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SUMMARY : CASE 192-383-01
Workers were harvesting almonds. The trailers they used to haul the almonds were leased. Moving these trailers was to be done only by the company owning the trailers, or the farmer could use a forklift. In order to save time, the farmer told his son and a farm worker to move the trailer without using a forklift.
The son and farm worker crawled under the trailer to unlock the brakes. They loosened the ring clamp from the outside housing of the brakes. This released a loaded spring, which sent the top of the outside housing flying into the farm worker's forehead.
Neither the farmer nor co-workers were trained in first aid. The farmer put the injured farm worker in his pickup truck, called 911, and drove him to a nearby road. An ambulance took him to a trauma center, where he was admitted with a broken skull.
How could this injury have been prevented?
BACKGROUND
On September 2, 1992, NURSE staff received a written report of an agricultural injury from a Regional Trauma Center. On August 29, 1992, a farm worker was struck in the head by the outside housing to the brakes on a flatbed trailer. The injury occurred while the farm worker was attempting to deactivate the brake system to move the trailer. This trailer was leased from a trucking company. Deactivating the brake system was usually done only by the trucking company.
A nurse from the NURSE Project interviewed the injured farm worker in the hospital on September 2, 1992. The NURSE senior safety engineer discussed the incident with the farmer hired to harvest the almonds on November 2, 1992. The senior safety engineer was unable to inspect the trailer because the trucking company had removed it from the farm. NURSE staff also reviewed the injured farm worker's medical records and the Emergency Medical Services (EMS) records.
The California Occupational Safety and Health Administration (Cal/OSHA) was not notified and did not investigate the incident.
The incident occurred on a 200-acre almond orchard. The injured farm worker was employed by a farmer who was hired by the orchard owner to harvest and deliver almonds to a hulling and processing plant. He had been employed by this farmer as a full-time employee for seven years. He had never received any training from this farmer, and had not disassembled any brake systems in the past. The farmer who employed him did not have a formal written safety program for his harvesting operation, as required by Title 8 California Code of Regulations 3203 -- Injury and Illness Prevention Program. (As of July 1, 1991 the State of California requires all employers to have a written seven point injury prevention program: 1. designated safety person responsible for implementing the program; 2. mode for ensuring employee compliance; 3. hazard communication; 4. hazard evaluation through periodic inspections; 5. injury investigation procedures; 6. intervention process for correcting hazards; and 7. provide training and instruction.)
INCIDENT
On August 29, 1992, at approximately 7:30 a.m., a 32 year-old Hispanic male farm worker was connecting a conveyor system to pick almonds off the ground. Almonds are harvested with a machine which clamps an arm to the tree and shakes the nuts onto the ground. A sweeping machine then sweeps them into the rows between the trees. A picking machine then sucks them up and places them on a conveyor belt, which leads to a bin behind the picking machine. When the bin is full it is emptied into a trailer. The trailer is eventually taken by a trucking company to the hulling and processing plant.
In this incident, the farmer leased the trailers needed for hauling the almonds. The trucking company set up the trailers with the brakes activated, locking the wheels. The trucking company told the farmer to move the trailers with a forklift. If the farmer needed the brakes deactivated, he was to call the trucking company.
However, to save time, the farmer told his son and the farm worker to deactivate the safety brakes on a trailer, and to move it without using a forklift. They crawled under the trailer. Neither of them had ever deactivated a brake system. They did not know that a special bolt must be screwed into the top of the brake system's outside housing. This special bolt takes the pressure off a loaded spring, thus safely releasing the brakes.
The farmer's son began by unfastening the ring clamp which kept the metal (outside) housing of the brake together. With the top of the metal housing loosened, the loaded spring released and sent the top of the housing flying, striking the farm worker on his forehead above the left eye. According to co-workers, he immediately lost consciousness. Neither the farmer nor his employees had any training in first aid or cardiopulmonary resuscitation (CPR). The farmer placed the injured farm worker in his pickup truck, and drove him out of the almond orchard to a nearby road. He called 911 on his truck phone. The Emergency Medical Services (EMS) was en route at 8:05 a.m., and met the pickup truck at 8:14 a.m.
They found the injured farm worker conscious, nauseated and complaining of pain in his neck. He could not remember the incident. He had a five-inch laceration over his left eye, and open facial and skull fractures. (An open fracture is one in which the broken bones cut through the skin.) The paramedics gave him oxygen and started an IV. They immobilized him and applied a dressing to his open wounds. The injured farm worker was transported to the Regional Trauma Center, arriving at approximately 9:00 a.m.
The injured farm worker was admitted to the hospital, with a depressed skull fracture and a torn lining (dura) of the brain. A brain scan revealed a depressed fracture in the left orbital (around the eyes) and left frontal bones (forehead) of the skull. It also revealed swelling of the brain in the left frontal lobe. An x-ray of the cervical spine did not reveal any damage. He had surgery the following day to clean the wounds, remove bone fragments, and repair the dura.
Two days later the injured farm worker developed a fever of 102øF, and was treated with antibiotics to prevent infection. He spoke Spanish, and understood very little English. When the nurse from the NURSE Project visited him, he asked for help to explain the nature of his injuries and the medical treatment he was receiving.
The injured farm worker was released after eleven days in the hospital. He was taking anti-seizure medication and was instructed to wear a hard hat because another blow to his skull could result in severe brain damage (possibly death). Nine days after discharge, he returned to the neurological clinic for a follow-up examination. He complained of sleepiness. On December 11, 1992, almost four months after the incident, the injured worker contacted the nurse from the NURSE Project with questions about his anti-seizure medication. He told the nurse he was continuing to have severe headaches and vision problems. His physician estimates that he will be out of work for at least a year.
PREVENTION STRATEGIESFURTHER INFORMATION
For further information concerning this incident or other agriculture-related injuries, please contact:
NURSE
Project
California Occupational Health Program
Berkeley office:
2151 Berkeley Way, Annex 11
Berkeley, California 94704
(510) 849-5150
Fresno
office:
1111 Fulton Mall, Suite 212
Fresno, California 93721
(209) 233-1267
Salinas
office:
1000 South Main St., Suite 306
Salinas, California 93901
(408) 757-2892
Publication #: CDHS(COHP)-FI-93-005-24
This document was extracted from a series of the Nurses Using Rural Sentinal Events (NURSE) project, conducted by the California Occupational Health Program of the California Department of Health Services, in conjunction with the National Institute for Occupational Safety and Health. Publication date: January 1993.
The NURSE (Nurses Using Rural Sentinel Events) project is conducted by the California Occupational Health Program of the California Department of Health Services, in conjunction with the National Institute for Occupational Safety and Health. The program's goal is to prevent occupational injuries associated with agriculture. Injuries are reported by hospitals, emergency medical services, clinics, medical examiners, and coroners. Selected cases are followed up by conducting interviews of injured workers, co-workers, employers, and others involved in the incident. An on-site safety investigation is also conducted. These investigations provide detailed information on the worker, the work environment, and the potential risk factors resulting in the injury. Each investigation concludes with specific recommendations designed to prevent injuries, for the use of employers, workers, and others concerned about health and safety in agriculture.
Disclaimer and Reproduction Information: Information in NASD does not represent NIOSH policy. Information included in NASD appears by permission of the author and/or copyright holder. More