REVENGE OF THE HAY-HOLE: EFFECTS OF DISTRIBUTION OF HAY-HOLE COVERS

Objectives: In Pennsylvania, many farms have two-story bank barns that have grain and hay on the upper level with the animal feeding area 8-10 feet below. Hay-holes are rectangular openings on the second floor used to drop feed to the ground level. Hay-hole falls (HHF) are a unique problem among rural Anabaptist communities, especially for children. We previously conducted a study through the creation of the Anabaptist Youth Trauma Prevention Consortium with subsequent distribution of 231 hay-hole covers throughout eight counties in South Central Pennsylvania. We aimed to follow up on this study by comparing a five-year period before the distribution of the hay-hole covers with the five-year period after. We hypothesized there would be a decreased incidence of HHF in this area following cover distribution.

Methods: A ten year retrospective, single institution study was performed using data from all patients presenting to our Level 1 trauma center with HHF from January 2011 through December 2021. The data was stratified by phase: Before Cover Implementation (BC):1/2011-12/2016, After Cover Implementation (AC):1/2017-12/2021. Univariate statistical analysis was performed.

Results: 49 patients met inclusion criteria. 41 (83.67%) were members of the Anabaptist community. 32 sustained injuries as a result of a HHF in the BC phase and 17 sustained injuries in the AC phase, which is indicative of a 47% decrease in the number of HHF and a significant decrease in incidence of HHF in the period after distribution. Characteristics of HHF patients are in Table 1. The average age of patients with HHF increased from 11.5 in the BC group to 22.4 in the AC group (p=0.035).

Conclusion: Given the decrease in the incidence HHF in the AC phase as compared to the BC phase, it appears that the distribution of hay-hole covers has significantly impacted the incidence of these HHF. The increased average age of patients with HHF in the AC phase suggests the effectiveness of these covers particularly for the pediatric population. The similar incidence of patients transferred out of our facility after HHF in both phases also shows the need to further add to this research given the importance of keeping the community together. Further investigation is needed to elucidate the long term impact of the hay-hole cover distribution on the incidence of HHF and could be used to guide future intervention efforts, such as another round of distribution of hay-hole covers or improvements in the design of these covers for long-term use.