Safety Hazards on the Farm and Intervention Recommendations

Ravinder Thaper, T’Anya Carter, Melanie Hayes, Charles Boyd and Priyanka Parab 1. Samuel Ginn College of Engineering, Auburn University, Auburn, AL, USA 2. School of Nursing, University of Alabama, Birmingham, AL, USA 3. School of Public Health, University of Alabama, Birmingham, AL, USA For any questions: Contact Ravinder Thaper: rkt0005@auburn.edu Abstract: The multiple hazards exist on the farms and majority of them are ignored, which might cause the farmer to pay later in terms of his ill health, potential injuries, or death. The current article discusses some of the common issues such as dust, air quality, environmental (weather) stressors, psychological stressors, noise, hearing loss, and tractor safety on the farms. Finally, the recommendations to overcome these hazards are discussed.

The following objectives were focused for the purpose of the article: 1. Dust and air quality concerns 2. Environmental (weather) stressors and psychological stressors 3. Noise and hearing protection 4. Tractor safety and seatbelt use 5. Safety training resources for new employees, seasonal workers, and students, including electronic and print sources that might be applicable to a policy and procedures manual

Air Quality
At the cattle operation, the cattle are fed a mixture of hay and dried feed. The components of this feed source are stored separately in large bins, inside of a large commodity barn. These bulk components consist of soybean husk, cottonseed, and other various feed products. These products are mixed in an agricultural feed mixer on an as needed basis. This mixing process takes place outside and produces large amounts of dust. There can be aggravated "allergy like" symptoms from the dust present in this process. When breathing large amounts of dust it can sensitize the worker causing allergy formation. There has been some evidence that exposure to soybean dust can lead to an increase in an allergic response to soybean husk (Ardusso et al., 2001). Along with the soybean dust, there is also a concern for general dust inhalation and endotoxin exposure in agricultural workers. A recent study of inhalable dust and endotoxins show exposures to these substances are very high throughout the agricultural industry (Spaan et al., 2006). Exposure to endotoxins has been associated with several negative respiratory health effects in agricultural workers (Environment, Health and Safety Online, 2019).
Depending upon which antihistamines are taken, there are some considerations that must be made, especially while working in an occupation that requires all the senses to be uninhibited.
Older antihistamines, or first-generation antihistamines such as diphenhydramine, have more of a sedative effect, as opposed to newer second-generation antihistamines such as loratadine, fexofenadine, or cetirizine (Church & Church, 2013;Randall & Hawkins, 2018). The firstgeneration antihistamines readily cross the blood-brain barrier and may cause drowsiness, fatigue, lack of concentration, poor effects on performance in children in school and impairment while working or driving (Church & Church, 2013). Studies have shown poorer performance is linked to older, first-generation antihistamines (Church & Church, 2013;Randall & Hawkins, 2018).
Antihistamines have also been linked to car and aviation accidents (Randall & Hawkins, 2018).
The farm workers suffer from allergic rhinitis, inflammation due to the release of histamine and other mediators (Randall & Hawkins, 2018). Allergic rhinitis may be seasonal due to grass or pollen, or year-around with such triggers such as pet hair, mold or dust (Randall & Hawkins, 2018).
Though the newer antihistamines are less sedating, the opportunity for some sedating effects to occur remains such as reduced reaction time and impaired judgement (Church & Church, 2013;Randall & Hawkins, 2018). If antihistamines are needed, consider taking the smallest dose possible to achieve the desired effects and follow the recommended dosing instructions provided in the package insert.
With large amounts of grain dust present in the air, there is some concern for the combustion of these airborne particles. The likelihood of grain dust explosion is higher in confined spaces. A likely situation for grain dust explosion could present itself in the storage area, the mixing process, or during loading and delivery of feed product. Evaluating the amount of grain dust present would be key to recommending controls for these respiratory and combustion hazards.
Determining the level of respiratory protection requires more characterization of the exposure during this process and the frequency with which this process is performed. Proper exposure evaluation would allow us to determine the appropriate respirator and whether fit testing required.
Personal sampling for endotoxins would allow to determine that risk as well. Making sure precautions are taken to reduce the likelihood of a combustible dust explosion throughout the process by reducing the amount of dust, removing ignition sources, and ensuring the process done outside would reduce grain dust explosion risk (Ardusso et al., 2001;Spaan et al., 2006).

Cold Weather Stressors
Beef cattle farming is one occupation where stress management is key. The health and welfare of the animals is a year-long process. The environmental elements not only create stress for the workers, but also for the cattle themselves. Though Alabama is located in the southern portion of the country, there are some winter seasons that can be unfavorably cool. During those cold winter months, extra care and precaution must be taken to minimize the effects of cold stressors on cattle. Cold stress for cattle leads to lethargy, increased respiration and heart rate, and

Heat Stress
Ten percent of agriculture related fatalities are related to heat-induced illnesses (Jackson & Rosenberg, 2010). Heat related injury or death is most likely to occur within the first few days for new employees, if not accustomed to working in the heat, or during a heat wave for all employees (Jackson & Rosenberg, 2010). The physical labor of agricultural work during warm weather may contribute to heat stress even in lower temperatures, especially when humidity is high and wind speeds are low (Jackson & Rosenberg, 2010). When exposed to heat, the body attempts to cool down by increasing the heart rate, dilating the blood vessels, increasing circulation to the skin, and sweating. Profuse sweating can lead to dehydration and electrolyte imbalance and inability to regulate body temperature if adequate fluid intake is not maintained. With prolonged blood circulation toward the skin for cooling, the internal organs can become deprived of proper blood flow leading to organ damage. Additionally, dehydration impairs the body's ability to regulate body temperature. If the body reaches 104 degrees (F) without immediate cooling measures and medical treatment, seizures, organ failure, and death can occur (Jacklitsch, et al., 2016).

Heat related illnesses
Jackson & Rosenberg (2010) noted that heat related Illnesses can be mild to severe. Heat rash is a mild, prickly, rash due to skin irritation as a result of clogged sweat glands. This rash may be more prevalent in areas of friction, but it can occur anywhere sweat glands are present on the body. Heat syncope is characterized by dizziness and temporary loss of consciousness due to decreased blood flow to the brain. This type of illness usually occurs in new employees who are not acclimatized to the heat; however, it may occur in seasoned employees at the start of summer season or during a heat wave. Heat cramps usually occur following profuse sweating and are painful muscle spasms that occur as a result of the loss of electrolytes from intense sweating. Heat exhaustion happens when the body temperature exceeds 100 degrees (F) and is accompanied by intense thirst, dehydration, fatigue and weakness. The person may also experience nausea and vomiting, headaches, confusion, irritability, difficulty with coordination, rapid heart rate, and low blood pressure. Heat stroke occurs when the body can no longer regulate core temperature and the body temperature reaches 104 degrees (F) or more. This heat illness is characterized by severe symptoms of profuse sweating, altered mental state (delirium or confusion), rapid breathing or hyperventilation, muscle soreness, irregular heart rate, difficulty breathing, coma, seizures, and, shock. This condition is a medical emergency. Immediate cooling and medical care should be provided to prevent permanent organ damage or death (Jackson & Rosenberg, 2010).

Recommendations
General recommendations to prevent heat stress include wearing light-colored, breathable clothing, acclimatization, maintaining adequate hydration, and modifying the works schedule on hot days (NIOSH, 2018). According to Jacklitsch et al. (2016), workers who are over 65 years old and/or who have certain medical conditions (e.g. hypertension, diabetes), or who take certain medications (e.g. beta blockers, diuretics, antihistamines) may be more susceptible to heat illness.
All workers should be educated regarding symptoms of heat strain and first aid measures for heat related illness. A buddy system should be implemented to watch for signs and symptoms of heat strain, e.g. weakness, dizziness, stumbling or unsteady gait, irritability, foggy thinking, skin color changes, or general fatigue or malaise (Jacklitsch, et al., 2016). Signs of heat stress require immediate cooling and medical attention to prevent permanent health effects or even death. The OSHA Quick Card: Protecting Workers from Heat Stress (OSHA, n.d.) is a quick reference for employers and workers.
Acclimatization is an important strategy to reduce the risk of heat illness and should be implemented over a seven to fourteen-day period. No more than twenty percent of the workday working in heat is recommended on the first day for new workers. The time spent in the heat can be increased by a maximum twenty percent per day until acclimatized. For seasoned workers, the schedule should be limited to no more than fifty percent of the usual workday and increased to sixty percent the second day, eighty percent on the third day, and one hundred percent the fourth day (NIOSH, 2018). Workers who are not physically fit may require more time for acclimatization.
Re-acclimatization should once again be achieved after a seven-day absence from working in the heat. If previously acclimated prior to the break, re-acclimatization can usually be achieved in twothree days. Breaks taken in the air conditioning will not increase the length of time needed for acclimatization (NIOSH, 2018). Hydration is a critical aspect of preventing heat illness and should be implemented before, during and after working in the heat. Workers should drink eight ounces of water every fifteen minutes (maximum six cups per hour) for the first two hours in the heat. For periods of prolonged sweating (over 2 hours), sports drinks should be used for rehydration.
Workers should be advised to avoid alcohol and drinks with caffeine and high sugar content as these may contribute to dehydration (NIOSH 2018).
Modifying work schedules to do more intensive work during the cooler part of the day and increasing rest periods in the hottest portion of the day are other ways to prevent heat stress.
Allowing workers to rest in the shade or air conditioning to cool down can decrease the likelihood of heat illness. Increasing manpower or utilizing tools or machinery to decrease the need for physical exertion in heat can also help prevent heat injury (NIOSH, 2018). NIOSH offers a free smartphone app that can be downloaded to monitor weather conditions and the risk for a high heat index or heat wave (OSHA-NIOSH, 2018). The app also lists warning signs and symptoms for heat stress and first aid measures.

Noise
Noise is typically defined as an unpleasant, unwanted or hazardous sound. Hearing loss is not as dramatic nor as sudden as traumatic injuries such as those from an overturned tractor or machine entanglement, but the damage is permanent (Depczynski et al., 2005). Hearing loss from noise is irreversible and significantly impacts the sufferer's quality of life (Depczynski et al., 2005). Research has shown that the prevalence of hearing loss is higher among those who work on the farms as compared to the general population (Beckett et al., 2000). The hearing loss is insidious in nature; with the gradual onset not recognized until significant losses have occurred (Beckett et al., 2000).
Agriculture is a hazardous occupation involving a relatively high rate of injuries and illnesses. After mining and quarrying, the National Safety Council has reported that agriculture has the second highest mortality rate in the United States (2006). Farmers are frequently exposed to noise from the heavy farming machinery being in addition to other equipment that may contribute to hearing loss (Depczynski et al., 2005). There are some other contributing factors such as aging, use of ototoxic (toxic to the ear) chemicals, diseases, etc. associated with hearing loss among farmers.
Hearing loss commonly affects those farmers working in high levels of noise (above 85 dBA). The hearing loss may lead to accidents and injuries on the farm, as this perceptual loss may prevent farmers from recognizing warning signals or imminent dangers associated with the use of farming equipment (Hager, 2002). There are various negative impacts of hearing loss which include irritability, negativism, anger, fatigue, tension, stress, depression, avoidance or withdrawal from social situations, social rejection, loneliness, reduced alertness, increased risk to personal safety, impaired memory and ability to learn new tasks, reduced job performance, reduced earning power, as well as diminished psychological and overall health (Hagar, 2002). Also, it may negatively impact the social as well as personal life of the exposed people (Hass et al., 2005).

Recommendations
Although hearing loss can be minimized by using proper hearing protection, many farmers remain unaware of the potential hazards of this noise and the permanent nature of hearing loss. In fact, in a research study in California, it was found that only 33% of farmers used hearing protection in high noise while 93% used personal protective equipment (PPE) to protect against chemicals. The hearing loss problem is aggravated by the fact that farmers generally do not wear hearing protection.
While hearing protection devices can help prevent noise-induced hearing loss, the best remedy to prevent hearing loss is using engineering controls. Hwang et al. (2001) found in their study in New York State that 'self-reported hearing loss' was a significant factor for injuries on the farm (Odds Ratio = 1.86) after adjustments for other covariates. Similarly, Browning et al. (1998) found that hearing loss increased the risk of injuries by 60%. Figure 1 is an example illustration for describing how long one should be exposed to various levels of sound.

Why Noise-Induced Hearing Loss Occurs
The hearing depends on the events which provide electrical signals by changing the sound waves. Fig. 2 represents the parts of the inner ear.

Recommendations to mitigate Noise-Induced Hearing Loss
Although hearing loss can be minimized by using proper hearing protection, many farmers remain unaware of the potential hazards of this noise and the permanent nature of hearing loss. In fact, in a research study in California, it was found that only 33% of farmers used hearing protection in high noise while 93% used personal protective equipment (PPE) to protect against chemicals. The hearing loss problem is aggravated by the fact that farmers generally do not wear hearing protection. While hearing protection devices can help prevent noise-induced hearing loss, the best remedy to prevent hearing loss is using engineering controls. Hwang et al. (2001) found in their study in New York State that 'self-reported hearing loss' was a significant factor for injuries on the farm (Odds Ratio = 1.86) after adjustments for other covariates. Similarly, Browning et al.
(1998) found that hearing loss increased the risk of injuries by 60%.
As hearing loss is preventable, provided are some of the precautions which can be followed to avoid hearing loss (nidcd.nih.gov): 1. The noises ≥85 decibels may damage the ear if one is frequently exposed to it.
2. When involved in loud noises always wear the earplugs.
3. If it is not possible to prevent the noise, one is advised to move away from it. 4. One should be alert to hazardous noises.
5. Protect the ears of children who are too young to protect their own.
6. Spread awareness among friends, family, and colleagues about the noise hazard.
7. Get hearing tested if exposed to loud noise for prolonged periods of time.
Noise-induced hearing loss continues to be one of the most widespread occupational conditions and hazardous noise exposure affects almost 22 million workers in the United States.
Occupational hearing loss is preventable through the hierarchy of controls, which should prioritize the use of engineering controls over administrative controls and then personal protective equipment. Companies do not periodically audit the sound levels or test their workers for Threshold shifts due to the associated high costs with the testing equipment. In 2016, there were 2.1 billion smartphone users worldwide, with this number projected to exceed 2.8 billion by 2020.
Due to this widespread use of smartphones, a lot of apps are being developed for human safety, especially occupational safety. They can be a highly effective and low-cost alternative to the traditional noise monitoring systems.
Whenever a smartphone app is used in place of a sound level meter or dosimeter, there are some questions that need to be answered (Thaper, et al. 2019).
1.) How accurate is the device/application compared to that of the sound level meter or dosimeter?
2.) If there is a difference in accuracy, is the difference of any practical significance?
3.) Does the device/application accurately measure sound levels at different frequencies?
The answers to these three questions will enable us to better assess the effectiveness of measuring noise levels using a smartphone app.
Noise exposure can be diagnosed and combated with the help of smartphone applications.
The advantages of a cheaper, more user friendly, and more accessible way to measure sound levels in the workplace. To detect the decibels exposed at the farm, the workers on site can use the NIOSH Sound Level Meter app for iPhone. It is preferred to use the app with a microphone to get the accurate results. The recommended app for Android smartphones is Decibel X when used with a microphone. There are no reliable apps developed on the Android platform yet. So, the Decibel X app is one of the apps that can be recommended for the Android users. The app though provides some great features such as real time scale level chart and wave graph on the display. So, it is recommended to use the Decibel X app with a microphone.

Body Mechanics
Farm work involves tasks requiring strength, reaching, bending, and high repetition. These tasks commonly cause strains, sprains, and back injuries. Solutions for these issues should be low-cost and not hinder productivity. Some general solutions for hand work include avoid placing One should retrofit their farm equipment with rollover protective structures (ROPS), however, a comment was made that seatbelts are worn only when on the main roads. This is consistent with the findings of Sanderson et al. (2006) showing only 4% of farmers who had seat belts on tractors used them. Keskin, et al. (2012) noted that only minor injuries and no fatalities occurred in tractor rollover accidents when the seatbelts were fastened, and the tractor was fitted with ROPS. According to Hard, et al. (2016), the best prevention includes ROPS and wearing a seatbelt any time one is operating the tractor. Tractors are least likely to roll over when traveling on main roads, and much more likely to roll over when the equipment is being operated on uneven terrain or when operating under heavy load. As such, a strict seatbelt use policy is recommended for all members operating tractors, as long as the tractor has ROPS installed (Keskin, et al., 2012).

Recommendations
A checklist for operators to utilize prior to daily tractor use will help ensure the tractor is in proper working order and slow-moving vehicle signs are visible and in good repair.
Additionally, for students and new employees working on the farm, the "Employer's Instructional Guide: Training Employees Who Operate Agricultural Tractors" (Iowa State University, 2013) is provided in Appendix A for training purposes.

First Aid and Emergency Plan
During the farm visit, it was noted that the closest hospital was in Opelika, Alabama.
Preparing ahead and sharing an emergency plan is an important safety measure for those working on the farm. The plan should include the address and closest cross streets to be given to emergency medical services, if one needed to call 911. Numbers of persons to call in an emergency, location of first aid kits, and a severe weather plan should also be included. Laminated cards with the emergency plan and a first aid kit should be in each farm vehicle, whether the vehicle is utilized on-road or off-road, and in the main buildings on the farm. Finally, a current tetanus booster every ten years should be a requirement for employment.
Inoculation of the cattle is another source of potential danger. Not only can the cattle cause crush injuries if a worker is caught between a frightened animal and a pinch point, ingestion of the medication or hormones can occur during this high-risk operation. To prevent such injuries, proper personal protective gear should be provided and worn. Goggles, gloves, and protective clothing can help prevent skin or mucus membrane contact or needle-stick injuries. Employees should be taught to never re-cap needles as this increases the likelihood of injury to the worker.