Nurses Using Rural Sentinel Events (NURSE)

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.


The California Occupational Health Program (COHP) has developed a model program for active surveillance linked with work-site specific and community-based prevention of occupational injuries in agricultural workers. The model links the reporting of fatal and severe injuries occurring in the agricultural workplace to investigations identifying potential risk factors, making recommendations for injury prevention, and facilitating on-site prevention programs, which integrate safety training, epidemiologic surveillance and research, and practical engineering solutions. Nurses are based in Fresno and Monterey counties which are the major agricultural counties in California. Nurses facilitate reporting, coordinate workplace follow-up, and assist or conduct workplace specific and broad-based education and training programs. The ultimate goal of the project is to prevent work-related injuries to agricultural workers and others exposed to hazards associated with agriculture.

The basic approach used was to identify, select, and recruit the key emergency medical care providers, including emergency departments in hospitals and emergency medical services in each county to report injuries related to agriculture. Injured workers, coworkers, and employers are confidentially contacted and interviewed by nurses and other project staff. Nurses arrange workplace visits, conduct workplace investigations in conjunction with a safety engineer, and coordinate and conduct workplace safety programs in collaboration with the California Agricultural Health and Safety Promotion System (University of California at Davis Cooperative Extension). Workplace specific recommendations for preventive interventions are developed and disseminated. Demographic, health and risk factor/exposure data is maintained in an automated database which used for case management, descriptive epidemiology, prioritizing workplaces for interventions, statistical analysis, and report generation.

Nurses maintain ongoing contact with reporters in the surveillance system to give feedback on reporting and case follow-up and to conduct long-term follow up with workers and employers. As part of an evaluation component, a plan is being developed to determine whether the recommendations or workplace interventions have been implemented, and/or to document the barriers for their implementation. To implement the NURSE project and to disseminate the findings and recommendations, we continue outreach and liaison to medical, agribusiness, labor, governmental and community service organizations in each county and state-wide coalitions as well as other groups involved in agricultural safety.

The proposal continues to be linked to the Farm Family Health and Hazard Surveillance (FFHHS) project. As source data from FFHHS project becomes available, these will be used to help develop and target materials which can be distributed to injured workers and others through the NURSE project. Activities in year three will expand upon progress made in previous years and concentrate on implementing a dissemination plan and developing an evaluation plan.

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