AgriSafe Health Services: An Innovative

Occupational Health Model

Denise Andress, RNWest River Health Services

Hettinger, ND

Phone: 1-701-567-6177Email: denisea@wrhs.comwww.wrhs.com

MissionMission

• The Mission of the Network is to support a growing network of trained agricultural health and safety professionals that assure access to preventive service for farm and ranch families and the agricultural community.

Vision

We envision a day when farmers and ranchers across the country have access to highly trained AgriSafe clinicians.

They will provide superior disease management and prevention services to match the farmer and rancher specific exposures.

Why AgriSafe?

• Agriculture is the nation’s most hazardous occupations

• Even though mining death rates have decreased in the past 20 years, Ag has been consistently high

• 55 deaths per 100,000 workers in the past year• 45 injuries per 100,000 workers in the past

year• Over 44% U.S. farmworker households have at

least one disabled member• Cost of disabling injuries in agriculture

exceeded 2.7 billion in 1990 alone!

Why AgriSafe?

• Health Insurance

• Workman’s Compensation

• Regulatory Agencies

• Barriers

• Prevention Services

Unique Occupational Health Needs

Farmers and ranchers suffer from an increased incidence of:

• respiratory diseases• zoonotic diseases• skin cancer• chronic back pain• musculoskeletal disorders• arthritis• hearing loss• depression• disabling injuries• occupational fatalities

AgriSafe ModelAgriSafe Model

Serves as an early point of entry into the health care system before serious conditions develop.

AgriSafe ModelAgriSafe Model

• Menu of services:

– Occupational health screenings

– On site farm site evaluations

– Personal protective equipment (PPE) sales and education

– Educational programs

AgriSafe Service LocationsAgriSafe Service Locations

• Commodity Groups Meetings/conferences

• Pesticide Applicator Training

• Farm Association Meetings/conferences

• Grain Elevators

• County Fairs

• Seed Dealers

• Stockyards

• Machine Dealerships

Agricultural Occupational Health and Safety Training

• Target audience– Practicing health professionals

serving rural areas– Nurses and other health

professionals intending to establish AgriSafe Clinics

– Health professional students intending to practice in rural areas

– Health professions graduate students including veterinarians intending to enter public practice.

Collaboration - ReferralsCollaboration - Referrals

• Family Physicians– Nurses

• Hospitals• Public Health• Specialists

– Ear/Nose/ Throat– Pulmonologists– Audiologists

• Chiropractor• Mental Health

Services• Pharmacists• Social Services• Occupational Health• Parish Nurses

Agricultural Respiratory Diseases

• Agricultural dust exposure

• Toxic fumes

• Agricultural chemicals

• Infectious diseases

• Prevention– Environmental assessment– Personal protective equipment

Agricultural Skin Diseases

• Contact Dermatitis

• Sun and heat induced dermatitis

• Anthropod induced dermatitis

• Plant induced dermatitis

• Infectious dermatitis

Agricultural Pesticides

• Organocholorines

• Organophosphates

• Pyrethoids

• Neonicodenoids

• Herbicides

• Fumigants

General Environmental Hazards

• Water pollution

• Air pollution

• Solid waste

• Confined animal feeding operations

Musculosketal Diseases

• Pain

• Chronic pain

• Acute pain

• Injuries

ERGONOMICS!!

Physical Factors Affecting Health in Agriculture

• Heat injuries

• Cold injuries

• Vibration injuries

• Noise induced hearing loss

Psychosocial Condition

• Social structure of farming and ranching communities.

• The sources and pychophysiopathology of stress.

• Anxiety disorders• Depression• Screening, treatment and prevention of

stress-related disorders• Suicide and prevention

Acute Agricultural Injuries

• Injury statistics

• Special medical considerations of agricultural injuries

• Injury scenarios and prevention

Hazards of Pharmaceuticals

• Veterinary biologicals of human health importance

• Needle sticks• Antibiotic; individual health risk and risk

of resistant microbes• Health hazards of growth promotants

– Estrogenic compounds– Progesterone compounds– Bovine growth hormones– Oxytocin– Prostaglandins

Rural Zoonotic Infectious Diseases

• General epidemiologic characteristics of zoonoses

• Summary of zoonotic diseases associated with the production of:– Swine– Dairy cattle– Sheep and goats– Poultry

• General environmental reservoirs

Prevention

• Regulations

• Engineering

• Education

• Personal Protected Equipment

• Ergonomics

Health Promotion in the Health Promotion in the Farming CommunityFarming Community

Social Services

Schools

Churches

Health Systems Government

Insurance/ Business

Mental HealthProviders

AgriSafe Clinic

Universities

Community LinkagesCommunity Linkages

• Think beyond the provision of direct clinical services.

• AgriSafe providers can be the link to other health professionals to get them on track with the latest agricultural health and safety information.

Occupational Health ServicesOccupational Health Services

Agricultural Specific Screening Services

– Occupational History

– Lung Function screening

– Hearing Test

– Skin Cancer Screening

– Back/Spine Lifting Safety Assessment

– Cholinesterase

– Tetanus Immunization

General Health Screening Services

– Height/weight evaluation– Blood Pressure– Cholesterol

Referral to Health Care Providers

Client Consent & OrientationClient Consent & Orientation

Pulmonary Function TestingCholesterol and

Cholinesterase Screening

Blood Pressure Height-Weight Evaluation and other Vital Signs

Hearing Testing

Identification of High Risk AreasIdentification of High Risk Areas

Health and Safety Education Specific to the farmer’s needs and the needs of

their spouse, children,other family members.

REFERRALS PLANNING

Personal Protective EquipmentPersonal Protective EquipmentFit, Education and SalesFit, Education and Sales

Farmer, ranchers and their families, local businesses, vendors, and

media

Respirator Fit Testing

Farm Site EvaluationFarm Site Evaluation

A collaborative research project between Iowa’s Center for Agricultural Safety and Health (I-CASH) at The University of Iowa and the AgriSafe Network

PROGRAM OBJECTIVE: to improve the health and well-being of farmers and their families by offering an innovative incentive package from public and private sector partners

– This model uses theory from the fields of epidemiology, engineering, industrial hygiene, ergonomics, and regulation.

– Includes education based on a combination of applied theories from safety education, social psychology, and public health.

– Inclusion of health and safety in the management of the farm operation is crucial.

Certified Safe Farm (CSF)Certified Safe Farm (CSF)

Certified Safe Farm (CSF)Certified Safe Farm (CSF)

• Remove or modify on-farm work hazards • Preventive health screening services to

detect and prevent high risk health conditions on the farm

• Identify informational needs and provide educational material

• Evaluation of data, including:

Illness, injuries, fatalities, PPE usage, modification of work hazards, and Insurance costs and coverage.

CSF Focus Group Responses January 2006

Question: Have you changed any of your health habits as a result of being in the CSF program?

• Carry earplugs at all times• Began wearing sun safe hats, use sun-screen more

often• Began wearing dust masks more often• Made diet changes and try to exercise more• Began wearing gloves when mixing chemicals; let

the elevator do chemical application

Safety Improvements (1998-02)

• 1,292 improvements reported including:

• 207 SMV signs, • 60 PTO master shields• 32 driveline shields• 77 machine guards/shields, • 83 lockout/tagout items, • 35 fire extinguishers• 139 lighting and marking items• 6 tractor ROPS, 3 skid steer loader cages

• Total value ~$70,000 or $650 per farm

Network ExpansionNetwork Expansion

• Must complete the 40 hour agricultural health training provided by Iowa’s Center for Agricultural Safety and Health (I-CASH) at the University of Iowa.

• Must pass I-CASH course exams.

• Maintain annual .5 CEU requirements.

• Must adhere to the Network’s Operations Manual and the affiliation agreement.

Required Professional Standards ofRequired Professional Standards of AgriSafe Clinic Providers AgriSafe Clinic Providers

Required Professional Standards ofRequired Professional Standards of AgriSafe Clinic Providers AgriSafe Clinic Providers

SummarySummary

• The AgriSafe approach to health care delivery reflects innovation in bringing the best preventive services to the farming and ranching population.

• AgriSafe health professionals should be considered as a “dissemination arm” to bring information directly to farmers and other health professionals.

• AgriSafe members receive multiple benefits including technical assistance in the development of clinical and educational services.

Contact InformationContact Information

Denise Andress, RNCommunity Health ManagerWest River Health ServicesHettinger, ND 58639Phone (701) 567-6177denisea@wrhs.com