NURSE REPORT #18
PLUM PICKER BREAKS ANKLE IN LADDER FALL
A farm labor contractor was hired to pick a plum orchard as quickly as possible. The field supervisor was in such a hurry that he skipped the usual morning safety meeting and sent the crew straight to work. The supervisor then left the field, without watching to see if the workers were picking safely.
Plums are often picked from ten foot ladders which weigh about 25 pounds. Each worker moves his ladder from place to place under a tree to easily reach plums. For one worker, this was his first day on the job. Standing on one of the top steps of a ladder, he reached for some plums that were beyond his reach. He lost his balance and fell off the ladder, hitting the ground eight feet below. The ladder fell on top of him and broke his ankle.
The only person trained in first aid was the field supervisor, who had left the orchard. The foreman put the injured worker in the back of his pickup truck and drove him to the hospital. At the hospital, the worker's ankle was put in a splint. He was still wearing the splint and out of work at the time of this investigation.
How could this injury have been prevented?
Train all employees in work methods, whether full-time or seasonal. Do not allow workers to begin work without any safety training.
All workers, including supervisors and foremen, should be trained in how to handle emergency situations; for example, calling 911 instead of moving the injured person.
CASE 192-163-01 October 8, 1992
REPORTE NURSE #18
PIZCADIR DE CIRUELAS SE QUEBRA EL TOBILLO AL CAERSE DE UNA ESCALERA
A un contratista se le dió el trabajo de que pizcara la cosecha de ciruelas de toda un huerta lo más pronto possible. El supervisor se encontraba con tanta prisa que esa mañana nó hizo las reuniones de seguridad usuales y mandó a la cuadrilla directamente a trabajar. El se fue enseguida, sin darse cuenta si los trabajadores trabajaban de una forma segura.
Usualmente se pizca la ciruela con escaleras de 10 pies de largo, las cuales persan hasta 25 libras. Cada trabajador mueve la escalera de lado a lado debajo del árbol para alcanzar las ciruelas con facilidad. Para uno de los trabajadores este fue el primer día en el trabajo. Mientras se encontraba parado en uno de los últimos escalones de la escalera, quiso alcanzar unas ciruelas que
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.
On June 26, 1992, NURSE staff identified an injury in a plum orchard while reviewing records at a a Level 1 Regional Trauma Center. A 65 year-old Hispanic male plum picker broke his ankle on June 16, 1992 when he fell approximately eight feet from his ladder to the ground. The plum farm employs approximately 170 employees, of whom 100 are seasonal (working 13-37 weeks per year). This worker had been hired by a farm labor contractor to pick plums during the harvest season. Instead of hiring farm laborers directly, some farm operators use farm labor contractors to recruit, train, and manage their seasonal workers. The injured worker had picked fruit in California before, but had been living in Mexico for the past ten years. He had only recently returned to California, and had been working (along with his son) for the farm labor contractor for less than two hours before he was injured.
A nurse from the NURSE project interviewed the injured plum picker on July 9, 1992. The NURSE Senior Safety Engineer discussed the incident with the farm labor contractor -- the worker's employer -- at the scene of the injury on July 21, 1992.
The California Occupational Safety and Health Administration (Cal/OSHA) was not notified and did not investigate the incident.
The farm labor contractor involved in this incident used a safety program that was prepared by an occupational safety consulting company. The Senior Safety Engineer reviewed the written program, and noted that, although brief, it addressed all seven points included in the 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: 1. designated safety person responsible for implementing the program; 2. mode for ensuring employee compliance; 3. hazard communication; 4. hazard evaluation through periodic inspections; 5. injury investigation procedures; 6. intervention process for correcting hazards; and 7. a health and safety program.)
According to the farm labor contractor, the farm owner had requested that the plums be harvested quickly because of the current price of fruit. Because the crew had to work fast, the field supervisor (a brother of the farm labor contractor) did not hold the usual tailgate safety meeting with the crew before beginning work on the day of the incident. Tailgate safety meetings are brief talks on safety practices given by the foreman or supervisor at the worksite before the start of the workday. Instead of watching the employees' work methods at the start of the workday as he usually did, the field supervisor left the field. The Senior Safety Engineer noted that there were records of safety meetings for the picking crews on days before and after this incident, indicating that tailgate safety meetings were usually conducted.
On June 16, 1992, at approximately 7:00 a.m., a crew was picking plums in a plum orchard. Plums are picked from ladders designed for picking fruit, consisting of a set of ladder steps and a single support pole. The trees are picked by two workers moving down adjoining rows, picking the fruit from opposite sides of the same tree. Each worker moves his ladder from place to place under the tree to easily reach all the plums. Even though the workers were being paid by the hour and not by the amount of fruit picked, they were working rapidly because the farmer had requested that the plums be picked quickly.
The plum picker was standing on a ladder picking plums. His ladder was ten feet high and weighed approximately 25 pounds. The picker was standing on the step near the top of the ladder when he reached his arm out to pick a plum that was not within easy reach. He lost his balance and fell off the ladder onto the plowed dirt between the plum trees. He landed on his right side. The metal ladder fell on top of him, landing on his left ankle. He felt a severe pain in his ankle and could not stand up.
The injured plum picker was diabetic and had a history of high blood pressure. His fall may have been partly due to dizziness or other factors resulting from his medical condition.
The field supervisor was trained in first aid and cardiopulmonary resuscitation (CPR), but still had not returned to the field at the time of the incident. The foreman, who was not trained in first aid and CPR, picked the worker up, placed him in the back of his pickup truck and drove him to the Level 1 Trauma Center (a county hospital), a journey of about 40 minutes. The worker arrived at the Trauma Center emergency department at 7:57 a.m. and was seen by a physician at 9:20 a.m.
At the Trauma Center he was treated for a fracture in three places of the tibia and fibula (the lower leg bones) at the ankle. His left leg was splinted and the worker was discharged home at 11:45 a.m. At the time of the NURSE interview on July 9, 1992, the worker was still in a splint, resting at home, and being treated as an outpatient at the orthopedic clinic.
1. Employers should provide adequate training of seasonal employees. This worker had been hired only a few hours before his injury. In an effort to save time that morning, the farm labor contractor had not conducted the usual tailgate safety meeting. Therefore, the plum picker had no safety training in handling the ladder or picking plums. If he had been trained, he might have moved his ladder within easy reach of the plums, instead of trying to reach them from his current ladder position.
2. Every field work crew should have a person certified in first aid and CPR, and who is always present at the worksite.(1) In this incident, the field supervisor was certified but not present on the farm. If he had been present, the risk of complications from the injury could have been reduced. A person trained in first aid might also have realized the potential seriousness of injury to a 65 year-old man (who had diabetes and a history of high blood pressure), and made sure that the Emergency Medical Services (EMS) were called.
3. Work crews should have a cellular phone or radio available in vehicles to contact the Emergency Medical Services (EMS). In this incident, the foreman should have called 911 before moving the injured worker. Because the worker did not receive appropriate first aid in the field, he was at greater risk of increased pain and complications. If 911 had been called, his leg would have been splinted by trained EMS personnel at the scene of the injury, thereby stabilizing him before transport to the hospital. EMS would also have evaluated other threatening medical conditions which might have been related to his fall.
4. Whether or not an injury has occurred, no worker should be transported in the back of a pickup truck. This places the worker at risk of serious injury or death in the event of a collision or rollover of the pickup truck. If the foreman had called 911 and allowed EMS to transport the plum picker, he would not have exposed the worker to the risk of further serious injury.
5. Employers should require field supervisors to closely monitor all workers as they begin each new workday. Supervisors should identify workers who need further training, or who will not be able to complete the work tasks safely. If the crew supervisor had observed that the plum picker was not moving his ladder often enough to easily reach the plums, he could have instructed the worker in safe work methods. This could have prevented the plum picker from overextending and trying to reach plums which were too far away, resulting in him losing his balance and falling off the ladder.
1. 1. 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."