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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 .

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CDC/NIOSH Cooperative Agreement U50 OH07541

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Karen Gilmore, M.P.H.

Midwest Stream Farmworker Health Forum

November 18, 2010

Austin, TX

CDC/NIOSH Cooperative Agreement U50 OH07541

sw ag center
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
Are You Prepared?
  • CPR training in the last 3 years?
  • Taken a first aid course in the past three years?
do you know
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
Do you know? contin.
  • What are the signs & symptoms of acute organophosphate pesticide poisoning?
what should be done first
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 contin1
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?
  • 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

rural community health issues
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
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
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
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
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
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
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 Practitioner’s Guide to Agromedicine
  • Interviews with EMTs and nurses who work in rural/agricultural communities
companion cd
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
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

Content Modules
bites stings
Bites & Stings
  • DVD Module
    • Recognition of risk
    • Recognition of symptoms
    • Appropriate first aid
c a r e model
C.A.R.E. Model
  • C- Call 911
  • A – Assess and stabilize the situation
  • R – Render First Aid
  • E – Eliminate risk factors
f a r m e as intervention
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
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
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
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 interventionof teaching peers.
  • 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
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.
additional ideas for dissemination
Additional Ideas for Dissemination
  • Church homes for farmworkers
  • Migrant Education Programs – parents
  • Promotores certification training
  • Questions?
  • 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