Arborists work with equipment utilizing hydraulics every day – chippers, chip-dump beds, stump grinders, aerial lifts and the list goes on. While accidents from hydraulic-fluid leaks are rare within the tree care industry, they can result in serious injuries and even amputation.
Before we talk about hydraulic injuries and how to prevent them, let’s look at some statistics:
- The pressure needed to penetrate skin is only 100 psi.
- Chippers, chip-dump beds, stump grinders and other equipment used daily by arborists can run at 4000 psi or higher.
- Amputation rates for an injection injury with solvents involved are 50-80%.
- With pressures greater than 7000 psi, the amputation rate is 100%.
High-pressure injection injuries occur when fluid under pressure is lost through a small hole in a hydraulic or other pressurized system and the pressurized fluid penetrates the skin of a victim. The injury is characterized by a small puncture wound that can appear mild in the beginning, and often gets dismissed as minor. Hydraulic-fuel injection injuries, however, are anything but minor. In fact, they are considered a surgical emergency. Hydraulic oils are highly toxic, and they poison you and your body’s tissues. Immediate treatment is required to save the patient’s digit, limb and/or life.
As an anecdote, we had a webinar about hydraulics safety, and one of the attendees shared a story about one of his employees. The employee was working from the bucket in their aerial lift and a hydraulic hose sprung a leak. The worker grabbed the hose and tried to plug the leak with his thumb. The owner of the company saw what was happening, knew the severity of hydraulic-injection injuries and drove the worker to the nearest emergency room. The hospital he went to didn’t have the capability to treat the injury and quickly airlifted the worker to a larger medical center in another city. The medical center immediately operated, and the worker’s hand was saved. The worker was in the hospital for a couple of weeks undergoing treatment for his injury.
So, what happens after a hydraulic-fuel injection injury? Let’s use an injury to the hand as an example. First, the initial “strike” feels like a pinprick or bee sting, is seemingly harmless in appearance and is often dismissed as nothing serious. Underneath the skin, however, the injectant begins damaging tissue and pressure builds up in the hand and fingers. Within hours, the fluid can quickly spread to all areas of the hand, wrist and forearm. The built-up pressure damages tendons, nerves, arteries, vessels and muscles. Unless pressure is relieved within hours of the injury, the victim risks amputation from lack of blood supply.
Surgery is always required for a hydraulic-fuel injection injury. During the surgery, as much of the injectant as possible will be cleaned out, and dead (necrotic) tissue must be removed. Typically, the wound must be left open to reduce the chance of infection and any further tissue damage, and a return visit to the operating room will be required within 24 to 48 hours.
Properly training your team is essential for avoiding or minimizing the severity of hydraulic injection injuries. Training should include:
- an overview on hydraulic pressure systems and basic functionality;
- a plan of action in case a leak occurs:
- Immediately shutting down the machine as soon as possible to avoid leaking fluid;
- Changing the hose after all stored energy has dissipated;
- Hydraulic-fluid cleanup and remediation;
- a plan of action if a hydraulic injury occurs:
- Notifying emergency personnel (911)
- First-aid treatment to include:
- For pain management, if needed, use Tylenol. Avoid ibuprofen, Aleve and aspirin, since they are mild blood thinners and there’s some chance of internal bleeding;
- Elevate the affected limb;
- DO NOT use compression wraps, tourniquets or ice. All of these increase the risk of amputation;
- DO NOT give the victim food or drink, since they will be needing immediate surgery;
- Get the patient to a trauma center or hospital immediately! A trauma center is recommended due to rapid access to a surgeon, transfer capabilities to higher levels of care, such as hand or vascular surgery, and immediate availability of X-ray and CT imaging. Early antibiotics (ideally within an hour) and early surgery (ideally within 10 hours) are the keys to reducing the need for amputation;
- Inform medical personnel that it is a hydraulic-pressure injury, and provide them with the safety data sheet (SDS) for the fluid;
- If the facility does not have treatment capabilities, the patient will need to be transported quickly. In one incident we are aware of, the patient was airlifted to the nearest hospital that had the ability to properly treat the injury.
- emphasis on never using your hands to check for leaks;
- training on checking and maintaining your hoses regularly, with a frequency of at least once per week; and
- ensuring that replacement of old hoses occurs when the machine is turned off and stored energy has dissipated following proper lockout-tagout procedures.
Remember to keep the training fresh in your team’s memory by including it as a topic in tailgate meetings a few times each season.
Margaret Hebert, CTSP, ISA Certified Arborist & Municipal Specialist, is coordinator for the Thrive risk-management program at ArboRisk Insurance, an eight-year TCIA corporate member company based in New Berlin, Wisconsin. Dawn Thierbach, CTSP, ISA Certified Arborist, is a consultant with the Thrive program. Jeff Thierbach, Board Certified Master Arborist (BCMA), CTSP, ISA Utility Specialist, is an industry trainer.