Tables

Occupational Health Hazards

  Physical forces/injuries from machinery and animals
     Ergonomic issues - repetitive stress
     Electrical
     Noise
     Organic and inorganic dusts
     Agricultural chemicals such as solvents, disinfectants and pesticides
     Toxic gases
     Infectious microorganisms
     Environmental - cold, heat, solar, and floods
     Psychological


Illnesses and Injuries


  Injuries – Fatal
                - Non-fatal-amputations, crush, lacerations, fractures, burns, back pain 
               and arthritis
     Respiratory disease
               Asthma
               Farmer’s Hypersensitivity Pneumonitis (FHP)			
               Organic Dust Toxic Syndrome (ODTS)
               Bronchitis
     Hearing Loss
     Cancer
     Pesticide-related illnesses
     Zoonoses
     Dermatitis
     Mental health conditions


Child Labor Act Issues


     Children must be over 14 and have a certificate of training to handle farm-type 
     tractors and self-propelled vehicles unless 17 years old and a high school graduate.

     Hazardous operations for children under 16
	     o  Operating tractors over 20 PTO horsepower
	     o  Connecting/disconnecting equipment to tractors as above
	     o  Operating corn picker, grain combine, haymower, auger conveyor
	     o  Working inside grain storage with oxygen deficiency
	     o  Handling agricultural chemicals (e.g. pesticides)
	     o  Transporting anhydrous ammonia



Agricultural Respiratory Hazards and Diseases



Occupational History
As developed by the Agromedicine Program of the Medical University of South Carolina
	Brief initial history: WHACS 
	W-what do you do
	H-how do you do it
	A-are you concerned about your exposures
	C-are co-workers (family members) concerned or have similar symptoms
	S-are you satisfied with your job (environment)

A more complete history can involve:
	o  a more detailed occupational and environmental history including a chronological listing of 
	    occupations, work practices, and use of personal protection devices
	o  agricultural chemical and pesticide use, crops and animals produced
	o  looking at material safety data sheets (MSDS)
	o  medical literature search.


Differentiation of ODTS  vs. acute FHP


Toxicologic Properties and Health Effects of Hydrogen Sulfide (H2S)
  o  Chemical asphyxiant with effects very similar to cyanide
  o  Heavier than air 
  o  Rotten egg smell at very low levels, paralysis of olfactory nerve at higher levels with loss of smell, 
       (cannot depend upon rotten egg smell to determine if safe levels because of low odor threshold)
      Respiratory and mucous membrane irritant at low levels
  o  Very toxic at higher levels when manure is agitated during emptying pits and can cause rapid loss 
      of consciousness, pulmonary edema, permanent neurologic damage, and death.
  o  Dust masks or chemical cartridges not adequate protection


Toxicologic Properties and Health Effects of Ammonia
  o  Lighter than air
  o  Pungent mucous membrane and respiratory irritant
  o  Penetrates deeper into lungs by adsorbing on dust and causes pulmonary inflammation 
  o  Leads to chronic sinus symptoms (non-allergic mucous membrane 
       inflammation syndrome) and chronic bronchitis
  o  2-strap dust/mist respirator and goggles adequate protection


Treatment of Silo Gas Exposures


Treatment of anhydrous ammonia exposure
  o  Always carry a 6-8 ounce squeeze bottle of water when working around anhydrous
  o  Keep 5 gallons of clean water in a container on the transport or application equipment.
  o  Flush the eyes in the field immediately with water for 15 minutes before 
      coming to the medical facility unless it is close by.
  o  Flush for at least 15 minutes with cool or luke-warm water in the Emergency 
      Department with IV tubing, eye cups, topical anesthetic.
  o  Obtain an Ophthamology consultation.


Selected Zoonotic Diseases found in Agriculture in the Midwest


Manifestations of Anthrax 
1.  Cutaneous
	a. Most common naturally occurring form
	b. Treated by antibiotics-20% fatal if not treated
	c. Progresses from papule to painless depressed black eschar
	d. From contact with infected animal, infected carcasses in rendering plants
2.  Gastrointestinal
	a. From eating contaminated meat
	b. Gastroenteritis with vomiting and bloody stools
	c. Mortality 25-75% without treatment
3.  Inhalational-most likely form due to bioterrorism
	a. Most severe, 100% fatality if not treated
	b. Mild nonspecific initial symptoms
	c. Later (3-5 days) rapid progression to severe respiratory distress
	d. Most fatal in young and elderly
	e. Early suspicion and antibiotic treatment can prevent death


Pathophysiology of organophosphate/carbamate poisoning
o  Organophosphates cause an irreversible binding of acetylcholinesterase (enzyme that breaks down 
     acetylcholine at nerve synapses) leading to acetylcholine excess.
o  Decreases plasma and red blood cell cholinesterase levels
o  Carbamates lead to a reversible binding of acetylcholinesterase
o  Muscarinic (cholinergic effects)-bradycardia, salivating, sweating, blurred vision
o  Nicotinic effects-muscle twitching, tachycardia, paralysis
o  Central nervous system effects-anxiety, personality changes, psychosis convulsions


Treatment of Organophosphate (OP) poisoning
o  Atropine given in large (massive) doses to reverse muscarinic effects in severe 
    poisonings for both OP and carbamate poisoning
o  In life-threatening cases, oximes (2-PAM or praloxidime) is given within 72 
    hours for organophosphate poisoning only to prevent irreversible 
    binding of acetylcholinesterase
o  Treat seizures with appropriate anti-convulsants (diazepam)
o  Provide adequate oxygenation with oxygen, bronchodilators
o  Consult with Poison Center


Diagnois of Organophosphate poisoning
o  Pattern of muscarinic, nicotinic, and CNS symptoms
o  History of working in fields, agricultural worker, pesticide applicator
o  Consider intentional poisoning in adult or accidental in child
o  Draw baseline red blood cell and plasma cholinesterase before starting treatment but do not delay 
     treatment while waiting for results. (after the fact diagnosis only)
o  Redraw cholinesterases in several days and follow for 1-3 months

	Occupational Health Hazards Physical forces/injuries from machinery and animals Ergonomic issues - repetitive stress Electrical Noise Organic and inorganic dusts Agricultural chemicals such as solvents, disinfectants and pesticides Toxic gases Infectious microorganisms Environmental - cold, heat, solar, and floods Psychological Illnesses and Injuries Injuries – Fatal - Non-fatal-amputations, crush, lacerations, fractures, burns, back pain and arthritis Respiratory disease Asthma Farmer’s Hypersensitivity Pneumonitis (FHP) Organic Dust Toxic Syndrome (ODTS) Bronchitis Hearing Loss Cancer Pesticide-related illnesses Zoonoses Dermatitis Mental health conditions Child Labor Act Issues Children must be over 14 and have a certificate of training to handle farm-type tractors and self-propelled vehicles unless 17 years old and a high school graduate. Hazardous operations for children under 16 o Operating tractors over 20 PTO horsepower o Connecting/disconnecting equipment to tractors as above o Operating corn picker, grain combine, haymower, auger conveyor o Working inside grain storage with oxygen deficiency o Handling agricultural chemicals (e.g. pesticides) o Transporting anhydrous ammonia Agricultural Respiratory Hazards and Diseases Occupational History As developed by the Agromedicine Program of the Medical University of South Carolina Brief initial history: WHACS W-what do you do H-how do you do it A-are you concerned about your exposures C-are co-workers (family members) concerned or have similar symptoms S-are you satisfied with your job (environment) A more complete history can involve: o a more detailed occupational and environmental history including a chronological listing of occupations, work practices, and use of personal protection devices o agricultural chemical and pesticide use, crops and animals produced o looking at material safety data sheets (MSDS) o medical literature search. Differentiation of ODTS vs. acute FHP Toxicologic Properties and Health Effects of Hydrogen Sulfide (H2S) o Chemical asphyxiant with effects very similar to cyanide o Heavier than air o Rotten egg smell at very low levels, paralysis of olfactory nerve at higher levels with loss of smell, (cannot depend upon rotten egg smell to determine if safe levels because of low odor threshold) Respiratory and mucous membrane irritant at low levels o Very toxic at higher levels when manure is agitated during emptying pits and can cause rapid loss of consciousness, pulmonary edema, permanent neurologic damage, and death. o Dust masks or chemical cartridges not adequate protection Toxicologic Properties and Health Effects of Ammonia o Lighter than air o Pungent mucous membrane and respiratory irritant o Penetrates deeper into lungs by adsorbing on dust and causes pulmonary inflammation o Leads to chronic sinus symptoms (non-allergic mucous membrane inflammation syndrome) and chronic bronchitis o 2-strap dust/mist respirator and goggles adequate protection Treatment of Silo Gas Exposures Treatment of anhydrous ammonia exposure o Always carry a 6-8 ounce squeeze bottle of water when working around anhydrous o Keep 5 gallons of clean water in a container on the transport or application equipment. o Flush the eyes in the field immediately with water for 15 minutes before coming to the medical facility unless it is close by. o Flush for at least 15 minutes with cool or luke-warm water in the Emergency Department with IV tubing, eye cups, topical anesthetic. o Obtain an Ophthamology consultation. Selected Zoonotic Diseases found in Agriculture in the Midwest Manifestations of Anthrax 1. Cutaneous a. Most common naturally occurring form b. Treated by antibiotics-20% fatal if not treated c. Progresses from papule to painless depressed black eschar d. From contact with infected animal, infected carcasses in rendering plants 2. Gastrointestinal a. From eating contaminated meat b. Gastroenteritis with vomiting and bloody stools c. Mortality 25-75% without treatment 3. Inhalational-most likely form due to bioterrorism a. Most severe, 100% fatality if not treated b. Mild nonspecific initial symptoms c. Later (3-5 days) rapid progression to severe respiratory distress d. Most fatal in young and elderly e. Early suspicion and antibiotic treatment can prevent death Pathophysiology of organophosphate/carbamate poisoning o Organophosphates cause an irreversible binding of acetylcholinesterase (enzyme that breaks down acetylcholine at nerve synapses) leading to acetylcholine excess. o Decreases plasma and red blood cell cholinesterase levels o Carbamates lead to a reversible binding of acetylcholinesterase o Muscarinic (cholinergic effects)-bradycardia, salivating, sweating, blurred vision o Nicotinic effects-muscle twitching, tachycardia, paralysis o Central nervous system effects-anxiety, personality changes, psychosis convulsions Treatment of Organophosphate (OP) poisoning o Atropine given in large (massive) doses to reverse muscarinic effects in severe poisonings for both OP and carbamate poisoning o In life-threatening cases, oximes (2-PAM or praloxidime) is given within 72 hours for organophosphate poisoning only to prevent irreversible binding of acetylcholinesterase o Treat seizures with appropriate anti-convulsants (diazepam) o Provide adequate oxygenation with oxygen, bronchodilators o Consult with Poison Center Diagnois of Organophosphate poisoning o Pattern of muscarinic, nicotinic, and CNS symptoms o History of working in fields, agricultural worker, pesticide applicator o Consider intentional poisoning in adult or accidental in child o Draw baseline red blood cell and plasma cholinesterase before starting treatment but do not delay treatment while waiting for results. (after the fact diagnosis only) o Redraw cholinesterases in several days and follow for 1-3 months