Skip shortcuts, save a life

If every farmer took time to think through their actions prior to carrying out a task, Ed Aukamp might be out of a job.

Aukamp is an EMT, paramedic and EMS instructor with over 30 years of experience responding to incidents in agricultural settings. It’s important to note that most injuries or deaths on the farm are now referred to as “incidents” rather than accidents because the latter term refers to an event that could have been prevented.

Most ag-related injuries are strains and sprains that can be managed with little or no professional treatment. Paramedics focus on the most severe injuries by ensuring the scene is safe and looking for and counteracting threats to the patient’s life.

Initial steps taken by medical responders include determining whether the patient requires specialized treatment at a trauma center, and if so, proceeding with plans for helicopter transport. Responders also look for entrapment or pinning, to stabilize the cervical spine and determining whether the patient has additional injuries.

In describing the first responder’s view of what occurs following a tractor rollover, Aukamp said the first task is to locate the patient and ensure the vehicle is stable. An experienced paramedic can assess injuries and ascertain the need for air transport in less than one minute.

Prior to operating any tractor, the operator should have received instruction regarding its proper, safe operation. Rollover protective structures (ROPS) were not standard until 1965, so tractors older than that should have added ROPS that meet standards established by the American Society of Agricultural & Biological Engineers.

PTOs and augers are prime causes of farm injuries. A PTO running at 540 RPM can pull in a seven-foot length of anything, including human limbs, in just one second, leaving no time for a reaction. When paramedics approach an entanglement, the first step is disabling the machinery to prevent continuation of the entanglement.

“The extrication process takes time,” Aukamp said. “We need to disassemble the equipment so we can get the patient disentangled. With amputation or trauma to extremities, there’s a high potential for life-threatening bleeds.”

Bleeding risk emphasizes the importance of including an easy-to-use tourniquet in the farm’s first aid kit. The goal is to make the tourniquet so tight that it stops arterial bleeds. There should be no pulse past the point of the injury.

A person on the scene should note the time the tourniquet was applied so the ER team is aware of how long the device has been in place. This helps trauma personnel determine how long the extremity has been without blood flow.

Aukamp discussed potential injuries from harvest equipment including entanglements, burns and crush asphyxiation. These injuries occur at pinch points and in some cases, picker heads that come down and pin a person.

“Crush-type injuries can lead to tissue asphyxiation with lack of perfusion [blood delivery] to muscles,” said Aukamp. “There’s typically a prolonged extrication time – it isn’t a quick fix. We have to use critical thinking about where the closest trauma center is and do we need the helicopter. If 30 to 40 minutes of the ‘golden hour’ [the first hour following the incident] are used up to extricate the patient, we are concerned about getting them to the trauma center as quickly as possible. We’re looking at oxygenation of the patient, stabilization of extremities and limbs and mitigating threats to life.”

With entanglement or crush injuries, the priority is disassembling the area of the entanglement, which is a sensitive operation that involves bleeding control and determining the nearest trauma center to re-attach amputated parts.

“Everyone who was caught in a PTO knew they weren’t supposed to do it, but they took a calculated risk that ‘It won’t happen to me,’” Aukamp said, “but it does happen to them.”

Burns are handled based on severity, size of the burn and location, and often require professional treatment. First-degree burns result in redness and are usually minor. Second-degree burns are more painful and include blistering. With third-degree burns, the affected area isn’t usually painful because nerve endings are burned and no longer working.

“A third-degree burn where the edges are still intact is where the pain happens,” Aukamp said. “With third-degree burns, everything is open and a lot of fluid is lost. One of the risks is dehydration.”

Burns on the face, hands or certain joints take priority. Black soot around the nose or mouth indicates the patient has likely inhaled a lot of smoke.

A concern with burns is super-heated gases entering the airway, which can result in swelling that leads to losing the airway. Immediate application of sterile water to clean burns helps with potential future infection.

Electrocution is the fourth biggest danger on a farm – one in 10 farmers will be electrocuted on the job. Machinery contact with overhead power lines, exposed wiring and damaged insulation can result in electrocution.

“If someone is trapped in a combine or tractor with downed power lines, the first thing we do is check for our own safety,” Aukamp said, emphasizing responder safety. “If lines are down, are they draped over a fence or lying in a ditch with water that might conduct electricity?”

An important factor in avoiding electrocution is not touching an electric-powered piece of metal and stepping on the ground at the same time. Aukamp advises bystanders to ignore their gut feelings and resist the urge to grab and pull at someone who is being electrocuted. Such action can result in a second electrocuted patient who requires emergency care.

While working in pairs is ideal, it isn’t always possible. Farmers working solo should always notify another person of their plans, work location and approximate finish time.

First responders see incidents resulting from a person working alone, sustaining an injury and not having a way to communicate they are in danger. The injured person may not have their cell phone at hand or is pinned in a way that prevents reaching for or using a phone. In some cases, the victim is too severely injured to call for help.

One solution for those working solo or in remote areas is a tracking device such as an Apple AirTag carried in one’s wallet or boot. Some smart watches and cell phones have sensors that detect a sudden impact, and if the user doesn’t respond, the device will contact emergency services. In any emergency, quick but careful action is essential.

“Once there’s a delay, it makes keeping the patient alive more difficult and another hurdle for us to overcome,” Aukamp said.

by Sally Colby