Surgeon General's Confimnce on Agricultural Sai%y and Heat& FARMSAFE 2000 o A National Coalition for Local Action Conmned by the National lnsthte rbr Occupational Safety and HeaM April 30 - May 3, 1991. Des Moines, Iowa MACHINE DESIGN By Sverker Hogliiltd, M.D. Director, Swedish Farmers Safety and Preventive Health Association Stockhoim, Sweden Dr. David S. Pratt: it is a distinct pleasure to introduce now, Dr. Sverker Hogiiind. Dr. Hogiijnd grew up on a farm in northern Sweden, completed his education as a physician, and went on to obtain specialty training-first in hematology and then in internal medicine and occupational health. He is currently an Associate Professor at the institute in Stockhoim, and he has worked actively in occupational health since 1974. in 1980, he became the Medical Director of the Swedish Farmworker Safety and Preventive Health Association - a very important model I think many of us could learn a great deal from. He is currently also the First Vice President of the international Association for Agricultural Medicine and Rural Health and also the Secretary of the Scientific Commitiee on Occupational Health-a part of the international Commission, Please welcome Dr. Sverker Hogiiind from Stockholm: Agriculture is a risky operation. Statistics from many parts of the world show that accidents and work-related diseases are frequent among farmers and agricultural workers. Often, however, statistics are insufficient because farming, in many countries, is based on small enterprises run by the farmer, his family, and few employees. The ambition to report accidents and other health injuries is probably limited. In Sweden severe accidents causing fatali- ties are, fortunately, rather few in agricul- ture. However, compared with the total worklife in Sweden, it is obvious that farm- ing is over-represented among fatalities due to work accidents. It has been shown that about 20 percent of the fatal accidents in Swedish worklife occur w&hin agriculture ahd forestry. Only about 3 percent of the total workforce are occupied within this field. Recent studies in our organization have shown that the real incidence of work accidents is about twice what is reported from official statis- tics. Moreover, work-related diseases have been shown to be cotion among farmers and agricultural workers. Forestry work by self-employed farmers is the most ris@ operation in the total worklife in Sweden. Work injuries, as well as work-related diseases, are to a high extent related to agricultural work using different kinds of machinery. Machine cl;tf2e;herefore, iS an important factor to . . THE PROBLEM Machine design may be related to hazards of two kinds. One is accidents causing acute injuries. The other is chronic inju- ries or illnesses because of long-term, unfavorable effects on the body during work operations. Symptoms from the loco- motor organs are most common because of bad ergonomics, vibrations, etc. Hearing loss due to damaging noise is also very frequent. Accidents In Sweden, approximately 150,000 persons are occupied within agriculture and forest- Surgeon General's Conference on Agricultural Safety and Health - 1991 351 intervention - Worker Protection from Environmental Hazards x-y. However, only about 50,000 are occu- pied full-time at this. According to official statistics, about 6,000 work accidents occur yearly. This informa- tion is based on the reports of injuries for workers' compensation. The compensation is less well developed for the self-em- ployed farmer. Therefore, the ambition to report accidents is less strong. During 1988, the Swedish Farmers' Safety and Preventive Health Association studied 20,000 farmers concerning work injuries that had occurred during 1987. The study was performed as a postal inquiry and a telephone interview with those who had reported an injury in the inquiry. Machine design may be related to hazards of two kinds. One is accidents causing acute injuries. The other is chronic injuries or illnesses because of long-term, unfavorable effects on the body during work operations. From the results of this random sample, an estimation of the total frequency of work accidents within agriculture and forestry among self-employed farmers and forestry owners could be made. It showed that the real frequency during 1987 was at least double that of the official statistics. The most common cause of agricultural accidents (just above 25 percent) was han- dling animals. Falling, on the same level or to a lower level, was almost as common a reason for accidents. Machine-related accidents were about 12 percent in agriculture, and in forestry about 20 per- cent. 352 Of those accidents related to tractor driv- ing, about 50 percent happened when climbing up and down the tractor ano about 35 percent when connecting equip- ment to and disconnecting it from the tractor. In these respects, the design of the machinery plays an important role. The turnover of tractors is still an impor- tant reason for severe accidents, as is un- shielded power takeoff (PTO). Tractor work may also cause injuries driving on uneven surfaces. Headbumps and hits from the inside of the tractor cabin are a risk, as are hydraulic devices with oil under pressure. Sometimes exhaust gasses may cause problems. One important machine that is commonly used in agriculture and forestry is the chainsaw. It may cause accidents by kick- backs of the sword. Chronic Injuries and Diseases More than 50 percent of the diagnoses at physicians' consultations with farmers con- cern locomotor organs. Neck and shoulder symptoms, back problems, and hip and knee diseases are common. A special interest has been focused on hip arthrosis. Recent studies in our country have shown a significant increase of this disease in farmers compared to the general population. The disease occurs about 8 to 10 times more often in farmers. Still, only limited studies have been performed relat- ing different factors in farmwork to the disease. So far results indicate that there is a posi- tive correlation between tractor work and the disease. One reason might be the de- sign of tractors where, even in modern machines, the driver has to sit in a bent Papers and Proceedings Machine Design, May 1, 1991 and twisted position to survey the equip- ment behind the tractor. It has been suggested that the twisted position in the tractor chair may cause a rotation in the hip joint. It can also cause unfavorable pressure on the cartilage, which may cause damage. Other well-known machine-related chronic injuries are, for instance, white fingers caused by vibration in chainsaws and steer- ing wheels on tractors. In farmers and forestry workers, hearing loss is frequent because of noise exposure from tractors and other vehicles, threshing mills, and chainsaws. INTERVENTION There is still a lack of knowledge concem- ing hazardous effects of different environ- mental factors in agriculture and forestry and further research is needed about caus- al relationships. However, today sufficient knowledge exists to start to improve the work environment in order to reduce the health hazards. The outline for an inter- vention program could consist of three main parts. 1. There may be legal actions taken in order to prevent extreme hazards. 2. There should be strong enforcement on constructors, manufacturers, and dealers of agricultural machines in order to improve the working environment. 3. Information and education must be in- tensified and directed to dealers of ma- chinery, extension service officers (agents), farmers, farm workers, and forestry workers. Legal Considerations In most countries there is some legislation concerning work environment and protec- tion from health hazards. The extent to which legislation should be used is always under debate. The ambition is to have as little legal enforcement as possible. In Sweden in 1959 the law was put forward concerning safety frames (roll-over protec- tion structures) in new tractors. It was also decided that employed agricultural workers were not allowed to work in tractors lack- ing such frames. Self-employed farmers and family members for many years were excluded from this law and could use old tractors without frames in farm work. A new tractor, of course, had this device. In 1983 the law was extended to include family farmers. It was later decided that even old tractors had to have frames if they were to be used in agricultural work. The effect on fatalities due to tractor turn- over since the year of legislation was strik- ing. It is obvious that this action from the authorities, unpopular as it might have been, has had quite a significant effect in preventing severe accidents. Side effects of this safety frame law have resulted in proper cabins on the tractors protecting the worker from noise, dust, wet, cold, etc. This is also quite a step forward concern- ing work environment. Another example of effective legislation concerns chainsaws. When they came into frequent use, it was soon obvious that they could cause severe damage to the user by so-called kickbacks. In 1971 in Sweden, it was enforced by law that a special protec- tive device should be applied to all saws. Surgeon General's Conference on Agricultural Safety and Health - 1991 353 intervention - Worker Protection from Environmental Hazards It operates so that when the sword is flung backwards, the device causes the chain to stop. The drop in severe injuries from chainsaw operations is also significant from the time the law was introduced. Improvement of Machine Design Legal actions can only be taken into con- sideration concerning specific work envi- ronment factors causing severe injuries of high frequency. However, many hazards remain where improved design of the ma- chinery could reduce the risk. It is impor- tant that occupational health professionals have the possibility to transmit knowledge about health effects of different factors to the designers of machinery, the producers, and dealers. In industry more work has been done in this area, mainly due to ef- forts from workers, and representatives in trade unions, etc. In agriculture and forestry, labor unions are weaker and the workforce is dominated by self-employed farmers. The individual farmer has very little possibility to get his opinion known to the machine designers. One major task for occupational health organizations in agriculture is, therefore, to improve communication between manufac- turers and users. When designing new equipment, they must understand the im- portance of also considering work environ- ment factors. In Sweden, we have been able to produce a specification of the demands for good and healthy work environments in tractors. It has resulted in a checklist. The work has been performed in close collaboration with the National Institute for Occupation- al Health, the organization of the machine manufacturers (LELA), and our organiza- 354 tion. The checklist now also exists in an English version. It is our hope that it should be accepted and used on a broad international basis. We have planned to invite representatives of tractor manufacturing companies to a seminar concerning this topic a year from now. There is, of course, standardization work going on internationally considering work environment factors. However, this check- list goes much further and aims to create a work environment that is healthier in all aspects. We have recently used the checklist per- forming a test of new tractors from the ergonomic and work environment point of view. The result has been published in the weekly farm magazine called Land. It has been very much appreciated by the farm- ers. The manufacturers who got many stars for their tractors are, of course, happy. Those with fewer stars have been rather angry with us. We think, however, that it is our job to take this kind of action. Our experience is that, after the first disap- pointment and angry reactions, the dealers with less than good results usually come back and ask for our opinion on how they could make their equipment better. This is exactly what we have wanted with our action. Today it often occurs that a manufacturer of some equipment asks for our opinion when he is planning a new product. When this happens, we think that our work has been, to some extent, fruitful. Papers and Proceedings To prevent injuries, there is still much to wish for in tractor design. The power- take-off shield is often of bad design and broken in many older tractors, which caus- es a significant risk. In collaboration with the Institute of Agri- cultural Engineering, we have been en- gaged in the construction of a new device. This seems to be a significant step forward. The coupling of equipment behind the tractor often causes injuries. The rapid coupling systems, which exist on the mar- ket are not ideal and little used by the farmers. Properly used, they cause a sig- nificant reduction of work loads and health hazards. A big part of the injuries related to tractor work occur when the driver is climbing up and down the steps. They are often of a miserable design and get slippery by dirt. Simple devices can improve this. The chronic diseases concerned with trac- tor driving are neck, shoulder, back, and hip problems related to the driver's twisted and bent position while controlling the equipment behind the tractor during long working hours. Knee problems are com- mon in tractor driving and are related to too-heavy clutches. As much as 600-700 newtons have been found in new tractors. In the new ergonomic check list, 150 newt- ons has been appointed as acceptable. Valmet, the only Nordic tractor construc- tor, presented a new model a couple of years ago where many of these problems have been considered. The driver's seat, steering wheel, and ma- neuvering devices could be turned 180 degrees so that the driver might sit in a backward position when much work had to Machine Design, May 1, 1991 be done with equipment behind the trac- tor. There was no clutch because of hy- drostatic driving of the machinery. Two important improvements from the work environment point of view were achieved by this construction. The need to sit in a twisted position was markedly re- duced, and the clutch operation was no longer needed. We need more of this new and brave thinking in the machine design for the future. Because of other technical reasons, the model still is experimental. It still happens that kickbacks cause in- juries concerning chainsaws. A Swedish doctor has constructed a new protection device, which should be more effective. It is now tested. The Swedish firm, Husquama, is going to provide some models with this new and safer device. Increased Awareness In spite of legal considerations and improved machine designs, there will still be hazards concerned with machine operations. It is, therefore, important, along with other actions, that knowledge about health hazards and how they can be prevented is increased. This is needed among the users of agricultural machinery and also among advisers within different branches of extension services to farmers, and among dealers of agricultural machin- ery. It is a difficult task. Farmers are usually very busy and get much information of dif- ferent kinds. They have very little time to consider different offerings. Written infor- mation often is neglected. The motivation to consider information about health haz- ards is usually low among people who are quite healthy and do not consider accidents a reality. Surgeon General's Conference on Agricultural Safety and Health - 1991 355 Intervention - Worker Protection from Environmental Hazards One way to improve the possibility to get information through is by an occupational health service. In Sweden since 1978, occupational health service for farmers and farm workers has been organized and now covers the whole country. It has about 60,000 affiliated members. Our customers are offered services consis- ting of regular health checkups, infor- mation meetings, farm visits, short courses concerning specific health problems, first aid, back and neck schools, etc. They also have access to health care in case of medical problems related to work. It has turned out that the awareness of health hazards has increased considerably during the last years. The farmers inquire about work-environ- ment factors when they are buying new machinery more than previously. They are also inclined to use the personal protective equipment more frequently. Nurses per- forming health checks on farmers, physio- therapists, and safety engineers visiting farms pointing out ergonomic details to the farmer on his tractor have golden opportu- nities to provide information to motivated farmers. It is also possible to concentrate on one specific problem and to broaden the infor- mation by educating advisers to the farmers. An ongoing project is to produce information materials concerning the new ergonomic checklist and to give the ex- tension service officers and safety engi- neers education on how to use it in their work with the farmers. Teachers at agri- cultural schools and dealers of agricultural machinery are also invited to these cour- ses. CONCLUSION Today's knowledge about health hazards in relation to machine operations is fragmen- tary but, in many cases, enough to start prevention programs. Thus, the hazards may be reduced and health and well-being improved among farmers, farm workers, and forestry workers. Legal actions may considerably reduce specific risks associated with machine de- sign. By influencing constructors and man- ufacturers, improved work conditions can be achieved. By effective information and education awareness of hazards, preventive measures can be augmented. A branch-specific oc- cupational health service for agriculture and forestry is a valuable tool in this re- spect.0 356 Papers and Proceedings Surgeon General's Conkrence on Agricuttural Safety and Health FARM&WE 2000 o A National Coalition rbr Local Action Convened by the National lnstituie riv Occupational Safety and Health April 30 - May 3, 1991, Des Moines, Iowa VECTOR CONTROL By Robert R Pinger, Ph.D. Public Health Entomology Laboratory Department of Physiology and Health Science, Ball State University Farmers, ranchers, and others employed in agriculture are, by the very nature of their work, at significant risk for acquiring cer- tain vector-borne diseases. Some of you may ask, "What is a vector-borne disease?" or, for that matter, "What is a vector?" A vector is an invertebrate animal, usually an arthropod, that transmits disease from a reservoir of infection to a susceptible host. What is an arthropod? An arthropod is a joint-footed animal with a hardened exos- keleton such as an insect or a tick. Exam- ples of arthropod vectors are mosquitoes, flies, fleas, lice, and ticks. Vector-borne diseases are caused by mi- croscopic agents such as viruses, bacteria, protozoans, or worms transmitted by these vectors, usually when they bite. Examples of vector-borne diseases that occur here in the United States include at least four arthropod-borne encephalitides, malaria, dengue fever, Rocky Mountain spotted fever, and Lyme disease. Before I discuss these diseases, I should like to state that those in agriculture are Dr. David S. Pratt: We are going to move along to this morning's program with Dr. Robert Pinger. Dr. Pinger got his undergraduate training at San Jose State in California, and received a master's and a Ph.D. from Iowa State University, right here in the great state of Iowa. He has worked extensively with vector control and entomological research both at the National Research Council at Waiter Reed Army Institute of Research in `74 and `75, and then also had some tropical experience in Brazil as an associate research scientist at the National Research institute of the Amazon. Since 1977, a little less tropical, he has been at Ball State University in Muncie, Indiana, and his current research interests include mosquito- and tick-borne diseases. Dr. Pinger's going to talk about vectors and agricultural safety and health. Dr. Pinger: also exposed to a variety of arthropod- related health problems. The insects or arthropods are themselves the agents of disease or injury. In these cases, the arthropods affect health directly, rather than indirectly (as vectors). Direct effects include entomophobia (an unrealistic fear of insects), annoyance and blood loss, envenomization caused by bit- ing and stinging, dermatosis, myiasis, and allergies. ENVENOMIZATION My students are sometimes confused about the difference between biting and stinging. Biting Biting refers to interactions in which the arthropod uses its mouth parts. Biting insects include, but are not limited to, mosquitoes, horse flies, fleas, lice, and bugs. Biting arachnids include ticks, such as the American dog tick, the lone star tick, the deer tick, and chiggers. Venomous arach- Surgeon General's Conference on Agricultural Safety and Health - 1991 357 Intervention - Worker Protection from Environmental Hazards nids include the brown recluse and the black widow spider. Stinging Stinging refers to interactions in which the arthropod uses its tail (usually a modified ovipositor) to inject venom. Stinging ar- thropods include bees, such as the recently arrived Africanized honey bee; wasps, including the newly introduced German yellow jacket; and in the South, fire ants and scorpions. Male entomologists, who are easily in the majority, generally enjoy pointing out at a time like this that virtual- ly all of this biting and stinging is done by female arthropods. Although all too familiar, and at times very annoying, these occurrences are of relative- ly minor public health importance com- pared with the disease transmission capa- bilities of arthropod vectors. Today I will describe some of these vector-borne dis- eases, discuss vector control strategies and outline personal precautions that can re- duce the likelihood of vector-borne disease transmission in the agricultural setting. VECTORS We can divide vectors into two major types: mechanical vectors and biological vectors. Mechanical Vectors As mechanical vectors, insects can be thought of as contaminators. They carry disease-producing agents from an unwholesome environment, such as septic tank overflow, to a clean environment such as the top of your beverage can or sand- wich. 358 In some rural settings, house flies may become so numerous that they represent a significant health problem. The variety of disease-producing agents that have been recovered from house flies is staggering. The list includes those agents that cause amebic dysentery, typhoid fever, cholera, shigellosis, trachoma, poliomyelitis, and infectious hepatitis.' Another mechanical vector is the cock- roach, from which about 40 strains of path- ogenic micro-organisms have been isolated. These microorganisms include four strains of poliomyelitis virus, cholera, diphtheria, pneumonia, tuberculosis bacteria, and numerous intestinal protozoans. Mechani- cal transmission can also occur when a blood-feeding insect, such as a horse fly or stable fly, is interrupted while feeding upon an infected host, then completes its feeding on a susceptible host. Although mechanical transmission by flies and cockroaches can be of public health concern in some agricultural settings, bio- logical transmission of diseases by arthro- pods is much more important. In biologi- cal transmission, the disease microorgan- ism undergoes developmental changes and/or multiplication in the vector. There is also an incubation period during which the arthropod is infected but not infectious. It is unable to transmit the dis- ease. After incubation, the arthropod be- comes infectious, and remains so for life. Biological Vectors Examples of biological vectors include mosquitoes, ticks, fleas, lice, and certain other biting flies. Mosquitoes, the most notorious of all insect vectors, are capable of transmitting at least 3 species of filarial worms, 4 species of malaria, and a large Papers and Proceedings number of disease-producing viruses. Of the roughly 500 different arthropod-borne viruses catalogued, 249 have been isolated from mosquitoes.2 Ticks also transmit a variety of disease agents including those that cause babesiosis, Lyme disease, Rocky Mountain spotted fever, Colorado tick fever, and Powassan fever. Disease agents transmit- ted by other insects include murine typhus and plague, transmitted by fleas; epidemic typhus and trench fever, transmitted by lice; and a multitude of viruses, bacteria, protozoans and worms transmitted by bit- ing flies and gnats. On a worldwide basis, vector-borne diseas- es continue to affect the health of agricul- tural workers on every continent. In Afri- ca the tsetse fly and sleeping sickness not only cause 7,000 human deaths per year, but also limit cattle production over 10 million km'. Therefore, they contribute to the severe protein malnutrition on that continent. Malaria and mosquito-borne encephalitis affect rice farming in Sri Lanka and el- sewhere in Asia.3 Yellow fever afflicts those clearing forests for farming in parts of Central and South America. In the United States, most of the vector- borne diseases that have an impact on agriculture and agricultural health are zoonoses, diseases of animals transmissible to humans. Among the best known zoono- ses are those caused by four mosquito- borne viruses: the St. Louis encephalitis (SLE), the California encephalitis (CE) viruses, the western (WEE) and eastern equine encephalomyelitis (EEE) viruses. Each of these diseases has its own geographical distribution and pattern of transmission. Vector Control, May 1, 1991 While periodic outbreaks of these mosqui- to-borne viral encephalitides occurred, no doubt, long before the arrival of Europe- ans", accurate records of outbreaks date only to the 1930's. Between 1930-1945, mosquito-borne encephalitis killed an estimated 300,000 horses and mules in the U.S.5 Human illnesses were often associat- ed with these epizootics. For example, in 1941 North Dakota alone reported 1,080 human cases with 96 deaths.6 During the period 1956-1969, reported human cases of arthropod-borne encephalitis numbered more than 3,000. In 1975, both SLE and WEE were epidem- ic and epizootic throughout much of the United States. There were more than 2000 human cases,' many of them in farm workers. The WEE epizoodemic spread into Manitoba, where the importance of outdoor exposure is illustrated by the dis- tribution of 14 human cases. All but three of these cases were men. Interestingly, all three women who con- tracted the disease were widows who pre- sumably then did more outside chores than their married counterparts. Why do we not hear about these diseases anymore? Are they still around? Let me call your attention to last year's St. Louis encephalitis outbreak in Florida. Although case investigations are still being completed, the first case occurred in Fells- mere, Florida, an agricultural area. At least some of the cases were in farm work- ers. The economic impact of this outbreak is still being felt. Disneyworld receipts were off lo-25 percent for October through December. The annual costs of mosquito Surgeon General's Conference on Agricultural Safety and Health - 1991 359 Intervention - Worker Protection from Environmental Hazards control ran $2-4 million above the normal cost, and there was a $270 million short- fall in Florida's tax revenue for 1990.8 It is true that the current epidemics and epizootics seem less pronounced than those of 50-60 years ago. There are sever- al reasons for this. First, there are fewer horses now than there were in the 1930's and 1940's. Second, vaccination of many of the remaining horses against WEE and EEE has no doubt contributed to the elimina- tion of large epizootics in horses. This does not explain the decline in human cases, however, particularly when there is no evidence of a decrease in the level of virus activity in nature. Gahlinger, Reeves, and Milby postulate that changes in people's behavioral pat- terns have been responsible for the decline in human cases in California. Their study demonstrated that the advent of air condi- tioning and television substantially reduced exposure to infectious mosquitoes. People were found to prefer remaining indoors during the peak feeding times of the pri- mary vector, Culex tarsalis.g Others suggest that the low number of confirmed cases is a product of our dis- ease-reporting system. This phenomenon has been referred to as the "vector-borne disease iceberg." In this model, we see that most of the cases of mosquito-borne encephalitis are never reported because of misdiagnoses, poor follow-up, and no confirmatory serum sample. Grimstad and coworkers deter- mined that the ratio of reported cases to actual cases in Indiana is about 1:250 for St. Louis encephalitis. The ratio of report- ed cases was l:l,OOO for the Lacrosse strain of California encephalitis." Some cases are reported incorrectly as aseptic meningitis or "unspecified viral encephalitis." Cases often end up in this category when no convalescent or follow- up blood sample is submitted. The season- al distribution suggests, though, that they are, in fact, arthropod-borne illnesses. A failure in reporting is less likely to occur when there is a severe or fatal case. It is important to note that, in addition to the pain and suffering associated with a severe case, there can be significant medical costs. This is particularly true if the patient is a child who requires many years of institu- tional care. Leaving the encephalitides, I want to men- tion two other mosquito-borne diseases that affect those in U.S. agriculture: ma- laria and dengue fever. Malaria, transmit- ted by Anopheles mosquitoes, is once again becoming a concern in California where there have been 60 introduced cases in the last 5 years, virtually all in farm workers in San Diego County." Florida suffered its first introduced case in 43 years in 1990. An introduced case differs from an imported case in that it is one in which transmission occurs within the state.' Another somewhat vector-borne disease that we have thought of in the past as an exotic disease, but which now poses a very real threat to many in agriculture is den- gue fever. Health officials are concerned that the dengue fever virus, imported from the Caribbean into California or Florida with the migrant workforce, could also be transmitted within the United States. 360 Papers and Proceedings This becomes increasingly more likely with the spread of the Asian tiger mosquito, Aedes albopictzq which is now considered to enjoy a statewide distribution in Florida.' This specie, which arrived in the United States from Asia in imported truck tires in 1984 or 1985, is a more aggressive biter and a more efficient vector of the dengue fever virus than the yellow fever mosquito, Aedes aegypti.12 l3 Since the early 1980's, tick-borne diseases have received much more publicity than mosquito-borne diseases. Who has not heard of Lyme disease? For those who have not, Lyme disease is a systemic, bacterial, tick-borne disease with protean manifestations including dermato- logical, arthritic, neurologic, and cardiac abnormalities. It is caused by the spiro- chete, Borrelia burgdorferi, which is trans- mitted by ticks in the Ixodes ricinw group. It is often the nymphal stage of these ticks that transmits the disease. The most noticeable early sign is a red rash emanat- ing from the site of the bite. The disease has spread rapidly in the United States since its discovery in 1975. It has now been reported from 47 states including, most recently, New Mexico.14 Actually during the period 1983-1987, tick- borne diseases made up more than three- quarters of all reported cases of vector- borne disease in the United States." Rocky Mountain spotted fever actually declined during the 1980's from a high of 0.52 cases per 100,000 in 1980, to 0.25 cases per 100,000 people in 1989.`"" Meanwhile, Lyme disease showed a dra- matic increase over the same period from 0.10 cases per 100,000 in 1980, to more than 3.5 per 100,000 in 1989. The 1990 Vector Control, May 1, 1991 case data are still incomplete for some states. It appears, however, that the num- ber of reported cases of Lyme disease may be leveling off or even declining slightly. This may be due to a change in the case definition, which now requires laboratory confirmation of clinical cases without a rash. VECTOR CONTROL The title given to this presentation was Vector Control. Obviously, in the time remaining, I cannot tell you how to control all of the species of mosquitoes, ticks, flies, and other vectors that are of importance to the occupational health of American farm- ers. I can review some widely accepted guide- lines, however. There are three approach- es to vector control: physical control, chemical control, and biological control. Physical Control Physical control is the modification of the environment to reduce or eliminate vector populations. This type of vector control is the most desirable because it is the most permanent. Populations of mechanical vectors such as house flies and stable flies can be reduced or eliminated by maintain- ing proper sanitary conditions. For example, the regular removal of live- stock and pet manure, soiled bedding, straw, garbage, and all other decaying plant and animal matter will reduce breed- ing sites for house and stable flies. Sirni- larly, cockroach problems can be reduced or eliminated by the proper construction of human dwellings, regular cleaning, proper food storage, and food waste disposal. Surgeon General's Conference on Agricultural Safety and Health - 1991 361 Intervention - Worker Protection from Environmental Hazards The distribution of the mosquito-borne dis- eases correlates closely with the distributions of their primary mosquito vectors. Since all mosquitoes are depen- dent upon standing (or very slow moving) water during the early stages of their de- velopment, proper water management in agriculture can substantially reduce the risk of infection with these diseases. In the west, physical control means effi- cient water management with respect to irrigation and other methods of watering crops. In the east and midwest, those in agricultural settings should strive to elimi- nate all standing water near the home. This means ditching, draining, or filling low areas near homes whether under cul- tivation or not. It means maintaining steep, weed-free banks in man-made ponds and lakes. It means removing all man- made and natural water holding containers from near the home. Integrated Pest (Vector) Management (IPM) is the use of the safest and most appropriate combination of methods (physical, chemical, and biological) to control vector populations. These containers afford breeding sites for the vectors of Lacrosse encephalitis. Examples of containers that should be eliminated are rain barrels; used car, truck or tractor tires; paint buckets; and plastic containers of all kinds. Tree holes that are found should be filled in with sand or cement. Physical control methods for ticks include the removal of ail unnecessary shrubs and vegetation from near living quarters, the 362 extension of the mowed portion of the yard, and the regular and close mowing of grass for at least a 50 foot perimeter around the house. The greatest enemy of ticks is desiccation. By removing vegeta- tion you reduce the survival time of ticks. Chemical Control Chemical control is the use of chemical agents (pesticides) to reduce or eliminate vector populations. Chemical control is best viewed as an adjunct to physical con- trol. When properly applied, it can be of great assistance in lowering the risk for disease transmission on a temporary basis. There are many excellent chemicals on the mar- ket for mosquito and tick control. However, we are all familiar with the problems associated with extensive reliance on chemical control. These include the development of resistance, the destruction of non-target organisms, and cost. Biological Control Biological Control is the use of biological agents, such as microorganisms, other ar- thropods, or vertebrates, to reduce or elim- inate vector populations. In' sqme respects, biological control is a promise that has never been fulfilled. Nonetheless, the use of mosquito fish, Gambusia, and the spore- forming bacteria, Bacillus thuriqqiensis var. `israelensis, have been moderately success- ful in mosquito control. Integrated Pest Management Integrated Pest (Vector) Management (IPM) is the use of the safest and most ap- propriate combination of methods (physi- cal, chemical, and biological) to control Papers and Proceedings Vector Control, May 1, 1991 vector populations. In medical en- tomology, IPM means the reduction of a vector population to a level below that which poses a significant health risk. PERSONAL PROTECTION Personal protection offers another avenue for lowering your risk of acquiring a vec- tor-borne illness. Personal protection is the practice of health-directed behavior that reduces the risk of acquiring a vector- borne disease infection. Examples include the following: 1. Avoiding areas where and when vectors are present. 2. If you must enter these areas, wearing the proper clothing (long pants and long sleeved shirt, socks, and shoes). REFERENCES Use repellents properly and ap- propriately. Removing ticks promptly using the correct method. Prompt removal great- ly reduces risk of disease transmission. Grasp the tick as closely to the skin as possible and pull slowly and directly out. Notifying a physician if illness occurs. Be sure to mention a tick if you are suspicious. knowledge of vector-borne diseases, a sound understanding of approaches to vec- tor control, and a familiarity with procedures for personal protection can reduce the risk of contracting a vector- borne disease.0 1. 2. 3. 4. 5. 6. 7. 8. Harwood, Robert F. and M.T. James. Entomology in human and animal health. 7th Ed., New York: MacMillan Publishing Co., 1979. Karabatsos, N. (Editor). International Catalogue of Arbovimses Including Certain Other Kruses of Vertebrates. 3rd Edition, San Antonio, TX, American Society of Tropical Medicines and Hygiene, 1985. Lacey, LA. and C.M. Lacey. "The Medical Importance of Riceland Mosquitoes and Their Control Using Alternatives to Chemical Insecticides," Journal of the American Mosquito Control Association. June 1990. (Supplement No. 2.) pp. l-93. Chamberlain, R.W. "Historical Perspectives on the Epidemiology and Ecology of Mosquito-Borne Viral Encephalitides in the United States," American Journal of Tropical Medicine and Hygiene. 37(3). (Supple- ment): pp. 8-17, 1987. Steelman, C.D. "Effects of External and Internal Arthropod Parasites on Domestic Livestock Produc- tion," Annual Review of Entomology. Vol. 21, pp. 155-178, 1976. Leake, J.P. "Epidemic Infectious Encephalitis," Public Health Reports. U.S. Public Health Service, 56(11) 39: pp. 1902-1905, 1941. Centers for Disease Control. Encephalitis Surveillance Report Annual Summary 1975. Issued May 1977. l- 23. John A. Mulrennan, Entomologist, State of Florida, HRS, P.O. Box 210, Jacksonville, FL 32231, Personal Communication, April 25, 1991. Surgeon General's Conference on Agricultural Safety and Health - 1991 363 Intervention - Worker Protection from Environmental Hazards 9. Gahhnger, P.M., W.C. Reeves and M.M. MiIby. "Air Conditioning and Television as Protective Factors in Arboviral Encephalitis Risk." American Journal of Topical Medicine Hygiene. 35(3) pp. 601610. 10. P.R. Grimstad, C.L. Barrett, R.L. Humphrey, and MJ. Sinsko. "Serological Evidence for Widespread Infection with Lacrosse and St. Louis Encephalitis Viruses in the Indiana Human Population." American Journal of Epidemiology, 1 19; pp. 913-930, 1984. 11. Bruce F. Eldridge, Department of Entomology, University of California, Davis, Personal Communication, April 19,1991. 12. Hawley, WA. 1988. "The Biology of Aedes albopictus, " Journal American Mosquito Control Association. December, 1988, Suppl. No. 1. pp. l-40. 13. Francy, D.B., C.G. Moore, and DA. Eliason. "Past, Present and Future of Aedes albopictus in the United States," Journal American Mosquito Control Association. 6(l); pp. l27-l.32, 1990. 14. Centers for Disease Control, Division of Vector-borne Infectious Disease. "Update on Reported Cases of Lyme Disease 1989," Lyme Disease Surveillance Summay. l(2), p. 1, 1990. 15. Centers for Disease Control. "Lyme Disease-United States, 1987 and 1988," Morbidity and MortaZity Week& Report. 38(39), pp. 668-672, 1989. 16. Centers for Disease Control. "Rocky Mountain Spotted Fever and Human Ehriichiosis-United States, 1989,"Morbidity and Mortal@ Week& Report. 39(17), pp. 281-284, 1990. 17. Centers for Disease Control. "Summary of Notifiable Diseases, United States, 1989, "Morbidity and Mortality Weekly Report, pp. 38(54). 1989. 364 Papers and Proceedings Suqeon General's Conference on Agrkuhuml Satkty and Health FARMSAFE 2000 o A National Coalition for Local Action Convened by the National Institute for Occupational Safety and Health April 30 - May 3, 1991, Des Moines, Iowa A CONSULTING ENGINEER'S PERSPECTIVE By Ray H. Crammonrt, P.E. Consultlng Engineer, Crammond Engineering Company Dr. David S. Pratt: The first perspective we will have is from a consulting engineer. Ray Crammond is a consulting engineer born here in Iowa and a graduate of Iowa State University. He has an extensive career and background both with county government and also as a private engineering consultant, at least since 1978. He has extensive knowledge dealing with farm-related and rural resident Issues. We are very happy to have A Consulting Engineer's Perspective. Mr. Ray Crammond: First of all I would like to say I appreciate the opportunity to be here to speak to you I have been asked why I got involved in today, and this is an issue I have a lot of consulting work. The best way to put it is I figured it was easier than farming. I interest in. I am glad that the session carried over to this afternoon, because I was tied up this morning in a deposition. It did not have to do with personal injury, just manure run-off between two neigh- bors. grew up on a farm in Southeast Iowa, and I am still involved in the farm, but I always figured there had to be a better way of doing things. So that is how I got into the agricultural engineering. A lot of times misunderstandings come up We talked some about stress the past day or two. In the 1950's, wheat was $3 a when you try to talk about a subject. As bushel and psychiatry was $3 an hour. an example, I was reminded of an agricul- tural engineer who had phoned a veteri- In the 1960's wheat was only $3 a bushel, narian, and he said, "Say, DOC, I have got a psychiatry was a little bit better operation; sick cat. He just lays around and licks his it was $20 an hour. paws. He has no appetite. What should I do?" The guy replied, "Give him a pint of In the 70's, wheat was still $3 a bushel. castor oil." Somewhat dubious, the agricul- Psychiatry was a little bit fancier digs, and tural engineer forced the cat to take the it was $60 an hour. pint of castor oil and a couple of days later he met the vet in town, and the fellow In the 1980's the farmer was into the psy- said, "Well, how's your sick calf." He says, chiatrist at $100 an hour, and the wheat "Sick calf? That was not a sick calf; it was was still $3 a bushel. That is the way a cat." He said, "Well, you did not give him the castor oil, did you." "Sure did," things have gone, and that is one of the reasons for the stress that the farm com- said the agricultural engineer, "last time I munity is facing. saw him he was going over the hill with five other cats. Two were digging, two On the other hand, some people have the were covering up, and one was scouting for idea that an engineer has a life where he new territory." can just sit back and say, "Yes, I went through your plans a few minutes ago, and that's all there is to it." Surgeon General's Conference on Agricultural Safety and Health - 1991 365 Intervention - Worker Protection from Environmental Hazards ENGINEERING This was a quote from Herbert Hoover who was an engineer as well as a number of other jobs that he had. He talks about it being a great profession: . ..the fmcination of watching the pigment of the imagination merge through the aid of science, to a plan on paper, that moves to realization in stone, or metal, or energy; and it brings jobs and homes to man; and then it elevates the standards of living and adds to the comforts of lve. That is the engineer's high privilege. The great liability, of the engineer, com- pared to men of other professions, is that his works are out in the open where all can see them. His acts, step-by-step are in hard substance. He cannot bury his rnis- takes as a-you can kind of fill in the blank with other professions. He cannot argue them into thin air or blame someone else. He cannot cover his failures with trees and vines, and he can- not screen his shortcomings by blaming his opponents and hope the people will forget. In other words, if he screws up, he is responsible. On the other hand, his is not life among the weak; destruction is not his purpose; quarrels are not his daily bread. That is one of the reasons why a lot of engineers do not like to get involved in liability cases or product suits. To the engineer falls the job of clothing the bare bones of science with life, com- fort, and hope. No doubt, as the years go by, people forget which engineer did it, even if they ever knew, or some politician puts his name on it, or they credit it to 366 someone else who used other people's money. But the engineer himself looks back at the unending stream of goodness that flows from his successes with a satisfaction that very few professions may know. The ver- dict of his fellow professionals is all the accolade he wants. I think that holds true in a lot of cases for the people in the engineering profession. The problem is that in some cases, depending on a person's temperament, training, background, or whatever, the engineering procedure can start you out with a simple premise that the sum of two quantities in the form of one plus one equals two; but then as you study and get deeper into your subject matter you know that one equals log of e and that one equals sine' x plus cosine2 x and so forth. You get down there and rewrite all those equations. At this point it should be obvi- ous that equation three is much clearer and more easily understood than equation one. Other methods could be used to clarify equation one, but these are easily discovered once the reader grasps the underlying principals. I think too many times what happens when you talk about whether it is the design of a product or a tax code, whatever it might be, you know that one plus one equals two, but to get back to it, after going through what is on the bottom line there, you won- der where you are at. This is one of the definitions I like about engineering; It is the art of directing the great sources of power and nature for the use and convenience of man. Papers and Proceedings Another thing regarding engineers is the study of both human needs and natural phenomenon. These two fields of study give essential unity to the profession for all engineers, whatever their specialty, must know both human ways and natural forces. Human Needs One of the biggest problems I have seen in the 20 years since I have gotten out of college, in the work that I do, is that the engineer-if I am looking at a particular problem on a site or whatever-has looked at only the natural forces. They ignored the human forces - whether by their na- ture, the course of study, or whatever, they tend to drop one-half of the input there. That is where a lot of problems occur. So, I think the biggest problem is people 71 I had one engineer say, on a grain bin case that, "Well, if there was a warning saying that it should only be piled to a certain level, by gosh that is what it should be. The grain should be put in at that level." Knowing how farmers operate and how equipment operates, if you have a building that is about 200 feet wide and over 600 feet long and you are running grain in there at 17,000 bushels an hour, you prob- ably will not hit that line right on the nose. You had better figure that what can be put in there up to the eaves is going to be put in there up to the eaves. If you do not design to that, you are only fooling your- self. A Consulting Engineer's Perspective, May 2, 1991 So, I think the biggest problem is people who ignore the human input. It is where they run into trouble. Natural Phenomenon It would be a lot easier these days to be, another type of engineer than an agricul- tural engineer because on top of every- thing else that we have got to contend with, just when we think we have got all of our data down we have to deal with some new factor. Whether it is growth hormone that suddenly changes the dimension of the stalls or the strength of the animals, or whatever it might be. You can also run into unexpected natural phenomenon, after having, in the past 15 months or so, drilled 200 or 300 holes in Iowa for waste storage basins for livestock facilities. I have run into situations like that. SYSTEMS DESIGN Now a couple of quick definitions from my perspective. I get involved in product de- sign, but more in systems design. If you are talking about a contractor, well then you are generally talking about a gambler who never gets to shuffle, cut, or deal. A bid opening is a poker game in which the losing hand wins. There is the bid that is a wild guess carried out to two decimal points. The low bidder is the contractor who is wondering what he left out. The engineer's es&rate is the cost of construc- tion in heaven. Meanwhile, the project manager is the conductor of an orchestra in which every musician is in a different union. Critical path methods, which some of you may have used, is the management tech- nique for losing your shirt under perfect Surgeon General's Conference on Agricultural Safety and Health - 1991 Intervention - Worker Protection from Environmental Hazards control. An auditor is a person that goes in for the wounded after the war is lost and bayonets the half maimed. A lawyer is the person who goes in after the audi- tors and strips the bodies. "Free" Advice I guess one of the things I have run into is the value of free advice might be worth less than what you paid for it. Too many times I have seen situations where some- body relied either on their good buddy or friend, or whomever; maybe even on tech- nical personnel, and come to find out that they got into deep trouble when they relied on a situation where they thought they were getting a good deal. Another case involved ventilation systems. Well, the fellow himself was not so much personally injured as he lost $50,000 worth of hogs. You know, any fool can design a ventilation system, a lot of people will say, and so many do. I have run into cases where you can lead a client to enlightenment. We have been talking about training and so forth. That is all fine and good, but there are some cases where they just simply will not pay atten- tion to you, or go on about their business and ignore you completely. Disclaimers Disclaimers should not be used to protect poor design. How many times I have been involved in grain bin cases-whether bin drownings or bin collapses-somebody has a decal or a warning saying, regarding roof vents for instance, that they should be kept cleaned out. The only way to get to them is to tie yourself off on a rope and swing out there like Tarzan to get to it, and 368 there are no ladders, nor access to it. Does that make any sense? Does it make the home office feel better that you have got a disclaimer on there so you are protected. To me it is just ridicu- lous, and you are not fooling anybody, especially the courts. You might find your- self in a lawsuit. Training The other thing is it is easier to teach rules and to train rules than to train judgment. That is an area where we have to focus on in training judgment, and we end up trying to legislate common sense. Poor Engineering Poor engineering entails failure and mis- fortune, inconvenience, suffering, death. In one case three people died in a manure pit when they went down to fix a pump malfunction. In this situation could we have pulled the pump out without having to go down into a pit so a father and his two sons would still be alive? I remember on a project one time when I was talking to a banker in 1974. He said, "What do we need an engineer for? The building company does all that?" It turned out later - a few weeks later - I got a call. He wanted me to work on this particular project. Since that time, I have had numerous referrals on similar projects. But in this case they had a $300,000 build- ing coming in a few weeks, and they had made no provisions or planning on where they were going to put this thing. So, they finally came around to realizing that may- be the building company does not do all of that. Papers and Proceedings Another comment that I hear out in the field, "I got a special deal on this. How do you like it." A lot of times not very well because it usually leads to either failure or injury; but, the guy got a good deal on it so, to him, it was okay. A farmer has a choice as to whether he wants to buy this option or accessory item. I think back to the time I sat through a seven-hour deposition involving a bin drowning. We started at nine in the mom- ing and ended up at four. We did not even break for lunch. The poor court reporter's fingers were about ready to drop off, I think. Some- body brought in some candy bars at about 1:30 p.m. The question was given to me, "Could this farmer buy these roof vents as an accessory item?" In this particular case I said, "In your own manual it says that if the roof is installed in a certain way with roof clips in the down position where there's no gap, that there must be one roof vent for every so many cubic feet per minute of fan capaci- ty." In this case, I think it figured out five or six roof vents. This 42-foot diameter bin had no roof vents on it whatsoever. The fellow was in there trying to poke down the corn with a rod, trying to get it broken up so it would feed into the unloading auger. They found him in the middle of the bin about six feet off the bottom. It had just been minutes before that his nine-year-old son was in there. If his wife had not insisted that the son get out of the bin, while she went to fix dinner that eve- ning, he would have been in there, too. A Consulting Engineer's Perspective, May 2, 1991 I pointed out to the attorney who asked me that question, "In their own manual it says that if the roof is installed in this position, there must be a roof vent for so many CFM of fan capacity. How can you, in good conscience, tell me that this is an accessory item?" He never asked me an- other question. That is where I think we get into the sys- tems approach. In this particular case, the farmer never got the manual, or he might have discovered there was a problem that he could have acted on differently. We found in discovery that the manual was on back order, and he never received it. Why did you build at this site? "Well, the salesman said it would work." That has created a number of problems, in some cases the health of people; in some cases their pocket book. One case where people spent over $300,000 were ready to move some livestock into a building. They were sued, and they had to change things. "A bin is a bin," spoken by a farmer, a social studies teacher, or someone who bought a bin company because he wanted to get into a business of his own. He put up over 40-thousand bushel bins, and the roof was blown out and disrupted the farmer's income. He was not around the bin at that time, but he lost the bin, he lost the farm, he lost his wife through the protracted, final settlement. Meanwhile, this guy had been warned by the bin company just a few months before. He was given decals to put on his customer's bins, which warned that there was a problem. He just ignored it. He never went out and contacted anybody. The other thing relating to that is when we took the deposition of one of the engineers Surgeon General's Conference on Agricultural Safety and Health - 1991 369 Intervention - Worker Protection from Environmental Hazards for the bin company. He had been with the company for over 30 years. He had been in every phase of it, and you would think he would know what was going on. He was asked, "On this warning we are talking about, `Do not run the fans during icy conditions,' define what that meant?" He said "I don't know." So, here is a company that charges an engineer with writing up a warning label. He has had 30 years experience with the company. He writes a warning label that he cannot even interpret, but they can stick it on their manuals or out on the bin and say, "Okay, it is up to you, farmer, to guess what this means." They think they are in the clear. It is things like that, which real- ly burn me up. CONSULTATION Sometimes you run into, "That Product B is no good." You ask them where they get their information. "Oh, the salesman for Product A said so." I think one of the problems in agriculture is there are very few independent consul- tants or consulting engineers who have been able to look at a situation and make recommendations regarding some of these factors. Another thing that was brought up is that we are dealing with, especially traditional agriculture, a farmer who feels that he is a jack of all trades. That being the case, they try to do most of their own repairs a lot of times, sometimes not with the best results. As an example of designing out problems, about 10 or 12 years ago a fellow came to 370 me. He wanted a tank designed for ma- nure storage. I changed his original con- cept. There are half-inch diameter steel cables that are enclosed within panels that go all the way around the tank. There is a special jacking panel where they come out. One of the problems you can run into on these tanks is the build-up of ice. In this particular case it was a couple or three feet of ice. All of a sudden a big sheet of ice collapsed. That is a lot of force. There have been metal tanks that I know of that have just split in those situations. In this case, there was a tremendous noise. The guy went running off and two fellows who were near the tank went running off. A guy coming back from the field could not figure out what was going on. They thought the thing was collapsing. Instead of collapsing it held together. That is what factors of safety are for in design. The panels had holes that are cast right in the panels. What happened was the top cable snapped; when you have 20 tons of force, a cable snaps. I thought back to the time when a friend of mine from high school was in the Navy over in Viet Nam on an aircraft carrier, and when one of those cables snapped, it cut him in half. I thought, well if you are designing a tank like that, if you have cables on the outside and a cable broke, what would happen. In this case it was completely contained. Nothing happened. In fact, they went on and used it for a year or so, and then the guy came back and threaded in a new cable. So, that is just one example of how problems can be designed out. I guess from this standpoint, we have heard about the gas from livestock causing problems. We have to decide whether we Papers and Proceedings A Consulting Engineer's Perspective, May 2, 1991 are going to encourage and train people or are we going to hit them with regulations and say that, you know the Ten Command- ments or whether it is going to be the Golden Rule. How would you do it so you would not cause problems for somebody else? TECHNOLOGY The other thing that is affecting this whole situation of injuries and accidents is misap- plication of technology. After my sopho- more year in 1968, I worked during the summer for a company in Burlington, Iowa. I remember being impressed at that time as I was putting together drawings from several different departments of a new crawler. One of the other engineers was walking by the drafting table, when he stopped and looked. He never said a thing to me. I was just a student trainee that year. Then he looked at that again. He went and got some other fellows. They looked at it again, and they had a conference. I did not know what was go- ing on. It turns out that when I had drawn in where the track would go around near the operator's platform, there had been a situation one time, where somebody had been injured or a problem had come up with clearance between the track and the platform for the operator. They caught it, and the design was changed to rule out that problem. You always have to deal with the question that came up yesterday that if somebody does suggest a change, who is going to pay for it, and whether or not we try to squeeze it out of the price that the farmer gets for the product that he sells. In any case, something needs to be worked out because we do need him and her. If not, food prices are going to be a lot higher, and I think our way of life is going to be changed quite a bit.0 Surgeon General's Conference on Agricultural Safety and Health - 1991 377 Surgeon General's Conference on AgrfculWa/ SaMy and Health FARM&E 2000 o A Natlonel Coalition Ibr Local Action Convened by the National lnetitute Ibr Oecupationai Sakty and Health April 30 - May 3, 1991, Des Moines, Iowa AN EXTENSION SPECIALIST'S PERSPECTIVE By Rollin D. Schnie&r, MS. Extension Safety Specialist, Universtty of Nebraska Dr. David S. Pratt: Rollin Schnleder has been in safety In American agriculture for 35 years. He is one of the real pioneers and leaders. He is someone I cettalnly have admired over a long period of time. Right now, he Is professor of Blosystems Engineerlng at the Unlverslty of Nebraska in Lincoln. For 35 years, he has been on staff there. He has helped to write the hlstory of the Emergency Medical System (EMS) program and the communications program In Nebraska. Dr. Schnieder has written a great deal and been a major contributor to the understandlng of safety in agriculture. He has also been collaborating with the people at the medical center in a way that Is allowing the two branches at the university, in both Lincoln and Omaha, to collaborate with each other. Although the medical college and Lincoln campus have worked together before, they are hoping to blaze new trails. Today, Roilin Is going to speak to us as only he can. He will speak to us from An Extension Safety Specialist's Perspective on this issue with a long history. Help me welcome Mr. Roiiin Schnieder: Dr. Pratt asked me to show this book to you. In 1965, when the Department of Transportation (DOT) was coming into being we had 16 parts of DOT. One of them was clean-up, One was the trans- portation of people. I can remember vividly the night in Sep- tember of 1965, in the Cornhusker Hotel, where we had a group of about twenty people that were looking at the EMS pro- gram and also the communications pro- gram. Looking at EMS, in 1983 or 1984, I told Dr. Ken Kimball, who was on this committee, and Brigadier General Don Penterman, who was looking at com- munications, that: We ought to write a book of what we know about the history of EMS and com- munications in the state. There is only one other that I am aware of in the nation. That is Wyoming. They have a 190-page pictorial booklet. We put ours in the form of writing. There will be another book coming out soon, probably 165 pages on farm accident rescue. The American Academy of Ortho- pedic Surgeons will publish it. Dave Morgan from our staff, who is a tractor test engineer and EMT instructor in his own right, and I wrote this up. Hopefully, this will be published by late fall. I am going to use a little different variation from Ray's (Crammond) presen- tation. I was most impressed with the speakers that we had yesterday. I wanted to add a few things as I sat there and lis- tened. So we did. STATISTICS This came out in 1985. It is a 264-page manual on the whole history. Dr. Hoghind spoke of statistics. He said that there is a variation in statistics. You had better believe me; there is a variation 372 Papers and Proceedings in statistics. When you try to compare the United States to Sweden to Denmark to England to Germany, there is a real varia- tion. Dr. Gary Erisman did not say it, but he and I have talked about this before. Gary's point was that we talk about the number of fatalities and the number of injuries we have. He has told me that "there are a lot more out there than we know about." I feel exactly the same way. In 1978 or 1979, after OSHA had been in force for a few years, we had some people comment, "My gosh, here we have got OSHA and the statistics are going up." No, they were not going up. They were out there all the time. People were just finding them. Gary and I were advisors to OSHA from 1972 to 1976 so we had a good background on what was taking place. I remember that there was a new safety specialist in Colorado. He called and wanted to know if I would train him. A few months later Sid said, "I am glad we don't have the problem that you have in Nebraska." I replied, "Sid, you have it in Colorado. I know my problem. I am going after the figures. You are not." That is what happens. We also know that some of these statistics are hidden. So, I appreciate the comments regarding statis- tics. I was back at a meeting with John Pollock and Dr. Pratt a few years ago. They had reinstituted a farm injury study in New York. An Extension Specialist's Perspecthre, May 2, 1991 It amazed them to know that they had 35 fatalities in that first year of their study. They were working with the Farm Bureau in New York. They could not believe that they had that many. They were there all the time. They just found out where they were. When you live in a little community, you might hear about the one in your county. You do not hear about the ones statewide. I can tell you that we have had 853 fatali- ties in Nebraska from 1969 through the present day. These are broken down by the type of accident. Even then I am sure that I might have missed a few. Sometimes the victim gets transported across state lines to medical facilities. It may be a Nebraskan who is taken to a Sioux City Hospital. That report comes into Des Moines and it eventually gets back to Lincoln. Sometimes there is a delayed one and I may not find it. So even I miss a few of those. So, to Gary and Sverker Hoghind, I appreciate your comments. DESIGN John Etherton is sitting back here. It is John's job to come up with a statement about roll-over protective structures, retro- fitting. There are a lot of people who say, "Let's retrofit everything." This all sounds well and good, but you change a tractor when you do that. For example, when we came out with the roll bar, people were complaining about the noise. You had the tuning fork con- cept or added noise. I had a lot of calls, Surgeon General's Conference on Agricultural Safety and Health - 1991 373 Intervention - Worker Protection from Environmental Hazards What can we do?" We can dampen. Some were putting sand down in the up- rights to dampen the noise. Some were putting loaded springs across to dampen them, anything to get this noise down. You can change characteristics of tractors. You have to realize that a lot of the equip- ment that we have in agriculture is not totally designed. This is what Ray (Crammond) was saying. For example, the first totally designed tractor came into being in 1971. We had tractors that were designed; then we had after-market cabs put on. That was not a part of the design and there were some noise problems. You have to realize that a lot of the equipment that we have in agriculture is In 1971, there were two totally designed tractors. One was a Deere, the other one was Allis-Chalmers. They designed the whole unit and had the cab as part of it. They came in with a noise level of 80 or less. It was right around 80 db at that time. This was a whole new concept. Now those tractors are running down around 74 db, because they are designed as a total unit. This concept is true with other machinery. I was involved in a lawsuit 28 or 29 years ago, where a little boy lost a leg in an auger. The auger was built by one com- pany; another part was built by another company. ' There were four people who went together on this, and they all thought, `The other one is going to put the safety features on." Nobody did. You have to look at the totally designed system. We can look at anhydrous ammonia as another example. You buy the running gear, order so many at a certain price. You buy the tank, order so many at a certain price. You buy the pop-off valves, so many at a certain price. Put a hose on. They are all component parts. One of those is the weakest part of the system, and so we have problems. We have to look at the total problem, not components. There is another thing we have to realize. It was alluded to yesterday. I do not know if it was Gary (Erisman) or Sverker (Hoghind). Many times engineering is overruled by advertising. I have seen this. We are going to put a product on the market. It is maybe not what we want, but we are going to get it out there. I think of one tractor whose advertising said, "We're going to boost the pump up a little bit to get two more horsepower at the drawbar." When they did this, they also got more noise out of it. Advertising wanted the horsepower; they did not care much about the noise. The engineers were put at a disadvantage. They can do their best design, but they are put at a disadvantage if marketing makes the final decision. I think Steve Konz alluded to this in his presentation this morning. 374 Papers and Proceedings PROTECTION Dr. Richard Fenske yesterday talked about protection. I am going by a few comments that people made. He talked about the closed tractor cabs for pesticide protection. This is good. In fact, Cornell did some work on this in 1978 or 1979. It is of benefit. The thing we have to watch is that if people mix the pesticide and then get in the cab, they take it in on their clothing. I have been on a pesticide-training program since 1978. Our recommendation is that if you have two people, have one do the mixing and one do the application. Or take your clothing off before you get in the cab if you are working alone. There is another thing that Richard talked about yesterday. It regards a question that I get all the time. How do we tell when the cartridge or the canister is loaded? I give the same answer that he gave yester- day. Right now we talk about time and con- centration. We can look at acidity, and we take litmus paper and test for acidity. Is there some way that an engineer, or epidemiologist, or somebody could design a cartridge or a canister that when the cat- ion/anion process gets to 90 percent being loaded (somewhat like the working device for telling when the turkey is done), it could send up a little flag or a change in color? It is a very simple process, and maybe there is a way that we could take care of this question. I made one comment. There was a ques- tion yesterday about coveralls in the green- An Extension Specialist's Perspective, May 2, 1991 house and the material going through. Nothing was said about an apron. One of the things we point out in our program is the need for hand protection, eye protection, and apron protection. We know that the hands constitute a major point of entry in to the body. The label still reigns supreme. It must be followed. Another thing came up about re-entry into fields. We have had some close problems (poisoning) with county agents. We have had farmers who have asked county agents to look at their field for insects. I think of one that we had where the farmer did not tell the agent that the night before he had sprayed his field with parathion. This has a 4%hour re-entry. The agent who was asked to go in there is 6 feet 5 inches and weighs 300 pounds. He was sick when he came out of that field. He was going to head back home. He did not. He sat along the roadway for about 2 hours. We had another instance. A young man was asked to go into the field. His situa- tion was almost identical. I think back when I was a young lad. Dad and I would go along the back roads, and if we saw a cornfield that looked good, we would want to walk out and see how that corn was. We would walk out in that field and check the neighbor's corn. I would never think of doing that today because you do not know what the plants might have on them. OTHER PROBLEMS This morning we heard a talk about vec- tors that was very interesting. We do not have some of those problems. Surgeon General's Conference on Agricultural Safety and Health - 1991 375