Injury Prevention 1995; 1: 97-102

Fatal and hospitalized agricultural machineryinjuries to children in Ontario, Canada

William Pickett, Robert J Brison, John R Hoey

AbstractObjectives-To assess rates and patternsof agricultural machinery injuries infarm children in order to both determinepriorities and develop strategies forinjury control in this population.

Methods-Coroners' files and hospitaldischarge data were examined forOntario farm children aged 0-19 who hadagricultural machinery injuries over afive year period ending 31 March 1990.Injury rates were described by age, sex,geographic region, type of machinery,and mechanism of injury. Common pat-terns of injury deserving of priority forprevention were then identified and des-cribed.

Results-283 machinery injuries to child-ren were identified. Injury rates were 116and 25/100 000/year for boys and girlsrespectively. Boys were at increasing riskrelative to girls as their ages increased.Young children were at greatest risk forfatal injury. There is a prominent sum-mer peak in occurrence. The farm tractorwas the machine most commonlyassociated with these injuries (33-2%),and entanglement, usually of clothing,was the mechanism cited most often(36-3%). The case fatality ratio (ratio ofhospitalizations:deaths) was generallylow whether assessed by machinery typeor by mechanism of injury. This providesan indication of the lethality of theseinjuries.Common patterns associated with

injury risk included: (1) inadequatesupervision ofsmall children; (2) permit-ting children to be in the area of movingor unguarded machinery; (3) allowingchildren to accompany workers usingfarm machinery; and (4) having childrenperforming work related tasks inapprop-riate for their age.

Conclusions-Machinery related injuriesare not uncommon in farm children andhave a high case fatality rate. These rateschanged little over the five year studyperiod. Feasible strategies for preventionof these injuries, four of which are pres-ented here, need to be developed andimplemented by public health profes-sionals working in cooperation withmembers of the agricultural industry.(Injury Prevention 1995; 1: 97-102)

Keywords: agriculture, trauma, epidemiology.

Despite increasing publicity about the familyfarm as a dangerous place to live,'`3 the farmenvironment continues to be a setting that isburdened with a substantial childhood injurycontrol problem.'`6 Canadian data on child-hood farm injuries are limited. However, theinternational literature describing these typesof injury suggests that they are common andespecially severe.7'3 In the United States, over300 deaths and 25 000 medically treatedinjuries occur to children less than 16 years ofage on farms annually.'3 Population basedstudies that fully describe the incidence oftheseinjuries and their etiology are needed todevelop sensible priorities for preventiveintervention.'4 15The farm environment serves several impor-

tant functions for farm children (who, in thispaper, are defined as persons living on farmswho are less than 20 years of age). As well asbeing a place of work, it also acts as a place ofhomelife and play. Demographic peaks in theincidence ofchildhood farm injury reflect thesetwo functions. High risk age groups include theages 2-5 (a result of children being surroundedby occupational hazards), and 12-15 (the agesat which children begin to contribute to thefarm work load).'6 Common risk factors forinjury in the farm environment include power-ful and often unguarded machinery or vehicles,large and unwieldy farm animals, and poten-tially toxic chemicals, gases, or biologicalagents.'7 In addition, because farm childrenoften live in relatively isolated areas, physicaleffects of injuries become exacerbated by thetime involved in getting to emergency medicalcare.18

In this study we examined patterns ofagricultural machinery injury experienced bychildren in the province of Ontario, Canada.Our objectives were: (1) to estimate rates ofagricultural machinery injury resulting infatality or hospitalization; (2) to quantitativelydescribe the nature of these injuries in terms oftime, age group, sex, geographic region, typeand anatomical site, agent and mechanism, andseverity; (3) to qualitatively describe importantpatterns among these injuries; and (4) to dis-cuss the implications of (1) to (3) for preven-tion.

MethodOVERVIEW OF STUDY DESIGNThe study population was defined as allresidents of Ontario farms who were betweenthe ages of0-19 years during the five year studyperiod ending 31 March 1990. Fatalities andhospitalizations for agricultural machinery

Department ofCommunity Healthand Epidemiology,Queen's University atKingston; and Centrefor Injury Preventionand Research,Kingston, Frontenac,Lennox and AddingtonHealth Unit, Kingston,Ontario, CanadaW PickettJR Hoey

Department ofCommunity Healthand Epidemiology andDepartment ofEmergency Medicine,Queen's University atKingston, Ontario,CanadaRJ Brison

Correspondence to:W Pickett/Dr RJ Brison,Departnent ofEmergencyMedicine, Queen'sUniversity, Kingston,Ontario, Canada, K7L 3N6.

97

on March 5, 2021 by guest. P

rotected by copyright.http://injuryprevention.bm

j.com/

Inj Prev: first published as 10.1136/ip.1.2.97 on 1 June 1995. D

ownloaded from

Pickett, Brison, Hoey

injuries experienced by these children wereinvestigated. Two systems for the surveillanceof traumatic farm injuries (one for each of fataland non-fatal injuries) were used in theiridentification and description. Rates of injurywere calculated for subgroups of children.Patterns of injury were described by severaldescriptive parameters. Examples typical ofthose observed in our surveillance systemswere used to highlight important patterns ofthese injuries.

THE SURVEILLANCE SYSTEMS(1) Fatalfarm injury surveillanceFatal childhood agricultural machineryinjuries were identified using informationobtained from these sources: (1) the in-housesystem of files maintained at the Office of theChief Coroner of Ontario; (2) the deathcertificate registry maintained by the RegistrarGeneral of Ontario; and (3) a registry main-tained at the head offices of the Ontario FarmSafety Association (FSA) which uses policereports, FSA field personnel, and a newspaperclipping service to identify injuries. Coroners'investigation reports were then obtained for allfatal childhood farm injuries identified by thethree sources of information, and these weremanually searched to describe the injuries.

(2) Non-fatal farm injury surveillanceChildren hospitalized for agriculturalmachinery injuries were identified using hos-pital discharge data tapes maintained by theHospital Medical Records Institute of Canada.These included all childhood farm injuriestreated in an Ontario hospital and where theexternal cause of injury was coded as E919 0,injuries caused by agricultural machinery.'9Demographic information from computerizedrecords was used to describe the personsinvolved, and the place and time of injury. Themechanisms and circumstances of injury weredescribed by having medical records personnelat the hospitals that reported treatment of atleast one of these injuries abstract informationfrom individual medical charts. One hundredand fifty eight (98%) of the 162 Ontario hos-pitals who were approached provided therequested descriptions,'6 and 259 (95%) of the273 records sent to the hospital were returned.The surveillance system was, however, unableto capture farm machinery injuries that werecoded incorrectly by medical records staff, andwe are unable to address this as a source of biasin the study.

ANALYSISThe surveillance information available to des-cribe the injuries included the month and yearof injury, the age and sex of the victim, theirgeographic region of residence, and the nature,anatomical site, agent, and mechanism ofinjury.The numbers of agricultural machinery

injuries identified among farm children wereplotted by quarter ofyear for the five year studyperiod. These quarters were: (1) January-

March, winter months in Ontario; (2) April-June which correspond with cultivating andsowing activities in most parts of the province;(3) July- September, tending and harvestseasons; and (4) October-December, lateharvest and winter months. For comparativepurposes, the number of machinery injuriesamong those older than 19 were plotted in asimilar manner.

Total and stratum specific rates of fatal andhospitalized childhood injury were calculatedby age group (0-4, 5-9, 10-14, 15-19 years),sex, and geographic region using denominatordata from the 1986 Canada Census of Agricul-ture.20 The primary injuries that wereassociated with each of the injury events weredescribed by type and anatomical site using theInternational Classification of Diseases, 9threvision, clinical modification (ICD-9-CM N-codes).'9 Injury rates were calculated fordifferent agents of injury (the machinesinvolved) and mechanisms of injury (whathappened to cause the injury). Cross tabula-tions were also used in these descriptions. Therelative severities were estimated by calculatingthe ratio of hospitalized injuries to fatalities fordifferent agents and mechanisms, so thatsmaller case fatality ratios generally indicatemore severe forms of injury. The case fatalityratio, although a crude measure of injuryseverity, is commonly used in the description ofinjuries and associated patterns.

Cases of injury typical of those observed inthe two surveillance systems were used toillustrate important patterns. Actual case des-criptions were not used so that individual datain the systems would remain confidential.

All data management and analysis performedduring this study were done using RBase(Microrim, 1991).

ResultsQUANTITATIVE ANALYSISTwo hundred and eighty three childhoodagricultural machinery injuries were identifiedfor the five year study period (24 fatalities; 259hospitalizations). The number of injuriesranged from a high of 69 in 1985-6 to a low of48 in 1989-90. The figure shows a seasonalpeak in incidence during the third quarter (Julythrough September) of each study year which,although evident for both adults and children,was especially pronounced among the latter.

100

(AU)._

._

0

z

2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 11985 1986 1987 1988 1989 1990

Fatal and hospitalized agricultural machinery injuries in Ontario,1985-90, by quarter ofyear in those < 20 and > 20years of age.

98

on March 5, 2021 by guest. P

rotected by copyright.http://injuryprevention.bm

j.com/

Inj Prev: first published as 10.1136/ip.1.2.97 on 1 June 1995. D

ownloaded from

Fatal and hospitalized agricultural machinery injuries to children in Ontario, Canada

Of the 24 fatalities which were recorded, 22of24 (92%) were identified in the FSA registry,17 of the 24 (71%) were identified in thedatabase search at the Office of the ChiefCoroner, and nine of 24 (38%) were identifiedin the search of the Registrar General registry.

Rates of injury by age, sex, and region areshown in table 1. Injuries to boys outnumberedthose to girls in all age groups, with an overall

Table I Childhood agricultural machinery injuries, Ontario 1985 through 1990, by age,sex, and region

Fatalities Hospitalizations Total Rate*

Total No of injuries 24 259 283 70

Males (by age)0-4 3 35 38 955-9 5 40 45 9910-14 5 60 65 11315-19 5 79 84 136

Total (0-19) 18 214 232 116

Female (by age)0-4 6 17 23 585-9 0 8 8 1810-14 0 13 13 2415-19 0 7 7 11

Total (0-19) 6 45 51 25

Region of OntarioWestem 9 78 87 67Southern 4 65 69 51Central 6 44 50 87Eastem 5 48 53 88Northern 0 24 24 136

*Number of fatalities and hospitalized injuries/100 000 farm children/year.

Table 2 Childhood agricultural machinery injuries, Ontario 1985 through 1990;description ofprimary injuries

Description N-code Injury No (%)

Total injuries 283 (100-0)

Fatalities 24 (8-5)

Hospitalized injuries800-809 Fracture: head, neck/trunk 23 (8-2)810-829 Fracture: upper/lower limb 71 (25 2)850-854 Intracranial injury 11 (3 9)860-869 Internal injury: chest, abdomen, pelvis 11 (3-9)870-879 Open wound: head, neck, trunk 11 (3-9)880-897 Open wound: limb 60 (12-3)920-924 Contusion with intact skin 15 (5-3)925-929 Crushing injury 22 (7-8)

Other/unspecified 35 (12-4)

Table 3 Childhood agricultural machinery injuries, Ontario 1985 through 1990, bymachine and mechanism ofinjury

Hospitalizations Fatalities Total Rate* Ratiot

Total No of injuries 259 24 283 71 10 8:1

MachineTractor 86 11 97 24 7-8:1Conveyer 24 0 24 6 $Hay wagon 20 3 23 6 6-7:1Baler 13 0 13 3Grain auger 12 0 12 3Manure spreader 7 2 9 2 3-5:1Combine 6 1 7 2 6-0:1Power take off 11 1 12 3 11-0:1Other (35+ machinery 80 6 86 21 13 3:1

categories)

MechanismEntanglement in machinery 94 5 99 25 18 8:1Run over by machinery 36 8 44 11 4-5:1Fell from, then run over by 36 5 41 10 7-2:1machinery

Struck or pinned by 35 1 36 9 35-0:1machinery

Fell from machinery 36 0 36 9Roll overs 10 5 15 4 2-0:1Other/unspecified 12 0 12 3 $

*Number of fatalities and hospitalized injuries/100 000 farm children/year. tRatio of hospitaliza-tions:fatalities. tUndefined ratio (division by zero).

ratio of boy to girl injury rates of 4-5:1. Thisratio varied from a low of 1 7:1 for the 0-4 yearage group, to a high of 12-0:1 for the 15-19 yearage group. Annual regional rates ranged from51/100 000 farm children in Southern Ontarioto 136/100 000 farm children in NorthernOntario.The natures of the primary injuries

experienced by the 283 injury victims aredescribed in table 2. Of those hospitalized, themost common were limb fractures, openwounds to a limb, fractures to the head, neck ortrunk, and crushing injuries. Together with the24 fatalities, these accounted for 201 of the 283injuries identified. Over 40 different types ofmachinery were represented. The most com-mon are described in table 3, as are themechanisms of injury commonly associatedwith specific injury events. The leading agentof injury, accounting for just over one third ofthose observed, was the farm tractor. Theleading mechanism was entanglement inmachinery, which was always moving andusually unguarded. The severity of injuriesassociated with different agents andmechanisms varied widely. Seven of thecategories described in table 3 were associatedwith case fatality ratios of 8:1 (or less)-arelatively high level of severity. Fivemechanisms, although common, wereassociated with no fatalities and thus had anundefined case fatality ratio which suggests alower level of severity. Among the hospitalizedinjuries, the natures of the primary injuries aswell as the mechanisms of injury varied by thetypes of machines involved (table 4).

QUALITATIVE DESCRIPTION OF IMPORTANTPATTERNS OF INJURYRather that restricting the analysis to a purelyquantitative approach, other important pat-terns are illustrated by describing typicalexamples of non-fatal injuries and deaths.

Pattern 1. The farm child who is unsuper-vised during busy summer months.

A 3 year old boy was playing in the gravel driveleading to the barn on afamilyfarm. He was beingwatched by his 8year old sister while theirfatherwas busy with haying, and their mother was in thebarnfeeding livestock. The girl briefly went insidethefarm house to get her brother a glass of water.During this time, the boy crawled under a wagonloaded with hay that was attached to a tractorwhich had been left idling. Not knowing that theboy was there, the tractor operator started movingthe tractor and wagon and ran over the boy.Death was due to multiple abdominal injuries.

Clear seasonal peaks in both fatal and non-fatal injuries occur during the summer months.In Ontario, summer coincides with: (1) max-imum exposure to field work and associatedhazards on farms and (2) holidays from school.Caregivers of farm children are commonlyrequired to participate in field work activities.This means that during the summer thesecaregivers have three basic options for child-care. They may seek other forms of supervision

99

on March 5, 2021 by guest. P

rotected by copyright.http://injuryprevention.bm

j.com/

Inj Prev: first published as 10.1136/ip.1.2.97 on 1 June 1995. D

ownloaded from

Pickett, Brison, Hoey

Table 4 Hospitalized childhood agricultural machinery injuries: machinery types byprimary injury and mechanism

Hay Grain PowerTractor Conveyer wagon Baler auger take off

Total No of injuries 86 24 20 13 12 11

Primary injury (%)Fracture 42 38 25 39 8 55Open wound/contusion 19 42 35 39 67 27Internal/crushing injury 23 4 15 23 0 0Intracranial injury 4 4 5 0 0 9Other/unspecified 13 13 20 0 25 9

Mechanism of injury (%)Entanglement 8 71 5 77 83 100Run over 22 0 25 0 0 0Fell from, then run over 29 0 40 0 8 0Struck or pinned by 13 25 10 8 0 0Fell from 14 4 20 8 0 0Roll over 13 0 0 0 0 0Other/unspecified 1 0 0 8 8 0

(which, if available, may be prohibitivelyexpensive); they may allow children to accom-pany them while doing their field work (whichmay put the child in proximity to machineryhazards); or they may leave their childrenpartially or totally unsupervised. There isclearly increased risk for injury associated withthe latter two options.

Because children are small they may not bevisible to operators of farm vehicles. As agroup, forward and backward run over injuriesassociated with farm tractors and other agricul-tural equipment were the second leadingmechanism of injury in the study. These weretypically caused by a tractor operator beingunaware of the presence of small child on theground beside them. (Similar patterns ofpedestrian injury have also been observed inurban settings, where young children are com-monly backed over by motor vehicles indriveways.2")

Pattern 2. The farm child who is left in theproximity of unguarded or moving machinery.A 12year old girl was watching her older brotheruse an elevator to load hay bales into the loft of abarn. Thegirl slipped on the wetground, and triedto regain her balance by grabbing onto theelevator. As she did so, her arm entered anunguarded portion of the elevator drivermechanism and her coat sleeve became entangled.Her arm was amputated at the shoulder.The leading mechanism of non-fatal injury

observed in this study was that of a childbecoming entangled in a moving piece ofagricultural machinery. Two factors generallycontributed to the occurrence of these injuries:(1) children allowed to be in the proximity ofoperating machinery; and (2) machinery witheither no safety guarding, or guarding that wasinappropriate to protect smaller limbs or bodyparts.

Pattern 3. The farm child who is allowed toaccompany workers in the proximity of movingfarm machinery.A 6 year old boy was riding on the fender of hisfather's tractor. As the tractor turnedfrom afarmfield onto a laneway, itjolted and the boy fell off.He was subsequently run over by the tractor tyre

and suffered multiplefractures of his legs and onearm.

There were numerous examples of fatal andnon-fatal injuries identified that occurred whenchildren were accompanying an older farmmember during work. In doing so, the childwas either assisting, or was being supervisedwhile performing field work or other chores.'Extra rider' injuries, where a child was ridingon a piece of moving farm machinery, fell, andwas subsequently run over, comprised thethird leading mechanism.

Pattern 4. The farm child who is performingwork tasks inappropriate for their age.A 1Oyear old boy was driving a tractor backfromafield where he had been helping with haying. Hewasfound dead lying in the field with the tractoroverturned in a nearby drainage ditch. It was

speculated that the boy had hit a bump whiledriving, fallen off the tractor seat in front of theback wheel, and had been crushed by the wheel.

Children are an important source of labouron farms. As such, they are often called upon tobe responsible for chores that are physicallydemanding, technically demanding, orrepetitive. These often involve the operation ofone or more types of large and dangerous piecesof machinery, which may or may not occur inthe presence of an adult. Some of these tasksmay stretch the capabilities of children to theirlimits.

PreventionWe propose four actions that we and otherinjury prevention specialists should take toimprove the safety of children on farms. Thesecome directly from the patterns of injuryobserved in the present study, and involve acombination of education, engineering control,and enforcement.2223 Targeting ofthe proposedinterventions is also discussed, followed by aninterpretation of the role of public healthprofessionals in ensuring the transfer of thesefindings into public health action.

(1) ENCOURAGE AND/OR SUBSIDIZE THECONSTRUCTION OF BARRIERS ON FARMS TOPREVENT CHILDREN FROM ENTERING PAR-TICULARLY HAZARDOUS AREAS

This strategy would apply to the very youngwho are at high risk for run over and entangle-ment type injuries. Barriers could consist ofitems as simple as fenced off areas of the farmresidence with selflocking gates erected to keeptoddlers and small children away from equip-ment. No one would advocate leaving smallchildren unattended for periods of time longerthan is appropriate for their age. However, itcould be hypothesized that it may be safer toleave these children unattended in a self con-tained play area by the home than to allow themto accompany older members during workactivities.

(2) WORK WITH GOVERNMENTS AND FARM-ING ORGANIZATIONS AT ALL LEVELS TO

100 on M

arch 5, 2021 by guest. Protected by copyright.

http://injuryprevention.bmj.com

/Inj P

rev: first published as 10.1136/ip.1.2.97 on 1 June 1995. Dow

nloaded from

Fatal and hospitalized agricultural machinery injuries to children in Ontario, Canada

DEVELOP PROGRAMS WHICH WOULD PRO-VIDE ADEQUATE CHILD CARE TO RURALRESIDENTS OF OUR PROVINCE

This would ameliorate the need for young farmchildren to be in the vicinity of machineryhazards, especially during busy seasons. Thereis an obvious need to augment this system ofchild care during harvest seasons and thesummer holiday for school children.

(3) WORK WITH GOVERNMENT ANDFARMING ORGANIZATIONS TO DEVELOP ANDENFORCE STANDARDS FOR THE SAFE-GUARDING OF ALL AGRICULTURAL EQUIP-MENT

Concems about the safety of agriculturalequipment are not new and the past 20 yearshas brought with it vast improvements in thedesign of most agricultural vehicles and imple-ments. Almost without exception, newlymanufactured pieces of agricultural machinerypose far less of a threat to operators andbystanders than do older models. One of theproblems with simply relying on this improvedengineering as a primary means of injurycontrol is that agricultural machinery tends tobe used for many years, and the replacement ofolder machinery with newer, safer modelscannot be expected to proceed quickly.22Second, farming remains one of the mostunregulated industries in terms ofenforcementof safety standards. Even the most modernpieces of equipment are hazardous if shieldsand other passive safety devices are not main-tained. Without enforcement of sensible stan-dards for the guarding of agricultural equip-ment on a widespread and systematic basis, wecan expect that the toll of childhood injuriesassociated with agricultural machinery toremain high.

(4) LOBBY THE GOVERNMENT TO PROHIBITCHILDREN FROM OPERATING ANY FARMTRACTOR BEFORE THE AGE OF 14, AND TOINSTITUTE FORMAL TRAININGREQUIREMENTS FOR THEIR OPERATION

For reasons of public safety, no one in Ontariois allowed to operate a motor vehicle beforethey reach the age of 16, and even then there is asystem of graduated licensing that limits theconditions under which a young person candrive. Paradoxically, no similar restrictionsprohibit the operation of a farm tractor bychildren of any age on private farm property.While voluntary programs do exist for thetraining of people in safe tractor operation,there is no formal requirement for anyone whowants to use a farm tractor to go through such a

program, and at the present time licensing oftractor operators is not required. This is thesituation despite the fact that tractors are

usually far more powerful than most motorvehicles in operation, and are the leading agentof unintentional childhood injury on farms.'We documented several cases of 9-12 year

old children who were injured or killed whiledriving a farm tractor. We suggest that tractor

operation exceeds the physical abilities of mostchildren in this age group, and that steps needto be taken to prohibit this situation fromoccurring. We do, however, recognize that itmay not be feasible to set a regulated cut offagefor farm tractor operation as high as 16 becauseof the demands for teenage labour in ouragricultural industry. We propose as a compro-mise an age limit of 14, which, while recogniz-ing the latter need, addresses the inherent risksinvolved in allowing younger children fromoperating equipment that is beyond theirphysical capabilities.

Targeting of preventive interventionsThe patterns of injury observed might suggestthat interventions aimed at the prevention ofagricultural machinery injuries should beaimed at farms with one or more boys inresidence, and farms in certain regions of ourprovince that have higher rates of childhoodinjury (Central, Eastern, and NorthernOntario). Our interpretation of the observedvariations in the incidence of these injuries isthat they mainly reflect differences in exposureto agricultural machinery hazards by sex andbetween regions. However, exposures by child-ren to the hazards associated with agriculturalmachinery are common to almost the entirefarm industry,' and the targeting of preventiveinterventions should reflect this fact. Second,the strong seasonal pattern observed, withpeaks occurring during the summer months,suggest a need for the targeting of farm safetyprograms in rural schools immediately beforethe summer school break.

Taking responsibility for translatingthis research into public health actionThe science of public health practice involvesseveral phases including the analysis ofinform-ation about perceived health problems, thedetermination of risk factors or causal path-ways, the development of interventions, andthe evaluation of those interventions. Thismodel has served public health practitionerswell in the containment of infectious diseases,particularly for diseases preventable throughvaccination. However, for the prevention ofchildhood injuries there is no single preventionstrategy-there is no vaccine.A need for injury control researchers to

advance their field by extending researchbeyond the realm of surveillance and into thepublic arena has been recognized.24Specifically, researchers have a responsibilityto describe how they will ensure that theirresults are turned into public health action. Tothis end, this paper proposes four strategiesthat could be used by injury researchers inpublic health settings to reduce the incidence ofchildhood farm machinery injuries. Each imp-lies some level of community or governmentintervention to achieve the desired result.24The causal pathways associated with these

injury events are complex and imperfectlyunderstood, and our interpretations of thesedata will be richer if the process also involves

101

on March 5, 2021 by guest. P

rotected by copyright.http://injuryprevention.bm

j.com/

Inj Prev: first published as 10.1136/ip.1.2.97 on 1 June 1995. D

ownloaded from

Pickett, Brison, Hoey

members of the community of affected individ-uals. To this end, we intend to share thisinformation with members of the health andagricultural communities through publicationin technical and non-technical formats, and bypresentations at community based meetings.We also intend to involve ourselves in thedevelopment and implementation of preven-tive interventions. In recognition of the factthat interventions that seem feasible to theresearcher and public health professional maynot be implementable by the farm operator, thedevelopment of interventions should be ashared responsibility. However, not allintervention strategies suggested by the farmcommunity will work. Public health interven-tions must be evidence based-otherwise wewill do the public a disservice by continuing touse resources and community enthusiasm to noend.

Public health professionals must becomeinvolved in injury prevention on farms. Publichealth units can ensure that local and regionalintervention strategies are developed, targeted,and evaluated based upon objective data.Health units also have expertise in theorganization of coalitions that share the com-mon goal of formulating workable interven-tions. In short, public health has a central partto play-but first, health units such as oursmust recognize that injuries are their problem.They must assume ownership and respon-sibility.

ConclusionChildhood agricultural machinery injuries arean important public health problem, asevidenced by the growing international body ofscientific literature on the subject and the highrates of traumatic injury observed in the pres-ent study. These injuries occur regularly, areoften severe, and are almost entirely preven-table.The childhood agricultural injuries that we

observed generally occurred because a childwas inappropriately situated in the vicinity of amachinery hazard. Sensible preventiveinterventions need to build on this fact byeither preventing farm children from goinginto areas where major hazards are known toexist, or if this is not possible, reducing thepotential for contact between the child and thehazard. To this end, this paper suggests avariety of preventive actions that could beapplied, and the role of public health in ensur-

ing that our findings are translated into publichealth action.

We thank the Information, Planning and Evaluation Branch ofthe Ontario Ministry of Health, and the Office of the ChiefCoroner of Ontario, the Registrar General for Ontario, and theOntario FSA for their help with obtaining data access. Theopinions expressed in this paper are those of the authors. MrPickett is a Career Scientist funded by the Ontario Ministry ofHealth.

1 Richards NR (chair). Report of the Ontario Task Force onhealth and safety in agriculture. Toronto: Ontario Minist-ries of Agriculture and Food, and Labour, 1985.

2 Salmi LR, Weiss HB, Peterson PL, Spengler RF, SattinRW, Anderson HA. Fatal farm injuries among youngchildren. Pediatrics 1989; 83: 267-71.

3 Bredfeldt RC, Heath AE, Junker JA, Cuddeback GA.Childhood farm injuries: a neglected aspect of patient andresident education. Fam Med 1989; 21: 217-20.

4 Pickett W, Brison RJ, Neizgoda H, Chipman ML. Apopulation-based survey of farm injuries in Ontario.Accid Anal Prev (in press).

5 LettsRM, Gammon W. Auger injuries in children. Can MedAssocj 1978; 118: 519-22.

6 Ontario Farm Safety Association. Injury report. Farm SafetyAssociation Inc. Guelph: Farm Safety Association,1973-93.

7 Cogbill TH, Busch HM Jr, Stiers GR. Farm accidents inchildren. Pediatrics 1985; 76: 562-6.

8 Stallones L. Fatal-unintentional injuries among Kentuckyfarm children: 1979 to 1985.Journal ofRural Health 1989;5: 246-56.

9 Walker RB, Raines D. Childhood accidents in a ruralcommunity: a five year study. J Fam Pract 1982; 14:705-8.

10 Purschwitz MA. Fatalfarm injuries to children, Marshfield,WI: Wisconsin Rural health Research Center, 1990.

11 Doyle Y, Conroy R. Childhood farm accidents: a continuingcause for concem. Journal of the Society of OccupationalMedicine 1989; 39: 35-7.

12 Swanson JA, Sachs MI, Dahlgren KA, Tinguely SJ.Accidental farm injuries in children. AmJDis Child 1987;141: 1276-9.

13 Rivara FP. Fatal and nonfatal farm injuries to children andadolescents in the United States. Pediatrics 1985; 76:567-73.

14 Layde PM. Beyond surveillance: methodological considera-tions in analytic studies of agricultural injuries. AmIIndMed 1990; 18: 193-200.

15 Zejda JE, Semchuk KM, McDuffie HH, Dosman JA. A needfor population-based studies of health and safety risks inCanadian agriculture [editorial]. Can Med Assoc J 1991;145: 773-5.

16 Brison RJ, Pickett W. Agricultural health and safety researchprogram: final report. Guelph: Ontario Ministry ofAgriculture and Food, 1993.

17 Elkington JM. A case-control study of farmwork-relatedinjuries in Olmsted County, Minnesota. Minneapolis,Minnesota: University of Minnesota, 1990. (Doctoraldissertation.)

18 Brison RJ, Pickett CWL. Non-fatal farm injuries on 117Eastern Ontario beef and dairy farms: a one year study.Am JInd Med 1992; 21: 623-36.

19 United States Department of Health and Human Services.International classification of diseases, clinical modification.9th Ed. Pittsburgh, PA: US Department of Health andHuman Services, (PHS) 89-1260, 1989.

20 Statistics Canada. 1986 Agricultural census for Ontario.Ottawa: Statistics Canada, 1987 (Cat No 96-108).

21 Brison RJ, Wicklund K, Mueller BA. Fatal pedestrianinjuries to young children: a different pattern of injury.Am J Public Health 1988; 78: 793-5.

22 Etherton JR, Myers JR, Jensen RC, Russell JC, BraddeeRW. Agriculturalmachinery-related deaths. AmJPublicHealth 1991; 81: 766-8.

23 Ontario Farm Safety Association. Safety programs of theFarm Safety Association in Ontario, Canada. Am J IndMed 1990; 18: 409-11.

24 PlessIB. Unintentional childhood injury-where the buckshould stop. Am J Public Health 1994; 84: 537-9.

102

on March 5, 2021 by guest. P

rotected by copyright.http://injuryprevention.bm

j.com/

Inj Prev: first published as 10.1136/ip.1.2.97 on 1 June 1995. D

ownloaded from