Hospital', published in the Irish Medical
Journal in January 2018, is a telling tale
of risk on Irish farms. Between 2009 and
2013 inclusive, 54 patients were admitted
to CUH with `major trauma caused by
a farm animal'. Sadly, one admission
was fatal and one child, aged two, suffered a
lower leg fracture as a result of being struck
by a cow. The median patient age was 56,
while 20 patients (36 per cent) were over-65.
"We live these statistics every day,"
says Dr van der Velde.
"Personally, what makes me sad is that more
than two-thirds of all farm deaths occur in
the farmyard and that is down to the way
the farm is designed here. People live on
their farms. And that is the most frightening
thing. The vast majority of times, it is family
members who suffer injuries on farms."
Making a difference
The approach to farm safety, as Dr van der
Velde sees it, is several-fold. On one hand,
there are pragmatic and practical measures
that farmers can apply and that can make a
"Engineering solutions exist for many things
that we do. So, for example, to rule out
road-traffic collisions due to cattle, you
build a tunnel under the road. Engineering
solutions also exist to enable you to have a
mobile phone signal throughout your farm
[if that is a problem]. These signal boosters
are a bit costly, but they are coming down in
price all the time. If you cannot call for help,
you are not going to get help," he says.
Two-way radios, commonly used by
farming contractors, are another solution to
unreliable mobile phone coverage.
"If you are working on or near a machine
and the likelihood exists that you could
become entangled or entrapped, then
you need some form of easy communication and you need to
let people know where you are. Two-way radios can be very
effective in scenarios like this. They cost very little and have up
to an 8km range. Keep one radio with you and give the other to
your wife, husband, father, mother or neighbour. If the mobile
phone doesn't work, it needs to be identified and the problem
needs to be solved."
Another engineering solution provides the physical boundary that
is absolutely essential to separate home and farm, he says.
"One of the main things, and I take this from rural South Africa,
is the need to fence off and gate where you live from where you
work. There is no excuse for not having an adequate boundary.
If you worked for a pharmaceutical or a petrochemical company,
for example, you would see a big fence and a big gate separating
that from nearby houses. Why does this boundary not exist in
"This is why kids get run over. This is why kids `play' in barns,
and fall from heights. This is why kids go after the dog, who has
fallen into the slurry pit. This is why kids
get caught in power take-off (PTO)
shafts. This is why grandpa and grandma are
getting injured while wandering into
the farm trying to be helpful only to get
taken down by heavy machinery. In what
other industry do you have individuals
who would normally be retired frequently
working around machinery?"
While pragmatism will get us so far, Dr van
der Velde has more ambitious and long-
term plans in his sights. Inspired by
an emergency medical services (EMS)
gathering that took place in Kerry two
years ago, he would like to roll out an
educational safety course for farmers,
focusing on ways to deal with a traumatic
accident and resulting catastrophic injuries.
At that Kerry meeting, the Anaesthesia,
Trauma and Critical Care (ATACC) Group,
of which Dr van der Velde is a member
(deputy medical director), was invited
to run a farming injury workshop, aptly
"We had a really, really successful
EMS gathering two years ago in Kerry.
We held a farm-safety workshop where
we set up a number of dreadful scenarios, in
order to educate our paramedics and fire
fighters who were attending the conference,
as well as farmers. And that sort of thing got
me thinking," he said.
"What I want to roll out is an educational
package along the same vein
as Farmageddon. A one-day course, which
I have already developed, which is toolbox-
based," he says.
"This would concentrate on common farm
accidents falling from heights, machinery
entrapment, sustaining injury from
animals, slurry risks, for example. So, on their own farms, in their
own environments, I would like to be able to teach farmers
about real lifesaving how to save life or limb, how to stop the
catastrophic bleeding, because if you don't, you'll be dead before
the ambulance arrives," he says. This is not a first aid course,
he explains. This is industry and injury specific.
"In the same way that other workers are taught how to deal with
a chemical-related incident, for example, farmers need to be taught
how to get themselves out of machines if they are trapped. That is
how we approach this.
"This is real life-saving stuff until the emergency services reach you.
That is what I want to roll out and I want to do it in a pragmatic
way across the country."
He has already contacted a number of the farming agencies
and key stakeholders about the logistics involved in such
an educational course. This may take the form of a Cork-
based pilot programme to begin with, although that has not
Dr van der Velde has devised a useful
acronym to help people make the
right decisions in the event of a serious
accident that involves machinery: DART
"This is just a way of explaining how
to help yourself, or a colleague, if
entrapment, for example, occurs," he says.
This refers to more than just switching
off the motor or the engine. It means
disengaging the drive shaft/mechanism,
or whatever is driving/powering the piece
This is simply about pain management
and accessing the correct analgesic
for the injury (provided by emergency
Once the mechanism is disengaged,
reverse it. A limb gets dragged into a
piece of machinery, but if you can reverse
that mechanism, the limb comes out.
Most of the time, if a limb is dragged
into a machine, there is going to be
catastrophic bleeding as it comes out.
When the limb is in the machine and
trapped, the pressure from that may
be preventing a person from bleeding
out. But once the limb is removed, the
pressure is also removed.
A tourniquet is needed and it should be