Deaths Among Children Aged ≤5 Years From Farm Machinery Runovers—Iowa, Kentucky, and Wisconsin, 1995-1998, and United States, 1990-1995 FREE

MMWR. 1999;48:605-608

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:

References: 5 available

*Information was collected using the NIOSH Fatality Assessment and Control Evaluation model, which evaluates the relations among agent, host, and environment during pre-event, event, and postevent phases of work-related fatalities. Cases in Kentucky were collected in collaboration with a NIOSH-sponsored Community Partners for Healthy Farming cooperative agreement.

†In addition to tractors, agricultural machinery includes animal-powered agricultural machines, combines, derricks (hay), harvesters, hay mowers or rakes, reapers, threshers, and farm machinery not otherwise specified.

‡References to sites of nonfederal organizations on the World-Wide Web are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites.

MMWR. 1999;48:485-488

1 table omitted

During 1995-1996, 27% of recorded injury-related deaths in California involved firearms (California Department of Health Services [CDHS], unpublished data, 1995-1996). In 1996, CDHS began passive surveillance of "severe" firearm-related injuries (i.e., resulting in death or hospitalization) with resources provided by the California Wellness Foundation.¹ To characterize firearm-related injuries in California, CDHS analyzed death records and hospital discharge records for 1995 and 1996 (the most recent years for which population data are available to calculate rates). This report summarizes the results of the analysis, which indicate that most of the 21,985 firearm-related injuries and deaths resulted from assault.

CDHS compiles state death records annually from death certificates submitted by each county's medical examiner or coroner, who investigates all firearm-related deaths. Patient discharge information from all nonfederal hospitals in California is reported to the Office of Statewide Health Planning and Development, which makes these data available for analysis. Data analyzed were for California residents for whom a firearm-related injury* was listed as the underlying cause of death or external cause of injury resulting in hospitalization. Discharge records of patients who died in a hospital were excluded, and transfers or other subsequent hospitalizations were eliminated to avoid counting cases twice.

During 1995 and 1996, gunshots resulted in 8832 deaths and 13,153 nonfatal injuries resulting in hospitalization. Most firearm-related deaths resulted from assaults (4847 [55%]) and self-inflicted gunshots (3619 [41%]). Most hospitalizations resulted from assaults (10,495 [80%]) and unintentional firearm-related injuries (1769 [13%]). Lethality of firearm-related injuries varied by intent (assaultive, self-inflicted, or unintentional). Of all firearm-related injuries, 90% of self-inflicted gunshot wounds resulted in death compared with 32% of assaultive and 10% of unintentional injuries.

Assaultive and self-inflicted injuries accounted for 8466 (96%) firearm-related injury deaths and 10,915 (83%) nonfatal injuries resulting in hospitalization in California during 1995-1996; 7389 (87%) deaths and 9858 (90%) hospitalizations occurred among males. Although more whites than persons of any other racial/ethnic group died from firearm-related injuries, the death rate was highest for blacks (34.6 per 100,000 population), followed by Hispanics (15.2), whites (10.6), and Asians/Pacific Islanders (6.2). For whites, most firearm-related fatalities were suicides. The suicide rate for whites (8.1) was more than double the suicide rate for blacks, the next highest group. For nonfatal firearm-related injuries resulting in hospitalization, both number and rates were lower for whites (number: 1657; rate: 4.8) than for blacks (3143; 69.4) and Hispanics (5321; 28.9). Asians/Pacific Islanders had the fewest hospitalizations (473) but the third highest hospitalization rate (7.0).

Total firearm-related injury deaths and hospitalizations were substantially higher among adolescents and young adults (ages 15-24 years) than among persons in older age groups. Among older persons, the rate of fatal firearm-related assault decreased but the rate for suicide increased. Among persons aged 35-44 years and older, suicide was the most frequently reported manner of fatal firearm-related injuries; 919 firearm-related suicides occurred among persons aged ≥65 years compared with 73 firearm-related homicides and four unintentional firearm-related injury deaths.

RB Trent, PhD, JC Van Court, MPH, AN Kim, MS, Epidemiology and Prevention for Injury Control Br, California Dept of Health Svcs. Div of Violence Prevention, National Center for Injury Prevention and Control, CDC.

The findings in this report demonstrate differences in fatal and nonfatal firearm-related injuries in California by focusing on the lethality of gunshots. Fatal and nonfatal firearm-related injury patterns are different, particularly among self-inflicted and unintentional injuries. During 1992-1993, data from the National Electronic Injury Surveillance System and vital statistics data indicated that the ratio of fatal firearm-related injuries to nonfatal injuries (including emergency department outpatients) was approximately 1:2.6;² in California, the ratio was 1:1.3. Analyses limited only to deaths or to hospitalizations give incomplete pictures of the problem. For example, only 10% of unintentional firearm-related injuries resulted in death, but 90% of self-inflicted firearm-related injuries resulted in death.

Some of the assaultive firearm-related injuries included in this report may have been inflicted in self-defense. The International Classification of Diseases, Ninth Revision, does not classify assaultive injuries as legally justifiable or unjustifiable. However, the California Department of Justice Supplemental Homicide Reports for 1995 and 1996 indicate that 2% of firearm-related homicides committed by persons other than peace officers were considered justifiable.

The findings in this report are subject to at least two limitations. First, the CDHS does not have statewide information on firearm-related injuries treated in emergency departments or outpatient settings. Injury reports from emergency departments will become mandatory in California on January 1, 2002.† Analyses of these reports will improve understanding of the incidence, cost, and nature of firearm-related injuries in California. Second, this analysis excluded federal hospitals and non-California residents.

Few researchers have compared nonfatal and fatal firearm-related injuries.^2-4 With assistance from CDC, systems permitting surveillance of both fatal and nonfatal firearm-related injuries have been developed in Colorado, Massachusetts, Missouri, New York City, Oklahoma, Washington, and Wisconsin.⁵ Other states and localities also conduct firearm injury surveillance.⁶

Analyses such as the one described in this report can guide firearm-related injury prevention efforts by identifying populations at high risk for such injuries (e.g., blacks at risk for fatal and nonfatal firearm-related assault). These data also can contribute to analytic studies on costs associated with firearm-related injuries, evaluation of interventions and new laws, and assessment of firearm use in relation to other factors (e.g., alcohol use and domestic violence). One example would be to estimate the cost and health-care applications of firearm-related injuries by including persons who died after hospitalization in an analysis of hospital discharge data.

References: 6 available

*International Classification of Diseases, Ninth Revision (for death certificate data), and International Classification of Diseases, Ninth Revision, Clinical Modification (for hospital discharge data), codes E965.0-E965.4 (assault), E955.0-E955.4 (self-inflicted), E922 (unintentional), E970 (legal intervention), and E985.0-E985.4 (undetermined).

†California, Health and Safety Code amendments, 1997-1998, chapter 735, statutes of 1998.