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Copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1999American Medical AssociationThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Children who reside on family farms are exposed to unique hazards. Young children may be present where work is being done and may wander into areas where machines are operating or may be passengers on these machines. This report describes four fatal incidents in Iowa, Kentucky, and Wisconsin in which young children were run over by farm machinery, summarizes national mortality data to characterize this problem, and provides recommendations for expanded prevention efforts.
Case information was collected and reported to CDC's National Institute for Occupational Safety and Health (NIOSH), Division of Safety Research (DSR), by state health departments in Iowa, Kentucky, and Wisconsin. Data were obtained through on-site investigations, telephone interviews, official law and medical examiners' reports, and news reports.*
In July 1998, a 5-year-old boy in Wisconsin and his two brothers, aged 8 and 12 years, were riding in the front bucket of a skid-steer loader (a compact loader that is steered by skidding the wheels) operated by their 9-year-old brother. The loader hit a bump, causing the 5-year-old to lose his balance and fall out of the bucket. He was run over by the loader and died instantly from massive head trauma. His brothers remained in the bucket and were not injured.
In April 1998, a 1-year-old girl in Kentucky was run over by a farm tractor driven by her father, who was spreading mulch around trees lining a farm road. He drove the tractor along the road, stopping every few feet to apply mulch. In the late afternoon, he took a break with his wife and three children who had come to visit with him. As he prepared to resume work, his wife and children walked to a nearby creek. He saw his wife and two of the children and, assuming the third child was also with his wife, he engaged the tractor. His daughter was run over by the right rear tractor tire and died instantly from blunt impact to the head, trunk, and extremities and crushing head injuries.
In May 1997, a 2-year-old girl in Iowa was killed on the family hog farm when she was run over by a tractor driven by her father. As the father was loading hogs into a livestock trailer attached to the tractor, his wife was assisting and the child was playing nearby. When he drove the tractor forward, the right front wheel ran over the child's lower torso. The child remained conscious and crying after the incident and was airlifted to a regional children's hospital where she died 4 hours after the incident from internal bleeding.
In October 1995, a 4-year-old boy in Kentucky died after being run over by a tractor driven by his 10-year-old uncle. Five children, aged 4-12 years, were taking turns driving the tractor in the field. The 10-year-old occupied the driver's seat. The other children sat on two flat fenders, two on each side. The victim was held by an 8-year-old girl. The tractor hit a bump on the dirt farm road, and the victim fell beneath the rear tractor tire. The child sustained a skull fracture and died at the scene.
Following receipt of these reports, DSR reviewed CDC's National Center for Health Statistics (NCHS) mortality data for 1990-1995 and identified 167 deaths among children aged ≤5 years caused by agricultural machinery (International Classification of Diseases, Ninth Revision code E919.0†). These data included all farm machinery–related cases, but excluded agricultural machines using public roadways (NIOSH, unpublished data, 1998). The average age of decedents was 3 years (range: 4 months-5 years); 73% were male. Approximately half the deaths occurred from April through July, with the largest proportions occurring in April (16.2%), June (12.6%), and July (12.6%); 27% occurred from August through October. One third (33%) of deaths occurred in hospital emergency departments, and 19% of the children died at the scene.
SH Pollack, MD, Univ of Kentucky depts of Pediatrics and Preventive Medicine and Kentucky Injury Prevention and Research Center; TW Struttmann, MSPH, Kentucky Injury Prevention and Research Center and Southeast Center for Agricultural Health and Injury Prevention, Lexington. C Zwerling, MD, R Rautiainen, MScAgr, J Lundell, MA, W Johnson, MD, L Etre, PhD, Dept of Occupational Medicine and Environmental Health, Univ of Iowa, Iowa City. LP Hanrahan, PhD, J Tierney, Wisconsin Dept of Health and Family Svcs. Div of Safety Research, National Institute for Occupational Safety and Health; Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC.
From 1979-1981 to 1991-1993, the rate of farm-related fatalities for persons aged <20 years decreased by 39%, but the rate for children aged <5 years declined 29%.1 During 1991-1993 in the United States, machinery was involved in 36% of farming-related fatalities of children aged <5 years.1 An earlier study of U.S. agricultural equipment fatalities indicated that the rate for fatal tractor runovers of farm residents was highest among children aged <5 years,2 and during 1979-1985, a study of farm-related deaths among children aged 1-9 years in Wisconsin and Illinois indicated that moving machinery was the most common source of injury (63% and 53%, respectively).3
Machine runover fatalities among children aged 1-4 years often were associated with playing near machinery, and runover fatalities in children aged 5-9 years often were associated with falling from and being run over by machinery.3 Peaks in unintentional farm-related childhood injury deaths from all causes occur at age 2 years and ages 13-15 years4; fatalities among very young children are related to accompanying their parents as they perform their work duties, and fatalities among older children are related to the children's increased time spent working on the farm. Most fatalities occurred in the spring and fall (i.e., times of planting and harvesting), when parents are busy with farm work and may have less time to supervise children.1,3,4
Prevention efforts can be improved to reduce and eliminate childhood fatalities caused by agricultural machines. Pediatricians, family practitioners, and health departments providing health care to farm families and agricultural safety specialists, farm machinery manufacturers, and organizations serving farm families should warn parents that young children are at high risk for runover by farm machinery and encourage parents to make changes that will make their farms safer. The following recommendations to parents for child safety on farms are summarized from the National Safety Council (NSC) recommendations5:
Design a fenced, safe play area that is near the house and away from work activities.
Inspect the farm on a regular basis for potential hazards, and correct such hazards immediately.
Equip all barns and the farm shop with latches that can be locked or secured so children cannot enter.
Always lower hydraulics, turn off agricultural machines, and remove ignition keys before leaving machines unattended.
Never carry children on tractors or permit them into areas where agricultural machines are used or stored, and never allow additional riders, especially children, on any agricultural machinery. In addition, NIOSH encourages parents to
Ensure that agricultural machines are in safe operating condition.
Carefully inspect the area around the machines before use to make sure no children are present.
After any work interruption (e.g., lunch with the family), clarify who is to supervise children and confirm their location before work is resumed.
Restrict operation of machinery to older adolescents and adults who possess the knowledge, skills, and physical capacity necessary for safe operation of these machines. Additional information about child safety and farm equipment is available from the National Children's Center for Rural and Agricultural Health and Safety, telephone (888) 924-7233 or (715) 389-4999, and on the World-Wide Web‡ at http:// research.marshfieldclinic.org/children; NSC, (800) 621-7615 (extension 2087) or (630) 775-2023, or at http://www.nsc.org/farmsafe.htm; Farm Safety 4 Just Kids, (800) 423-5437 or (515) 758-2827, or at http://www.fs4jk.org; NIOSH, (800) 356-4674 or http://www.cdc.gov/niosh/homepage.html; or NIOSH Centers for Agricultural Disease and Injury Research, Education, and Prevention, (304) 285-5711.
Deaths Among Children Aged ≤5 Years From Farm Machinery Runovers—Iowa, Kentucky, and Wisconsin, 1995-1998, and United States, 1990-1995. JAMA. 1999;282(7):626–627. doi:10.1001/jama.282.7.626