If you look at the hands of old farmers, "there are a lot of lost digits," observed Mary Beth Voights, NP.

That's because farming the land, while far safer today than in the past, remains among the nation's most dangerous industries, claiming the lives of 293 farmers and ranchers in 2007 alone, according to the U.S. Bureau of Labor Statistics.

Older farmers, in particular, seem at increased risk for accidents, said Voights, who sees plenty of "agri-trauma" in her role as trauma services coordinator at Carle Foundation Hospital, a level I trauma center in Urbana, Ill.

Tractor turnovers kill or wound more farmers than any other type of agricultural accident. Fortunately, a modern tractor comes equipped with a roll-over protection structure (ROPS), basically a protective frame built around the cab where the farmer sits. But many older farmers still drive tractors built in the 1970s that don't have ROPS, according to Voights.

 "With ROPS, the result is usually minor head injuries, rib fractures, maybe some abdominal organ injury," she said. "Without ROPS, farmers suffer tremendous injuries to the head, chest, abdominal and pelvic areas" that can require mechanical ventilation, IV fluids, blood transfusions, invasive monitoring of the brain, fracture splinting and emergency surgery.

Entanglements, Entrapments
Perhaps more horrific, a farmer can get caught in a power takeoff (PTO) shaft, a fast-spinning device at the back of a tractor used to transfer energy from the tractor to whatever it pulls: mowers, feed grinders, balers or grain bin augers.

A PTO shaft can spin up to 1,000 rpms -- 16 times per second -- according to Duane Bales, agricultural program director for the Illinois Fire Service Institute in Champaign, Ill. Should a dangling shirt sleeve, pant leg, flap of a jacket, even a tiny thread, catch on a wrap point of the shaft, a farmer could get swept up, entangled, lose a limb, maybe get killed, before he knew what hit him. Farmers with long hair have been scalped by PTO shafts.

"It's not a clean amputation, like a guillotine or surgical amputation," Voights said of limbs lost to PTO shafts. "These are twisting amputations that cause a lot more nerve and blood vessel damage. In the past 15 years, surgeons have largely stopped trying to reimplant these limbs. Over time, they've realized they can achieve better outcomes with a very good prosthesis rather than the damaged limb."

Even after harvesting, danger lurks. When corn sits in a grain bin before it's sold or used, moisture can form and create a crust on the top.

"Farmers want to break up that crust but sometimes don't realize there's a void underneath," Bales explained. "When they step onto the crust, it breaks and they go down. There is complete engulfment in about 20 seconds. Every time you breathe in, the pressure pushes your chest in, and you suffocate."

Farmers should use a pole to break up the crust or wear a harness and be lowered down, he said. "There have been a lot of grain-bin deaths this year, more than other years," Bales said. "Some farmers tell themselves, 'I'm tired, I'm in a hurry. I'll break it up. I've done it before.' But this time they get entrapped."

Freeze-Burns
Agricultural chemicals pose another threat, especially anhydrous ammonia, a common fertilizer stored in tanks under extremely high pressures.

Meant to be plowed into the earth, anhydrous ammonia, if accidentally released into the air, will drop in temperature from 100° F to -28° F. It can instantly freeze-burn eyes, nose, throat and lungs -- and kill if inhaled. "It will freeze a person's hands to the point where the fingers will just break off," Bales said.

A farmer can fall victim when hooking up a tank of anhydrous ammonia to the implement on his tractor and the connecting hose leaks or gets away from him, releasing a deadly spray. "We see terrible freezing burns to exposed areas, mostly to the face and hands," Voights said. Flushing with water helps neutralize the chemical's caustic effects.

Agri-trauma may be uniquely rural, but emergency medicine is universal, Voights concluded, recalling the recent case of a 1,100-pound steer that rolled over a 9-year-old boy at a county fair.

"Is this a joke?" the trauma surgeon, a newly transplanted Chicagoan, asked Voights as the team assembled in the emergency department.

"No, he'll be here in a minute," she told him. "Treat it like any crush injury. This time it was just a cow doing the crushing."

Michael Gibbons is a senior associate editor at ADVANCE. Reach him at mgibbons@advanceweb.com.