Research Profile - When Home is a Dangerous Workplace

Preventing and Treating Injuries in Rural Canada

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Dr. William Pickett's passion for ending what he calls an 'epidemic' of farm injuries in Canada was born in the farming community of St. George, Ontario, where his father was the rural coroner.

Growing up, Dr. Pickett understood the unique risks that friends and family members faced every day – a knowledge underscored by his father's account of a preschooler crushed in a barn when the shelves he was climbing on toppled over, and the family friend killed by suffocation when a corn crib collapsed on him. That understanding led the epidemiologist to study the causes of farm injuries, and to develop prevention strategies.

As part of that work, Dr. Pickett, a professor at Queen's University in Kingston, Ontario, has joined forces with a multidisciplinary international team and co-principal investigator Dr. James Dosman of the Canadian Centre for Health and Safety in Agriculture at the University of Saskatchewan. Their CIHR‑supported research, the Saskatchewan Farm Injury Project, has been renewed for a second phase after the team discovered that fatigue and the physical state of farms are important causes of injuries that include tractor rollovers, falls and blunt animal trauma.

The team, which includes researchers from Australia and the United States, surveyed and followed more than 5,500 people living on 2,400 farms in Saskatchewan about everything from their sleep patterns to the type of injuries they experienced and their knowledge of the risks. Initially, the researchers expected to find that depressed economic circumstances and the traditions of farm life drove the epidemic of trauma. But they discovered that the long hours farm families work, and hazards such as the condition of buildings or equipment, create the biggest risks.

Seniors and children are most vulnerable to injury, says Dr. Pickett. This is an especially difficult problem since more farmers are working into their 70s and 80s, and children accompany their parents as they work. Children are often killed in the presence of adults, he says.

"They just turn their backs and the kid is exposed to some devastating hazard – they are either out the door of a tractor and being run over, or they drown," Dr. Pickett says.

Drs. Pickett, Dosman and their team are sharing their findings with the 29,000 members of the Agricultural Health and Safety Network, and more broadly. But education is not enough, says Dr. Pickett. Policies that encourage farmers to make the condition of their equipment and farms a priority are critical, he believes.

When children or adults do get injured in rural areas, either because of a farming accident or any other injury, getting them to a specialized trauma centre gives them a 25% greater chance of survival, says Dr. Barbara Haas, a surgical resident at St. Michael's University in Toronto, and a graduate student in clinical epidemiology.

Haas, who received a CIHR fellowship, is working on a team led by Dr. Avery Nathens that has studied the outcomes for rural trauma victims. In their study of 3,486 trauma deaths in Ontario from 2002‑2003, the team found that people in the most rural locations and those with limited access to timely care at a trauma centre were twice as likely to die before reaching a hospital. Those patients who reached a hospital but had limited access to a trauma centre were three times more likely to die in the emergency room than those treated at a trauma centre.

"From our perspective, trauma centre care is the most important aspect of treating someone who has a severe injury, and ensuring access to that care is extremely important," says Dr. Haas.

In Ontario, all trauma centres are in cities. Since at least 15% of Ontario residents live more than an hour away from a trauma centre, the gap, when it comes to trauma treatment, is significant. Transfers, either by air or land ambulance, are one way to bridge that gap.

Dr. Haas and her colleagues will work with emergency responders, physicians and nurses in non-trauma centres to identify and reduce the barriers health-care providers experience that prevent them from identifying and transporting severely injured patients directly to trauma centres, or transferring them as quickly as possible.

Making small changes at all levels of the health-care system that respond to these injured patients can result in big improvements, says Dr. Haas. "This is a big puzzle," she adds. "Piecing this puzzle together is going to help us find solutions that will help patients."

"Rural health is an enormously important area of research because about 21% of Canadians live in areas that are rural or remote, and these populations have a number of determinants of health outcomes that are often quite different than those in urban areas."
– Dr. James Dosman, Director, Canadian Centre for Health and Safety in Agriculture