A comprehensive look at issues associated with a 2016 farm fatality involving a non-enclosed manure storage basin in Wisconsin. Presentation contains information about known risk factors and specific safety recommendations BOTH for enclosed (confined) spaces as well as these outdoor structures. Monitoring fundamentals are covered within the context of the "Safety Hierarchy" (which must be considered in any safety program effort).

1. Investigative Analysis of 2016 Manure
Gas Fatality in Portage County, WI
John Shutske, Professor & Agricultural Safety and Health Specialist
Department of Biological Systems Engineering, UW-Madison College of Agricultural and Life Sciences

2. This segment of the program
• From the UW
Center for
Agricultural Safety &
Health
• Thank you to the
state of Wisconsin
for your generous
support of these
efforts

3. First…
• Our hearts go out to the
Biadasz family – Bob, Diane,
Mike’s sisters Lisa, Amy, and
Megan
• Thank you for your passions,
your commitment and
assistance
• Mike’s incident, a fatal H2S
exposure happened on
August 15, 2016

4. Details reported August 18, 2017, CDC’s Morbidity & Mortality
Weekly Report (MMWR)

5. Why Was this Unusual & Warranting Attention?

6. When Farm Workplace Deaths Happen – Multiple Factors

7. Some of These Known in this Case
• Weather – cool morning, no wind,
80’s week before, inversion
• Significant sulfur being fed &
showing up in manure tests
• Sulfur also an issue in PA with
gypsum cow bedding
• Crusted surface, agitation, rapid gas
release
• Awareness of dangers (plus –
working alone and other factors)

8. Some Fundamentals: Manure Storage

9. Gas Production
Anaerobic
microorganisms in
manure degrade
organic matter
During breakdown,
manure gases are
produced and
released throughout
storage, including:
• Methane (CH4)
• Carbon Dioxide (CO2)
• Ammonia (NH3)
• Hydrogen Sulfide
(H2S)
Gases are
dispersed into the
atmosphere when
liquid is disturbed

10. Hydrogen Sulfide (ATSDR 2006)
Property Concentration in air (ppm)
Typical background level 0.0002
Odor threshold (AIHA 1989) 0.001-0.008
Offensive odor, headache 0.3
Very offensive odor 3-5
Asthmatics affected 2
Human gas 3-18
Olfactory paralysis 150
Central nervous system depression, loss of
consciousness, neurological problems may
persist
>500
Lung paralysis, collapse, death >600-1,000 (concentrations in actual
events are uncertain)
**Agency for Toxic Substances and Disease Registry

11. Purdue
Study
• 139 cases involving
manure storage
nationwide over last
several decades
• Multiple victim situation
is NOT uncommon
• We also had a five-person
incident in WI in 1989 -
Attributed to methane
• H2S likely played a role as
well

14. Common Denominators
from My Study of These
Events over 32 Years
• Often a complete lack of
awareness1
• Have never seen a case where air
was being monitored; SCBA was
being used; or/and where there
were special efforts to maximize &
add ventilation
• Multiple deaths at event are not
uncommon
• Those first on the scene sometimes
struggle to respond
• The events I’ve looked at most
closely followed a HOT period of
days

15. So What Does Mike’s Case Tell Us
About Prevention?

16. New Bulletin
• Search Google – “UWEX
Learning Store”
• Reducing Risks from
Manure Storage Gases
• Authors: Larson,
Aguirre-Villegas,
Shutske, Skjolaas,
Nelson, Shauer and Erb

17. Use Personal Protective Equipment
Includes masks, respirators, SCBA, safety glasses,
hearing protection, etc.
Train & Educate
Provide “how to” instruction, demonstrate safe
processes and procedures , and encourage the
trainee to demo back.
Warnings, Instructions
Warning labels, owners’ manuals, training
guides, written protocols. (I argue that these
should be lower on hierarchy)
Safeguards, Separation, Etc.
Includes failsafe sensors & monitors. Can
include fencing, barriers. With equipment
this includes guards, shields, ROPS
Eliminate the Hazard
Get rid of the hazard completely, replace
old systems, change production and other
system factors – In this case, includes
excess sulfur
Safety Hierarchy Applied to Agriculture

18. Monitoring
has its place,
but, must:
Manage sulfur
Know that presence of wind (air
movement) is critical to evacuate
contaminant
Temperature plays a role – more study
needed
Crust impedes gas release
More agitation & movement means more
rapid release

19. We Now Know
If pumping and
work near liquid
manure in ZERO
or low wind, there
is significant
“hazard potential”
By pumping in a
high hazard
potential and
relying on “lower”
safety hierarchy
methods, risk
increases
In addition, we are
concerned by the
addition of ANY
feed, bedding, or
other high sulfur
sources.

20. Let’s Apply
the S.H. to
Confined
Spaces…
• Worker can enter
and perform work
• Limited means of
entry or exit
• Not designated for
continuous occupancy

21. We Typically Recommend
NOT going in wherever
and whenever possible
For farmers -- hiring
work done by qualified,
equipped professionals
(in insurance, we called
this risk transfer)
Maximal ventilation
Continuous air
monitoring
Working in a team
setting, equipping
entrant with life harness
and outside means to
retrieve a victim
Self-contained breathing
apparatus

22. Inside OR Outside, a Few
Notes on Respirators
• Typical masks, cartridges,
“air purifying” respirators
provide zero protection
from dangerous H2S levels
• Many use considerations –
regulatory and other: fit
testing, medical oversight,
facial hair, and others

23. SCBA Provides
Air & Eye
Protection
• Cost ($1,500
minimum)
• Lots of training,
maintenance, and
skill needed
• THE ONLY option
with dangerous
gas levels or lack
of oxygen

24. On Monitors
They are really only a
“NO HAZARD”
verification tool (based
on John Shutske’s
opinion)
They are not a tool
designed to help you
skate on the thin edge of
the ice
They are not a perfect
technology (far from it)
We must WATCH for
“dependency” – that is,
luring people to false
sense of security

25. Monitor Considerations
Cost - initial purchase
and ongoing
calibration
Gases and conditions
monitored
Ability to store/log
data
Battery life and/or
replaceability
Sensor flexibility and
interchangeability
Training required

27. Some Considerations
4*-Gas Monitors:
Generally: O2,
Combustible gases,
Hydrogen Sulfide,
Carbon Monoxide
• In the $575 -- $2,500 range (or
higher)
01
Single gas monitors:
Can select H2S only
monitor for around
$150 (will not give you
indicators of low O2 or
other gases)
02

28. Additional Considerations
Pumps that aid
diffusion into
device
Calibration kits
“Bump testing”
kits
Ongoing service
(and calibration
off site)

29. Minimal (ONLY
OUTSIDE)
• Single gas, inexpensive
• Often short life (typically
one or two years)
• Data logging limits
• Few adjustments
• Simple
• Pretty robust and reliable

30. If Manure is a Commercial Service
Business for Me
1
I’m going to invest
in a higher end 4-
gas monitor with
the calibration gear
2
An SCBA unit for
emergency &
occasional confined
space use in the
scope of a bigger
confined space
entry program
3
Appropriate
ventilation fans,
tubing, retrieval
equipment
4
I would want to
invest more in
worker education
and other hands-on
training

31. We Must Be Careful that Safety Actions
Don’t Inadvertently Increase Risk
A monitor that’s used incorrectly
Getting “too far” in to an unsafe situation (even
with a monitor)
Incorrect use of a respirator or airpack (SCBA)
Asking an older worker (or those with
heart/lung) issues to wear a “mask”

32. Summary --
• Big Picture: Farming = high risk venture
• Getting rid of controllable hazards is best
• As we step down safety hierarchy, risk changes
• Avoid circumstances where hazard cannot be
completely eliminated (outside – agitate & pump
only on windy days/times; enclosed spaces – hire
experts or invest in array of confined space gear,
training, and required protocols)
• Monitor ONLY to verify no gas!
• It’s fall! Wear your seatbelt. Get rest when you
can. Be safe…The world needs you!

33. Thank You
• …to the men and
women who work to
make our dairy
industry strong &
feed a growing
world population!