Date: 1 May 1997
Subject: Farmer Killed When Tractor Turns Over
A 56-year-old farmer was killed when the tricycle tractor he was
operating on a hillside overturned. He had been going up and down
the hill to bring loads of dirt in the tractor's front-end loader
in order to bury a calf. The hillside was relatively steep, and
the ground was wet from recent rains. As he attempted to turn
with the loader filled and raised, the tractor rolled over several
times, crushing the victim. He died at the scene. In order to
prevent similar incidents, the FACE investigator recommends:
On 7 February 1997, a 56-year-old male was killed when he was
crushed in a tractor rollover incident. KY FACE was notified of
the incident on February 28 by the coroner who handled the case,
and an investigation was initiated. A FACE investigator traveled
to the site of the incident on March 6, 1997. Interviews were
conducted with the county coroner and the emergency medical service
(EMS) personnel who were present at the scene. Photographs of
the scene and the equipment involved in the incident were obtained,
and information from the death certificate, the coroner's report,
and the EMS run report was shared.
The victim in this case was a 56-year-old male who had been a
full-time farmer for most of his life. He raised beef cattle and
tobacco on the farm where he lived with his wife, who was recovering
from surgery at the time this incident occurred. He was in good
health, and did not have a history of previous injury incidents.
The tractor was a John Deere Model 40-T, manufactured between 1953 and 1955. It was a tricycle tractor with attached front-end loader. The two-cylinder engine was gasoline powered. Its total weight was 2941 pounds. The tractor was not equipped with a rollover protective structure (ROPS) or a seatbelt. There were no front-end counterweights, and the tires were not fluid-filled.
The weather was cold and clear on the day of the incident, although
recent rains had left the ground wet. The steep hillside was covered
with mud and patchy grass. A calf had recently died, and the victim
was burying it on the hillside, using dirt from a pile near the
barn at the top of the hill. Although there were no witnesses,
it appeared that he had made one trip and was bringing the second
load of dirt down the hill when the incident occurred. The front-end
loader was elevated and fully loaded. When the victim attempted
to make the turn toward the calf, the tractor flipped over, spilling
the load of dirt, and then rolled over several more times.
The victim's wife became concerned after he had been out longer
than she expected, so when her home health nurse arrived, she
asked her to check on him. The nurse found the victim lying beside
the overturned tractor, and came back to the house to call 911.
EMS personnel, including the county coroner, arrived at 1:31 pm.
They checked and found no vital signs. The coroner pronounced
the victim dead at the scene as of approximately 1:00 pm.
CAUSE OF DEATH
The cause of death as listed on the death certificate was multiple
chest injuries. No autopsy was performed.
Recommendation #1: Older tractors should be retrofitted
with rollover protective structures (ROPS) and seatbelts.
Discussion: In this case, the John Deere Model 40-T tractor
was manufactured between 1953 and 1955; a commercial ROPS kit
is available for it from Saf-T-Cab for less than $500.00. ROPS
and seatbelts protect a tractor operator by creating a "zone
of protection." Whenever possible, operators should reserve
the use of non-ROPS-equipped tractors for safer work areas and/or
activities. Since 1985, as a result of voluntary agreements among
tractor manufacturers, virtually all new tractors sold in the
US have been equipped with ROPS and seatbelts. Many tractor manufacturers
are currently offering ROPS retrofit kits at cost to encourage
owners of non-ROPS-equipped tractors to have them installed.
Recommendation #2: Tractor tires should be fluid-filled,
and front-end counterweights should be used, to lower the tractor's
center of gravity and improve traction and stability.
Discussion: Such measures can improve tractor stability.
While it is not possible to say that they would have prevented
a rollover, especially in this particular case with the combination
of factors - the tricycle tractor, the raised front-end loader,
the steep hill and wet ground - they are always worthwhile safeguards.
Recommendation #3: Front-end loaders should be kept in
as low a position as possible; when lifted, they change the balance
and handling properties of the tractor.
Discussion: Lifting the front-end loader to maximum height
changes the tractor's center of gravity. It is not designed to
be used in an extended upright position during transport. In this
case, the victim was travelling downhill with the loaded bucket
raised; the attempt to turn the tractor in this situation upset
the balance and caused the tractor to roll over several times.
Recommendation #4: Tractor operators should take into consideration
environmental conditions and terrain, and make adjustments as
necessary to accommodate to them.
Discussion: In this case, the hill was both steep and wet.
Since the grass was patchy, some areas were covered by wet grass,
and others were muddy. Any one of these factors can lessen the
traction of a tractor. The combination of steepness, slick grass
and mud would make maneuvering difficult, and a tricycle tractor
is especially vulnerable to such conditions.