Higher Incidences of Severe Medical Emergencies and Poorer Out-of-Hospital Cardiac Arrest Outcomes in Farmlands Compared to Other Outdoor Workplaces.

INTRODUCTION

Farmland is an essential yet hazardous workplace where an aging population is engaged. This study aimed to compare the characteristics and severity of emergencies between farmlands and other outdoor workplaces and clarify whether the rurality might influence the differences between farmlands and other outdoor workplaces.

METHODS

This retrospective cohort study analyzed the nationwide emergency medical service (EMS) transportation database between 2016 and 2021, combined with out-of-hospital cardiac arrest (OHCA) data.

FINDINGS

Farmlands emergencies accounted for 0.26% of all non-pediatric (≥15 years) emergencies (72,162 out of 27,998,839) and 40.6% of outdoor workplace emergencies (177,923 cases). These emergencies were less frequent in winter (12.9% versus 19.7%) and during daytime hours (83.3% versus 87%) but more common in rural areas (31.4% versus 15.7%) compared to other outdoor workplaces. Farmland emergencies involved a lower proportion of male patients (67.6% versus 94.1%) and a higher proportion of older adults (≥60 years) (85.9% versus 34%), medical emergencies (42.7% versus 33.8%), outpatient deaths (3.9% versus 1.1%), and out-of-hospital cardiac arrests (OHCA) (5.1% versus 2.7%). EMS response and transport times were significantly longer for farmland emergencies. These differences in characteristics were more pronounced in non-rural EMS areas. Farmlands were strongly associated with higher outpatient death rates even after adjustment for other factors, with this association further strengthened in specific subgroups: non-rural emergencies, daytime hours, females, and cases not transported to high-class emergency hospitals. Regardless of the EMS rurality, OHCA in farmlands exhibited lower bystander CPR rates, fewer shockable rhythms, and limited public access defibrillation compared to other outdoor workplaces, alongside higher proportions of unwitnessed and medical cases. Neurologically favorable one-month survival was significantly lower in farmlands (1.6% versus 5.4% in rural areas and 2.9% versus 10% in non-rural areas). However, after adjusting for OHCA characteristics, survival differences were not statistically significant (95% confidence interval (CI) of adjusted odds ratio (OR): 0.41-2.63 in rural and 0.52-1.10 in non-rural EMS).

CONCLUSIONS

Severe medical emergencies are more common in farmlands, and EMS and bystander responses to OHCA are poorer than in other outdoor workplaces, leading to worse outcomes in OHCA in farmlands. Implementing effective health and safety protocols and strategies to improve preventative health management programs and strengthening collaboration between local EMS and agricultural communities are critical to improving outcomes and aligning with the Sustainable Development Goals (SDGs) for agriculture.