Pergamon

Accid. Anal. and Prev., Vol. 30, No. I, pp. 53-60, 1998 0 1998 Elsevier Science Ltd All rights reserved. Printed in Great Britain 0001.4575/98 $19.00 + 0.00

PII: S0001-4575(97)00061-4

STUDIES ON TRACTOR RELATED INJURIES NORTHERN INDIA

ADARSH KUMAR
* ,

IN

DINESH

MOHAN~

and

PUNEET

MAHAJAN~

Centre for Biomedical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110 016, India and Department of Applied Mechanics, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110 0 16, India
(Receiced 3 February 1997)

Abstract-Epidemiological studies were conducted in two phases each of 1 year duration in nine and 30 villages, respectively, in two northern states of India. Investigations were carried out to determine the causal factors, the activities involved and severity of injuries for farming and non-farming activities in tractor related accidents. A total of 76 cases involving five fatalities and 71 non-fatal injuries were recorded. The pattern of tractor related injuries in India have been found to be very different compared to those reported from highly industrialized countries. Fifty-four percent of tractor related injuries in the first phase and 49% in the second phase were because of non-farming activities. Of the total injuries recorded in both the phases only 1 and 6% were tractor related. A major cause of tractor related injuries were collisions. In the two phases 28 and 40% injured were passengers on tractor or trailer. 8 1998 Elsevier Science Ltd. All rights reserved Keywords-Epidemiology, India, Injuries, Prevention, Tractor accidents

INTRODUCTION Sixty-seven percent of the work force (Census of India, 1991) in India is dependent on agricultural occupations. Agricultural production in India has increased in the past three decades with the introduction of hybrid varieties of grain and increased mechanization, and so have the injuries and health hazards along with these developments. The use of tractors on Indian farms has increased from a population of 52,000 in the 1960s to 1,517,869 in the 1990s (Government of India, 1993). The tractor is the most commonly used power source on farms throughout the year, unlike other agricultural machines which have specific and occasional use. The tractor is used in conjunction with all kinds of machinery: mounted; semi-mounted; and trailed equipment. The use of tractor is not merely restricted to farms, but it is also used as the main mode of transportation in rural areas. The tractor is also used under stationary conditions: taking power from auxiliary sources, like power take off (PTO) pulleys for threshing and tube well running. Most of the studies done on tractor related injuries have originated from highly industrialized countries (HIC). Baker et al. (1984) have recorded that from 1930 to 1980 the death rates due to
*Corresponding author. Tel: 00919 686 2037; e-mail: adarsh@cbme.iitd.ernet.in

I I 685 8703; fax: 00919 11

53

unintentional injuries in the United States declined by 60% but farm machinery injuries increased by 44%. The involvement of the tractor in injuries as reported in different studies of all agricultural machines is shown in Table 1. Tractors are reported to be involved in 40-70% of injuries and fatalities in all studies except the one from India where the involvement rate was 6% (Mohan and Patel, 1992). A summary of tractor related injury studies is given in Table 2. These studies show that the most common causes of injury are overturns, run-overs, falls, collisions and PTO injuries. Field and Gong (1982) reported that in China 670,000 regular tractors and 2,000,OOO power tillers were in use. They estimated that in 1980 there were 3000 tractor and machinery related deaths and 4000 serious injuries. Of the total fatalities lo-15% were operators while the rest were either pedestrians or passengers on tractors. Juha (1992) studied the characteristics and prevention of tractor accidents using statistical data on 403 tractor accidents in Finland in 1987. In a case study on 50 tractor accidents, detailed analysis showed that 42% injuries resulted while climbing in and out of the cab and 30% while hitching and unhitching equipment. Tractors are not only involved in overturning or fall related injuries but also cause PTO related prob-

54

A. KUMAR

et al.

Table 1. Injuries

caused

by farm equipment

as reported

in studies from different

countries

Study* Young and Ghrmley (1946) 1935543 U.S. Huston and Smith (1969)+ 1955567 Canada Howell and Smith (1973) 1969 Canada Simpson (1984) 1980 Canada McKnight and Hetzel (1985)+ 1975581 U.S. Cogbill and Busch (1985) 1978883 U.S. Etherton et al. (1991)+ 1980-85 U.S. Mufti et al. (1989) 1982284 Pakistan Mohan and Pate1 (1992) 1987-88
India

Machinery Fodder cutter m/c Thresher Tractor Trolley Tillage tools Hand tools Auger Corn-picker Combine Engine Mower Bailer Sugar crusher Tube well Miscellaneous Total

9 (5) 34 (18)

2 (1) 2 (1)
169 (68) 19 (37) 18 (43) 1940 (60) 118 (52) 1523 (69)

6 (6)
17 (16) 32 (31) 38 (36)

64 (11) 10 (2)
27 (5) 8 (I) 52 (9) 267 (47)

10 (4) 29 7 6 6 (15) (4) (3) (3) 11 (4) 3 (1) 4 (2) 2 (4) 46 (19) 247 (100)

15 (29) 6 (12) 4 (7) 4 (7)

7 (17) 4 (9)

46 (1) 57 (26) 93 (3)

61 (3) 26 (1) 53 (2)

27 (5)

3 (7)

42 (2)

IO (2) 133 (18) 576 (100) where the study was done.

95 (52) 186 (100)

4 (8) 52 (100)

10 (24) 42 ( 100)

1150 (36) 3229 ( 100)

50 (22) 225(100)

511 (23) 2216(100)

*The study is included by authors name and date of publication, +Fatality studies. *Number of victims (percent). Pesticide contact through sprayers included.

the period covered

by the study and the country

Table 2. Causes

of injury in tractor

related

accident Tractor

studies injury cause (%) Crushed PTO or other part 10 6 14 5 9 3 Others 15 13 13 10

Study* Karlon and Noren (1979), 1961-75, Wisconsin, U.S.. N=415 Tupi (1988)+, 1976685, Finland, N=287 Lehtola et al. (1994)+, 1988892, Iowa, U.S., N= 136 Smithurst (1968), 1964-66, Australia, N= 162 *The study is included +Fatality Studies. by authors

Overturn 52 42 56 53

Runover 12 12 17 12

Fall 11 18 17

Collision

name and date of publication,

the period covered

by the study and the country

where the study was done.

lems. McElfresh and Bryan (1973) showed that PTO injuries included traumatic amputations, multiple fractures and large skin avulsion including denudation of genitalia. Kalenak et al. (1978) and Heeg et al. (1986) also described PTO injuries as serious and potentially fatal. Most of the studies conducted from HICs show that when tractors are either equipped with rollover protection devices or bars they give some protection in tractor rollovers (Kelsey and Jenkins, 1991; MMWR, 1993). The present study was conducted with the objective of understanding the causal factors associated with tractor injuries experienced in northern India. The results are reported along with suggestions for counter measures for injury control.

METHODOLOGY In the first phase nine contiguous villages were selected in the Sonipat District of the Haryana State. The study was conducted from 1 July 1987 to 30 June 1988. The second phase of the study was extended to 30 villages which included the villages from Phase I, nine from the Baraut District of Uttar Pardesh and 12 from Rai Block of the Sonipat District of Haryana for the period 1 July 1990-30 June 1991. These villages were selected due to their high agricultural activities and use of modern technology. These three areas predominantly grow wheat, sugarcane and rice. In Phase I, field workers were trained to collect injury data from household surveys. The field workers visited every house once every 2 weeks and obtained informaion on all injury related events. In Phase II, informers

Studies on tractor

related

injuries

in Northern

India

55

were selected in each study village to report cases of all agriculture related injuries to us. For every injury case reported, trained investigator visited the home of the victim and obtained all the injury and equipment related information. A form was prepared for collecting detailed information about each case which included event and tractor details. Follow up forms were also designed to record details of injury recovery period. The field assistants visited all the victims for follow up interviews periodically. The severity of injuries were coded according to the Abbreviated Injury Scale (American Association for Automotive Medicine, 1990). Phase I was a base-line study and we were able to obtain records of all injuries which disabled victims for > 1 day in a total population of 19,723. However, in Phase II we expected the informer to report serious injury (AIS > 2) cases only. This study was conducted to get a large sample of AIS > 2 injuries to obtain a better epidemiological understanding of the factors involved. The population covered in Phase II was 59,167. The first phase gives a better idea of all injuries where as the second phase gives a bigger sample of more severe injuries but is not representative of all injuries.

machinery related injuries were associated with tractors in Phase I and 50 and 25% in Phase II. Tractor relatedfatalities There was a total of five fatal cases in the two phases combined. Two tractor drivers died because of their tractors overturning. One driver went to bring fodder from the field and on the way a sudden appearance of a buffalo in front of the tractor forced the driver to apply the brakes, which resulted in the tractor overturning and the driver being crushed underneath the tractor. Another rollover occurred in a field near an irrigation channel with a high slope causing the driver to be crushed. The third victim was an occupant of a bullock-cart (wooden cart pulled by bullocks or buffalos), which was hit by a tractor from the rear with the front wheel of the tractor subsequently crushing the victim who had fallen on the road. Two children were runover by tractors, where in both the cases the tractor driver could not see the children.

RESULTS

AND

DISCUSSION

A total of 2059 and 576 injuries were reported in Phases I and II, respectively. These included 576 (28%) and 282 (49%) agricultural machinery or implement related injuries, respectively. A total of 76 cases (39 and 37, respectively) of tractor related injuries were reported in both phases (Table 3). In tractor related injuries 18 (46%) and 19 (51%) were due to farming related activities and rest were associated with non-farming activities. We have defined farming related activities as those which have some correlation with agricultural operations and non-farming activity as that which is purely for transportation, leisure, etc. This shows that in India injuries caused by tractor are associated not only with farming activities but non-farming activities also. Although the total percentage of tractor related injuries were very small, the corresponding percentage in severe injuries were quite large as shown in Fig. 1. All severe injuries of AIS and AIS in agricultural
Table 3. Distribution Injuries Total injuries Agric. related Tractor related Parentheses indicates of injuries in two phases Phase I 2059 (100) 516 (28) 39 (2) percentage. Phase II 576 (100) 282 (49) 37 (6)

Figures 2(a and b) show the age distribution of persons involved in tractor related injuries. The 15-54 age group constitutes 80 and 70% of the total tractor related injury cases in Phases I and II, respectively. Seven children in the O-14 age group were involved in tractor related injuries. Of these there was only one involved in agricultural activities. This was a cranking injury suffered by a lZyear-old child. Two children, aged 1 and 3 years, respectively, were runover by tractors in Phase I. No driver of ~23 years of age was injured in any phase. This condition is quite different from the study by Lehtola et al. (1994) where younger operators had fatal accidents. The older age group (> 64 years) were injured mostly in non-farming activities in both phases. The causes of injuries Phase I, The causes of tractor injuries is shown in Fig. 3. Injuries due to collisions were most frequent and accounted for 12 (30%) injury cases. These collisions occurred because tractors are frequently used for transporting people and are used on rural roads. Transportation is generally done with flat-bed open trailers which are either single or double axles attached to the tractor with a hook (Fig. 4). Seven injuries were caused by a part of a tractor hitting the victims. Four ( 10%) injuries were sustained while working with implements for hitching/unhitching or adjusting the connecting links. Three (8%) injury cases occurred while working with tractors when fixing some auxiliary structure or putting rocks under tyres for parking etc. Two cases. respectively,

56

A. KUMAR

et al.

r-~m

.--

Phase-l, m

N-576 Other Machines 1

Phase-Ii,

N-282

Tractor

AlS6

0%

25%

50%

75%

100%

Fig. 1. Percentage

of tractor

related

injuries in two phases of the study.

occurred when repairing a tractor, while working with a PTO shaft and falling from a tractor. Cranking, climbing and playing each contributed to one injury. Phase II. The distribution of the injuries in Phase II are different from Phase I because Phase II data are based on reporting by informers whereas Phase I data were obtained from regular house-hold visits. Phase II data mainly includes AIS> injuries. Non-rollover collisions resulted in nine (24%) injury cases, including one fatal case where one passenger of a bullock cart was hit by tractor and then runover. Rollover associated injuries include a total of nine (24%) cases which included two resulting from collisions. Four injuries were caused while working with implements. Three injuries were due to failure of the trailer hook and resulting in injuries to the trailer passengers. Two cases each were associated with climbing up/down, falling from the tractor, cranking the engine, repairing and playing. There were no reports of PTO related injuries in this phase. In both the phases the injuries caused were mostly associated with transportation and were caused because of collisions, overturning and trailer hook failure. Injuries caused while repairing fan belts and generator/alternator of tractors were also recorded in four cases. No steps are provided on trailers to help passengers to climb up or step down, which causes injury especially in single axle trailers which are very unstable. Fall injuries were associated mainly with passengers sitting on the mudguard who fell because of rough terrain and got trapped between the tractor and trailer. A low incidence of PTO related injuries were encountered because PTO operated machines are rarely used.

Tractor collisions
Tractor collisions are a major cause of tractor related injuries. There were 25 cases of tractor crashes (Table 4) resulting in three fatalities. Two children were runover in the first phase and a female on a bullock cart was hit by a tractor and then runover in the second phase. The other frequent situation included the attachment of a modified bullock cart to a tractor in which passengers sat on the edge with their legs dangling outside the cart. This was the cause of four injuries recorded in the second phase. Tractors were also hit by trucks on two occasions in the second phase. The collisions resulted in the overturning of the tractor/trolley in two incidents in Phase II. Out of all the collisions, nine collisions occurred between 18:00 and 06:OO hours while the rest took place at 06:00~18:00 hours. Truck-tractor collisions happened in dark between 18:00 and 24:00 hours. Poor visibility and absence of bright headlights, taillights and reflectors on the tractors could be associated factors in these collision.

Distribution of victims Phase I. As shown in Fig. 5, 11 (28%) victims

were passengers on tractors or trailers, 12 (3 1%) were occupants of other vehicles and 10 (26%) were working with the tractor. Only 5% of the victims were drivers who were injured while operating the tractor. Phase II. There were 15 (41%) victims who were passengers on tractors or trailers. Working with tractors caused 10 (27%) injuries and occupants of other vehicles and drivers were involved in 5 (14%) injuries. In both the phases the injury to the passengers of

Studies on tractor

related

injuries

in Northern

India

No

of

cases

8r

Non

Farm

Activity

IIEI

o-4 (a)

5-14

15-24

25-34

35-44

45-54

55-64

~84

Aga,yaara

6r

No

of

case8

Farm

activity

Non

Farm

Activity

o-4
(age @I of one tractor

5-14
driver

15-24
Is not

25-34 35-44 Age,yeara

known)

45-54

55-64

a64

Fig. 2. (a) Age distribution

of tractor

related

victims (Phase

I). (b) Age distribution

of tractor

related

victims (Phase

II).

the tractor and trailer clearly highlighted the frequent usage of tractors for transportation. There are no proper arrangements either on the tractors or trailers for passenger to sit, which makes them more vulnerable to injuries. As indicated in Table 4 the occupants of tractors were involved only in two collision cases but a much larger number of passengers got injured when being transported either by falling from the tractor/trailer or from trailer hook failure. Severity of injury From the analysis, tractor injuries came out to be very severe with 21 injuries in both phases being AIS or above. This constituted 54 and 57%, respec-

tively, of the total injuries. Compared to total agricultural machinery related injuries in two phase studies 13 and 44% were AIS and above. Out of the total agricultural machines, only 7 and 13% injuries were caused by tractors and trailers. But tractors/trailers were responsible for 25% of AIS2, 22% AIS and all of the AIS and AIS injuries in Phase I (Fig. 1). In Phase II, 17% of AIS2, 7% of AIS3, 50% of AIS and 25% of AIS injuries were caused by tractors and trailers. This clearly indicates the severity magnitude of tractor related injuries. Recovery time Tables 5(a and b) indicates the recovery period distribution in farming and non-farming activities in

58

A. KUMAR et al.

Collision Overturning Imp. Working Hit by tractor part Reparing Tractor Working Trailer hook failure Fall Cranking Climbing Playing Power Take Off Runover 0 2 4 6 6 10 12

No.of
Phase-l. N-39 m Fatalities Fatalities of tractor

injured

cases

ES3 Injuries
Injuries related injuries

I i

Phase-II, N-37 a

Fig. 3. Mechanisms

Fig. 4. Tractor

attached

with loaded

trailer.

both phases. In Phase I, 15 (38%) farming activity injuries and 14 (36%) injuries related to non-farming activities took > 1 month to recover. Longer recovery times were observed with injuries caused by nonfarming activities than with those from farming activities in this phase. In Phase II nine (24%) farming related injuries and 12 (32%) non-farming related injuries took 1 month to recover. Farming activity related injuries took > 1 month to recover in this phase. The average recovery time was 27 and 39 days in Phases I and II, respectively. The recovery time for

injuries caused by farming activities was 20 and 39 days and for non-farming activities 33 and 38 days in Phases I and II, respectively. This was because in Phase II only serious injuries were reported by the informers.

CONCLUSIONS Tractor related injuries are not only confined to farming activities but also resulted from non-farming activities. Injuries caused by using the tractor for transportation constituted a significant percentage of

Studies on tractor

related

injuries

in Northern

India

59

Table 4. Details Phase I No. of injured Tractor impacted by Tractor (%)

of crashes

in tractor

related

transportation

injuries Phase II

cases object (%) 4 (29) 2 (14) l(7) 1 (7) 2 (14)* l(7) 3 (22) 14 (100) Total (%) 4 (29) 2 (14) 1 (7) 1 (7) 2 (14)* 1 (7) Tractor

No. of injured (%)

cases Total (%)

Other

Other object (%)

Cycle Scooter Tempo Truck Bus Car Tractor + cart Bullock cart Pedestrian Total *Overloaded fodder trolley injured bus passengers.

2 (8)
1 (9) 2 (18)

2 (8)
1 (9) 2 (18)

3 (22) 14 (100)

2 (18)

4 (36) 1 (9) l(9) 9 (82)

4 (36) 1 (9) 1 (9) 11 (100)

5
Driver Playing Other
Veh. Occup.

2 5

15

Passenger

10
Working-Tractor

Phase-l

Phase-II

N=39 Fig. 5. Distribution of tractor related victims

N-37

the injuries. The victims injured were passengers riding on tractors or trailers. Passengers tend to fall when using the tractor for transportation and also get hurt when the trailer hook failed. It was also observed that most of the trailers were single axle and were therefore more unstable. The observations as follows: are summarized (1) Tractor related injuries were caused because of non-farming activities in 54 and 49% of cases in Phases I and II, respectively. (2) No drivers ~23 years of age were involved in an injury event. (3) No tractors were equipped with rollover protection structures (ROPS) or cabs. (4) Out of 76 accident cases only 13% were caused

by overturning. The reasons are the flat terrain, low horse power tractors and the use of small equipment in the study area. (5) An extremely high percentage of victims (28 and 41%) were tractor/trailer passengers in Phases I and II, respectively. This is because tractors are commonly used for transportation. (6) A total of 31 and 24% of injuries were due to collisions on the road in Phases I and II, respectively. The Lack of bright headlights, over loaded trolleys and mismatched trailers were often the cause of collisions. (7) Very few PTO related injuries, due to the nonavailability of PTO operated equipment in the study region were observed.

60

A. KUMARet al.

Table 5. Recovery period for different activities: (a) Phase 1 and (b) Phase 11 Recovery time (days) (a) Phase I O-10 Ill20 21-30 31-60 61-90 91-150 151-200 Total (%) (b) Phase II O-10 1l-20 21-30 31-60 61-90 91-150 151-200 Total (%) Farm activity 9 5 1 1 1 1 0 18 (46) 3 2 4 6 2 2 0 19 (51) Non-farm activity 8 5 2 1 2 2 21 f54) 2 6 4 4 0 1 18 f49) Total (%) 17 (43) 10 (25) 3 (8) 2 (5) 3 (8) 3 (8) l(3) 39 (100) 5 (14) 8 (22) 8 (22) 10 (27) 2 (5)

agricultural trauma. Journal of Emergency Medicine 3, 205-210. Etherton, J. R., Myers, J. R., Jensen, R. C., Russell, J. C. and Braddee, R. W. (1991) Agricultural machines related deaths. American Journal of Public Health 81, 766-768.

Field, W. E. and Gong, S. F. (1982) Agricultural Machinery Safety in China. Paper presented at the 1982 Summer
Meeting, ASAE, Paper No. 82-5007, 1982. American Society of Agricultural Engineers, St. Joseph, Michigan. Government of India (1993) Motor Transport Statistics of India 1991-93. Transport Research Wing, Ministry of Surface Transport, Government of India, New Delhi, India. Heeg, M., Duis ten, H. J. and Klasen, H. J. (1986) Power take-off injuries. Injury 17, 28-30.

Howell, J. M. and Smith, E. S. 0. (1973) An agricultural accident survey in Alberta. Canadian Journal of Public
Health 64, 36-43. Huston, A. F. and Smith, Saskatchwen. Canadian C. (1969) Farm accidents in Medical Association Journal

1 (2) 1 (2)
37 (100)

Maintenance injuries were also prevalent, occurring mainly while repairing fan belts and the generator/alternators of tractors. The following suggestions are made based on observations gathered during the two phases of the study: so as to make (1) Redesigning the tractors/trailers passenger transport safer. for the (2) Redesigning the hitching arrangement trailer and implements to make hitching and unhitching safer. (3) The tractors should be made more conspicuous by providing better headlights, sidelights and reflectors. (4) Provision of safety structures and ROPS. (5) Training of drivers in safer methods of maintenance and use of tractor trailers on roads. Training of drivers regarding the conditions of (6) tractors and tractor-trailer rollovers.
(8) Acknowledgements-The field work was supported by CAPART, Ministry of Rural Development and Ministry of Social Welfare. The study was assisted by Rajesh Pate1 and data entry done by Mahesh K. Gaur. S. J. Shah and H. Kumar helped in data collection.

100, 764-769. Juha. S. (1992) Tractor accidents and their prevention. International Journal of Industrial Ergonomics 10, 321-329. Kalenak, A., Gordon, S. L., Miller, S. H., Greer, R. B. and Graham, W. P. ( 1978) Power take-off injuries. Journal
of Trauma 13, 775-782. Karlon, T. and Noren, J. (1979) Farm tractor related fatalities: the failure of voluntary safety standards. American Journal of Public Health 69, 146-149.

Kelsey, T. W. and Jenkins, P. L. (1991) Farm tractors and mandatory roll-over protection retrofits: potential costs of the policy in New York. American Journal of Public
Health 81, 921-923.

Lehtola, C. J., Marley, S. J. and Melvin, S. W. (1994) A study of five years of tractor related fatalities in Iowa. Applied Engineering in Agriculture 10, 6277632. McElfresh, E. C. and Bryan, R. S. (1973) Power take-off injuries. Journal of Trauma 13, 775-782.
McKnight, R. H. and Hetzel, G. H. (1985) Trends in farm machinery fatalities. Agaric Engineering 66, 5, 15- 17. MMWR 42(3), 57-59 (1993).

Mohan, D. and Patel, R. (1992) Design of safer agricultural equipments: application of ergonomics and epidemiology. International Journal of Industrial Ergonomics 10, 301-309. Mufti, A. I., Ahmad, S. I. and Majid, A. (1989) Farm accidents in Pakistan. Agricultural Mechanisation in
Asia, Africa and Latin America 20, 73-75.

REFERENCES
The Abbreviated Injury Scale (1990) American Association for Automotive Medicine, Arlington Heights, IL. Baker, S. P., ONeill, B. and Karpf, R. S. (1984) The Injury Fact Book. D.C. Health and Company, Lexington, MA.

Simpson, S. G. (1984) Farm machinery injuries. Journal of Trauma 24, 150-152. Smithurst, B. A. (1968) An epidemiological study of 162 tractor accidents in Australia, 1962 to 1966. Medical Journal of Australia 1, 5 l-54. Tupi, K. (1988) Fatal occupational accidents with tractor in Finnish agriculture in 1976685. International Conference on Agricultural Engineering, Paris, pp. 62-63. National Centre for farm machinery, agricultural engineering, water and forestry, Montpellier, France. Young, H. H. and Ghrmley, R. K. (1946) Accidents on the farm. Journal of the American Medical Association 132, 768-77 1.

Census of India (1991) Series I, Paper 2 of 1991. Regional General and Census Commissioner, India. Cogbill, T. H. and Busch, H. M. (1985) The spectrum of