Falls and Other Traumatic Injury

Falls and other Traumatic Injuries While the physical injuries that result from agricultural work are generally similar to injuries occurring in other contexts, occupational injuries may have unique characteristics. Most often, occupational injuries are the predictable outcome of the combination of a the work environment, farm-level work practices, and individual worker behavior. The clinician has an important role in making the farmworker patient aware of the range of contributing factors, and to assist him/her in considering what factors might reasonably be altered to prevent re-injury. Of concern is that an injured worker may well be more vulnerable to future injury.

Falls (from height and at ground level), machinery and animals related injury account for most of the serious and fatal traumatic farmworker injuries. The WORKSITE VISIT section of this website is designed to assist the clinician understand the activities involved in the farmworker patient’s work. After an occupational injury occurs, it may be helpful to review the patient’s work task videos to discuss how the injury occurred, and how it may be prevented in the future.

Injury epidemiology provides a model for thinking about the multiple contributing factors that often lead to injury. Three broad categories of factors, “victim characteristics” “injury source (meaning the machine, structure or other thing that does the harm) characteristics,” and “environmental (social or physical environment) characteristics” have been created to help us think about a wide range of factors that combine to lead to injury. The tables below are examples of how falls from a height, slips/trips, and other common agricultural injuries can be analyzed using this model. These lists are not intended to be exhaustive, but rather to show examples of the three types of factors.

Clinical Key Point: Understanding the farm environment may reveal exposures and contributing factors not previously considered. When speaking to patients, suggest some possible contributing factors, and ask them if they can think of others. If you can identify multiple causes, there is a greater chance that you will find some over which the farmworker patient may have some control.

Common factors in agricultural falls

Falls from a height
Common Victim Characteristics	Injury Sources and Their Characteristics	Work Environment Characteristics
Fatigue Lack of knowledge of how to do the job Leaning off of ladders onto branches, other structures Not accustomed to climatic conditions Improper footwear Mental health / substance abuse Other underlying health conditions	Ladders that are broken or placed on wet, slippery or soft ground Ladders that are the wrong size for the job Walls, roofs, or other structures that are not sturdy enough to hold a worker Machinery (such as front loader bucket, or side of tractor) not designed for standing or climbing	Wet or frozen ground under ladder Workers are allowed to (or expected to), ride as extra riders on tractors to stand in the loading bucket to work at a height without fall protection Pressure to work at high speed Poor relationship with manager and/or poor communication

Slips, trips and other ground-level falls
Common Victim Characteristics	Injury Sources and Their Characteristics	Work Environment Characteristics
Improper footwear Fatigue Previous injury or illness Lack of knowledge of how to do the job Not accustomed to climate	Tripping can occur when source is placed in a new location Spills; wet and/or slippery surfaces Steep or unsafe stairway surface Uneven or rough walkways or floors, Places where ice accumulates Tripping can occur when source is placed in a new location Spills; wet and/or slippery surfaces	Long work hours with little or no break time Areas with poor lighting Poor housekeeping, including objects left out on floors, stairs or in walking areas Loading docks and drop-off areas Fields and orchards (uneven, slippery) Poor relationship with manager and/or poor communication Long work hours; little break time

Other common traumatic injuries – (machinery, animal)
Common Victim Characteristics	Injury Sources and Their Characteristics	Work Environment Characteristics
Fatigue Lack of knowledge of how to do the job Not accustomed to climatic conditions Improper footwear Mental health / substance abuse Other underlying health conditions Language barriers	Machinery that does not have the usual safety guards (tractor roll bars, PTO shaft shields) Hostile or disturbed animals; animals in heat Machinery that is broken or being used in a way that it was not intended	Long work hours with little or no break time Animal facilities not designed to separate workers from animals Workers are allowed to (or expected to) use machinery without safety guards or training Workers fear manager or employer

Further Farmworker injury related links:

Treatment and return to work, by M Rowland, Migrant Clinicians Network
Workers compensation, by S Davis, Migrant Health Newsline.

Farmworker injury prevention and education links:

NYCAMH Fall prevention (English)
NYCAMH Preventing slips, trips and falls (English)
NYCAMH Winter slips, trips and falls (English)
NYCAMH Animal safety (English) and Back to Common Farmworker Health Conditions and Diagnostic Tools