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1Mosby items and derived items © 2010 by Mosby, Inc. an affiliate of Elsevier Inc.

Farm Response


Learning Objectives

Discuss common mechanisms of injury in the farm setting

Explain the differences in approach to crush injury compared to laceration injury

Discuss the causes and management of compartment syndrome


Learning Objectives (Cont’d)

Explain urgency of caring for a patient who received a hydraulic injection injury

Describe how to recognize organophosphate poisoning

Identify the hazards associated with farm-confined spaces and the risks posed to potential rescuers


Introduction

Farm unique responses Unique equipment Specialized

chemicals Long response

times typical Often long delays

between injury anddiscovery of the injured


Introduction (Cont’d)

Farm hazards Chemicals and hazardous materials Toxic environments Confined spaces Injuries involving animals Health conditions caused by dusts, molds,

animal diseases


Tractor Emergencies

Overturns Half of all farm

deaths Must stabilize

tractor Tractor fluids Nonstandard

engine shut off Power take-off

suddenly stopped, significant torque


Tractor Emergencies (Cont’d)

Crush syndrome Result of

compressive injury Muscle cells die

and release toxins Restored blood

flow has fatal effect on heart and kidneys



Crush syndrome Epidemiology and demographics

• Few data available• Rarely investigated

History and physical findings• Suspect crush syndrome when

large muscle mass has been compressed for >1 hour Patient trapped >4 hours with compromised circulation



Crush syndrome Differential diagnosis

• Chest injuries and internal bleeding common• Crew safety



Crush syndrome Therapeutic interventions

• Treat life-threatening airway, respiratory, and circulatory injuries

• Medications administered prior to extrication• IV therapy 1–1.5 L/hr NaCl• Sodium bicarbonate 50–100 mEq 20 minutes before

extrication• Albuterol• Glucose • Morphine


Machinery Emergencies

Become familiar with equipment Pinch points Wrap points Shear points Crush points Pull-in points


Machinery Emergencies (Cont’d)



Compartment syndrome Pressure within closed muscle compartment Exceeds perfusion pressure and prevents

blood flow Impairs nerve signals Physical findings

• Pain disproportionate to injury • Skin appears taut and shiny• Feels tingling or burning sensation • Distal tissue may be cyanotic, numb, and cold



Compartment syndrome Therapeutic interventions

• Not corrected in field• Treat all associated injuries• Injured extremity should be kept at heart level• Be alert for crush syndrome



Hydraulic injection injuries Pinhole high-

pressure hydraulic leaks can penetrate clothing and skin at up to 7000 psi



Hydraulic injection injuries Injection causes

• Physical distention of tissue Vascular compression Ischemic necrosis Gangrene

• Chemical irritation Inflammation Inflammatory edema Vascular compromise



Hydraulic injection injuries History and physical findings

• Injection site appearance not remarkable• Progressive swelling and inflammation• History of hydraulic repair is the key to determination

Therapeutic interventions• Cold compresses• Elevation


Chemical Emergencies

Types of farm chemicals Insecticides Herbicides Fungicides Rodenticides Fertilizers Cleaners Disinfectants Sanitizers Fuels


Chemical Emergencies (Cont’d)



Types of farm chemicals Many are nerve agent derivatives Cholinesterase inhibitors

• SLUDGE-BBM



Routes of exposure Inhalation Ingestion Absorption Injection



Organophosphates and carbamates Attack the nervous system Inhibit cholinesterase Easily absorbed through the skin Early signs

• Runny nose• Salivation• Wheezes



Organophosphates and carbamates Therapeutic interventions

• Appropriate personal protective equipment (PPE)• Airway management• If using RSI, avoid succinylcholine• Atropine



Organochlorines Contain chlorine and carbon Found in herbicides, insecticides, fungicides,

industrial chemicals Some are carcinogenic



Organochlorines History and physical

findings• Abrupt onset• Affects CNS • confusion• Tremors• Headache

• Dermal irritation• Respiratory problems• Dizziness• Nausea• Facial paresthesia• Seizures, coma



Organochlorines Therapeutic interventions

• No specific antidote available• Manage life threats identified• Manage airway • Painful stimulus can trigger seizures• If ingested consider activated charcoal• Cardiac monitoring



Bipyridil herbicides Family of pesticides that includes Paraquat

• Highly toxic• Symptoms take several hours to occur• Slow painful progressive toxicity• Death from respiratory failure• Builds up surfactant-producing cells in lungs and

kidneys• Do not give O2



Bipyridil herbicides Ingestion most common route Absorbed Inhaled



Bipyridil herbicides Due to the toxicity, Paraquat has additives

• Blue dye • Strong odorant • Agent to cause vomiting

Large ingestion results in:• Immediate pain and swelling of mouth and throat• Nausea• Vomiting• Abdominal pain• Diarrhea



Bipyridil herbicides Therapeutic interventions

• Decontamination• Supportive care• O2 if patient is having respiratory distress• IV fluids for potential dehydration

Patient and family education• Restricted pesticide in the United States• Must be licensed to apply



Patient assessment Goals

• Remove patient from chemical• Remove chemical from patient

Zones• Hot zone• Warm zone• Cold zone



Patient assessment Ensure open airway Adequate breathing Stable breathing but cardiopulmonary or

neurological deficit, give O2 Circulation, CPR if necessary Control bleeding Assess pulses and BP IV access Assess neurological status


Confined Space Emergencies

OSHA definition Large enough for someone to enter Limited egress Not designed for continuous occupancy


Confined Space Emergencies (Cont’d)

Silos Used to ferment

feed• Creates heat• Creates gasses• Decreases O2

concentration Some are O2

limiting



Silos Silo filler’s disease

• Results when exposed to silo gas: nitrogen oxides (NOx)

• Low concentration NOx commonly inhaled• Moderate concentration NOx inhaled without

developing immediate symptoms• High concentration NOx can kill in minute




• History and physical findings In lower concentration mild irritation to upper airway Higher concentration may render worker unable to

leave




• Presentation for mild exposure Ocular irritation Cough Possibly dyspnea Fatigue Nausea Vomiting Cyanosis Vertigo Drowsiness




• Later signs/symptoms Pulmonary edema Bronchiolitis obliterans Progressive inflammation of lung tissue High concentration Immediate distress Collapse and death in minutes




• Differential diagnosis Hypersensitive pneumonia Toxic organic dust syndrome




• Therapeutic interventions Remove from environment O2 Bronchodilators Assisted ventilation as necessary




• Patient and family education Farmers must understand hazards associated with

newly filled silos Once filled, no entry for 2 weeks Doors closed to prevent NOx from running down chute Before entering, open from ground with rope Detector tubes



Silos Other silo gases

• Carbon monoxide• Methane• Present in small

quantities• Silo fires gases• Fresh air• O2• Ventilating silo



Manure storage gases Ammonia

• Irritant Hydrogen sulfide

• More hazardous• Rotten egg odor

Gasses in higher concentration when manure pit is turned over



Manure storage gases Lower level

• Irritated mucous membranes• Irritated respiratory system• Wheezes• Headaches



Manure storage gases Higher levels

• Acute symptoms• Confusion • Coughing• Dyspnea• Pulmonary edema• Cyanosis• Vertigo• Nausea• Vomiting



Manure storage gases Extreme concentration

• Cardiopulmonary arrest• Myocardial infarction• Seizures

Differential diagnosis• Asthma• Bronchitis• CO toxicity• Cyanide toxicity



Manure storage gases Therapeutic interventions

• Remove from environment• Intubate if necessary• Oxygenate• Treat with bronchodilator if necessary• Treat pulmonary edema if necessary



Scene size-up considerations General silo size-up

• What is the crop inside the silo?• When was the last load put into the silo?• How full is the silo?• How long was the victim inside?• How is the silo unloaded?• Is the power to the silo unloader shut off? • Can the silo blower be turned on?



Scene size-up considerations General manure storage size-up

• Has farmer been agitating the manure pit?• Is ventilation of the space possible?• Is the power to pumps off?• Do we have the training, skills, and equipment to

enter? If not, from where will the appropriate responders be dispatched?


Summary

Managing emergencies on the farm often requires modified procedures, protocols

Most farms use at least one tractor daily; tractor overturns result in half of all farm deaths

Crush injury syndrome can be seen in farm trauma situations because of the length of time the person is often entrapped


Summary (Cont’d)

Numerous hazard points on farm machines can cause severe entanglement that can challenge even seasoned rescue technicians

Power take-off entanglements can result in severe crushing injuries and acute amputations


Summary (Cont’d)

Hydraulic oil pressure normally 2000 psi, can exceed 7000 psi through a pinhole leak; fluid can easily penetrate the skin and cause serious complications

Hazardous materials are present on farms to which farmers, their families, and employees can be exposed Some materials are derivatives of nerve agents


Summary (Cont’d)

Many areas on farms are considered confined spaces by OSHA definition; emergency responders must recognize confined spaces and follow OSHA confined space standards when managing these emergencies

Emergency responders must recognize the potential for deadly gases generated inside silos and manure storage


Questions?

farm response - mhemss.org · mosby items and derived items © 2010 by mo sby, inc. an affiliate of...

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