How do Agricultural Workers Get Illness from Their Workplace? Frederick W Oehme DVM, PhD
Agricultural workers are active and at risk in their largely isolated field and rural environments, while health care providers are usually at urban locations some distance from where the risks occur. The lack of "on farm" observations and experience with actual farming operations offers a background gap in circumstances that lead to worker illnesses and complaints. The health care community may see producer-patients suffering from excessive environmental exposures to ultraviolet light, noise, heat, gases and dusts, and numerous chemical and agricultural drugs. Working around hazardous farm equipment may produce trauma and falls causing skin, muscle, and bone injuries. Inadequate ventilation systems in animal confinement buildings and machinery shops may lead to respiratory difficulties, and the presence of stinging insects and dangerous snakes, animals and plants in the rural setting can lead to the presentation of unusual clinical syndromes. Waters on the farm may be polluted, raising the potential for digestive tract and organ dysfunction. The wide scale use of pesticides, fertilizers and animal drugs can lead to acute exposures with emergency responses necessary. Gases generated by silos, confinement housing, and manure pits are potentially lethal. Grain and pollen dusts, animal dander, mold spores, and vapors from petroleum products offer risks of allergic/anaphylactic respiratory effects. Veterinary supplies accidentally injected can induce local and systemic reactions and infections. Animal diseases, often producing unusual effects in humans, may be "picked up" by the livestock worker. The challenges of identifying and appropriately treating and managing such conditions in agricultural workers places a heavy responsibility on the health care provider and require an understanding of the risks and circumstances in which the producer is working. It additionally necessitates a scope of understanding for the need of early and accurate diagnosis, the application of diverse and appropriate diagnostic tests, and the prompt treatment or referral of affected individuals for needed therapy.
Agricultural Injuries and Illnesses Several hundred agricultural workers are fatally injured each year and thousands experience nonfatal injuries or develop illness due to farm work. Machinery, primarily the tractor, is the leading cause of fatal farm injuries. Young children and elderly workers have a high incidence of such fatalities. The acute trauma response is a vital life-saving action that is needed for machinery injuries, injuries induced by animals, respiratory problems from anhydrous ammonia and other gases, and even health effects from vibration frequencies. Hearing loss, respiratory disorders, musculoskelatal problems, zoonotic infections, and cancer are chronic conditions resulting from the diverse hazards of agricultural work. Agricultural machinery accounts for about 26% of recorded farm injuries. Increased mechanization of agriculture has brought many improvements in workload demands, but has also created hazards which must be effectively and safely faced by the worker. Machine operators and owners should understand the basic concepts of machine safety to recognize, manage and control these hazards, but the health care provider faced with patients injured from these dangers must understand the bizarre and often tragic nature of the resulting injury. health care providers should reinforce the information and skills necessary for safe equipment operation. Constant reminders are often necessary to reinforce safe strategies for the control and management of such problems.
Chemical Hazards In the highly sophisticated contemporary farm operation, dozens of chemical products are used. These products are necessary for their toxic effects on insects, weeds and farm pests. Unfortunately improper use of these compounds and the human reluctance to take time and effort to employ protective equipment and clothing, results in significant exposures to such chemicals. Insecticides are frequently handled, mixed and applied in hazardous circumstances, with direct application or spillage on the farm worker occurring. Prompt recognition, decontamination, and therapy is essential to prevent serious health effects. Utilization of rapid diagnostic tests will confirm the presence of such excessive exposures. Toxic rodenticides are widely used for pest control and may be accidentally consumed. Petroleum products used on farm equipment for lubrication, fuel and cleaning offer inhalation and skin exposures. Fertilizers, particular anhydrous ammonia, can be extremely toxic if inappropriate applied, mishandled or inadvertently inhaled. Animal confinement facilities contain aerosols of endotoxins and other allergy-inducing materials. Decaying hay in silos produce gases, such as nitrogen oxides, that can have devastating pulmonary toxicity. Asphyxia and acute death, can result from collections of gases such as methane and hydrogen sulfide, in manure pits. Understanding the mechanisms of such agricultural chemical toxicities, the unique exposure circumstances that produce often high exposure volumes, and the utilization of clinical diagnostic techniques and tests are vital to dealing with farm workers presenting with such illnesses. Strategies to prevent chemical poisonings on the farm should be stressed. Proper storage and handling of farm chemicals, and the selection and mandatory use of personal protective equipment are a vital part of the health community’s preventive strategy for reducing such poisonings.
The often frequent use of biological products (vaccines) and antibiotics for livestock disease prevention and treatment by farm workers introduces a hazard of accidental self-administration of such materials. Difficulty in restraining animals receiving such medication not infrequently produces injury from the injection equipment or results in accidental dosing of the worker with the intended animal product. Understanding of the formulation and composition of such animal drugs is necessary to allow appropriate health care response to the injured worker. Utilization of databases and poison control center information will give useful direction for effectively treating such chemical administration.
Water Supplies Most farm workers utilize wells or springs on the farm for drinking water or for cooking foods. While most ground water is safe to drink, water sources which are polluted from agricultural chemicals or animal wastes offer hazards to consuming individuals. Pesticides may leech through the soil, and animal wastes may drain coliflorm organisms and organic matter into existing wells. The realistic long term risk of organ damage or potential for cancer development must be clearly understood by community health personnel to address concerns by farm personnel. Nitrates resulting from animal waste drainage, are particular risks for newborn infants or elderly individuals with existing organ dysfunction. Although polluted groundwater is nearly impossible to clean up, the existing water supplies may be treated using various water treatment techniques, a new well in a "clean" location may be drilled, or drinking water may be secured from another source such as purchased bottled water. Unfortunately all such options are expensive and often inconvenient for practical farm operations. Prevention of pollution of existing drinking water supplies is an important role for community health workers.
Grain Industry Issues Grain processing has many serious health and safety hazards. After harvesting, grain is moved to farm storage bins, silos or transferred to elevators. Silage gases, fires, explosions and other hazards are present in such intense storage facilities. Grain dust is a serious hazard for explosion, fire and inhalation health risks. Deaths due to suffocation from grain or silage gases are not uncommon, while machine entanglements, falls and electrocutions are possible in grain handling facilities. Grain dust may produce asthma, skin rashes, grain fever, allergic reactions, and eye, nose and sinus irritations. Limiting exposures and training grain-handling personnel in appropriate prevention mechanisms, while addressing the risks inherent in the industry, are vital to reduce hazards.
Beef Cattle and Horse Safety Handling large animals, particularly beef cattle ranks second only to machinery as a frequent cause of agricultural injuries. The sheer strength and bulk of mature cattle, together with their often fractious nature and anxiety upon entering into livestock operations and transport, produce major potentials for serious traumatic injury. Livestock handlers must reduce their injury risk by understanding cattle psychology, employing appropriate cattle handling techniques, and using well-designed and constructed facilities and equipment for working with livestock. Utilization of horses on farms is a popular but sometimes dangerous recreational activity. If preventative measures are taken appropriately, almost all such injuries can be avoided. Accident awareness is a basic essential and guidelines for ensuring safety of children and visitors, as well as for farm workers, are a needed part of the prevention program. Such safe practice guidelines include how the horse is selected and handled, it’s appropriate placement and work routine within the stall, safety to avoid fire around the farm or in the barn, and proper grooming, saddling and riding habits. Protective equipment and proper clothing, while contrary to the often desired "wild west" appearance, is used to ensure rider safety.
Farmer Skin Disease The highest risk of skin disease of any occupation is found for farmers who are exposed to outdoor environmental conditions, high levels of solar radiation, and repeated contact with irritant or allergenic plants. Outdoor work poses a risk of stings and bites from insects and other animals, with the additional risk of hypersensitivity reactions, transmission of zoonotic infections, and toxic envenomations. Fertilizers, herbicides, pesticides, veterinary products and animal feeds, as well as feed additives, may lead to skin irritation or allergic contact dermatitis. Awareness of such potential skin disease causes is useful for physicians dealing with such concerns. The frequent occurrence of such skin diseases is of additional concern due to the economic pressures of increasing medical insurance costs and the necessity of compliance with OSHA and worker compensation laws. In general agricultural skin diseases may be classified as contact dermatoses, irritant, allergic, photoallergic, phytophotocontact/allergic dermatoses, heat-induced, skin-induced, infectious dermatoses, and skin cancers. Animal diseases of concern for farm workers include leptospirosis, Strep suis, Q fever, lyme disease and rabies.
Animal Housing Indoor Hazards Modern production techniques for livestock and poultry now usually require large indoor environmentally controlled housing facilities. With increasing production efficiency, many undesirable conditions develop within these facilities that threaten the health of both the animals and workers. Ventilation and environmental control are key elements of proper building design to minimize the effects of harmful gases, humidity and heat. In addition, air pollutants such as dust, ammonia, hydrogen sulfide, carbon monoxide and carbon dioxide are present. Mechanical hazards, electrical hazards, noise and fire hazards must also be evaluated. Many of the confined housing areas induce respiratory disease in workers. In addition, respiratory disease may be seen from other agricultural work circumstances. The respiratory problems include organic toxic dust syndrome, acute and chronic bronchitis, occupational asthma, chronic obstructive pulmonary disease, and hypersensitivity pneumonitis. Such illnesses are induced by organic agricultural dusts, inorganic materials as aerosols, improper ventilated swine, poultry, dairy, beef and sheep facilities, and hazardous conditions in meat and poultry processing structures. In addition, silo gas, such as nitrogen dioxide from decaying silage can cause acute respiratory illness and permanent lung damage. Confined space in grain and produce storage risks the presence of carbon dioxide asphyxiation hazards. Hydrogen sulfide gas found in manure pits is rapidly fatal. Welding fumes are a specific farm occupation danger. Pesticide aerosols may enter the respiratory system, as may infectious disease organisms unique to the farming environment.
Agricultural Hygiene Evaluations As with all industries, anticipation, recognition, evaluation and control of health and safety hazards is a key to decreasing injuries and illnesses in agricultural workers. Exposure guidelines and identification of hazards and their prevention are essential risk reduction measures. Equipment may be required to measure concentrations of various hazardous substances in the farmer’s environment to identify gases, aerosols, dust, microbial organisms, and naturally occurring toxins and diseases. Compounds to be specifically considered are anhydrous ammonia, the gases generated from freshly filled silos, livestock gases such as ammonia from animal urine breakdown, the hydrogen sulfide from manure pits, carbon monoxide from internal combustion engines, oxygen deficiency in confined spaces with oxygen-consuming biological activity, fumigants and disinfectants, inorganic and organic particulate dust material, microorganisms, and naturally occurring toxins of fungal or grain origin.
Migrant and Seasonal Worker Safety A very vulnerable population in the hazardous agricultural work field is that of migrant and seasonal workers who often are assigned the most dangerous jobs, have substandard housing and sanitation, practice high risk work and social behaviors, and present significant danger of communicable diseases. Work hazards of such populations extend to the home because residential quarters are often in close proximity to fields, orchards and livestock housing facilities. Availability of health data is often limited because of migratory lifestyles, and such transient activity minimizes the effectiveness of educational safety and health programs. They’re often the least protected farm population in terms of financial resources, access to medical care, educational opportunities, unionization, workers compensation and strategies to improve rural farm health and safety. Language barriers may exist when health care is sought that reduce the effectiveness of history-taking, immediate treatment, and compliance with continuing health needs. The unstable nature of this population may enhance communicable disease spread through their migratory activities.
General Farmstead Safety Of the overall farm population, children and the elderly are often the most vulnerable members. They’re most likely to be in accidents and victims of unintentional injuries. Understanding the developmental capabilities of children and the parents’ appropriate responses to expanding family activities are vital. Falls are the leading cause of unintentional death for people 80 years old and over. Stairs and floors lead to most hospitalizations for persons over 65 years of age as compared to other home furnishings, facilities and fixtures. Disposing of household chemicals and farm materials appropriately, recognizing measures needed to assure child safety and creating a safe farm environment requires a continuing effort by responsible family members and concerned health care providers. The continuing physical, economic and environmental stresses upon farming communities and personnel result in significant stresses with depression and suicide outcomes. Marital and family problems are associated with the mental health difficulties of coping and adapting to the diverse fluctuations in the farming community. In addition to dealing with physical, chemical, and infectious illnesses ubiquitous to the farm worker, the extensive expertise of the concerned health care family must continually recognize the interactions of the farming communities’ emotional stresses in the health concerns presented to the physician, nurse and community health care professional.
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