trauma registries of four trauma centers located in North Dakota, South Dakota, and Minnesota between January 1, 2010 and December 31, 2021. We characterized the incidence, severity and outcomes of traumatic tractor-related agricultural injuries for pediatric and adult patients. We described the nature of these injuries by severity, anatomical site, type, age, sex, and length of stay (LoS). Injury severity was evaluated using Injury Severity Score (ISS) and Abbreviated Injury Scale (AIS).

RESULTS

Findings indicated that farmers aged 65 and older experience polytraumatic, severe tractor-related agricultural injuries and fatalities. Of the 177 tractor patients analyzed, 40 patients were between the ages of 65 and 74 years and 45 patients were 75 and over. Male farmers aged 65 and older are injured year-round, many are discharged to skilled nursing facilities for additional care, are spending more time in the hospital, and have the highest rate of critical injuries out of all age groups. Moreover, the patients who died as a result of tractor-related agricultural injuries were men over 65 years. The most common tractor-related agricultural injuries include falls from tractors (n = 53), struck by object falling/propelled from tractor (n = 25), rollovers (n = 26), and runovers (n = 24). Falls from tractors accounted for 33% of all tractor-related upper extremity fractures, 36% of head injuries and 29% of chest injuries.

CONCLUSION

The findings from this study indicate that tractor-related agricultural injuries represent a significant problem in the upper Midwest. Older, male farm workers experience a higher incidence of tractor-related agricultural injuries, and all tractor-related fatalities occurred in individuals 65 years of age and older. These results underscore the need for further investigation into aging-related farm safety issues.

Tractors, Trees, and Rollover Protective Structures: A Cause for Concern

Injury and fatality events that are caused by tree work and tractor-related activities contribute to the already elevated rates of work-related injuries in the agriculture and logging sectors. This brief report highlights the circumstances surrounding these events, as well as a number of surveillance sources that identify the extent to which they contribute to the injury burden in these hazardous industries. These data sources include fatality investigations, agricultural injury news reports, consumer product injury data captured from emergency rooms and near-miss reporting data captured from individuals participating in the National Rollover Protective Structure Rebate Program (NRRP). Several recommendations for further research and interventional efforts are outlined, with particular consideration of the manner in which rollbars have been involved in falling object incidents.

Farm Machinery Injuries: A Retrospective Analysis of Admissions at a Level I Trauma Center in North Dakota

OBJECTIVES

The purpose of the present study was to characterize the incidence, injury characteristics, and outcomes of patients presented to a Level I adult trauma center in Fargo, North Dakota, with farm machinery injuries (FMI).

METHODS

We performed a retrospective review of the trauma registry of Sanford Medical Center Fargo (SMCF) between January 2010 and December 2020. We compared admission characteristics of FMI admissions to non-FMI admissions, identified the types of machinery that are most commonly associated with FMI, and described the nature of these injuries by severity, anatomical site, type, age, sex, and length of stay (LoS). Injury severity was evaluated using Injury Severity Score (ISS).

RESULTS

Findings indicated that FMI admissions had a higher mean ISS, longer ICU LoS, and a higher mortality rate than non-FMI admissions. The leading cause of fatal and non-fatal FMI in this region are tractors. Males experience 91.2% of tractor injuries, and individuals 65 and over account for nearly 53% of all tractor injuries (n = 18). Males accounted for all deaths, tractor and otherwise. The "other machinery" category was the second most common category and accounted for 50% of female patients. Additionally, 24.5% of all FMI are related to machine maintenance.

CONCLUSION

The findings from this study indicate that FMI injuries represent a significant problem in the upper Midwest. Older, male farm workers experience a higher incidence of tractor-related injuries, and all tractor-related deaths occurred in individuals 65 years of age and older. These results underscore the need for further investigation into aging-related farm safety issues.

ROPS commentary-Addressing our fatal blind spot: Applying evidence-based solutions to reduce the most frequent cause of death on U.S. farms

Tractor overturns are the most prominent contributing factor to death on U.S. farms and have been for decades. While public health researchers hypothesized years ago that overturn fatalities would largely disappear as older tractors were replaced by newer ones, this has not happened. In the meantime, farmers continue to die in these easily preventable and tragic events. Not only are tractor rollover protective structures (ROPS) 99% effective in preventing death in the event of an overturn, a national program exists to connect farmers with ROPS. While this program has been popular with farmers, and the cost-effectiveness of providing farmers with technical support and cost-sharing rebates has been demonstrated, many states lack access to ROPS rebates, even those states with the highest number of overturn fatalities. Given the evidence, it is difficult to reconcile the lack of policy or public investment in a solution that decisively addresses the most pernicious contributor to death in the agricultural industry. In this commentary, we highlight the science behind this proven solution to tractor overturns and the essential role that the media and implementation science can play in encouraging policy-makers to save lives.

Trends in Work-Related Fatal Farm Injuries, Saskatchewan, Canada: 2005-2019

OBJECTIVES

This study was conducted to estimate farm fatality rates and to describe patterns of fatal agricultural injuries on Saskatchewan farms from 2005-2019.

METHODS

Data on work-related farm fatalities was collected from January 2005 to December 2019 in the Province of Saskatchewan as a part of the injury and mortality surveillance for the Canadian Agricultural Injury Reporting (CAIR) program. Data were abstracted from records made available by the Provincial Coroner's Office.

RESULTS

There were 166 farm work-related fatalities recorded between 2005 and 2019 in Saskatchewan. The majority (93.4%) of work-related fatalities were in males. The overall work-related fatality rate was 10.5 (95% CI: 8.9-12.1) per 100,000 farm population. The overall age-adjusted work-related fatality rate was 18.1 (95% CI: 15.2-20.9) per 100,000 farm population among males and 1.4 (95% CI: 0.6- 2.3) per 100,000 farm population among females. Age-adjusted rate decreased from 91.2 (95% CI: 69.4 - 117.66) per 100,000 farm population in 2005-2009 to 89.7 (95% CI: 64.9 - 120.2) per 100,000 farm population in 2015-2019 in males. Trend analysis of the work-related fatality rate in all cases showed a non-significant average annual decline of 2.6% (p=0.156). Rollover injuries contributed to a high proportion of fatalities in children (30.0%) and the elderly population (14.9%). The most common causative agent was a tractor, and the most common location of injury was the farmyard or field.

CONCLUSION

The burden of mortality in this industry is still substantial. There was a non-significant decreasing trend in the injury rate over the 15 years period. Elderly farmers continue to be at high risk for fatality while the rates for children have declined. Application of the hierarchy of control to this workplace could reduce the risk of fatal injury, and in particular the high proportion of rollover injuries in children and the elderly population.

More than time and money: A mixed-methods study of the barriers to safer cattle handling practices

BACKGROUND

Cattle are responsible for more injuries and fatalities than any farm animal, and cattle-related nonfatal injuries are some of the costliest, requiring more time off work than other injuries. Though research has improved our understanding of cattle behavior, developed low-stress handling practices, and determined how facilities can be safer, injury rates remain high. This project identified the types of equipment commonly used on farms and assessed farmer perceptions of safety and barriers to implementing changes.

METHODS

A mixed-methods design was used for this study. The study was comprised of a survey (N  = 66) and four site visits conducted at operations focusing on different types of beef production in Iowa, United States. Information collected included descriptive characteristics of the operator and operation, tasks carried out on the farm, handling facility components and design, and incidents of handling-related injuries.

RESULTS

Most farms indicated that they utilized equipment like alleyways, a manual headgate, a sorting/diverter gate, and a manual squeeze chute. Farmers cited the cost of equipment, lack of necessity (their setup worked well already), and lack of time as being the main reasons they have not implemented changes in their operations. However, qualitative responses provided additional details and nuance, illuminating farmers' anxieties related to farm transitions, knowledge, and trust of equipment sales personnel.

CONCLUSION

This study provides health and safety professionals with additional details about why beef cattle producers may choose not to invest in safer handling equipment, even when they recognize the safety benefits of doing so.

Rollover Protective Structures, Worker Safety, and Cost-Effectiveness: New York, 2011-2017

OBJECTIVES

To measure cost-effectiveness of an intervention to increase retrofitting of rollover protective structures (ROPS) on tractors.

METHODS

Tractor overturns are the leading cause of farm fatalities. ROPS prevent these deaths. This study updates a 2011 cost-effectiveness assessment of a New York State intervention to increase use of ROPS. We subtracted intervention cost from the cost of injuries averted, then divided this figure by the number of averted injuries. We used related probabilities and costs of fatalities and injuries from published literature to calculate the program's cost-effectiveness.

RESULTS

The total cost of the injuries averted from 2007 to 2017 was $6 018 742 versus a total program cost of $1 776 608. The one-time retrofit costs will continue to prevent injuries as long as the tractors are used, generating additional (projected) future savings of $12 136 512, $15 781 027, and $18 924 818 if retrofitted tractors remain in operation 15, 20, or 25 years after their retrofit.

CONCLUSIONS

Social marketing was cost-effective for reducing injuries from tractor overturns. Public Health Implications. These results indicate that the intervention model is effective from both a public health and economic standpoint and should be expanded into other states.

Adapting the T0-T4 implementation science model to occupational health and safety in agriculture, forestry, and fishing: A scoping review

BACKGROUND

Despite much research to develop life-saving innovations for the agriculture, forestry, and fishing workforce, these populations continue to face the highest fatal and non-fatal injury rates in the United States, as many of these solutions are not fully adopted.

METHODS

A scoping review was conducted to provide an overview of research to practice efforts in this field. The language used to describe these initiatives, the utility of the NIH T0-T4 model, and the progress along the research to practice continuum were examined.

RESULTS

Fourteen eligible references demonstrated that progress in implementation science is lacking and that there is little consistency in how researchers apply the T0-T4 model; thus, a new model is presented.

CONCLUSIONS

Researchers in this field face several challenges when moving from research to practice. While some challenges are addressed with the proposed model, additional resources and infrastructure to support such initiatives are necessary.

Lighting and marking policies are associated with reduced farm equipment-related crash rates: a policy analysis of nine Midwestern US states

OBJECTIVE

To evaluate the effectiveness of roadway policies for lighting and marking of farm equipment in reducing crashes in Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota and Wisconsin.

METHODS

In this ecological study, state policies on lighting and marking of farm equipment were scored for compliance with standards of the American Society of Agricultural and Biological Engineers (ASABE). Using generalized estimating equations negative binomial models, we estimated the relationships between lighting and marking scores, and farm equipment crash rates, per 100 000 farm operations.

RESULTS

A total of 7083 crashes involving farm equipment was reported from 2005 to 2010 in the Upper Midwest and Great Plains. As the state lighting and marking score increased by 5 units, crash rates reduced by 17% (rate ratio=0.83; 95% CI 0.78 to 0.88). Lighting-only (rate ratio=0.48; 95% CI 0.45 to 0.51) and marking-only policies (rate ratio=0.89; 95% CI 0.83 to 0.96) were each associated with reduced crash rates.

CONCLUSIONS

Aligning lighting and marking policies with ASABE standards may effectively reduce crash rates involving farm equipment.

Trends in non-fatal agricultural injuries requiring trauma care

Background

Efforts to control agricultural injuries have been underway for years. Yet, very little is known about their trends over time. We examined trends in non-fatal agricultural injuries through analyzing injuries reported in a state trauma registry.

Methods

Using Iowa Trauma Registry data collected by the Iowa Department of Public Health, we examined trends in non-fatal agricultural injuries reported by acute care hospitals accredited as Level I, II, and III Trauma Care Facilities from 2005 to 2013. Rate ratios and corresponding 95 % confidence intervals were used to examine the burden of non-fatal agricultural injuries across this period. Negative binomial regression was used to calculate the average annual change in agricultural injury rates over time. Joinpoint regression analysis was used to examine the average annual change in the number of injuries over time.

Results

Between 2005 and 2013, a total of 1238 agricultural injuries were reported to the trauma registry by Level I, II and III trauma facilities. From 2005 to 2013, the rate of agricultural injuries per 100,000 hired workers, ranchers, and farm operators increased by 11 % for every unit increase in year and had nearly tripled over this time period. From 2005 to 2008 there was a significant annual increase of 31.74 % in the number of agricultural injuries whereas from 2008 to 2013 there was a non-significant annual increase of 3.70 %. The number of moderate and severe/critical injuries increased steadily and significantly over the study period, with annual percent increases of 13 and 20 %, respectively.

Conclusion

Non-fatal agricultural injuries are rising, although the documented increases could be influenced in some part by treatment patterns in the trauma system, reporting bias or increases in farm work exposure. However, these issues do not likely account for all of the increase found, and this calls for an increase in priority of agricultural safety programs. Since the majority of research involves fatal injuries, information about non-fatal injuries may help inform new intervention approaches.

Field Tests of a Tractor Rollover Detection and Emergency Notification System

The objective of this research was to assess the feasibility of a rollover detection and emergency notification system for farm tractors using field tests. The emergency notification system was developed based on a tractor stability model and implemented on a mobile electronic device with the iOS operating system. A complementary filter was implemented to combine the data from the accelerometer and gyroscope sensors to improve their accuracies in calculating the roll and pitch angles and the roll and pitch rates. The system estimates a stability index value during tractor operation, displays feedback messages when the stability index is lower than a preset threshold value, and transmits emergency notification messages when an overturn happens. Ten tractor rollover tests were conducted on a field track. The developed system successfully monitored the stability of the tractor during all of the tests. The iOS application was able to detect rollover accidents and transmit emergency notifications in the form of a phone call and email when an accident was detected. The system can be a useful tool for training and education in safe tractor operation. The system also has potential for stability monitoring and emergency notification of other on-road and off-road motorized vehicles.

Action Learning: a new method to increase tractor rollover protective structure (ROPS) adoption

Action Learning is a problem-solving process that is used in various industries to address difficult problems. This project applied Action Learning to a leading problem in agricultural safety. Tractor overturns are the leading cause of fatal injury to farmworkers. This cause of injury is preventable using rollover protective structures (ROPS), protective equipment that functions as a roll bar structure to protect the operator in the event of an overturn. For agricultural tractors manufactured after 1976 and employee operated, Occupational Safety and Health Administration (OSHA) regulation requires employers to equip them with ROPS and seat belts. By the mid-1980s, US tractor manufacturers began adding ROPS on all farm tractors over 20 horsepower sold in the United States (http://www.nasdonline.org/document/113/d001656/rollover-protection-for-farm-tractor-operators.html). However, many older tractors remain in use without ROPS, putting tractor operators at continued risk for traumatic injury and fatality. For many older tractor models ROPS are available for retrofit, but for a variety of reasons, tractor owners have not chosen to retrofit those ROPS. The National Institute for Occupational Safety and Health (NIOSH) attempted various means to ameliorate this occupational safety risk, including the manufacture of a low-cost ROPS for self-assembly. Other approaches address barriers to adoption. An Action Learning approach to increasing adoption of ROPS was followed in Virginia and New York, with mixed results. Virginia took action to increase the manufacturing and adoption of ROPS, but New York saw problems that would be insurmountable. Increased focus on team composition might be needed to establish effective Action Learning teams to address this problem.