Karen Gilmore, M.P.H.

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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
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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

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Are You Prepared?

• CPR training in the last 3 years?
• Taken a first aid course in the past three years?

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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

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Do you know? contin.

• What are the signs symptoms of acute
  organophosphate pesticide poisoning?

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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?

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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?

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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
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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.

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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)

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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

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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

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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.

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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

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Training Manual

• Content was based on
• 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 Practitioners Guide to
  Agromedicine
• Interviews with EMTs and nurses who work in
  rural/agricultural communities

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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

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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

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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

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Bites Stings

• DVD Module
• Recognition of risk
• Recognition of symptoms
• Appropriate first aid

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C.A.R.E. Model

• C- Call 911
• A Assess and stabilize the situation
• R Render First Aid
• E Eliminate risk factors

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Prepare for Effective 9-1-1 Call
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C.A.R.E. Eliminate Risk
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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

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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.

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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

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YOUTH Training EffectivenessF.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.

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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

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Results Youth as Trainers

• The intervention group scored significantly
  higher on anticipatory action (t2.23, p.03) but
  not knowledge acquisition (t1.37, 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.

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First Aid Kit Assembly
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Additional Ideas for Dissemination

• Church homes for farmworkers
• Migrant Education Programs parents
• Promotores certification training
• Questions?

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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