Traumatic injuries in agriculture.

The National Coalition for Agricultural Safety and Health (NCASH) in 1988 addressed issues in agriculture and noted "a sense of urgency... arose from the recognition of the unabating epidemic of traumatic death and injury in American farming . . ." This article provides an update to the NCASH conference on traumatic injuries in agriculture, a history on how the facts and figures were arrived at for the NCASH conference, and a current report on the status of traumatic injuries in agriculture in the U.S. Fatal and nonfatal injuries are addressed along with national and regional surveillance systems. The Census of Fatal Occupational Injuries (CFOI) was used for reporting national agricultural production fatal injuries from 1992-1998 (25.8 deaths per 100,000 workers), the Traumatic Injury Surveillance of Farmers (TISF) 1993-1995 was used to report nonfatal injuries occurring nationally (7.5/100 workers), and Regional Rural Injury Studies I and II (RRIS-I and RRIS-II) were used to illustrate a regional approach along with in-depth, specific analyses. Fatality rates, which showed some decline in the 1980s, were fairly constant during the 1990s. Changes in nonfatal injury rates for this sector could not be assessed due to a lack of benchmark data. The main concerns identified in the 1989 NCASH report continue today: tractors are the leading cause of farm-related death due mostly to overturns; older farmers continue to be at the highest risk for farm fatalities; and traumatic injuries continue to be a major concern for youth living or working on U.S. farms. Fatal and nonfatal traumatic injuries associated with agricultural production are a major public health problem that needs to be addressed through comprehensive approaches that include further delineation of the problem, particularly in children and older adults, and identification of specific risk factors through analytic efforts. Continued development of relevant surveillance systems and implementation of appropriate interventions are the primary challenges for the current decade.