California Department of Health Services
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SUMMARY : CASE
192-344-01
A fifteen
year-old irrigator was taking apart sprinkler lines in a garlic
field with another worker. While his partner lifted one section
of pipe, making a gap where two sections of pipe were joined,
the irrigator grabbed the next section by the gap at its mouth.
This time the two sections of pipe were stuck. His partner
moved his section to break them free. The young irrigator's
hand got caught where the pipes joined. His fingers were cut
and broken, and the top of his little finger was almost cut
completely off.
The
farm did not have a procedure for taking care of injuries.
The foreman told the worker's father, who was also working
as an irrigator, to take him to a doctor. The father took
him to the emergency department of a hospital, where the cuts
were stitched. The next day the irrigator's hand was so swollen
he could not work. Upon hearing this, the farm owner told
the father to take him to a rural medical clinic. The clinic
further treated the young irrigator's hand, and sent him to
a hand surgeon. At the time of this investigation, it was
possible that the young irrigator might still lose his finger.
How
could this injury have been prevented?
- Employers
should have a safety program that trains workers and tells
them about dangers on the job.
- Be
ready to respond to injuries, by giving first aid and calling
the Emergency Medical Services.
BACKGROUND
On August
28, 1992 a nurse from the NURSE Project received a written
report of an agricultural injury from a rural medical clinic.
On August 17, 1992, the clinic treated a 15 year-old Hispanic
male for an open fracture of his fifth finger. The injury
occurred while the worker was dismantling and moving irrigation
pipes in a garlic field on a large farm growing garlic, melons,
and cotton. The farm employed 18 full-time workers, 150 casual
workers (working 1-12 weeks per year) and 25 seasonal workers
(13-37 weeks per year).
A nurse
from the NURSE Project interviewed the injured irrigator and
his father on September 3, 1992. The Senior Safety Engineer
of the NURSE Project discussed the incident with one of the
farm owner/operators on September 11, 1992. (The farm is run
as a partnership, with two owner/operators.) The pipeline
sprinkler system had been dismantled and moved soon after
the incident, so the NURSE engineer was unable to inspect
the setup. NURSE staff also reviewed the Doctor's First Report
of Occupational Injury or Illness from the rural medical clinic
that reported the injury.
The
California Occupational Safety and Health Administration (Cal/OSHA)
was not notified and did not investigate the incident.
The
Senior Safety Engineer reviewed the farm's injury and illness
prevention program and found that at the time of the incident
it did not address all the points 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. a health and safety
program.)
The
Senior Safety Engineer noted that the employer's injury and
illness prevention program was not organized in a usable fashion.
Neither the hazard evaluation component nor the employee training
was being carried out.
The
injured worker was a part-time irrigator, on his summer vacation
from high school. He had worked for a farm labor contractor
on this farm for a short time three weeks earlier. The worker
was on his first day of compensated work as an irrigator.
In the past, he had helped his father, who worked as an irrigator
for the same farm owner, but had not received wages. While
workers who dismantle and move irrigation lines are usually
paid by piece rate, on this farm the irrigators were paid
by the hour. He had not received any training in how to handle
and move irrigation pipes, or in the use of personal protective
equipment (such as leather gloves) from the farm owner/operators.
His only experience and training in moving irrigation pipes
came from helping his father. One co-worker noted that workers
received safety training only if they were seen doing their
job incorrectly.
INCIDENT
On August
16, 1992, at approximately 8:00 a.m., a 15 year-old Hispanic
male was helping dismantle and move a pipeline sprinkler system
in a garlic field. This was his first day on the job. Sprinkler
systems consist of long sections of pipe, 20-30 feet in length
and 10 inches in diameter. One end of each section of pipe
has a flare (see figure). The straight end of the next pipe
section is inserted into the flared end, and water pressure
and a rubber gasket create a seal. When workers dismantle
the pipes, one worker lifts and tilts up a section of pipe
to drain the water from it. The other worker lifts the flared
end of the attached pipe. The injured worker lifted his end
of the pipe by curling his fingers around the mouth of the
pipe. While his hand was still hooked around the edge of the
pipe, the first worker began pushing, pulling, and rotating
his section of pipe to free it from the first section. This
action trapped and crushed the worker's hand in the coupling
between the pipes. The fifth finger on his right hand sustained
a severe "open" fracture, in which the bone came through the
skin, and the top part of his finger was almost torn off.
The third and fourth fingers of his right hand were badly
cut.
After
being notified of the injury, the foreman told the injured
worker to go to any physician he wanted for treatment. The
injured worker's father took him by car to the nearest small
local hospital. Upon their arrival, at approximately 9:00
a.m., the hospital staff sutured the young irrigator's lacerations
and sent him home. (The father had used this hospital in the
past because it accepted payment in cash, and he had been
reluctant to apply for Medi-Cal at the public county hospital,
which was the Level 1 Regional Trauma Center.)
The
next morning the injured worker reported for work, but his
hand was so swollen he was unable to work. One of the owner/operators
advised the father to take the young irrigator to the rural
medical clinic that functioned as the farm company's doctor
(it was this clinic who reported this injury to the NURSE
Project). At this clinic the worker's lacerations were dressed,
his hand was splinted and x-rayed, and he was referred to
a hand surgeon for immediate further evaluation. His father
drove him to the hand surgeon, who surgically re- attached
the portion of the fifth finger which had been partially amputated.
However,
at the time of the interview (September 3, 1992), the possibility
existed that, because of complications, surgical amputation
of the fifth finger might be required. The worker had intended
to continue working through the harvest season and use his
high school's home study program. But, because of his injury
and his inability to work, he returned to school. At the time
of the interview, the hand surgeon had not yet authorized
him to return to work (or play sports).
PREVENTION STRATEGIES
- The
farm owner should have a comprehensive written injury prevention
program*. Workers should be trained to recognize and avoid
hazards associated with specific tasks. In this incident,
the 15 year-old irrigator was on his first compensated day
of work and had received no safety training on how to handle
and move irrigation pipes. If he had been trained before
he started this job, his injury may have been prevented.
Although he may have observed others, including his father,
dismantling irrigation pipes, he should have still received
safety training on how to correctly perform this task. The
safety training for this task can be given in a short time.
* Title 8 California Code of Regulations 3203: Injury and
Illness Prevention Program (See Background).
- Field
crews should have an adequate emergency medical response
procedure. The crew should have a cellular phone or radio
available to contact the Emergency Medical Services (EMS).
Crews should be trained to call 911 before moving an injured
worker. One or more members of the crew should be certified
in first aid and cardiopulmonary resuscitation (CPR).**
In this incident, the father of the injured worker took
the responsibility to transport his son to an emergency
department. A foreman was present and should have ensured
that the injured worker received appropriate emergency medical
treatment. If appropriate emergency medical care had been
given at the scene of the injury, it is possible that the
risk of complications from this injury could have been decreased.
In addition, the injured worker may have initially been
taken to a facility that could have provided more definitive
treatment sooner. ** Title 8 California Code of Regulations
3400 (b): "In the absence of an infirmary, clinic or hospital,
in near proximity to the workplace...a person or persons
shall be adequately trained to render first aid.".
- Employers
should provide and require workers to use personal protective
equipment, along with instruction on proper use. This irrigator
was not told what appropriate personal protective equipment
(such as leather gloves) to wear. If he had been wearing
heavy leather gloves, the injury might have been less severe
even if his hand had been crushed between the pipes.
- Workers
who are working as a team need to be sure that there is
constant communication and visual contact between them.
In this incident, the two workers were dismantling a sprinkler
pipe together. However, the co- worker pushed his section
of the pipe forward before the irrigator had removed his
hand, resulting in injury. If they had paused momentarily
at the completion of each step and checked with one another
to make sure they were ready for the next step, this injury
might have been prevented.
FURTHER 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
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
NASD Review: 04/2002
This
document,
CDHS(COHP)-FI-92-005-20
,
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: October 1992.
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.
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