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
292-127-01
Manual
lettuce harvesting is often a two-person job. One person cuts
the lettuce (the picker), while the other picks it up and
packs it into a box (the packer). When full, these boxes weigh
about 60 pounds. Wheel barrows are used to move these boxes.
On the
day of this incident, it was unusually hot. The lettuce packer
began packing lettuce early in the morning, and continued
into the afternoon. However, he needed to take many breaks
to drink water. During his lunch break, he only drank water
and didn't eat anything. When back at work in the field, he
collapsed. His supervisor called for an ambulance. The ambulance
crew immediately started cooling him down by pouring fluids
over him. He was taken to a hospital, where he was given treatment
for heatstroke. He stayed in the hospital for close to a month.
Although he recovered and went home, he has been advised not
to return to this type of work in hot environments until he
is examined again.
How
could this injury have been prevented?
- Educate
workers and field supervisors on early signs of heatstroke.
- Have
workers immediately stop working if they show signs of heatstroke.
- Take
immediate action to cool a worker if they become sick on
a hot day.
- Make
work tasks as easy as possible (especially on hot days).
- Provide
shade for workers on hot sunny days.
BACKGROUND
On May
21, 1992 NURSE staff received a telephone report from a county
Emergency Medical Services (EMS). The EMS reported that a
35 year-old Hispanic male suffered seizures while packing
lettuce in a lettuce field on April 28, 1992. The lettuce
packer was transported to a local community hospital by ambulance
and admitted with a diagnosis of hyperthermia (heatstroke).
On June 23, 1992, a nurse from the NURSE project interviewed
the worker (who was recovering at home). On July 14, 1992,
the nurse discussed the incident with the son of the farm
labor contractor who employed the lettuce packer. He was responsible
for the safety program. NURSE staff also reviewed the EMS
record, the medical chart, and the "Doctors First Report of
Occupational Injury or Illness."
The
California Occupational Safety and Health Administration (Cal/OSHA)
was not notified, and did not investigate this incident.
A nurse
from the NURSE project reviewed the company safety program.
He 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 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.)
The lettuce packer had worked for approximately two weeks
in this geographic area for this farm labor contractor. This
contractor employs approximately 200 workers (170 of whom
are seasonal employees working 13-37 weeks per year and 30
are casual workers working 1-12 weeks per year). Some farm
owners and operators use farm labor contractors to recruit,
train, and manage workers. The safety director said that field
foremen are trained in community first aid and cardiopulmonary
resuscitation (CPR). He also said that all employees receive
training for specific job tasks, including safety training.
However, no specific training related to working in hot environments
was given to workers. Both written materials and on-the-job
training are used to provide job-specific training.
INCIDENT
The worker
began packing lettuce in the field at approximately 7:00 a.m.
on April 28, 1992. The lettuce harvesting technique used in
this incident involves both workers who cut the lettuce with
a hand held knife at ground level and workers who pick it
up and pack it in a box. These boxes, weighing approximately
60 pounds when full, are moved through the field on a modified
wheel barrel. Boxes are then loaded onto a truck. The lettuce
harvesting starts early in the morning and ends late in the
afternoon. Workers are paid on a piece rate basis, calculated
by the number of boxes of lettuce packed. Drinking water is
available on the bus used to transport workers; the bus, which
is parked next to the field, also provides the only shade
from the sun. During the morning of this incident, the supervisor
noticed that the lettuce packer was taking breaks every 10-15
minutes to drink water. After a lunch break (during which
he did not eat) he began to fall behind in his work because
he was continuing to drink water so frequently. His supervisor
asked him if he was feeling well enough to work. The worker
told him he was fine and continued to work; however, he continued
to fall behind further as he took many breaks to drink water.
His supervisor decided to talk with the worker again because
he was so far behind the rest of the crew. At approximately
2:30 p.m., the supervisor discovered that the lettuce packer
was incoherent. He then lost consciousness, collapsed to the
ground, and had a seizure. The seizure lasted approximately
two minutes. When it stopped, the worker was still unconscious
and was having difficulty breathing. The supervisor realized
the worker needed emergency medical treatment. At 2:39 p.m.,
he then called 911 on a mobile telephone in his car. A paramedic
unit from the Emergency Medical Services (EMS) responded.
The supervisor pulled the worker under a truck to shade him
from the sun. The high temperature recorded in the area for
this day was 93 degrees F, an unusually high temperature reading
for this geographic area.
Upon
arriving at 2:42 p.m., the paramedics removed the lettuce
packer's clothing and poured saline solution over him to cool
him. At this time, the worker began seizing again and paramedics
(upon orders from the base hospital) gave him Valium to control
the seizures. Paramedics also gave him oxygen. The paramedics
attempted to intubate the worker but were unsuccessful due
to his seizures. With the air conditioning in the ambulance
turned on full power, the worker was transported to an acute
care hospital. During transport, the worker continued having
seizures and remained unconscious. The ambulance arrived at
the emergency department at 3:31 p.m. In the emergency department,
the worker was given specific drugs to reverse the metabolic
effects of the hyperthermia and control his seizures. He was
also covered with cooling blankets (water filled mattresses
which are temperature controlled). The emergency department
noted his core body temperature was 108.7 degrees F (which
is over 10 degrees higher than normal) upon arrival to the
hospital. Also upon arrival, his heart was beating very rapidly
(almost three times faster than normal).
The
lettuce packer was admitted to the intensive care unit and
placed on a respirator. He remained in a coma, with a high
fever, for several days and then slowly began to regain consciousness.
He was hospitalized for 28 days. During his hospital stay,
he was treated for seizures, a high fever, and for both kidney
and liver damage which occurred because of the hyperthermia.
The hospital records showed that he had previously been exposed
to the hepatitis virus, but was not currently infected. There
were no signs of previous illness which could have contributed
to his heatstroke or high fever. The lettuce packer was then
released in fair condition. He was advised, upon his release,
not to continue working as a lettuce packer and not to work
in hot environments without further evaluation.
PREVENTION STRATEGIES
- Employers
should train workers and field supervisors to be aware of
the signs and symptoms of heat-related health conditions.
Agricultural workers often work in the sun all day in high
temperatures. Some workers may not be affected on hot days.
Others may be susceptible to high temperatures and may suffer
from heat-related problems. The lettuce packer in this incident
was constantly taking breaks to drink water every 10-15
minutes. The supervisor observed this behavior but did not
take action until the worker collapsed. In this incident,
the worker developed hyperthermia while working at a temperature
that was high for the geographic location. The delay in
recognizing that the worker needed medical attention meant
a delay in appropriate medical treatment. Heatstroke is
a medical emergency and may result in death if not treated
quickly by cooling the affected person.
- Employers
should provide working conditions that encourage workers
not to forfeit their health to make more money. This lettuce
packer was working on a piece rate basis. Being paid by
piece rate may provide a disincentive to stop working because
of illness. Although the lettuce packer denied feeling poor
the morning of the incident, he could have lost money if
he did not keep working. If he had been encouraged by the
supervisor to stop working, he might have prevented his
heatstroke.
- Employers
should attempt to make work tasks as easy as possible. There
are automated methods used by some agricultural companies
and farm labor contractors to harvest and pack lettuce.
These methods decrease the physical labor demands placed
upon the field workers. In this incident, if the lettuce
packer was not required to move heavy boxes, his work would
not have been as strenuous. He was performing a very strenuous
activity under temperatures higher than normal. If the lettuce
packer was not required to work so hard on such a hot day,
he might not have become overheated.
- Employers
should provide workers with personal protective clothing
and ensure that it is used. High temperatures on hot, sunny
days are an environmental exposure which may be hazardous
to workers. In this incident, the only shade available to
the lettuce pickers and packers was under the bus. If field
workers, such as lettuce packers, were provided with umbrellas
to shade them from the sun on hot days, or hats with large
shades, this may decrease their exposure to the sun while
they are working. This is an inexpensive way to help prevent
heat-related problems.
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(COHP)-FI-92-005-16
,
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: October 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.
|