Epidemiology of Farm Injuries in New South Wales

Injuries to people living and working on farms in New South Wales continue to be a significant burden on the health system, Workers’ Compensation system, agricultural industries and farming families. Strategies to reduce the number and severity of injuries suffered by farmers and people working on farms rely on accurate information. Unfortunately there is no one dataset available to describe the circumstances surrounding farm injuries and the size of this burden in Australia. Hence, a number of different data sources are required to provide a picture of farm injuries. To date, there has been very little critical examination of what value each of these datasets provides to describing farm injuries. This Thesis aimed to: • Undertake surveillance of injuries occurring to people on farms or during agricultural production in NSW using data from an Emergency Department, NSW Hospital Separations information, NSW Workers’ Compensation Claims, and ABS Deaths data. • Critically examine the utility of Emergency Department, Hospital, Workers’ Compensation, and ABS Deaths Data for the surveillance of farm injuries in NSW. • Critically examine data classification systems used in Emergency Department, Hospital, Workers’ Compensation, and ABS Deaths data collections to describe the breadth of farm injuries in NSW. • Define the priority areas for farm injury prevention initiatives in NSW based on the information obtained from the examination of the data from Emergency Department, Hospital, Workers’ Compensation, and ABS Deaths. • Evaluate the effectiveness of the NSW Rollover Protective Structure (ROPS) rebate scheme and examine the utility of the data currently available in NSW to measure the performance of the program. Four datasets, Tamworth Emergency Department, Hospital Separations, Workers’ Compensation and the Australian Bureau of Statistics (ABS) Deaths data were used to provide information on the surveillance of farm injuries, describe the breadth of classifications used to describe farm injuries, and define priorities for the prevention of farm injuries. There were 384 farm-related injuries which presented to the Emergency Department at the Tamworth Base Hospital between 1 September 1997 and 31 August 1998. Emergency Department data collected in this study used the Farm Injury Optimal Dataset (FIOD) for classification, which allowed for a comprehensive picture of the circumstances surrounding the injury event. The three most common external causes of injury were related to horses, motorcycles, and animals. Commonly people were working at the time of injury. Children represented 21% of the people injured. The average number of injuries per 100 farms per annum was 34.7. An examination of hospital discharge data for NSW was undertaken for the period 1 July 1992 to 30 June 2000 where the location of the injury was a farm. Classification of cases in this dataset conformed to the International Classification of Disease (ICD) versions 9 and 10. There were 14,490 people who were injured on a farm during the study period. The three most common external causes of injury were motorcycles, animals being ridden and agricultural machinery. Children represented 17% of all farm injury cases. The rate per 1,000 farms ranged from 19 to 42 per annum. An examination of Workers’ Compensation claims for agricultural industries in NSW between 1 July 1992 and 30 June 2001 was undertaken. The ‘Type of Occurrence’ classification system was used to code the claims. There were 24,332 claims of which the majority were males (82%). The incidence of injury / disease in agriculture per annum varied from 37 per 1,000 workers to 73 per 1,000 workers. The rate per 1,000 agricultural establishments varied from 54 to 76. The average cost of a claim was $10,880 and the average time lost per claims was 9.2 weeks. There were 81 deaths and 3,158 permanent disabilities. The three most common agents were sheep / goats (5%), ferrous and non-ferrous metals (5%), crates / cartons / boxes / etc (5%). Using ABS deaths data to examine the deaths of people working and living on farms was limited to males whose occupation was recorded as ‘farmer and farm manager’ and ‘agricultural labourer and related worker’. There were 952 deaths over the period 1 January 1991 and 31 December 2000. The information provided a consistent series of cases over time. Areas where prevention should be directed included motor vehicle accidents; falls; agricultural machinery; other machinery; firearms; poisoning; and drowning. Using any one of the datasets alone to examine people injured on farms not only underestimates the number of people injured, but also misses particular types of agents involved in farm injuries. Each of the datasets used in this Thesis provides a different perspective of farm injury in NSW. By examining the information together, there are a number of areas which are consistently represented in each dataset such as falls and agricultural machinery. While no one dataset provided all the information that would be useful for the prevention of injuries, the available information does provide direction for the development of prevention strategies. The overall weakness of the information provided is that it misses a number of risk factors that contribute to farm injuries such as fatigue and training. The lack of appropriate denominator information also makes it difficult to directly compare the datasets and estimate the size of the problem. There are a number of additional coding categories that could be included in each dataset that would provide a better understanding of the different groups at risk of sustaining an injury on a farm or during agricultural work. These coding categories include activity at time of injury, admission to hospital, and occupation. An example of the use of data to determine the effectiveness of a farm injury prevention program is the ‘NSW Rollover Protective Structure (ROPS) Rebate Scheme’ evaluation. Tractor rollover deaths have been identified as an issue for prevention by Farmsafe Australia; however, such deaths were not identified in any of the datasets used in this Thesis due to coding limitations in the ABS data. In this Thesis information about the evaluation of the ‘NSW ROPS Rebate Scheme’ is presented. The scheme was successful in fitting 10,449 ROPS to tractors and the following lessons were learnt: when providing a rebate, the administration (i.e. sending the cheque) needs to be done well; advertising is important and should be co-ordinated, increase the awareness of the risk(s) the intervention is aiming to prevent and effectiveness of subsequent solution (s); the program should ensure there is an increased awareness of the outcome the intervention is aiming to prevent; if regulation is part of the program, enforcement needs to undertaken; and should address any barriers to uptake. The information provided in this Thesis highlights the substantial burden that farm injury places on the agricultural and rural sector of NSW. While there is no one data source that can describe the circumstances and the burden of farm injuries, the currently available datasets do provide an insight into the circumstances of farm injuries and the burden these injuries place on health, Workers’ Compensation, agricultural industries and farming families

“First, Do No Harm”: Old and New Paradigms in Prehospital Resuscitation in the Aquatic Domain

The balance between benefit and risk is central to the work of all those involved in aquatic services. The Hippocratic exhortation of Primum non nocere, “First, do no harm,” has a history of over 2000 years. Superficially, all would support this dictum, but harm can result from inaction. The balance between no or little intervention on the one hand and proactive intervention with iatrogenic risk on the other is complex and enduring. Risk implies that one does not have all the information available to know the exact likelihood of an outcome, a common situation involving rescue, first aid, and resuscitation. The theme of Primum non nocere (and its congener, risk-benefit ratios) in the aquatic rescue and resuscitation domain has both ethical (e.g., Good Samaritan) and legal (e.g., tort action) implications. Recently, a reversal in intervention philosophy, “Any attempt at resuscitation is better than no attempt,” has emerged. This aphorism is in stark contrast to the traditionally conservative, “Don’t do anything for which you are untrained.” Current and continuing research audits are needed to assess whether this newer paradigm results in a risk-benefit ratio low enough to counter the traditional Primum non nocere

Socio-Ecological Nature of Drowning in Low- and Middle-Income Countries: A Review to Inform Health Promotion Approaches

Most deaths by drowning (91%) have occurred in low- and middle-income countries (LMICs), particularly in Southeast Asia (35%) and Africa (20%), in proportion to total drowning deaths worldwide. Poor data collection in LMICs hinders the planning, implementation, and evaluation of prevention strategies. The objective of this study was to review the rates and risk factors of unintentional drowning in LMICs and to identify drowning prevention strategies within a socio-ecological health promotion framework. A systematic search, guided by PRISMA, was conducted on Ovid MEDLINE, CINAHL, Informit health, PsycINFO (ProQuest), Scopus, SafetyLit, Google Scholar, and BioMed Central databases for all relevant studies published between 2012 and 2017. McMaster appraisal guideline was used for critical review. The disparity of available drowning data was observed across selected countries. The highest rates were identified in low-middle income South-east Asian countries. The socio-economic background of the family, overcrowding, and living close to water bodies were important predictors for paediatric drowning in LMICs, while the presence of mother as caregiver was identified as a protective factor. The over-reliance on active injury prevention strategies was identified. Further research focusing on developing relevant upstream drowning prevention and water safety promotion is needed to ensure the sustainability of drowning prevention in LMICs

Measuring Australian Children’s Water Safety Knowledge: The National Water Safety Quiz

Water safety knowledge levels of Australian children are poorly understood. Royal Life Saving developed an online National Water Safety Quiz (NWSQ) as an interactive means of determining water safety knowledge amongst Australian primary school children (ages 5 to 12 years). Over a period of 8 months, a total of 4,215 children participated in the NWSQ. The NWSQ identified areas of water safety where knowledge was poor including the topics of CPR, swimming, and river safety. Children achieved a better result as they aged. Females out-performed males overall and specifically from ages 10-12 years. Children from independent schools performed better. This research is the first of its kind to measure water safety knowledge at a population level for primary school children, using an online web-based tool. Understanding children’s water safety knowledge is important as it enables the tailoring, delivery and evaluation of programs which help to reduce the burden of drowning

Drowning of Pet Owners during Attempted Animal Rescues: The AVIR-A Syndrome

The rescuer who drowns can result from the attempted rescue of a human or an animal. We report here a total population analysis of all drowning fatalities for the 14-year period 1–July-2002 to 30-June-2016 which involved an attempted rescue of an animal. Cases were drawn from the Royal Life Saving National Fatal Drowning Database, which in turn, derived its data primarily from the National Coronial Information System (NCIS). Eight people drowned, all adults (ranging in age from 19-74 years), in the attempted rescue of an animal. Seven of the animals were domestic pet dogs, and in two cases farm animals. Six of the eight fatalities occurred in inland waterways. The AVIR-A syndrome, the ‘Aquatic Victim Instead of Rescuer– Animal’ (AVIR-A) drowning syndrome, is a subset of the AVIR drowning syndrome. Environmental design and regulation are unlikely to prevent this type of fatality. Public awareness, with emphasis on non-contact rescue training should be the approach taken

Application of the PRECEDE-PROCEED model in the development of evidence-informed interventions for drowning prevention: a mixed-methods study protocol

Introduction Drowning is a global public health threat, disproportionately impacting low-income and middle-income countries. In the Philippines, it is estimated that more than 5200 people die from drowning per annum. This number is likely to be higher than currently estimated with the inclusion of disaster-related and transportation-related drowning. Drowning is preventable if appropriate preventive interventions are put in place which redress known risk factors. Methods and analysis This study uses the PRECEDE-PROCEED model (PPM), an eight-step health promotion planning and evaluation model for building and improving intervention programmes. This mixed-methods study, which can be used in any location, will be implemented in Los BaÅ os, Laguna, Philippines, identified as an area of concern for drowning. Using the PPM, data on drowning will be collected from death records, community observation, key informant interviews, focus group discussions and community survey. A range of analytical methods will be used to explore drowning data including univariate and χ 2 analyses, analysis of variance, relative risk and calculating rates using population data. The quantitative data and themes drawn from qualitative data will be used to populate the first four phases of the PPM. Following the data collection, the remaining stages of the PPM will be designed and implemented in the barangay (village) with the highest drowning rate. Ethics and dissemination This study has obtained ethical clearance from the University of the Philippines Manila Research Ethics Board (UPMREB 2017-425-01). Study findings will be disseminated through workshops and presentations to the local community as well as through peer-reviewed literature and conference presentations. The PPM has rarely been applied to drowning prevention and it is the aim that the study described in this protocol is expanded across other areas of the Philippines and to other countries with a high drowning burden to inform prevention efforts

Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020

Background: The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. Methods: For this analysis, we constructed burden-weighted dose–response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15–95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. Findings: The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15–39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0–0) and 0·603 (0·400–1·00) standard drinks per day, and the NDE varied between 0·002 (0–0) and 1·75 (0·698–4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0–0·403) to 1·87 (0·500–3·30) standard drinks per day and an NDE that ranged between 0·193 (0–0·900) and 6·94 (3·40–8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3–65·4) were aged 15–39 years and 76·9% (73·0–81·3) were male. Interpretation: There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol

Adolescent transport and unintentional injuries: a systematic analysis using the Global Burden of Disease Study 2019

Background: Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10–24 years during the past three decades. Methods: Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10–14, 15–19, and 20–24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings: In 2019, 369 061 deaths (of which 214 337 [58%] were transport related) and 31·1 million DALYs (of which 16·2 million [52%] were transport related) among adolescents aged 10–24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34·4% (from 17·5 to 11·5 per 100 000) for transport injuries, and by 47·7% (from 15·9 to 8·3 per 100 000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80·5% to 42 774 for transport injuries and by 39·4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010–19, the rate per 100 000 of transport injury DALYs was reduced by 16·7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48·5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0·2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010–19. Interpretation: As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low–middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury

Addressing gaps in our understanding of the drowning patient: a protocol for the retrospective development of an Utstein style database and multicentre collaboration

Introduction: This retrospective observational study aims to create a comprehensive database of the circumstances of drowning (including care provided and outcomes of care) to report against the Utstein style for drowning (USFD) for patients presenting to the emergency department (ED). Four areas will be examined: a feasibility study of the USFD; a comparison of classification and prognostication systems; examination of indications and efficacy of different ventilation strategies; and differences in the circumstances, severity, treatment and outcomes of drowning by sex and gender. Methods and analysis: This protocol outlines retrospective data collection for all patients presenting to EDs of the Sunshine Coast Hospital and Health Service in Queensland, Australia with the presenting problem or discharge diagnosis of drowning or immersion between 2015 and 2022. Patients computerised health records (emergency medical service record, pathology, radiology results, medical and nursing notes for ED, inpatient units and intensive care units) will be used to extract data for entry into an USFD database. Descriptive (eg, median, IQR) and inferential statistical analyses (eg, analysis of variance) will be used to answer the separate research questions. Development of an International Drowning Registry using the USFD dataset and the Research Electronic Data Capture (REDCap) web application is discussed. Ethics and dissemination: This study has been approved by Metro North Human Research and Ethics Committee (Project No: 49754) and James Cook University Human Research Ethics Committee (H8014). It has been endorsed by national drowning prevention organisations Royal Life Saving Society Australia (RLSSA) and Surf Life Saving Australia (SLSA). Study findings will provide data to better inform clinical management of drowning patients and provide an evidence base on sex and gender differences in drowning. Results will be disseminated through peer review publications, conference presentations and media releases. Results will also be disseminated through RLSSA and SLSA membership of the Australian and New Zealand Resuscitation Council and the Australian Water Safety Council