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California Department of Health Services
A summary
of this document is available in english and spanish.
(Un resumen de este documento está disponible en inglés y español.)
SUMMARY : CASE
191-002-01
A cantaloupe
picker collapsed and died of heat stroke after four hours
of work. The summer cantaloupe harvest is one of the hardest
jobs in farming. Workers stoop to pick the cantaloupes and
put them in bags they carry on their shoulders. When the bags
are full and weigh about 50 pounds workers carry them to a
truck. Crews are paid by the number of trucks they load in
a day, and so workers do not stop for breaks.
The
worker began picking at 6:00 a.m. At 9:00 a.m. he complained
of a headache. He worked for another hour, and then his crew
took a bus to another field. On the bus he began to pant,
and felt anxious and sick to his stomach. The foreman stopped
the bus and called an ambulance. The worker was taken to the
hospital and treated, but died 36 hours later of heat stroke.
How
could this death have been prevented?
- Have
a person certified in first aid, including knowing the symptoms
and treatment of heat stroke, on every field work team.
- Train
workers to be aware of the dangers of working in the heat.
- Make
crews take breaks and drink water, especially crews working
at piece rate.
BACKGROUND
On July
25, 1991 NURSE staff received a report from a local community
program that a 25 year-old Hispanic male had collapsed after
picking cantaloupes. The local coroner informed NURSE staff
that the picker had died from complications of heat stroke,
or hyperthermia. A brother of the deceased picker, who had
been working with him that day, took the body home to Mexico
to be buried. A nurse from the NURSE Project traced the brother
when he returned from Mexico and interviewed him on March
9, 1992. On February 6, 1992 the Senior Safety Engineer conducted
an on-site investigation and discussed the incident with the
safety director of the farm company. NURSE staff also reviewed
the emergency medical service run sheets, the hospital records,
and the coroner's records. The employer notified the local
California Occupational Safety and Health Administration (Cal/OSHA)
compliance office, but Cal/OSHA did not conduct an investigation.
The
cantaloupe field where the deceased picker was working was
owned by a farming corporation which employs, through a separate
harvesting company, approximately 320 employees during the
peak harvest season. The corporation has a full-time safety
director. Field foremen of the company are trained at the
beginning of the season using the safety training outline
in the company Injury and Illness Prevention Program. Employees
are trained periodically.
The
NURSE Senior Safety Engineer reviewed the company safety program
and noted that it addressed all seven points 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: designated safety person responsible for
implementing the program; mode for ensuring employee compliance;
hazard communication; hazard evaluation through periodic inspections;
injury investigation procedures; intervention process for
correcting hazards; and a written health and safety program.)
INCIDENT
Cantaloupe
harvesting is one of the most strenuous jobs in agriculture.
The workers stoop over to pick the cantaloupes off vines at
ground level, and place the melons in a bag. They carry the
bag over their shoulder until it is full (weighing about fifty
pounds) and then carry the bag to a truck that is moving through
the field. Cantaloupe pickers are paid on a piece rate basis,
calculated by how many trucks a crew loads in a day. After
the crews begin working they generally continue until mid-day
without scheduled breaks. When the trucks reach the end of
a row there is a 1-2 minute interval while they turn around,
and the workers use this opportunity to drink water while
they wait for the truck to align with a new row. Drinking
water is available on the cantaloupe trucks and is also carried
on the buses used to transport workers to different fields.
The
cantaloupe picker was employed as part of a 10 to 15 member
crew, and had three years of experience. As part of a scheduled
weekly training he had been trained the day before on proper
lifting and carrying techniques to prevent back injury. However,
no training on heat stroke prevention was given. The worker
was moderately obese, at 5'5" and over 200 pounds. The ambient
temperature during the initial part of the work day was 70
degrees F with a relative humidity of 70-80%, the noon time
reading was 95 degrees F and the high for this day was 101
degrees F with a relative humidity of approximately 25% at
4 p.m. The high temperature for the previous day was 99 degrees
F with a relative humidity of 22% at 4 p.m.
The
worker began to pick and load cantaloupes in the field at
6:00 a.m. At approximately 9:00 a.m. he told the field foreman
that he had a headache and was not feeling well. He was perspiring
heavily and asked for an aspirin, but continued to work in
the field for another hour before walking to the bus with
the rest of the crew in order to be transported to a new field.
While traveling on the bus the worker became extremely ill:
anxious, nauseated, and short of breath. At 10:40 a.m. the
bus was stopped near a county road maintenance crew, who were
able to call the local emergency medical service (EMS). The
EMS dispatcher gave instructions to place the worker in the
shade of a tree. One of his brothers (a co-worker) stayed
with him until the EMS arrived, approximately 20 minutes after
they were called.
When
the EMS paramedics arrived they found the individual disoriented,
hyperventilating, and vomiting. They established an IV of
Lactated Ringers solution with valium to provide him with
fluid replacement. He was transported to a level 2 trauma
center, a fifty minute journey, and arrived almost one and
a half hours after the EMS was called. His body temperature
was 105.6 degrees F when he arrived at the emergency department.
He was admitted to the intensive care unit of the level 2
trauma center in poor condition with an admission diagnosis
of heat stroke with metabolic encephalopathy and seizure disorder.
He was placed on a ventilator but developed renal failure
and pneumonia and died 36 hours after the EMS was first called.
The
cause of death listed by the coroner was complications of
hyperthermia with acute bronchopneumonia.
PREVENTION STRATEGIES
- Employers
should provide appropriate training for workers to recognize
all hazards and avoid them. In this incident the worker
was aware that he was becoming sick; however, apparently
he did not attribute this to working in the temperature
extremes. Work crews in high temperature conditions should
be advised of the hazards of working in hot environments
and should be trained in the symptoms of heat stroke. This
training should be given upon hiring of the employee and
included in the weekly safety training. Training is especially
important in the case of high risk workers; in this incident
the worker weighed over 200 pounds and was only 5'5" tall.
If the worker had been trained to recognize he was in an
adverse work environment (high temperatures), he might have
stopped working earlier and his death might have been prevented.
- There
should always be a person certified in first aid on a field
work team.* First Aid training should include identification
of heat-related symptoms and appropriate first aid. In this
incident, the worker developed hyperthermia while working
at a temperature that was within the normal range for that
geographic location. The delay in recognizing that the worker
had hyperthermia meant a delay in appropriate medical treatment.
This delay may have contributed to his death. * 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." Title 8 California Code of
Regulations 3439 (b): "There shall be at least 1 employee
for every 20 employees at an remote locations with training
for the administering of emergency first aid."
- Remote
work crews should have a cellular phone or radio available
in vehicles to contact the Emergency Medical Services if
needed. In this incident the foreman could not notify EMS
until they found a road crew with mobile communications,
resulting in a possible delay of treatment for heat stroke.
- The
employer should provide a working environment which encourages
that workers do not forfeit their health in order to make
more money. In this incident the employer should have required
a rest stop for all employees, even if the crew was working
at piece rate for less than a full working day. A break
should be required by the employer at least every two hours
to allow employees to drink water. This would also provide
an opportunity for the foreman to review the health of the
crew at this time and identify anyone showing symptoms of
heat stroke. Besides drinking water on their breaks, each
worker should be given water canteens to carry with them
to act as a constant thirst quencher. These canteens could
be refilled on their breaks. In this incident, the work
crew had a disincentive to take rest breaks and drink water.
If breaks had been encouraged and workers provided with
an incentive to take them, then this death may have been
prevented.
- Employees
should be aware of their own responsibility for their health
and safety. In this incident the worker was in poor physical
condition for the difficult work tasks he was required to
perform, however, he continued to work under these conditions.
If he had tried to improve his immediate work situation
by drinking a lot of water and not overexerting, or even
stopping work when he was becoming sick, he might not have
become hyperthermic and died.
- Employers
should attempt to make work tasks as unstrenuous as possible.
In this incident, if the pickers were not required to carry
a bag of cantaloupes, and instead placed them immediately
in a mechanized packing truck the work task would not be
so strenuous. In this incident the worker was performing
a very strenuous activity under high temperature environments.
If he was not required to perform such strenuous activities
his death might have been prevented.
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
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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(COHP)-FI-92-005-07
,
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: May 1992.
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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