The West-Jutland Study on Prevention of
Farm Accidents,Phase1: A Study of Work Specific
Factorsin 257 H ospital-treatedAgricultural I nj uries
O. Carstensen,J. Lauritsen, K. Rasmussen
Abstract
The aim of the presentstudywas to obtain detailed knowledgeof fatal and nonfatal
unintentional injuries and working conditions related to farming for purposesof
designing possiblepreventiveinterventions.The study is geographicallyrestrictedto
one counry in Denmark with 270,000 inhabitants,13,835 of whom are engagedin fulltime farming on7,922 farms. Most farms are owned and operatedby single families.
Production is focused on only one of three qpes: swine, dairy or crop. The study is
basedon injuries treated at local hospitals.A total of 257 farm injuries were reported
during the period l January to 31 December 1992. The results do not indicate any
single preventive effort, but some aspectsare consideredimportant. The majoriry of
injuries occurred near or in production builflings during work with animals and
machinery.Approximately one-third of the injured personswere employedpart-time in
farming. A three times higher incidencewas seen among 15- to 29-year-o\dfarmers
than among older farmers. Fractures were seen more often after injuries in which
"unusual'conditions
reported
animalswere involved.Seventy-fourcases(30.7%o)
on the
(30.3o/o)
stated that they had changed
day of the incident. When asked directly 73
routines of work or equipment as a consequence
of the injury. Comparisonswith other
studies indicate the necessityof careful data collection on both etiology and injury
statistics.
Keyu.tords.
Farm, Agriculture,Accident, Injury Prevention.
T\
I
J,J
enmark has for centuries been an agricultural country with an agriculrural
f strucrure characterizedby single farms most often operatedby the farmer
himself with the assistanceof family members or one employee(DFA,
tee3).
Although farm work often carriesthe connotation of fresh air and robust health,
surveysindicate that the farm is a dangerousworkplace (Myers, 1990; Purschwitz
and Field. 1990).In 1.992the incidencerate of fatal farm accidentsin Denmark was
11.7/100,000 person years - three times higher than the working population in
general.According to the Danish Work Environment Service (DWES), farming
ranks highest in fatal accidentsfor the years 1990 and 1991, and secondhighest in
1992 (DWE5,1992).
Article was submitted for publication in November 1.994;reviewed and approvedfor publication in
July 1995.
The authors are Ole Carstensenand Kurt Rasmussen,Dept. of Occupational Medicine, Herning
Hospital, DK7400 Herning, Denmark; and Jens Lauritsen, Assistant Professor,Institute of Community
FIealth,Dept. of Epidemiology,University of Odense,DK5000 OdenseC, Denrnark.
C o r r e s p o n d i n g a u t h o r : O l e C a r s t en s e n , M D , D e p t . o f O c c u p a t i o n a lN { e d i c i n e ,H e r n i n g I J o s p i t a l ,
DK7400, Herning, Denmark. Telephone:+45 9927 2470.
Journal of A4acultural 1afety and lealr.hl(a):231'239
@ 1995 A9AE1O74:/583 / 95 / O1O4A231
A Swedish survey from 1988 showed an incidence of 60 farm injuries/1,000
person years-All_the injuries were treated by general practitioners, the majoriry were
minor injuries (Janson, 7987). American and Canadian prospective fiita siudies
basedon telephone interviews among dairy and beef/dairy farmers found incidence
ratesof166 and 7011,000personyearsrespectively(Pratt,1992; Brison,1,992).
The siruation in Denmark was studied approximately 10 yearsago.An emergency
room basedconsecutivesampling of farm injuries in 1984 in Ringkoebing Counry
identified 1.42farm-related-injuryvictims demandinghospital ca.e,lorrespondingto
an incidenceof 1511,000full-time engagedfarm-workersper year (Nielsen, 1986).
A l l t i e a t m e n t i n t h e e m e r g e n c yr o o m w a s b a s e d o n r e f e r r a l f r o m g e n e r a l
Practitioners.The compulsorynotification systemof the Danish Work Environment
Serviceregistered2.82 farm relatedaccidents/l,000 workers (DWES, 1992) during
the sameyear.Completenessrate of the notification sysremhas been estimatedt6
only 10% of all notifiable cases(Lauritsen, 7992) for the branch of agriculture. The
notification systemis basedon accidentsleading ro at least one day 6f absence.No
occuPationalhealth care system or safety organization exists at the farm level in
Denmark. Consequently there are insufficient systemsof surveillanceon farm
injuries and a complete lack of detailed information on causesand risk factors in
accidentsassociated
with farm work.
The aim of the present study was to get detailed knowledgeof working
conditionsrelatedto farm incidentsfor purposesof possibleinterventions.The study
has three phases:(1) during 1992,severeand fatal farm injuries were referredto fivb
hospitals; (2) continuous weekly work activiry and injury registration in 400 farms
during one year-with ongoing data collection,and, finally; (3) an intervention srudy
basedon the information from the two first phases.This report includesresultsfrom
phaseone.
Methods
_ T h e s t u d y i s g e o g r a p h i c a l l yr e s t r i c t e d t o W e s t - J u t l a n d , t h e c o u n t y o f
Ringkoebing,which has 270,000 inhabitants,13,835of whom are engagedo.r a fulltime basiswith farming on 7,922 farms (DBPS, 1993). Of the iounty's active
workforce, 8.80/oare employed with farmwork. Farm rypes are typically small family
farms with one to three full-time persons and a fluctuating number of family
membersworking a few hours daily in the production.Most farms focus production
on only one of three types:swine,dairy or crop.
The county is served by two central and three smaller local hospitals.Each of
thesehas around the clock emergencyroom service,which requiresreferralfrom the
family physician. The family physician refers only the more serrerecases,and treats
all minor injuries himself. During l January 1992 to 31 December 7992 the staff of
these five emergencyrooms were asked to register all farm-related injury victims.
our definition of a farm injury is an incident that took place during farm work or
farm-relatedwork. For each of the five hospitals,the project had a primary contacr
physicianwho had the responsibilityof ensuringa high degreeof precisionand low
level of dropout, i.e., to catch all relevant contacts,even the doubtful ones. It was
done by reading all the emergency department records.The primary medical
r e g i s t r a t i o nf o r m s i n t h e e m e r g e n c yr o o m s w e r e a l l s t a m p e d w i t h a n e a s i l y
identifiablelabel in red color: "Farm accident?-Yes -No". The injuries marked "yes;'
on the medical form are hereafter referred to as a "farm contact". only medical
diagnosis,date and place of treatment,and name of personsinjured were transferred
once a month to the project secretaryat the Department of OccupationalMedicine
Jotrnat ot AqnculLural 9afet 1 and Heatth 1(4):231.239
in Herning. A telephone interview with the injured person was subsequently
performed two to four months after the time of accident.Interviewers were two
MDs, one a qualified specialistin occupationalmedicine (KR) and the other a
trainee(OC). The interview was performedusing a structuredquestionnairewtth 22
questionssupplementedby qualitative injury data. The questionnairewas nor
piloted, but was read and evaluatedby a group of 20 farmers.
During and after the interview the information was codedinto approximately70
variables.
Injury Framework
Formulation of questionsand variableswas basedon the iniury framework seen
i n f i g u r e 1 . T h i s f r a m e w o r k , o r i g i n a l l y d e v e l o p e di n F i n i a n d , p r o p o s e st h a t
information regarding the injury can be meaningfully detailed into the following
aspects:conditions prior to injury, contact situation and consequencesof the
accident(Touominen, 1982). Each of the aspectscan be associatedwith (influenced
by) facilitating and prohibitive factors.
Material
For the period l January to 31 December 7992, three hundred visits to
emergencyrooms qualified as "farm contacts".Based on emergencyroom and/or
interview data, 43 injuries were classified as nonoccupationalcontacts,mostly in
relation to traffic, play or other leisure activiry, leaving 253 injuries conforming to
"farm
the stricter
injury" definition: (1) farmers or nonfarmersinjured during
farmwork, or (2) bystanders injured by farmwork (children playing in a barn weri
not included).These 253 injuries seenat the hospitalswere supplementedwith four
fatal farm injuries. Data on the fatal injuries were obtained from death certificates
and the coroner'sinquest. AlJ 1.992death certificatesfor unexpecteddeathsfrom the
counry (number 21,9)wereevaluatedfor possiblerelationshipswith farm work.
Of the 257 injured persons,1.6refusedparticipation in the interview,comprising
247 index cases.Rate of participation was 93.70/o.
The 16 nonparticipanrs were
randomly distributed when looking informally at age,sex,injury date and diagnosis
of the injury from the emergencyroom files. Official population statistics(statewide
farm surveyscarried out annuall, include only full-time employedpersons(DBPS,
1993); therefore estimatesof incidence measuresinclude only this subgroup.All
other analyseswere basedon the 247 caseswith interview information. The srudy
has been acceptedby the RegionalEthics Committee and the registryauthoritiesin
@r
|@
t
@
Figure l-Accident framework. Main elements ofdata collection,
each is associated with facilitative and prohibitive factors
(Touominen, 1982).
Journal of Aqricultural 9afely and Health 1(4):231-239
Denmark. Dl?.lTlyii:-yas^
made_usingstandard epidemiologicaland starisrical
packages(SPSS/PC, EPI-Info, StatXact)and procedures.
Results
Resultswill be describedaccordingto the injury framework shown in figure 1.
Persons(table 1)
The median age-of injury victim s was 42 years,range 2 to g7 years;207 were
malesand 34 were fem1l9s.ownership: 131 (i4.4%) *.i" o*r,.rr, ++
*rrc
1tg.soto!
employeesand 40 (16.60/o)
were relatives.Of the 131 owners,103 (7go/o)
'60 workedfulltime as farmers.Approximately.65%(our data suggestthe range
to 7\o/o,butwe
cannot.distinguishsomegroups) of all injured weie-working fuI-time in agriculture.
jnjury rateJor rhe estimated full-time working p".rror,, (N = 1;6), 11.34
9::fI
(95%oc.I.: 8.9 to 12.4)/.1,OOO^person
y-ears.The."-"."rt. stratified by age groups:
to a0.1);30
to 49years
9.6(95o/oc.i,z.i
rEp.L);
!s^*??years29.0.(95vo^c_.1:2L.7
50to 69years
8.6(95o/o
c.l:6.3to 11.3);
70+years
t.e lssoto
c.L o.zto 5.6).
Environment (table 2)
Any_particular farm consists of a variety of different work environmenrs,
approximately.T5o/o
of
injuries occ.t..ed in the immediate vicinity of the
.a11.
production buildings or inside these buildings, the rest occurredin the fieid. Most
injuries occurred inside buildings (61%o).only 16 (79o/o)animal-relatedinjuries
o c c u r r e do u t s i d e ,b u t t h e s e w e r e m o r e s e r i o u s t h a n t h e i n d o o r i n j u r i e s .T h e
dominant
particular environments is the dairylteef stable
9dilg-l:g":ding
comprising 77 (32o/o)of all injuries; 13 of these occurred while operating stable
machinery.
There is a seasonal
plT".:"jl the injury rate.Two-thirds of the 149(620/o)
injuries
occurredin summer and fall- This partern coversboth animal and machineryrelat"d
injuries.In the spring,machineryrelatediniuries occurredar rwice the rate of animal
relatedev€nts.D.uring-otherseasons,
therL was-roughlya one-to-onerelationship
betweenthe number of animal versusmachineryiniurles.
Contact
C?nrl.;
injured personsand environment was classifiedas enrrapmenr
"
'caught
*y*l
in" 27o/o,"hit" by an.object 44o/o,and falls 72.4%. only 2.9o/oof the i'njured
were bystanders-tofarmwork. of the 15 children under 15 years of age, 10"were
injured during farmwork, the remainder were bystanders to farmwoik. call for
assistancey.1.^s.4.q as significant to the reducrion of injury sequelaeby 22 (9o/o)of
the injured (78.60/oof those who actually called for assistancei.
Table 1. Aspects of accident framework Age Group
0-14
15-29
30-44
45-59
60-69
70+
Total
N=241
persons
(o,6)
15
59
59
75
26
7
6.2
24.5
24.5
241
100.0
J I.I
10.8
) q
Journal of Aqncultural Safety and Health 1(4):2Zt2Zg
Table 2. Aspects of accident framework-
Place ofaccident
BeefTdairystable
Farm field
Barn
Near vicinity of farm buildings
Pigpen
Other (garden,etc.)
Total
environment
N=241
(o/o)
77
53
42
40
21
8
32.0
22.0
247
100.0
t/ -)
76.6
8.7
3.3
(oh)
Animal involved
Dairy cows
Young cattle
Pig/hog
Horses
Beefcattle
Other
86
Total
Machinery involved
Type of nacbinery
Tractors (incl 2 PTO injuries)
Indoor machinery
Haruestingequipment
Wagons
Equipment for soil preparation
Inigation equipment
Other and hand held tools
2
3
3.5
85
100.0
47.3
22
19
t6
t4
11
19.3
r o ./
74.1
LZ.J
23
9.6
7.9
20.1
t74
100.0
o
WorAtask to be completed
Soil preparation
Harvesting
Transponation
Other (e.g.,machineryrepair)
28
63
7.0
13.2
24.6
55.3
t74
100.0
6
I)
Total
Total
6
41..9
24.4
20.9
7.0
1t4
Total
Carrying- handling goods
Other (e.g.,chemicals)
35.7
36
2t
18
28
5.4
11.6
241.
100.0
l-t
Injury (table 3)
Types of injury are shown in table 3. The distortions occurred when the farmer
jumped to uneven and unstable ground. Two tractor roll-over injuries occurred
leading to minor cerebralinjuries (roll-over protection is compulsoryon tractorsin
Denmark). A few injuries were the result of defective brakes and narrow space.
C a t t l e - r e l a t e d i n j u r i e s a r e g e n e r a l l y m o r e s e r i o u sw i t h m a n y f r a c t u r e s a n d
contusions.This differenceis highly significant (P < 0.001). Two separateinjuries
led to multiple lesions after a bull gored the victim.
Journal of Aqriclltural 9afeLy and Leallh 1(4):231-239
Table 3. Aspects of accident frameworkinjuryby ICD8 diagnosis
Animals
ICD8 diagnosis
N
(800.00-829.99)3 6
Fracture
(830.00-839.99) 1
Luxation
(840.00-849.99)1 1
Distortion
Cranialtrauma(850.00-854.99) 1
Ipternalinjury (859.00-869.99) 1
Amputation (885.00-888.99)
(8es.00-898.9e) 0
(870.00-884.99)
Wounds
(890.00-894.99)1 1
Lesionofmuscleandtendons
(e05.00-909.99) 0
(920.00-929.99)24
Conrusion
Other
1
(%)
Machinery
Other
(Vo)
N
4 1 . 8 26
22.7
r.2 0 0.0
72.8 1 5 13.2
1.2 5
4.4
t.2
1
0.9
N
(%)
IJ
.\t.t
0
8
3
0
0.0
19.5
7.3
0.0
0.0
8
7.0
0
0.0
t2.8
32
28.1
7
17.2
0.0
3
27.8 22
)
t.2
2.6
19.3
1.8
2
4
4
4.9
9.7
9.7
86 100.0 114 100.0 47 100.0
Total
ICD-8 diagnosisas defined by WHO, 1982.
Consequence(table 4)
After initial treatment at the emergencyroom 32 cases(13.5%o)
were hospitalized.
Fifry (21.70/o)
receivedno further treatment,while 187 cases(78.90lo)
receivedsome
form of treatment afterwards and were seen by general practitioners,hospital
gutpatient clinics, and others.There were 841 contactsin total (median2, range 1 to
72). At the time of interview, approximatelythree months after the injury,84
(35.4o/o)
still had somecomplaint of disability andlor persistentpain.
Table 4. Aspects of accident framework Animals
N=86
(%)
1
1.2
Death
Length oftemporary
disability
0d
t-/
a
8-20d
>20d
Length ofsick leave
0d
L-/ O
8-20d
>20d
IJ
t4
10
48
21.
12
9
43
Length ofthe need for
additional help on the farm
0d
38
.L-/ O
8-20d
>20d
/
6
34
consequences
Machinery
N = 114
Other
e/6) N = 41
1 Q
e,4)
1 /
74.9 10
20.2
3
1,6.7 6
46.5 21,
24.4
7.3
14.6
55.8
17
23
19
53
24.4
14.0
10.5
50.0
32
t9
t4
47
28.r 1.2
1,6.7 3
r2.3
6
47.2 19
29.3
7.3
14.6
46.3
44.1.
8.1
7.0
39.5
53
46.5
8 7 . 0
t4
72.3
37
32.5
t).t
lb.J
lt.o
19
1
6
14
j \-z
46.3
2.4
t4.6
34.2
Journal of Aqricullural 9afety and I'ealth 1(4):231'239
No significant differences were found in the distribution of work disabiliry sick
leaveor need for additional assistancebetween the groups working with animals and
machinery (Chi squareanalysis).Seventeenpersons(7.9o/o)
reported continued
psychologicalsymptoms two to three months after the injury. Symproms were sleep
disturbances,.nightmare,
and recurrentrecollectionof the accident.These symptoms
point at post traumatic stress disorder, but we do not have sufficient health
examinationdata to confirm the diagnosisas definedin ICD-10 (WHO, 1992).
Four events resulted in fatal injury: (1) A 2 1,/2-year-old boy was thrown off and
trapped by a feeding cart which turned over on bumpy ground. (2) A 62-year-old
male was found dead in a field with cattle, one of them a young bull. The causeof
deathwas multiple fracturesand inner chestlesionsof the lung and heart. (3) A74year-old male, who was found dead under a harrow (a three-wingedcultivator).He
had removed a key bolt from the harrow. (4) A 73-year-old male, who fell from the
upper level of the barn through a hole in the floor. Case2, 3, and 4 were working
alone and were found dead. Case 1, 3, and 4 had causeof death stated as brain
injury.
Indicators for prevention
"unusual"
Seventy-fourcases(30.70lo)reported
conditions on the day of the
"Particular
"unfamiliarity
event.
haste" (24;32.4o/o)and
with equipment/untrained
personnel"(77;23.5o/o)were mentioned. Only 5.4o/oreporteddefectiveequipment.
Half of the injured persons (45.2o/o)indicated how the accident could have been
prevented.They pointed at suitableworking procedures,use of safety equipment,
and better safery devices.When asked directly, 73 (30.3o/o)stated that they had
changedsomething as a result of the injury.The majorityof these,48 (65.80/o),
had
"routines
changed
of work"; the remainder indicated different changes,e.g., "new
t o o l s / n e w m a t e r i a l s "( 4 ; 6 0 / o )a n d " e n h a n c e dp e r s o n a lp r o t e c t i o n / c h a n g e st o
buildings"(5; 6.8o/o).
Discussion
Our srudy indicated that farm-related injuries occurredto people of all ages.A
statisticallysignificant (three times) higher incidence was seen among 15- to
29-year-old workers than among older farmers. Fractureswere seenmore often after
injuriesin which animalswere involved.Some indicatorsof preventabiliryhavebeen
identified.
The aim of the presentstudy was to developbaselinedata regardingthe etiology
and consequences
of injuries taking place in agriculturein the study region. It was
our understanding before the study that some major groups of injuries could be
describedthrough hospital data, which in turn could be collected with relatively
limited effort (five hospitals for one county with approximately8,000 farms).
Finally, it was our expectationthat the resultscould provide a basisfor the planning
of targetedinterventions.
An uncertainty in the material is the total number of contacts.Analysis of
seasonaldistribution of the data indicates inaccuraciesin the emergencyroom
proceduresat the end of the study period (only 25o/oof the monthly averagereported
in the last month). The figures presentedare thereforeconsideredto estimate the
minimum number of injuries fitting our definition.
The finding that there was a statistically significant higher incidence among
15- to 29-year-old workers is different from other studies where no difference
Journal of Aqricultural 9afely and tleal'r,h1(4):231-239
berween age groups has been found (Janson,7987). The findings need further
confirmation in studies with precise denominator information. Finding the true
d e n o m i n a t o r ( a t o t a l n u m b e r o f p e r s o n s o c c u p i e d i n D a n i s h a g r i c u l t u r e )i s
problematic,becauseof the many part-time employed,family-membersand children
working in agriculrure.
The srudy does not point at any single preventive effort, but the following aspecs
are.consideredimportant for the planning of prevention methodologies:-The
majority of injuries took place near or in production buildings.Two large groups of
activities associatedwith injuries are working with animals and machinery.Two
indicators,eachrepresentingone-third of the material,point at items relevantto the
'preventability
potential":one is the questionof "unusual"situations,the other actual
changeof work proceduresas a consequenceof the injury. The data does not allow
any conclusion as to the actual preventability or expected successin preventive
among
Programs,but we do find the mentioned one-third indicativeof an awareness
injured personsworking in agriculture.
A striking fearure of reported incident measuresis the great variation in the
availableliterature:60/1,000 farm workers (Janson,7987),766/1,000 (Pran, 1992),
70/7,000 (Brison, 7992),1.5/7,000(Nielsen,1986),3/1,000 (DWES, 7992), and
our study 11.3/1,000 just to mention a few. The variability is basedto a great extent
on the different sourcesof outcome (interview, primary health care,hoipitals) and
"time
at risk" (number full-time working, total number working, eta.). These
differencesemphasizethe need for strict control of injury reporting in situations
where the point of interest is to prevent the occurrenceof events.Therefore, our
study is now continuing with phase 2, which directly includes the estimation of
"time
occurrenceof eventsat the farm levelwith simultaneousassessment
of
at risk'.
AcxNowI-eocMENTs. The authors gratefully acknowledgethe emergencyroom
staff of the five local hospitals in the county of Ringkoebing, Denmark. This study
was suPPortedby a grant from the Public Health ResearchFund of the countiesof
Ribe and Ringkoebing,Denmark.
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Journal of Aqricultural 9afety and Health 1(4):231-239