FIRST AID for FARMWORKERS : USING
INTERACTIVE LEARNING MODULES TO
IMPROVE EMERGENCY PREPAREDNESS
Karen Gilmore, M.P.H.
Midwest Stream Farmworker Health Forum
November 18, 2010
Austin, TX
CDC/NIOSH Cooperative Agreement U50 OH07541
www.swagcenter.org
SW Ag Center
• NIOSH funded – research, interventions &
education activities to improve safety and
health practices for agricultural workers
• Since 1995 - UTHSCT
– Regional focus (AR, LA, NM, OK, TX)
– Project partners
– NCFH
• Research track for Midwest Stream Forum
• Research to develop toolkit for promotores
• Research to demonstrate effective model for
working with employers
Are You Prepared?
• CPR training in the last 3 years?
• Taken a first aid course in the past three
years?
Do you know?
• What are the 3 major ways pesticides can
be absorbed into the body?
• Which of these symptoms indicate
anaphylactic shock?
– Itching
– Feeling that throat is closing
– Shortness of breath
– Feeling that heart is racing
Do you know? contin.
• What are the signs & symptoms of acute
organophosphate pesticide poisoning?
What should be done first?
• A person is found at the bottom of a steep
incline. The leg is twisted in an unusual
angle and the bone is sticking out. What
should be done first?
Do you know? contin.
• What is the appropriate method to remove
the stinger from a bee after a sting?
• Is it possible to develop an allergy to bee
venom even if the person has been stung
before without any problem?
• What is one myth about treating a snake
bite?
Objectives
• Identify types of injuries or emergency situations for
farmworker populations and factors that contribute to
those circumstances.
• Review an interactive DVD educational program for
emergency preparedness in farm communities.
• Know the C.A.R.E. Model of emergency responses in
rural emergency situations.
• Know how to assemble a first aid kit.
• Explore opportunities to use the curriculum to help
prepare those likely to be first on the scene.
CDC/NIOSH Cooperative Agreement U50 OH07541
www.swagcenter.org
Rural Community Health Issues
• Farming is a hazardous occupation
• Among people aged 1 to 34 years injuries are
the leading cause of death and disability.
• Farms are typically isolated from immediate
emergency care.
• First on the scene for agricultural worker
emergencies are usually family, co-workers,
community members.
• Educational preparation is needed to provide
the knowledge and skills to respond effectively
and efficiently.
Why First Aid?
• Organization of work varies from farm to
farm
• Language barriers between workers and
supervisors/employers
• Inexperience of worker and/or lack of
sufficient training by employer
• Emphasis on working quickly
• Worker Fatigue (Nature of work may require long
work days in extreme conditions)
Promoviendo Farmworker
Safety
• NCFH (2007)
• 8 Focus groups with farmworkers (65)
and promotores (18),
• Results
– Sun & heat exposure
– Pesticides
– Frequent injury accidents & First aid practices
– Farmworker preferred learning style/format
LA Health Farm Family Initiative
• A cross sectional survey conducted in
1998 among 657 farm women in
Southeast LA
• Survey Results:
– 166 (25.3%) felt that farm work was
hazardous
– 86 (13.1%) participated in first aid course in
last year
– 118 (18.0%) participated in CPR course in last
year
F.A.R.M.E. -Program Development
• Ann Carruth, DSN, RN, Professor of
Nursing Southeastern Louisiana University
• Created in response to population-based
survey and subsequent focus groups
• Designed in collaboration with rural
emergency personnel
• Dissemination strategies have been tested
for effectiveness and acceptability.
First Aid for Rural Medical
Emergencies (F.A.R.M.E.)
• Instructor Manual is designed for use by
First Aid instructors to teach members of
the agricultural community.
– EMS responders
– Nurses
– First aid certified instructors
– HealthTeachers
– Student leaders
• Companion CD
Training Manual
Content was based on
1. extensive collection of articles and documents
including:
–
–
–
–
NIOSH publications and website
First on the Scene (NRAES-12)
Farm Safety Association Fact Sheets
Ag-Med: The Rural Practitioner’s Guide to
Agromedicine
2. Interviews with EMTs and nurses who work in
rural/agricultural communities
Companion CD
Self-contained course – InterCom Training
Inc.
– Audio recorded lecturettes with powerpoint
presentations
– Narrated video clips
Emphasize injury risk of farm work
Demonstrate first aid
– Games to reinforce content
– Internet resources/references
– Discussion on how to facilitate Case
Scenarios
Outline of Contents
Learning Modules Curriculum
– Principles of Learning
– 10 Modules
*Introduction and discussion of contributing factors
leading to injury/illness
*First Aid instruction
Fractures, pesticide/chemical overexposure, heart attack,
bites/stings, amputation, etc
– Case Scenarios and answer key
– Test questions and answer key
• Companion DVD
Content Modules
• Theories of Behavior
Change
• Fractures &
Dislocations
• Head & Spinal Cord
Injuries
• Pesticide/Chemical
Overexposure
• Trauma – Heavy
Machinery
• Cold Related
Emergencies
• Electrical Shock
• Bites & Stings
• Heat Related
Emergencies
• Dermal Burns
• Medical Emergencies
– heart disease,
asthma, diabetes
Bites & Stings
• DVD Module
– Recognition of risk
– Recognition of symptoms
– Appropriate first aid
C.A.R.E. Model
•
•
•
•
C- Call 911
A – Assess and stabilize the situation
R – Render First Aid
E – Eliminate risk factors
Prepare for Effective 9-1-1 Call
C.A.R.E. – Eliminate Risk
F.A.R.M.E. as Intervention
• Pre-Nursing Elective in School of Nursing,
• AHEC sponsored state wide conference,
CE for nurses, EMTs
• FFA – Train the Trainer program
– Federation Day – AgScience event
• CE for Registered Nurses
• AgriSafe sponsored national web
conference
College Level Elective
• Hybrid course design combines:
– eLearning activities for acquisition of
skills
– the transfer the knowledge and skills to
community members through service
learning activities
– N213 First Aid for Rural Medical
Emergencies (F.A.R.M.E.). Credit 3
Hours.
College Student Course Evaluation
• Methods
– Reflective journals
– Content Evaluation
• Post test scores on four measures F.A.R.M.E.
hybrid course compared to f2f EHC course.
– Knowledge Acquisition: First Aid and Safety/Injury
Prevention
– Anticipatory Action: First Aid and Safety/Injury
Prevention
• Thinking and Talking scores on Health
Protection were significantly higher for Hybrid
course members
YOUTH Training Effectiveness
F.A.R.M.E.
• 43 AgScience students in the Train-the-Trainer
intervention effectiveness study.
• A quasi-experimental design was used to evaluate
knowledge acquisition and anticipatory action among
groups:
– those participating in training
– comparison group with no training.
• Posttest scores evaluated knowledge acquisition and
anticipatory action scores between groups.
• Focus group sessions assessed attitudes, experiences,
and values held following the intervention of teaching
peers.
Observations
Group sessions using the C.A.R.E
scenarios must be “modeled”.
Adolescents enjoy teaching peers, both
teens and adults retain knowledge better
with hands-on experiences
Results – Youth as Trainers
• The intervention group scored significantly higher on
anticipatory action (t=2.23, p=.03) but not knowledge
acquisition (t=1.37, p=.18).
• Focus group data suggest that the Train-the-Trainer
format bolstered confidence in teaching, confirmed that
teens enjoy learning from teens, and fostered pride in
team work.
• The F.A.R.M.E. program is an effective educational
training program for promoting knowledge and skill
acquisition of first aid and injury prevention among rural
high school students.
First Aid Kit Assembly
Sturdy waterproof container or
Tool Box with handle
Tools:
Miscellanous:
•Heavy duty to cut clothing
• Cotton swabs
•Wire Cutter
•Instant cold compress
•Flashlight – extra batteries
• Heavy duty zipper bags, large
garbage bags
Cleansing materials:
Extras:
•Liquid soap
•Blanket
•1 large & 2 small towels
•Flares and waterproof matches
Dressings for Wounds:
Emergency Numbers (in plastic)
•Elasticized gauze bandage
•Nonstick sterile pads
•Band aids
•Self-adhesive wrap
Directions to farm, homestead,
field, work areas
Additional Ideas for
Dissemination
• Church homes for farmworkers
• Migrant Education Programs – parents
• Promotores certification training
• Questions?
Partners
Southwest Center for Agricultural Health, Injury Prevention and Education
Dennis Rappold, NREM-I Certified Instructor
Roberta Connelley, RN, MSN Regional AHA training director
Cameron Crandell, MD, Dept of Emergency Medicine, UNMHSC, Albuquerque, NM
Jim Criswell, PhD, Dept of Entomology, OSU, Stillwater OK
Avril Font, MA, Education Consultant, LA Dept of Education
Shirley Jacob, PhD College of Education SLU
Raymond Hunke, PhD, PE, Biosystems and Ag Engineering, OSU
Karen Mulloy, D.O., MSCH
Steve Shelton, PA-C MBA East Texas AHEC
Karen Gilmore, MPH, Southwest Center for Agricultural Health, Injury Prevention and
Education
Covington High School FFA Chapter
Bill Lambert, AgScience Teacher Covington High School
Ted Scharf, PhD, NIOSH, DART
Henry Cole, University of Kentucky
Farm families in southeast Louisiana!!
Support: Cooperative Agreement NIOSH U07/CCU612017 and U50OH075401