Surveillance is a critical component of effective prevention and intervention which has been integrated into the Great Plains Center for Agricultural Health (GPCAH). Through these surveillance activities, the Center contributes to the evidence base for the prevention and intervention of agricultural injuries by increasing the quality of available data and increasing access to this information.
Iowa has several ongoing surveillance activities to characterize the incidence of fatal and severe agricultural injuries and the prevalence and characteristics of less severe non-fatal injuries. Three data sources will be integrated into the Center’s surveillance activities.
Fatality Assessment and Control Evaluation (FACE) program
The NIOSH-funded FACE program is a collaborative effort of the University of Iowa and the Iowa Department of Public Health. As a rural state, one of Iowa’s FACE priorities is agricultural injuries including a statewide occupational fatality surveillance component. Fatalities reported through the State Medical Examiner’s Office, Iowa OSHA, and a newspaper clipping service are reviewed to verify that the death was occupational. Case data are augmented with employment and workforce data from the Iowa Workforce Development office to enable calculation of statewide fatality rates for agricultural injuries and their risk factors. The FACE program also investigates most agricultural fatalities. These investigations include the collection of available reports, such as those from the Medical Examiner and local law enforcement, as well as interviews with witnesses and employers. These in-depth investigations provide details about the causal mechanism for the death from which prevention strategies can be developed.
GPCAH faculty and staff are also an integral part of the Iowa Fatality Assessment & Control Evaluation (FACE) Program team that investigates occupationally-related fatalities (http://www.public-health.uiowa.edu/face/). The resulting technical report is provided to NIOSH and disseminated to the public by both Iowa FACE and NIOSH. These reports can be viewed at http://www.cdc.gov/niosh/face/stateface.html. Recent agriculture-related reports submitted by Iowa FACE include:
- Farmer engulfed in soybeans while operating grain vacuum in steel bin (Report #2012IA001)
- Farmer engulfed then asphyxiated by corn in grain bin (Report # 2009IA012)
- Farmer crushed by corn head when disengaging it from combine (Report # 2008IA081)
- Farmer caught in compression rollers of hay baler (Report # 2009IA037)
- Farmer dies from injuries after being attacked by bull (Report # 2011IA043)
Iowa FACE issues hazard alerts if warranted.
Iowa Statewide Trauma System Registry
In 2001, Iowa enacted the Iowa State Trauma Act, which established the Iowa Trauma System and Iowa State Trauma Registry. Iowa became one of the first (and remains one of the only states) to designate each licensed acute care hospital according to their trauma resources. It led to the implementation of standard triage and transport protocols throughout the state, so that a severe injury in the most isolated rural areas of Iowa would be treated with similar protocols to a severe injury in a large town.
The Trauma Registry has a specific variable to identify agricultural injuries. Information about the agricultural injuries includes variables about the patient (age, gender, zip code of residence, primary occupation); the injuries (primary nature of injury, Injury Severity Score (ISS), mechanism of injury, work-relatedness of injury, and discharge disposition); and the event (time, date, location, location within farm (to differentiate between fields, buildings, and the farm home) and activities leading to the injury).
Newspaper Clippings and Interactive Map
For several years the GPCAH maintained a newspaper clipping database of injuries and deaths related to agriculture. Although not population-based, this clipping service provided information that may not have been reported by other sources.
In 2012, GPCAH conducted an extensive review of this activity as a source of information, resulting in discontinuation of its use. The full review can be read here. In addition, an interactive map of the region was plotted with locations and basic information on all 2011 agricultural-related deaths for our nine-state region (click here for the map and click on the red dots).
Information about agricultural injuries is incorporated into the Burden of Injury in Iowa report, a collaborative effort between the Iowa Department of Public Health and the University of Iowa Injury Prevention Research Center. The report includes two parts: a statewide report and a series of reports that describe injuries in each county. The Great Plains Center collaborates by providing information about agricultural injuries for both reports.
The Great Plains Center Surveillance project provides technical assistance to Center collaborators to incorporate agricultural injury data into ongoing research. Researchers need to request permission from the IDPH to use the State Trauma Registry data and must obtain UI IRB approval. Once these permissions have been granted, investigators are assisted in the orientation to and appropriate use of the data, focusing on developing scientific presentations, peer-reviewed presentations, developing evaluation plans for research and for state and local agencies, and interpretation of data for state and local agencies.