Pediatric Fall Injuries in Agricultural Settings: A New Look at a Common Injury Control Problem

Injuries and illnesses to children in commercial fishing in Alaska: A brief report

BACKGROUND

Commercial fishing is the most hazardous occupation in the United States. While the epidemiology of adult injuries and fatalities are well documented, injuries to children (<18 years old) are not described. The purpose of this report was to describe the characteristics of nonfatal injuries to children involved in commercial fishing.

METHODS

Nonfatal commercial fishing injuries to children were identified in the Alaska Fishermen's Fund. The Alaska Fishermen's Fund is an emergency fund payor of last resort. Data on nonfatal injuries to victims aged 17 or younger were analyzed. Descriptive statistics were used to characterize demographics and injury characteristics.

RESULTS

Forty-four nonfatal child injury claims were made between 2012 and 2016. The mean age at the time of claim was 15.6 years (SD = 1.8) and 84% were male. The most common types of injuries among children were sprains and strains and the most commonly injured body parts were upper extremities and the trunk. Most injuries occurred in salmon fisheries.

CONCLUSIONS

Children are participating in commercial fishing. Based on the results of this analysis, children are also experiencing occupational injuries. The results of this analysis underscore the need for additional safety and health information, guidance for supervisors, and intervention to prevent injuries to children participating in commercial fishing.

Preliminary results of a novel hay-hole fall prevention initiative

BACKGROUND

Hay-hole falls are a prevalent source of trauma among Anabaptists-particularly Anabaptist youth. We sought to decrease hay-hole falls in South Central Pennsylvania through the development and distribution of all-weather hay-hole covers to members of the at-risk Anabaptist community.

METHODS

Following the creation of a rural trauma prevention syndicate, hay-hole cover prototypes co-designed and endorsed by the Pennsylvania Amish Safety Committee were developed and distributed throughout South Central Pennsylvania. Preintervention and postintervention surveys were distributed to recipients to gain an understanding of the hay-hole fall problem in this population, to provide insight into the acceptance of the cover within the community, and to determine the efficacy of the cover in preventing falls.

RESULTS

A total of 231 hay-hole covers were distributed throughout eight rural trauma-prone counties in Pennsylvania. According to preintervention survey data, 52% of cover recipients reported at least one hay-hole fall on their property, with 46% reporting multiple falls (median fall rate, 1.00 [1.00-2.00] hay-hole falls per respondent). The median self-reported distance from hay-hole to ground floor was 10.0 (8.00-12.0) feet, and the median number of hay-holes present on-property was 3.00 (2.00-4.00) per respondent. Postintervention survey data found 98% compliance with hay-hole cover installation and no subsequent reported hay-hole falls.

CONCLUSION

With the support of the Pennsylvania Amish Safety Committee, we developed a well-received hay-hole cover which could effectively reduce fall trauma across other rural communities in the United States.

LEVEL OF EVIDENCE

Epidemiological study, Level III.

Social environments, risk-taking and injury in farm adolescents

Background

Farm environments are especially hazardous for young people. While much is known about acute physical causes of traumatic farm injury, little is known about social factors that may underlie their aetiology.

Objectives

In a nationally representative sample of young Canadians aged 11–15 years, we described and compared farm and non-farm adolescents in terms of the qualities of their social environments, engagement in overt multiple risk-taking as well as how such exposures relate aetiologically to their reported injury experiences.

Methods

Cross-sectional analysis of survey reports from the 2014 (Cycle 7) Canadian Health Behaviour in School-Aged Children study was conducted. Children (n=2567; 2534 weighted) who reported living or working on farms were matched within schools in a 1:1 ratio with children not living or working on farms. Scales examining quality of social environments and overt risk-taking were compared between the two groups, stratified by gender. We then related the occurrence of any serious injury to these social exposures in direct and interactive models.

Results

Farm and non-farm children reported social environments that were quite similar, with the exception of overt multiple risk-taking, which was demonstrably higher in farm children of both genders. Engagement in overt risk-taking, but not the other social environmental factors, was strongly and consistently associated with risks for serious injury in farm as well as non-farm children, particularly among males.

Conclusions

Study findings highlight the strength of associations between overt multiple risk-taking and injury among farm children. This appears to be a normative aspect of adolescent farm culture.

Childhood Injuries Due to Hay-Hole Falls: A 19-Year Experience at a Rural Pediatric Trauma Center

OBJECTIVE

Children who live, work, and play on farms with barn design that includes hay-holes are at risk for a particular type of fall. This study retrospectively reviews all children admitted to a pediatric trauma center with injuries due to fall through a hay-hole over a 19-year period. This study is the first to specifically describe hay-hole fall injuries.

METHODS

A retrospective review from a 19-year period at a rural pediatric trauma center identified 66 patients who sustained injuries from a hay-hole fall. Charts were reviewed for patient demographics, injuries, interventions, and hospital course.

RESULTS

Sixty-six patients sustained injuries from hay-hole falls. Median patient age was 4 years, and median Injury Severity Score was 14. Forty-one percent of patients were admitted to the intensive care unit, and 26% of patients were intubated. Injuries included skull fracture (73%), facial fracture (27%), intracranial hemorrhage (53%), and noncraniofacial injuries (12%). Eighteen percent required a therapeutic intervention. There was 1 fatality (2%).

CONCLUSIONS

Hay-hole fall appears to be a distinct injury mechanism, and patients present with different injury patterns than other types of falls. In this study, a high proportion of patients were young, and craniofacial injuries accounted for the majority of injuries. Only a small proportion of patients sustained noncraniofacial injuries. Injury prevention strategies should be targeted to this unique agrarian injury.

Hospitalized head injuries in agricultural settings: who are the vulnerable groups?

OBJECTIVES

The goal of this study was to identify subgroups of the farm population that are particularly vulnerable to head injury.

METHODS

A retrospective case series of hospitalized head injuries was assembled from a national registry of agricultural injuries. Vulnerable subgroups were identified based on a priori criteria and the causes and consequences of their injuries were profiled.

RESULTS

Three distinct subgroups of farm people were identified as being vulnerable: (1) farm children under the age of 10, injured most frequently by a fall from a structural height (42.5%); (2) females 10-19 years, injured most frequently by large animals (68.8%), mainly horses, and (3) men over age 60 years, who were injured by a diversity of mechanized and animal-related external causes.

CONCLUSION

This identification of vulnerable groups provides foundational information from which to develop and direct prevention efforts.