The apprentices are all First Aid and CPR certified! We prioritize preventing incidents from occurring in the field, but it’s important that our crew is prepared in case something does happen.
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Boston Area Gleaners 
It can get intense out in the field sometimes, so to cover all of our bases, this week we are learning about first aid training! Of the many conditions that could require some quick first aid, I was assigned Asthma to report on. In the United States, nearly 1 in 13 people have Asthma in varying severity. The basic definition of the condition is that it is when one’s airways narrow, swell, and produce extra mucus. As you might expect, this makes it hard to breath and often causes people to cough and wheeze (Mayo clinic).
Like I mentioned above, for many people, asthma does not play a big role in their life and they can get along just fine. For others, an asthma attack could lead to a life-threatening situation if not treated right away. Most asthma attacks are situation dependent; someone could have exercise-induced asthma, occupational asthma (which is triggered by irritants such as chemical fumes or dust), or allergy-induced asthma, Therefore, the main symptoms asthma vary, but generally include shortness of breath, chest tightness, wheezing, trouble sleeping caused by any of the above, and any of the above getting worse if the person has a respiratory virus.
We have touched on some of the triggers of asthma, but what actually causes it? It is not completely understood why some people have the condition, but doctors guess that it is due to both genetic factors and environmental triggers. Therefore, if someone lives in an environment where there is a lot of pollen, air pollutants, and cold air, and they have genetics that favor asthma, they are more likely to develop it. Other triggers to the condition include medications such as beta blockers, aspirin, and ibuprofen, sulfates and preservatives added to some types of food, having large amounts of stress or even having gastroesophageal reflux disease (GERD) (Mayo Clinic).
There is no way to completely get rid of your asthma once you have it. However, there are many strategies people take so that they may live a relatively normal life. This includes taking long-term medications such as inhaled corticosteroids, oral leukotriene modifiers, or combination inhalers. There are also quick-relief medications to be used in the case of an asthma attack, which include short-acting beta agonists, anticholinergic agents, or oral corticosteroids. If someone has a severe case of asthma that cannot be improved with medications, they can have a bronchial thermoplasty, where the insides of the airways are heated with an electrode, which limits its ability to tighten. Overall, asthma treatment is flexible and should be modified as one’s asthma condition changes.
Asthma is definitely something that we all need to be aware of when working at BAG. Gleaning can become very physical, especially when you are lifting a lot of heavy banana boxes in the heat. Such physical exercise can get the lungs pumping and could trigger an attack, which is why it is essential we make sure we know if any of our staff or volunteers have asthma, and if they have an inhaler around in the case of an attack.
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Allergy and Anaphylaxis
Anaphylaxis is the name for the severe allergic reaction (inflammation) that applies to the whole body and especially the respiratory system. It can be life threatening in a short amount of time. Symptoms include difficulty breathing, facial swelling, vomiting or diarrhea. The short term solution to reversing this reaction is to use epinephrine, or an Epipen, in combination with Benedryl and a steroid. This treatment plan has low risk of further hurting the patient but must be followed by a visit to the hospital because the treatment is temporary (15-20 minutes).
People who experience anaphylaxis won’t always have a history of allergies, but those who do will likely have an Epipen they carry with them. It’s important to know if anyone has severe allergies before starting a gleaning trip and that person should feel comfortable performing the necessary tasks in the environment before starting. If there’s danger of that person experiencing a reaction and they aren’t prepared, they should not join the trip.
A good example of this might be on a farm where there are bees. Bee stings are a common cause of anaphylaxis among allergic people but are also an unavoidable part of the farm environment. People who are severely allergic to bees should be made aware of this threat, especially if they will be working near bee hives that are kept purposefully on the farm. It would also be helpful to speak with the farmer about their regular emergency procedures and to know where the nearest hospital is or how accessible EMS support is.
Volunteers should know before beginning that experiencing seasonal allergy symptoms is likely while working outdoors during the growing season. They can come prepared with their normal treatments and communicate this to trip leaders.
Other minor allergic reactions show localized swelling and itching and most likely won’t need medical attention beyond being removed from the source of reaction. Other possible allergies might include poison ivy, other insect stings or bites, or to food that is being harvested.
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Working outside in the summer months for hours at a time is no joke and can lead to serious complications. Luckily, the risk from these potential dangers can be mitigated by following proper procedures and just a bit of general preparedness. Working with the Boston Area Gleaners it is essential to keep staff and volunteers informed of the health risks high temperatures can cause.
While field labor in late summer can be uncomfortable — hot and sweaty, possibly excessively dry or humid — it is important to distinguish between mild discomfort and risky symptoms. Because the human body prefers a nice and stable 37° C, our skin sweats in hot situations in order to facilitate evaporation over a large surface area. Sweating is an effective means of temperature control, and is part of a normal bodily response to high temperatures. However, the fluid loss associated with sweat can lead to larger problems if fluid intake is not consistent with temperature and amount of perspiration.
If temperatures are high enough, sweat may evaporate so rapidly from the skin that you may not be able to tell whether you are producing an adequate heat response. An additional marker of fluid retention is in the color and quantity of passed urine. If passed urine is dark in color, or minimal in quantity, an increase in fluid consumption is generally recommended.
Dehydration from excessive sweating and inadequate fluid intake may lead to heat exhaustion, with symptoms like nausea, dizziness, and headache. Oral rehydration or IV drip are both possible solutions, depending on available materials. Oftentimes an electrolyte balance may be needed, as sweat also releases salt from the body, which coupled to intensive hydration may eventually lead to hyponatremia (low sodium).
Heat stroke is the most severe form of heat-related illness. Patients with heat stroke may show signs of dehydration, but they also display a dangerously elevated core temperature and reducing that temperature is of utmost priority. Cold water immersion, as well as ice packs at the groin and neck, are both recommended forms of treatment. Moving the patient into a shady region may be sufficient to lower body temperature, and a more plausible field response. Dehydration may also be present in those suffering from heat stroke, but should be treated as a secondary measure. Evacuation from the environment following cooling is preferred.
In general, staying aware of your body, wearing appropriate clothing, and ensuring adequate fluid intake will be enough to prevent heat induced illness. In a high stakes environment like gleaning, where field work can move at a fast pace, reminders to hydrate are essential. Reminding volunteers to bring additional personal shade like long sleeves or sun hats would also mitigate the danger posed by excessive heat and dehydration.
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Even just in this first month, we’ve become quite aware of some of the many hazards of doing this work, I’ve definitely become more aware of body management and taking care of myself during work–and I think the apprentice team does a great job looking out for each other, whether that’s checking in individually with others if they’ve taken a water break recently, or offering to help carry a heavy box. I think we, as a team, have gotten into a good flow of caring for ourselves and each other and being alert to our surroundings, all of which is vital for safety and injury prevention, but there are always still hazards we need to be aware of in the fields and at the field station! Some of the common hazards we see are vehicles like tractors, trucks, and forklifts; hazards related to the heat and dehydration; tripping hazards on the ground; and hazards from the tools we use to harvest certain crops. Especially in this August heat, it is super important for us to dress properly, in light breathable clothing and wearing a hat (as well as our face masks, of course!) to help keep us cool, and also staying super hydrated!
My assigned first aid topic is bleeding and wound care. Though this is, of course, a topic that has a wide range of causes and symptoms, the first aid pocket guide we read offers some helpful general guidelines for treatment. When it comes to bleeding and wound care, prevention is the most important step. Being aware of hazards at the site is important, like tripping hazards and slippery terrain. Safe handling of any sharp objects, like clippers or knives that we use for harvesting certain crops, is essential, and a good bit of introduction to proper usage should be provided for folks, like new volunteers, who may not have experience using these kinds of tools.
According to the Red Cross Wilderness and Remote First Aid Pocket Guide, if someone does become wounded, when attending to bleeding wounds, as with any injury, the surrounding environment and available resources should be checked, and the patient should be assessed using the ABCDE (general assessment), DOTS (hands-on physical exam), and SAMPLE (medical history) checklists if appropriate. Proper ‘body substance isolation’ (BSI) precautions should occur to prevent disease transmission–an important step in this when attending to bleeding or wounds would be to wear disposable gloves.
While a lot of wounds could easily be attended to by a trained person with a typical first aid kit, there might be some extreme circumstances in which the patient should be taken to a medical facility at once. According to the Red Cross pocket guide, if a patient’s wound has any of the following signs or symptoms, they should be evacuated from the site: is heavily contaminated, opens a joint space, involves tendons or ligaments, was caused by an animal bite, is deep and on the face, involves an impalement, or was caused by a crushing injury. There are also some instances in which a patient should be evacuated slowly and carefully, which include: mild head injury (when responsive, this patient can walk out if able to keep balance and the terrain is safe), a wound that cannot be closed in the field, or an infected wound or skin infection that does not improve within 12 hours of treatment or which spreads to other parts of the body.
To administer care for bleeding or wounds, direct pressure should be applied to the injured site to control bleeding. However, if the wound is on the head or neck, the instructions are different–for neck wounds, one should carefully pinch the opening of the wound closed instead of pressing directly, and for head wounds, the wounds should be covered with a bulky dressing and pressed lightly. Then, the wound should be washed thoroughly with lots of disinfected water, under pressure if possible. Then, one should close and protect wounds with antibiotic ointment, covered with sterile dressings and secured in place with bandages. However, iff the wounds are bigger than a half inch wide, are animal bites, deep puncture wounds, wounds that expose bone, tendons, or ligaments; or dirty/infected wounds. All of these specific types of wounds should be packed with sterile dressings, apply antibiotic ointment on top, then covered with dressings and then bandages. The wounds should be monitored and re-cleaned often, especially if infection is suspected at all. To promote drainage (and prevent infection), wounds should be packed with moist sterile dressing, then dry dressing, at least twice daily.
If bleeding is uncontrolled by direct pressure, or if direct pressure isn’t possible to apply, on an arm or leg, a tourniquet can be applied. The date and time a tourniquet is applied need to be noted. To apply a tourniquet, one should use a commercial device or an improvised one, at least 4 inches wide, placed about 2 inches above the wound but not over any joint, then should be tightened until all bleeding stops. After other issues or injuries have been attended to, if any, and the environment is safe, one should apply direct pressure to the wound and loosen the tourniquet device–it should not be left tightened for more than 2 hours. If bleeding continues and can’t be controlled, the tourniquet can be reapplied.
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Injuries
This past week we completed a first aid certification course in order to be better equipped in the field to deal with any first aid issues if they happen to occur. The course helped me to feel prepared to help someone who is injured whether it is a team member, volunteer, or myself.
‘Injuries’ is a broad topic, but according to the Red Cross training, the categories are soft tissue injuries, burns, and head, neck, or spinal injuries. It is important to have permission from the injured person before treating them. Red Cross recommends wearing gloves when helping other citizens and being aware of staying out of contact with any bodily fluids.
The most important thing to check for and be aware of after an accident is heavy bleeding that could be life-threatening. Cover the wound with a sterile dressing and apply direct pressure until the bleeding stops. Apply more dressing on top of other dressing if the blood soaks through. Then bandage over the dressing with more sterile dressing or using any clean cloth that you have available. If the bleeding does not stop call 9-1-1. There are opportunities for cuts and scrapes in the field as well as at the field station.
Burns need to be cooled right away using cool but not cold water. Cover loosely with sterile dressing. Burns are unlikely to happen in our field setting and are more likely to occur at the field station where there is a stove and hot coffee.
Head, neck, or spinal injuries need to be stable and minimizing the movement of the head neck and spine is critical. Other broken bones also need to be stable and splinted. It is best for a person who has experienced a fall to remain in place until they can be evaluated. It may be necessary to hold their head stable with your own hands.
At work we should always have a first aid kit, which I believe we store in the truck. It is also important to have a working cell phone to call 9-1-1 in an emergency. In my opinion, after working at BAG the most likely of these injuries to occur would be a cut or a strained back, and possibly a head injury if someone tripped and fell.
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