California NURSE Project
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of this document is available in english and spanish.
(Un resumen de este documento está disponible en inglés y español.)
SUMMARY: CASE
193-368-01
A nectarine
picker was busy picking in the orchard. When his basket was
full he would empty it in a bin on the ground. This meant
going up and down the tripod ladder often. A tripod ladder
has a single pole on one side which supports a set of ladder
steps on the other. When emptying his basket, fruit on the
ground would stick to the bottom of his boots.
The
nectarine picker started climbing down the ladder to empty
his basket. Suddenly, his boot slipped off a step. He began
falling when his foot hooked on a step. This flipped him upside
down, smashing his head on the ground and bending his neck
forward. He hung upside down.
Co-workers
released the nectarine picker's foot and lowered him to the
ground. Then they moved him so a tractor could pass by. It
took one half hour to find their supervisor to get instructions
on what to do with the injured worker. Finally, the nectarine
picker was loaded into a van and taken to a hospital.
How
could this injury have been prevented?
- Work
crews should be trained not to move an injured worker, especially
one with a possible neck or spinal injury.
- Employers
should have written safety programs. These programs can
help workers and supervisors identify hazards such as fruit
on boot soles.
- Supervisors
and workers should call 911 if someone has a severe injury.
BACKGROUND
On August
31, 1993, NURSE staff identified an injury in a nectarine
orchard while reviewing records at a Regional Trauma Center.
On August 26, 1993, a nectarine picker's foot slipped as he
was climbing down a ladder. As he began falling, his foot
hooked on a step which flipped him upside down and left him
hanging.
On September
3, 1993, a nurse from the NURSE Project interviewed the injured
worker at his home. On October 25, 1993, a safety engineer
from the NURSE Project met with the farm labor contractor
who employed the worker to discuss the incident. An on-site
investigation was not possible because the nectarine orchard
was destroyed and replanted soon after the incident. Replanting
orchards with younger trees is a routine procedure when fruit
trees reach an age at which their productivity decreases.
Also, NURSE staff also reviewed the Emergency Medical Services
(EMS) ambulance record and hospital medical records.
When
meeting with the farm labor contractor, the safety engineer
noted he did not have a written injury and illness prevention
program, as 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. provide safety training and instruction.)
However, the farm labor contractor told the safety engineer
he trains fruit pickers on-the-job after they are hired, along
with monthly refresher training. Yet, the injured nectarine
picker told the nurse that he never received safety training.
The
nectarine picker worked for this farm labor contractor for
the past two summer harvest seasons. This contractor employs
approximately 550 workers (300 of whom are seasonal employees
working 13-37 weeks per year and 250 are casual employees
working 1-12 weeks per year). Farm labor contractors are used
by some farm owners and operators of large corporate farms
in California to recruit, train, and manage workers.
INCIDENT
On August
26, 1993, at approximately 10:30 a.m., a 21 year-old Hispanic
male nectarine picker was working in the orchard picking nectarines.
He carried a basket, secured by a strap over his shoulder,
to hold the nectarines. He stood on a ten-foot aluminum tripod
ladder. A tripod ladder is designed for picking fruit, with
a single pole on one side that supports a set of ladder steps
on the other.
Rotten
fruit stuck in the rubber soles of the nectarine picker's
boots. As he began climbing down the ladder sideways, his
left foot slipped off a step. The foot caught in the third
rung from the top of the ladder. He fell backwards with his
foot still caught on the ladder step. His neck bent forward
as his left shoulder and back of the head hit the ground.
He hung upside down.
Working
approximately ten feet way, three other nectarine pickers
quickly released the injured nectarine picker's foot and lowered
him to the ground. The injured worker complained of neck pain.
A co-worker ran to get the supervisor at the other end of
the orchard. Meanwhile, the injured nectarine picker was moved
again to allow a tractor to pass by. After this, he said he
could not move and had lost all feeling in his legs and left
arm. The supervisor and five co-workers then loaded the injured
nectarine picker into a van to take him to a hospital.
They
arrived at a local rural hospital at approximately 11:20 a.m.
Because of possible neck injuries, fire department paramedics
were summoned to remove the injured nectarine picker from
the van. They placed a cervical collar around his neck and
immobilized him on a spinal board. This was done to prevent
any further injury to his neck and spinal cord during transport.
In the
emergency department, he was given pain medication and an
IV was started. Feeling returned to his legs and arm, and
he was able to move them again. X-rays and a CAT scan were
taken, yet no injuries were detected. Therefore, the emergency
department requested the injured nectarine picker be transferred,
via an ambulance, to a Regional Trauma Center.
The
injured nectarine picker was admitted to the Regional Trauma
Center with probable spinal injuries. In the Intensive Care
Unit (ICU) he was placed in a halo, a device designed to perfectly
align the neck and spinal column by immobilizing his head
and neck. His progress was monitored daily with x-rays to
determine the extent of damage. On August 31, 1993, four days
after being admitted, the injured nectarine picker was released
with a possible separation of the first and second cervical
vertebrae in his neck. The injured nectarine picker contacted
the nurse nearly three months after the incident, and stated
he is still wearing the halo and is not expected to return
to work for several months.
PREVENTION STRATEGIES
- Employers
should have an appropriate emergency response plan. This
includes work crews being trained to call 911 and to not
move an injured worker suspected of having a neck or spinal
injury. Also, supervisors and workers should be trained
in first aid and cardiopulmonary resuscitation (CPR). If
the supervisor and co-workers had been trained in first
aid and CPR, they would have known not to move a person
with a possible neck or spinal cord injury unless there
was immediate danger.* They would have also known to immediately
call 911. In this incident, the injured worker was moved
three times without proper immobilization of his neck. This
may have resulted in further damage to his spinal cord beyond
the injury sustained in the fall. Field crews should be
issued portable communication devices to use in emergencies.
In this incident, it took one half hour to locate the supervisor
to find out what action should be taken. This resulted in
a delay of medical care for the injured worker. If the workers
had a cellular telephone or radio they could have quickly
contacted him. Also, if 911 had been called using a portable
communication device, the injured nectarine picker would
have received emergency medical care much faster than he
did. * 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."
- The
employer should have an implemented written injury and illness
prevention program.* The farm labor contractor's safety
program should have included components on hazard evaluation
of specific tasks. In this incident, if the nectarine picker
had been trained in ladder safety and how to recognize hazards
such as rotten fruit on the soles of shoes, this incident
may have been prevented. * Title 8 California Code of Regulations
3203: Injury and Illness Prevention Program. See Background
section.
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(OHB)-FI-94-005-32
,
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: February 1994.
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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