AGRICULTURAL MACHINERY EXTRICATIONS
Responding to agricultural incidents such as one that involves a corn picker/chopper extrication can tax even the most experienced rescuers. Lack of knowledge, experience, and training (about this type of call) is only a small part of the reason personnel have difficulty managing these events. Run surveys in most jurisdictions show that farm rescues are a very small portion of overall responses. The emphasis on training and planning for these incidents, therefore, may be less than that put on more frequently occurring accidents such as auto extrications.
Another problem when responding to this kind of incident is the commonly held myth that standard hydraulic rescue equipment and techniques used for the typical motor vehicle accident (if there is such a thing) are adequate for dealing with farm implements. This is not necessarily so. Farm equipment generally is built of heavier gauge materials, has more structural members, and has a more complex degree of components. Chains, cogs, rollers, augers, hydraulic hose—all are combined within a confined area of entrapment.
Rescuers’ personal and primary-response experiences are important factors in agriculture-related incidents and their outcomes. Rescuers “born on the farm” or who have worked in this type of environment may be more adept in these situations than their “city-bom” counterparts.
(Photo courtesy of Vesper (Wl) Fire Department.)
An ongoing survey (“Agricultural Injury Survey”) conducted by the Emergency Department of St. Joseph’s Hospital and the National Farm Medicine Center in Marshfield, Wisconsin, reveals the following:
- The majority of agricultural incidents occur during late afternoon (dusk).
- The operator may have been in a hurry, may have been tired, and may have attempted a shortcut.
- Hands and arms primarily are injured (91 percent during the period from 1986 to 1991).
- A number of these accidents result from the victim’s attempt to un-
- clog product from the snapping or husking bed rollers.
- Another cause of these accidents is the catching of the victim’s clothing on the exposed power take-off shaft resulting from the machinery owner having modified or removed the safety guard to make the implement more “user friendly.”
Treating the patient may be very difficult until the extrication is completed. Shock must be managed by aggressively controlling bleeding, splinting, administering oxygen, and applying a PASG (pneumatic antishock garment), as well as administering intravenous therapy’—all must be considered. Don’t forget the other aspects of your assessment, since other areas of the body may have been injured as the victim attempted to escape from the entrapping machinery or was thrown into or against it. It is not uncommon to find the patient alert and aware of all surroundings. Be careful, therefore, when commenting on the type and extent of the injuries.
Should an amputation occur, properly handling the amputated part is your responsibility. Wrap it in plastic wrap and keep it on ice so that tissue ischemia is kept to a minimum. Do not immerse the parts in any solutions (normal saline or Ringer’s lactate); doing this may cause extensive tissue edema and jeopardize chances for successful revascularization.
Rescuer as well as victim safety should be priorities in farm rescues, just as they should be in other types of incidents. All responders must wear full turnout gear. Fire hazards from fuel, hot engines, and dry crops are always present. Charge and staff hoselines so they can be used immediately if needed. Exposure to fuels, hydraulic fluid, and other farm chemicals may present exposure hazards. Think SCBA! Rescuers also can be injured by jagged metal and exposed machinery’ parts. Agricultural operations often become very involved, making the need for an incident command system evident. These incidents often necessitate multiagency responses—fire, rescue, EMS, ALS, air transport, and haz mat, for example. Transporting victims to the most appropriate facility may7 be among the IC’s numerous duties.
The first step in addressing any incident involving farm machinery is to turn off the power to the equipment—and to make sure that it stays off. Machinery engines can be shut down in several ways, depending on the equipment involved. Every brand of farm tractor has a different method for turning off the power. Do not randomly push and pull the control knobs in an attempt to find the knob that shuts down the tractor engine. Turning off the power may cause the hydraulic system to lose power, which in turn may cause an implement being suspended by hydraulics to fall and injure the victim further or harm a rescuer. To eliminate these possibilities, stabilize the implement before you begin working. You may need numerous stacks of cribbing to accomplish this. If conscious, the victim may be able to tell you how to turn off the power.
(Photo by author.)
THE CORN PICKER
Every part of the chopper/picker may require a slightly different approach to accomplish extrication.
Chains and cogs. These components probably are the least difficult to release. Generally, they can be cut with standard cutting, hydraulic, or hand tools without much difficulty. Don’t waste time looking for master links; they often are covered with grease, oil, and mud. It would take too much time to try to identify and remove them in the conventional manner.
(Photos courtesy of Vesper (Wl) Fire Department.)
Rollers. A different approach is needed for these components. Prying on them generally causes tools to slip, which could cause additional crush injuries to the victim. Trying to “back out” the entrapped hand/arm could cause “blowout” injuries to the digits; such injuries have occurred. A “nuts and bolts” extrication may be your answer. This requires a good set of hand tools. The screwdriver and crescent wrench carried in most ambulances will not be effective. Removing the carrier bearing that holds the roller in place often is the safest method. If the hardware is damaged or is so rusty or old that the tools will not work, the alternative is to cut the carrier, which can be done with portable band saws, reciprocating saws, air chisels, or even a cutting torch. Remember, charged and manned hoses must be on hand to protect the patient when tools are in use.
Power shafts. Power take-off shafts generally cannot be cut with power hydraulics because their construction often is a solid shaft surrounded by a tube of the same design. Shields— which, as noted above, may or may not be in place due to modifications by the machinery’s owners—can be cut with portable saws and some of the aforementioned cutting tools.
Hydraulic hose. Never cut hydraulic lines under pressure; in fact, avoid cutting them in general. They can inject fluid from a pinhole leak into exposed skin as easily as a hypodermic needle. Hot spraying fluid can cause burns and severe eye injuries.
Augers. Remove the shroud that surrounds the augers using metal cutting tools (air chisels, can openers, side cutting snips, for example). Once the auger is exposed, it then can be removed in the same manner as the rollers. Some of the large hollow augers may be lifted with hydraulic equipment to give you the room needed for the extrication operation.
ADDITIONAL HINTS AND REMINDERS
The following hints and reminders can expedite extrications from farm machinery:
- Be sure to bring adequate lighting to the scene. (Remember, many incidents occur at dusk.)
- Have utility knives on hand. It sometimes is virtually impossible to get scissors underneath clothing that has become tightly wrapped around machine shafts or pulleys.
- Submit photos (showing in detail the area of entrapment and the type of mechanism that caused the injuries) taken at the incident scene with your report to the hospital’s receiving surgeon and staff. An instant camera (which costs about S35) can be carried on board your apparatus so that you routinely can provide photos that can accompany the victim to the hospital.
- Compile a list of farm implement dealers in your area and determine whether they would be willing to come out and assist during an emer-
- gency. Their mechanics know the equipment very well and can be valuable resource “tools.” Ideally, you should include these resources in a training session so that working together at an incident would be more efficient.
- Remember that metal has “memory”—just as springs have—and that every action has a reaction. Before cutting any parts of the machine loose, carefully check to see what the possible consequences could be. Think one step ahead.
Working against time is a challenge for emergency responders during incidents involving farm machinery. These operations can devour a great portion of the “Golden Hour” (as a general rule, a victim’s chance for survival is greatest when medical attention is received within the first 60 minutes)—which already may have passed before you arrive on the scene. A number of farm machinery victims are not found until some time after their entrapment. Among the reasons for this is that they often are working alone and at a distance away from the farmhouse. Although we can’t control all the elements related to time, using the time we are on scene efficiently will benefit the victim. Preplanning and training add to efficiency.*
(The author would like to thank Dean Stueland, M.D., and Paula Bue, RN/EMT, of the Marshfield Clinic, St. Joseph’s Hospital, National Farm Medicine Center, Marshfield, Wisconsin.)
Stueland, D.T., B. Lee, P. Layde. 1991“Surveillance of Agricultural Injuries in Central Wisconsin: Epidemiologic Characteristics,” J Rural Health. 7:63.
Stueland, D.T., P. Layde, B. Lee. 1991. “Agricultural Injuries in Children in Central Wisconsin. / Trauma. 31:1503.
Stueland, D.T., P. Stamas, Jr., T. Zoch, et al. 1990. “The Spectrum of Emergency Care of Agricultural Trauma in Central Wisconsin. Am. J. Emerg. Medicine. 8:528.