Farm Safety – considerations for rural GPs.

If you search the internet for “Australia’s most dangerous job”, you will find agriculture, forestry and fishing listed as the most dangerous industries in the country. Many RVTS registrars work in just these sorts of communities, and they need to be prepared for any eventuality. This is why all remote RVTS registrars attend a “Farm Safety Day” at one workshop during their training. The Farm Day is certainly one of the many highlights of the workshop programme where fun and learning meet. The Day is usually held on a working farm, so that registrars can gain a better understanding of the environment where these injuries take place, and can appreciate the difficulties and limitations of providing treatment in such an environment.

As a rural registrar, you may be called on to assist on the scene, as you are often the closest medical provider and the first respondent before other emergency personnel arrive, so understanding and anticipating the possible injuries and difficulties will go a long way in preparing you to improve outcomes in these dangerous industries.

So what can go wrong on a farm? Well, anything really – from minor to major trauma. Some scenarios that we work through on the RVTS Farm Safety Day include:

  • Quad bike Rollover
  • Entrapment
  • Electrocution
  • Blast injury
  • Chemical Exposure
  • Near drowning  

Consider some of the issues you’d need to anticipate in each of these scenarios. There are some factors that are universal: your safety first, call for assistance, primary and secondary assessments. But each of these scenarios have some unique concerns.

In the simulated scene of a Quad bike rollover, some things registrars needed to consider included how to safely extricate a patient from an accident scene, early stabilisation of the patient and packaging of patient for transfer. Your FAST Ultrasound skills will most likely be put to use, as these patients usually present as multi-trauma victims. Head injuries are common, especially if no helmet is worn. You can review some statistics on factors contributing to Quad bike fatalities on the Safe Work Australia Site.

For the entrapment scenario, the learning objectives included understanding the danger of PTO equipment. This may be something you need to consider. Your patients may use tools and equipment that are unknown to you. It’s worth finding out what they use and consider the possible hazards. FYI – a PTO is a Power Take Off  – a  device which transfers mechanical power from an engine to another piece of equipment, especially on a tractor or similar vehicle. It rotates very fast and clothing can get caught on the shaft and do some serious damage to limbs and more. You can search the internet to find out about the safety concerns related to equipment that is being used by your community.

In the electrocution scenario, there was a hazard of a live wire which needed to be identified first. It’s imperative to identify electrical hazards before attending the victim, otherwise you’ll be the second victim on the scene. It’s also very useful to understand surface voltage gradient and step and touch voltage that can create a life threatening situation. If you’re interested, look up high voltage electricity to get a better understanding of the hazards.  Essentially the important thing to remember is: if there’s electricity involved in the scene, don’t go near it until you’ve phoned the local Energy company to switch off the power. Victims can present in various ways from broken bones to cardiac arrhythmias. Sticking to the basics of primary and secondary survey will help you figure out what the life threatening injuries are. Ergon Energy has some useful patient education (See Network – Safety) on power safety to prevent injuries from occurring.

When considering blast injuries, you should consider the various combustible substances on farms, the most common being gunpowder in a gun. Blast injuries can be complex, as you need to consider the nature and size of the blast; the time of occurrence; the proximity of the patient; patient displacement by the blast (with secondary injuries); the presence of fires, smoke, dust, or chemical or radioactive contamination (and all those related injuries); and the possible complication of entrapment in collapsed structures. Penetrating wounds, blunt trauma, burns and inhalation injuries are some injuries that will need to be considered.

There are also various chemicals on farms. Recognising and managing chemical exposure as well as recognising the risk of secondary exposure in treating personnel is important. Presentations will vary according to the exposure (oral / dermal / eye etc) and the particular chemical. You can contact the Poisons Information Centre for assistance with management of acute presentations. Useful patient information can be found on Better Health Channel – Farm Safety and Handling Agrichemicals.

There are usually open dams on farms with no fencing and easy access, especially for children, and so the registrars were encouraged to consider the consequences. In the case of near drowning, it’s essential to focus on basic life support. At the RVTS Farm Safety Day, registrars were encouraged to consider how management would differ for cold water drownings. Take a look at the Guidelines at Australian Resuscitation Guidelines (see Section 9.3) to find out more. Actually, while you’re there, you can review guidelines for nearly all the scenarios we’ve described.

You may not have the opportunity to attend a high-fidelity simulated scenario session, but you can consider the possible injuries that could take place in your community and surrounds. Discuss these with your supervisor or colleagues to mentally prepare for what you will need to do in the event of being called upon to assist on site. You could run a training session with your staff (practice nurse, receptionist, cleaner and whoever else is around) on preparing for an emergency, allocating tasks, what is involved with each task.

The best you can do in your community, by far, is educate your patients and make them aware of the dangers and how to avoid getting into trouble in the first place.

There are some great websites you can review and refer your patients to. Some that I use include:

Wouldn’t it be good if we could collectively work together towards changing the stats on morbidity and mortality of “Australia’s most dangerous jobs”: agriculture, forestry and fishing. You can start by increasing awareness of the risks, educating your community, and upskilling yourself and your team, so that you can be of assistance at the scene when prevention has failed.

 

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