Monthly Meeting 10am – 12pm Community Health Center of



Monthly Meeting 10am – 12pm Community Health Center of
Monthly Meeting 10am – 12pm
Community Health Center of Franklin County
August 18, 2015
Call-in: 1-800-531-3250, Conference ID: 9337941
July 21, 2015 Minutes—to be e-mailed shortly
2015 Program
Affordable Care Act (ACA)
o ACA MSFW Outreach & Enrollment
Outreach Payments
Voucher Payments
Executive Office of Labor and Workforce Development, Anderson Hernandez, Outreach
Quality Improvement Plan [HRSA Program Requirement #1: Needs Assessment and #8: Quality
Improvement/Assurance Plan]
o Patient Satisfaction Surveys
o Focus Groups
CHC Clinical Performance Measure Report
o Table of additionally selected clinical measures for improvement in 2015 (updates from
bolded CHC?):
CHC, Inc.
Oral Health
Quality of
HIV Linkage
to Care
Screening &
Population Estimate as part of Needs Assessment [HRSA Program Requirement #1: Needs
Emergency Preparedness Funds
Expanded Services Funds
Budget Period Renewal Application
2015 East Coast Migrant Stream Forum
o North Carolina Community Health Center Association Stipend
o CRVFHP Scholarship
Health Center Visits
o Sept. 14th to Sept. 18th; Sept. 21st to Sept. 25th
Stories from the Field
Updates from the Field
 Ag Worker Access 2020 article
 Promoting Health Care Access to Lesbian, Gay, Bisexual, and Transgender (LGBT) Farmworkers
 Health Tips/Consejos de Salud from NCFH; Available in English and Spanish. Visit our website for
previous editions
 Cultural Connection-Integrating Research Education and Services to Reduce Behavioral Health
Disparities in Hispanic and Latino Populations from the National Hispanic & Latino ATTC
 CBS News: The growing demand for “fair food”
 Notes from the Field to resume in September
Upcoming Events/Meetings
 Aug. 20-25: NACHC Community Health Institute & EXPO
 Aug. 27: Clinical Directors Network hosts Current Status of HCV and HIV: Federal
Recommendations, Screenings, Linkage to Care and Management from 10:00 a.m. to 11:00 a.m.
 Sept. 15: CRVFHP Monthly Meeting from 10:00 a.m. to 12:00 p.m. at Holyoke Health Center in
Holyoke, MA. Click here to RSVP.
o Sept. 14 to Sept. 18; Sept. 21 to Sept. 25: CHC visits by Michael
 : CHC visits by Michael
 Oct. 15-17: East Coast Migrant Stream Forum at the Sheraton Memphis Downtown, Memphis,
Reporting Month of Service:
Completed By (Outreach Worker):
Submission Date:
estimated # of unduplicated contacts seen for the 1st time this month ever:
estimated # of unduplicated contacts seen for the 1st time this month in 2015:
# of primary care patients this month:
# of dental patients this month:
# of duplicated contacts assisted by trained O/E worker:
# of unduplicated contacts assisted with insurance application submission:
# of unduplicated contacts enrolled in affordable insurance coverage:
# of primary care visits this month:
# of dental visits this month:
Enabling Service
Contact Type
Age for Male Patients
Age for Female Patients
Registered MSFWs into CRVFHP
(unduplicated Eligibility Apps)
Assistance in securing access to
available health, social service,
pharmacy and other assistance
Case finding, education or other
services to facilitate access /
patient &
Personal assistance provided to
promote health and healthy
behaviors (to be detailed on pg. 3
of Contact Sheet)
translation /
Translation (number of times used
as a translator)
Transportation (each one way trip
for each person)
case management Health agency referral (health
center, health dept, specialist, etc.)
case management Pregnancy related referral (family
planning, pregnancy test, prenatal,
post natal)
case management Referrals received from health /
social service organizations
case management Follow-up / case management
Other (please
Other (please specify):
* location = CHC, Camp, Home, Field, Other (please specify). Do NOT list specific names; they should be included on p2.
2015-OutreachContactSheet.xlsx / p1
4/20/2015 11:42 AM
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Reporting Month of Service: 0
Please list # of farms visited:
# of trips to the farms (delivering meds, etc):
Please list farm names, contacts and
locations visited during this month.
Please provide best estimates:
% Migrant
% Seasonal
% Users needing interpretation/bilingual services
Please provide the number of completed:
Focus Groups
Patient Satisfaction Surveys
Please list MSFW countries
of origin (and percentages).
2015-OutreachContactSheet.xlsx / p2
Country of Origin
4/20/2015 11:42 AM
2 of 4
Reporting Month of Service:
# of pamphlets distributed:
# of condoms distributed:
General Health Topics:
Please list health topics discussed (e.g diabetes,
hypertension, oral health, condom use,
hepatitis, HIV/AIDS, STDs, tuberculosis, etc.)
NOTE: Please focus on the CRVFHP Health
Care Plan Goals and Objectives that are listed
in the 2015 Request for Proposal (RFP)
Group Education Sessions:
Health Fairs:
External Referrals:
2015-OutreachContactSheet.xlsx / p3
# of attendees:
# of attendees:
# of attendees:
# of attendees:
# of attendees:
# of attendees:
Participating Agencies:
# of Dental:
# of Eye:
# of Mental Health:
# of Substance Abuse:
# of Lab:
# of X-ray:
# of Hospital:
# of Other:
4/20/2015 11:42 AM
3 of 4
Reporting Month of Service: 0
Please provide a brief narrative of monthly activities (no more than 1000 words) in the box below.
Please type the narrative directly in Excel or copy from Microsoft Word, Notepad, etc. and paste here.
NOTE: To insert a hard return, press Alt+Enter.
2015-OutreachContactSheet.xlsx / p4
4/20/2015 11:42 AM
4 of 4
Find the
the One-Stop
One-Stop Career
Career Center
Center Nearest
Nearest You
Visit a Massachusetts One-Stop Career Center for:
➜Job search assistance;
➜Career planning information;
➜Workshops on job search techniques including
interviewing, networking, and resume writing;
➜Data on the current statewide and local job market; and
➜Resources to help you find the right training opportunities;
➜Tools to help you conduct an effective job search.
For more information about One-Stop Career Centers, go to
Greater Boston
Boston Career Link
1010 Harrison Avenue
Boston, MA 02119
617-541-1400, TTY#: 617-442-3610
75 Federal Street, 3rd Floor
Boston, MA 02110
617-737-0093, 800-436-WORK (9675)
Career Source
186 Alewife Brook Parkway, Suite 310
Cambridge, MA 02138
617-661-7867, 888-454-9675
TTY #: 800-439-2370
Career Source
(limited services)*
4 Gerrish Avenue
Chelsea, MA 02150
Employment and Training Resources
1671 Worcester Road
Framingham, MA 01701
Employment and Training Resources
275 Prospect Street
Norwood, MA 02062
The Career Place
100 TradeCenter
Suite G-100
Woburn, MA 01801
781-932-5500, (888) 273-WORK
Northeastern Massachusetts
ValleyWorks Career Center
Northern Essex Community College
100 Elliott Street, Haverhill Campus
Student Center, 1st Floor, Room SC118
Haverhill, MA 01830
ValleyWorks Career Center
Heritage Place
439 South Union Street, Building #2
Lawrence, MA 01843
Career Center of Lowell
107 Merrimack Street
Lowell, MA 01852
978-458-2503, TTY #: 978-805-4915
North Shore Career Center
70 Washington Street
Salem, Massachusetts 01970
Taunton Career Center
72 School Street
Taunton, MA 02780
North Shore Career Center
(limited services)*
5 Pleasant Street
Gloucester, MA 01930
Central Massachusetts
Access Point - NSCC – Lynn
(limited services)*
North Shore Community College
300 Broad Street, LW 131
Lynn, MA 01901
Southeastern Massachusetts
Attleboro Career Center
95 Pine Street
Attleboro, MA 02703
34 School Street
Brockton, MA 02301
Fall River Career Center
446 North Main Street
Fall River, MA 02720
Career Opportunities, Falmouth
(limited services)*
210 Jones Road, Unit #14,
Falmouth, MA 02540
508-444-2874, TTY #: 508-732-5300
Career Opportunities Hyannis
372 North Street
Hyannis, MA 02601
508-771-JOBS (5627), TTY #: 508-862-6102
Greater New Bedford Career Center
618 Acushnet Avenue
New Bedford, MA 02740
Plymouth Career Center
36 Cordage Park Circle, Suite 200
Plymouth, MA 02360
508-732-5300, TTY #: 508-732-5300
Quincy Career Center
152 Parking Way
Quincy, MA 02169
North Central Career Center
(limited services)*
25 Main Street
Gardner, MA 01440
978-632-5050, TTY #: 508-792-7571
North Central Career Center
100 Erdman Way
Leominster, MA 01453
978-534-1481, TTY #: 978-534-1657
Workforce Central Career Center
425 Fortune Boulevard, Suite 201
Milford, MA 01757
508-478-4300, TTY #: 508-478-1887
Workforce Central Career Center
5 Optical Drive, Suite 200
Southbridge, MA 01550
508-765-6430, TTY #: 508-765-6437
Workforce Central Career Center
44 Front Street, 6th Floor
Worcester, MA 01608
Western Massachusetts
Franklin/Hampshire Career Center
One Arch Place
Greenfield, MA 01301
413-774-4361, TTY #: 413-772-2174
Franklin/Hampshire Career Center
178 Industrial Drive, Suite 1
Northampton, MA 01060
413-586-6506, TTY #: 413-586-4921
850 High Street
Holyoke, MA 01040
413-532-4900, TTY #: 413-535-3098
BerkshireWorks Career Center
160 North Street
Pittsfield, MA 01201
413-499-2220, TTY #: 413-499-7306
One Federal Street, Building 103-3
Springfield, MA 01105
413-858-2800, TTY #: 413-858-2800
* Limited Services – Not all services listed at the top of this page may be available at this One-Stop Career Center.
2066A Rev. 04-15
Performance Measures and Report Schedule – 2015-16
CHC of
Family HC
Health Center
Oral Health
Quality of Care
Clinical Champion
To be updated
E. Kate
Nichole Morgan
Marie Yardis LOA
Quarterly schedule
for performance
measure updates
HIV Linkage to Pap Test/Cervical
Cancer Screening
Screening &
Revised August 2015
Training Stipend Application
If applying for a training stipend, please DO NOT fill out a separate registration form or prepay.
The North Carolina Community Health Center Association (NCCHCA) is pleased to offer a limited number of
training stipends to support attendance to the 28th East Coast Migrant Stream Forum.
Training stipends will be awarded only to those who do farmworker or community health outreach in an East
Coast state. Conference speakers and presenters, staff of organizations within the Farmworker Health Network,
and federal and state employees, do not qualify for training stipends.
Training stipend determination will be weighted as follows:
How does your attendance at the Forum benefit your job? (50%)
How is your attendance at the Forum dependent on receiving a stipend? (30%)
Are you a first-time attendee? (10%)
Do you work in an East Coast state? (10%)
Recipients must be willing to moderate at least one conference session if requested to do so.
Recipients must attend two 3-or 4-hour intensive trainings and at least two 90-minute educational
sessions during the conference.
Recipients will be required to fill out on-site evaluation forms for all sessions attended.
The maximum support available to an organization is up to $1,000 (or approximately 3 registration stipends).
Applicants may be awarded one or a combination of the following which are prioritized in the following order:
Conference Registration Fee ($325). Awards will be used to waive the registration fee. Please DO NOT
pre-pay for your registration.
Two Nights Lodging ($134.00 per night plus tax only). Incidentals such as phone charges, parking, movie
rental or room service will not be reimbursed. Applicants are responsible for making their own
reservations; however NCCHCA will automatically cover the charges if awarded a training stipend. Note:
NCCHCA will only cover the block rate at the conference hotel therefore applicants are encouraged to
make hotel room reservations immediately regardless of being awarded a training stipend.
Applications must be received by Wednesday, August 26, 2015. Recipients of training stipends will receive
electronic notification by Friday, September 4, 2015.
October 15-17, 2015
Sheraton Downtown, Memphis, Tennessee
Training Stipend Application
Send Applications to:
ATTN: Allison Lipscomb
By Email: [email protected]
By Fax: 919-469-1263
If applying for a training stipend, please DO NOT fill out a separate registration form or pre-pay.
SUBMISSION DEADLINE: Wednesday, August 26, 2015
If more than one staff person is applying from the same organization, you are encouraged to please submit all applications
together on behalf of the whole staff group.
Zip Code:
Daytime Phone Number:
**E-mail (required):
Do you need interpretation assistance (Spanish/English)?
Please check if you have special needs that must be addressed in order to fully participate in the conference.
Describe (attach a separate page if necessary)
How many years have you worked in Farmworker Health?
Less than 1 year
1 to 3 years
4 to 6 years
7 to 10 years
11 years or more
Which category best describes your primary occupation? (Required – Check One)
Primary Care Association staff
Health/Primary Care Provider
Behavioral Health Provider
Lay Health Worker/Promotor(a)
State/Federal Employee
Clinical Support Staff
M/CHC Board Member
Dental Professional
Outreach Worker/Coordinator
Executive Director/CEO
Practice/Office Manager
How many times have you attended the East Coast Migrant Stream Forum? (Required)
First-time attendee
Three or more
Have you ever been awarded a training stipend to attend the ECMSF? YES
If YES, please tell us in what city or which year(s)?
By submitting this application I pledge to do the following:
1. Attend the full conference beginning Thursday, October 15 at 1:00PM and ending Saturday, October 17
at 2:00PM.
October 15-17, 2015
Sheraton Downtown, Memphis, Tennessee
Training Stipend Application
2. Moderate at least one session as requested.
3. Participate in two 3 or 4-hour intensive trainings.
(Intensive trainings will be held Thursday, October 15, 1:00PM-4:30PM / Friday, October 16, 2:00PM5:30PM)
4. Attend at least two 90-minute educational sessions.
(Educational sessions will be offered Friday, October 16, 10:30AM-12:00PM and Saturday, October 17
9:00AM-10:30AM & 10:45AM-12:15PM)
5. Complete on-site written evaluations of all sessions attended.
Please address all of the following points in 250-500 words. You may attach a separate sheet if necessary.
1. Describe how you and your organization’s participation in the Forum will benefit your job and contribute
to the health of migrant and seasonal farmworkers living and working on the East Coast.
2. Include how your attendance at the conference is dependent on receiving this training stipend.
3. Looking at the program online, which two (3-hour) intensive sessions do you plan to attend?
4. Looking at the program online, please indicate which 3 sessions are your top 3 choices if requested to
moderate a session.
Answers less than 250 words will NOT be considered.
Please type your answer here:
Applications must be received by Wednesday August 26, 2015. **Training stipend recipients will receive
electronic notification by Friday, September 4, 2015. If applying for a training stipend, please DO NOT pre-pay
for your registration.
Send Applications to: Allison Lipscomb by email [email protected] or fax 919-469-1263.
October 15-17, 2015
Sheraton Downtown, Memphis, Tennessee
Promoting Health Care Access
to Lesbian, Gay, Bisexual, and
Transgender (LGBT) Farmworkers
July 2015
There is a common misconception that few
or no lesbian, gay, bisexual, and transgender
(LGBT) people exist within the farmworker
community. As a result, the health care needs
of LGBT farmworkers are often overlooked. It
is important for health centers to recognize
and address the unique challenges faced by
LGBT farmworkers in order to provide quality
care to this highly vulnerable population.
Overview of Farmworker Population
There are an estimated 2.5 million farmworkers working on farms and ranches in
General Challenges
Facing LGBT Farmworkers
the U.S. When we include farmworkers’ spouses and children, the number jumps
There is no data regarding the number of LGBT individuals in the farmworker
to roughly 4.5 million. According to the 2012 National Agricultural Workers Survey
community. However, outreach workers, clinicians, and researchers who provide
(NAWS) conducted by the U.S. Department of Labor, the majority of farmworkers
health care and public health interventions to farmworkers know from experi-
(54%) are between 25 and 44 years old.¹
ence that LGBT people exist within the community, and that many face enormous challenges in accessing care, finding support, and feeling safe.⁴,⁵ LGBT
Most farmworkers are foreign born. Approximately 68% of farmworkers were born
“invisibility” within the farmworker community stems from strong cultural and
in Mexico and 3% were born in Central America.² Seventy-eight percent of farm-
religious taboos regarding sex in general, and sexual and gender minority iden-
workers earn incomes below 200% of the Federal Poverty Level, and 25% earn
tities specifically. It is common for LGBT persons to hide their identity in order
below the Federal Poverty Level.³ While the majority of farmworkers and their
to protect themselves from shaming, assault, and isolation from their families
families speak Spanish as their dominant language, there are a growing number of
and communities.⁶ The stress caused by hiding one’s identity and dealing with
farmworker communities who speak an indigenous language as their primary lan-
stigma has been associated with higher rates of depression, suicide attempts,
guage. Farmworkers from indigenous communities in Southern Mexico and Guate-
drug and alcohol abuse, and unsafe sexual behavior in LGBT people.⁷,⁸
mala are the fastest growing farmworker population in the U.S. Farmworkers from
these communities may have distinct cultural beliefs from other Latino populations.
LGBT farmworkers who are “out” to their employers risk job termination or
demotion, and harassment from co-workers. A 2009 story by the California
Report, a public radio show, illustrated the challenges faced by openly LGBT
farmworkers. A transwoman farmworker related her experience in the fields
while transitioning from male to female. Her boss started verbally harassing
her; later her boyfriend, who also worked at the asparagus packing house where
she worked, was attacked by other supervisors. Finally, she was demoted from
supervisor to the assembly line.⁹ Unfortunately, this story is not unusual for
openly lesbian, gay, bisexual, or transgender farmworkers working in the fields.
¹ National Agricultural Workers Survey 2011-2012, Analysis by Farmworker Justice.
Available at:
⁴ Somerville GG, Diaz S, Davis S, Coleman KD, Taveras S. Adapting the popular opinion leader intervention for Latino young migrant men who have sex
with men. AIDS Educ Prev. 2006;18(4 Suppl A):137-48.
⁵ Rhodes SD, Daniel J, Alonzo J, et al. A systematic community-based participatory approach to refining an evidence-based community-level intervention: the HOLA intervention for
Latino men who have sex with men. Health Promot Pract. 2013;14(4):607-16. intervention for Latino men who have sex with men. Health Promot Pract. 2013;14(4):607-16.
⁶ Sue DW. Sexual orientation microagressions and heterosexism. In:Microagressions in Everyday Life: Race, Gender, and Sexual Orientation. Hoboken, NJ: John Wiley & Sons, Inc.; 2010.
⁷ Grant J, Mottet LA, Tanis J, et al. Injustice at every turn: a report of the National Transgender Discrimination Survey. Washington: National Center for Transgender
Equality and National Gay and Lesbian Task Force; 2011.
⁸ IOM (Institute of Medicine). The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies
Press; 2011.
⁹ The full story from the California Report, “LGBT Farmworker Discrimination,” can be found at
Greatest Health Care Challenges
Facing LGBT Farmworkers
Farmworkers generally face numerous challenges when accessing health care. These challenges include
lack of transportation, cost of services, and fear of employer retaliation due to lack of sick leave, among
others. For LGBT farmworkers, these challenges are just the tip of the iceberg. As mentioned previously,
there is a pervasive fear among LGBT farmworkers of being “outed;” patients therefore may not disclose
their sexual behavior to their providers, resulting in missed opportunities to receive much-needed HIV/
STD testing and treatment. This reluctance to disclose may be especially true for men who have sex with
men (MSM) farmworkers who are married to women, as family members are often heavily involved in each
other’s health care decisions. A married MSM farmworker may fear that the provider will reveal his sexual
history to his spouse. In addition, farmworkers who have same-sex relationships (e.g., men who have sex
with men or MSM) may not label themselves as gay or bisexual, and may not think they are at risk for HIV/
AIDS, believing that only those who identify as part of the “gay” community are vulnerable to infection.
Providing sexual health education to farmworkers in group settings, such as at a labor camp, also poses
challenges. Health outreach workers may find it difficult to include same-sex relationships as part of the
discussion, given the cultural stigma. In addition, LGBT farmworkers in a group setting may completely shy
away from taking or discussing the use of condoms.
Transgender farmworkers encounter additional, unique health care challenges. Most do not have the
financial means to access medical care (such as hormone treatments and surgeries) needed to transition
and affirm their gender identity. Some may turn to the black market to purchase hormones and silicone
treatments. These are often self-injected with shared needles, few instructions, and no medical oversight,
leading to multiple health risks.¹⁰
¹⁰ Wallace P. Finding self: A qualitative study of transgender, transitioning, and adulterated silicone. Health Education Journal. 2010; 69: 439-46.
Best Practices for Health Centers to Build Trust
with LGBT Farmworkers
Due to the stigma and fear faced by LGBT farmworkers, it is essential that health centers create a welcoming
and affirming environment. Health centers should incorporate the following best practices to ensure that they
provide the highest quality of care to LGBT farmworkers (note: some of these best practices are adapted from
tips for Legal Advocates Working with Lesbian, Gay, Bisexual, and Transgender Clients developed by the
National Center for Lesbian Rights, California Rural Legal Assistance, and Legal Services Corporation).¹¹
• Become comfortable with providing care to LGBT people. This can involve training all health center staff in general
• Conduct medical appointments in complete privacy, apart from spouses and family members. Providers must
LGBT concepts, terminology, and health needs. The National LGBT Health Education Center provides trainings,
make sure that they respect family members’ need for involvement while ensuring that the patient’s privacy is
technical assistance, and resources for health care organizations (
protected. They should seek explicit consent from a patient to disclose medical information since medical infor-
• Include sexual orientation, gender identity, and gender expression in your non-discrimination policy and post
mation may accidently expose the patient’s sexual orientation or gender identity to family members. The provider
the policy in high-profile locations, such as on the walls and on your website. In addition, establish a well-defined
should let the patient know that the patient has the right to confidentiality of medical information and ask the
process for reporting and responding to any discrimination that may occur.
patient whether it is permissible to discuss medical issues with his or her family members.
• Revise patient intake forms to include a question on sexual orientation and questions about gender identity and
sex at birth. Recommended questions can be found on the website of the Center of Excellence for Transgender
Health: and at
• At all levels of the health center, from the front desk to the clinicians and administration, use inclusive language
for all patients. An example of inclusive language is “are you in a relationship?” instead of “do you have a wife or
girlfriend?” Another example is “how may I help you?” instead of “how may I help you sir/ma’am?”
• Conduct medical appointments in the language that is most comfortable for the patient. Make professional interpreters available so patients do not have to rely on family members for interpretation.
• Ensure all medical staff, including medical assistants, interpreters, clinicians, and any personnel with access to the
patient’s medical records respect the patient’s confidentiality and do not use any verbal or non-verbal cues that
may indicate discomfort with the patient’s disclosures.
• Provide behavioral health referrals, if necessary, and/or community support services for LGBT patients.
• Build trust by emphasizing the confidentiality of the information.
• Provide education on sexual health, including the proper use of prophylaxis, to mitigate high-risk sexual behavior.
• Explain that questions related to sexual history and sexual orientation are asked of all patients. Also clarify that
• Implement universal HIV screening for all patients and a program that engages patients into HIV care.
these questions are used to create an accurate health assessment and that the information is confidential. It’s
important that patients feel they will not be judged, singled-out, or shamed for their answers.
• Reach out to LGBT organizations. This may include legal services, community organizations, or national organizations that can provide resources and support to health centers and LGBT patients.
¹¹ National Center for Lesbian Rights, California Rural Legal Assistance, and Legal Services Corporation, “Tips for Legal Advocates Working with Lesbian, Gay, Bisexual, and Transgender
Clients,” Available at
Available Support Systems
for LGBT Farmworkers
Because farmworkers tend to live in more isolated rural communities, there are
For more information about how you can promote health care access for LGBT
few LGBT support services available. LGBT farmworkers who live near an urban
farmworkers, you can contact:
center may be able to more easily access LGBT community organizations and
support services. Health centers should be familiar with the LGBT resources
in their communities to refer patients. Health centers may also function as a
• The National LGBT Health Education Center at the Fenway Institute,
Fenway Health –
limited support system. It is possible that the health center provider is the only
• Farmworker Justice –
person with whom the farmworker can talk openly and seek assistance.
• NCFH Call for Health hotline – 800-377-9968;
In California, California Rural Legal Assistance (CRLA) provides support to
LGBT individuals in rural areas, particularly LGBT farmworkers, through its
• Migrant Clinician Network’s Health Network
Proyecto Poderoso project. The project, a collaboration of CRLA and the Na-
• California Rural Legal Assistance –
tional Center for Lesbian Rights, provides community education, legal assis-
• Center of Excellence for Transgender Health –
tance, and leadership development to promote equality and dignity for LGBT
• National Center for Lesbian Rights –
individuals in rural California communities. More information about this project
• HRSA –
can be found on CRLA’s website.
Acknowledgements: Farmworker Justice and the National LGBT Health Education Center would like to thank Carlos Castañeda, Special Population Health
This publication is supported by grant numbers U30CS22741 & U30CS22742 from the Health Resources and Services Administration’s Bureau of Primary
Programs Coordinator at Adelante Healthcare in Phoenix, Arizona, and Emily Oake, Special Populations & Outreach Coordinator at the Arizona Alliance for
Health Care. The content of this publication is solely the responsibility of Farmworker Justice and the National LGBT Health Education Center and do not
Community Health Centers for their contributions to this publication.
necessarily reflect the official views of the Bureau of Primary Health Care or the Health Resources and Services Administration.
Farmworker Justice
National LGBT Health Education Center
1126 16th St NW # 270
The Fenway Institute
Washington, DC, 20036
1340 Boylston Street
Boston, MA 02215
A Publication of the National Center for Farmworker Health
April-June 2015
First Aid in Agriculture
Mario works at Orange Peel Farm. His job is to bend over, pick up boxes of oranges, and
place the boxes on a truck. A few days ago, he twisted his knee as he lifted a box. He felt
a sharp pain, and then his knee got swollen and bruised. The crew leader trained in first
aid, told him to rest the leg, then applied ice, wrapped the knee with a bandage and put
his leg up. Later, he sent Mario home with some instructions on how to care for his knee.
Yesterday, Mario was moving his knee again, and it didn’t hurt as much. He will be able
to come back to work soon.
b b b b b b
Pedro is a fruit picker at Onion Creek Farm. He has to climb up on a ladder to do
his job. Yesterday, the wind was very strong and as Pedro was climbing up, he lost
his balance, fell along with the ladder, and broke his leg. Pedro was in a lot of
pain, but his coworker knew about first aid for broken bones. First, to prevent him
from moving the leg and hurting it more, he put a splint on it. Then he took Pedro
to the urgent care center.
v v v v v v v v v v v v
Injuries like these happen all the time in agriculture. In fact, agriculture is one of the most dangerous
occupations. Injuries may happen for different reasons.
• Accidents can be caused by weather conditions, or the use of machinery, equipment or vehicles.
• Some work tasks can be really hard on the body, like bending over and picking up objects over
and over again.
• Not knowing or not following the safety rules can lead to injuries.
No matter what the dangers may be at your work site, you should be prepared in the case of injuries
or accidents. The best way to be prepared is to learn first aid.
To download this issue of Health Tips visit
So, what is first aid?
First aid is the care that you give to a person that gets injured or gets ill very
suddenly, before emergency medical care is available. First aid can include
many different things, from cleaning a cut, to helping someone who is
having a heart attack. First aid can:
• save the person’s life if he or she is seriously injured or ill
• prevent an injury from becoming more serious, like in Mario’s case
• reduce the amount of medical treatment the person needs and the time it will take to recover
• reduce time lost from work
The person that provides first aid should always first make sure he is safe. Then, he should call
someone else for help or call 911, if needed. Then, he can provide care for the injured person while
help is on the way.
What you should know about first aid at work
The U.S. Department of Labor requires all employers to have at least one person
trained to provide first aid if the work place is not close to a hospital or clinic.
The employer should also have first-aid kits available with the right supplies
for the most common injuries that can happen. So, make sure you ask your
• who are the people trained in first aid,
• what you should do if a coworker gets injured or ill, and
• where the first-aid kits are in case you need them.
Also make sure you have the telephone numbers for medical emergency services such as firefighters,
police or ambulance (EMS).
Now that you know the importance of first aid at work, keep reading to learn about three of the most common
work injuries in agriculture. The next articles will show you first aid steps for these injuries, but REMEMBER,
taking first aid classes and practicing with a trained instructor is the best way to be prepared. Look for classes
offered by health centers, hospitals, community colleges or other organizations in your community.
This publication was made possible through grant number U30CS0 9737 from the Bureau of Primary Health Care, Health Resources and
Services Administration, U.S. Department of Health and Human Services. Its contents are solely the responsibility of the authors and do not
necessarily represent the official views of the HRSA.
A Publication of the National Center for Farmworker Health
First Aid for Strains and Sprains
wo common injuries that occur in agricultural work are called strains and sprains. These injuries
can happen when you suffer a fall, lift heavy objects, or make the same movements over and
over. Usually these injuries are minor but if you don’t take good care of them they can get more
serious. First aid can help heal the injury much more quickly and make sure you don’t lose more time
from work. So let’s learn more
about strains and sprains, what to do if these injuries happen
to you or someone else, and when you should go to the doctor.
What is a strain?
A strain is an injury to a muscle or a tendon. A tendon is a thick
cord that attaches the muscle to the bone. A strain happens when
you twist, pull too much, or tear a muscle or a tendon. You know
you have a strained muscle or tendon when:
• You feel pain and/or have swelling
• You have trouble moving the muscle
• You feel weakness in the muscle
• You feel cramps on the muscle
What is a sprain?
A sprain is an injury of the ligaments of a joint. Ligaments are
short bands of tough and flexible tissue that connect two bones.
A sprain happens when you stretch too much or tear the
ligament. You know you have a strained ligament when:
• You have pain and/or swelling
• You see a purple bruise around the injured area
• You cannot move the joint where the injured ligament is
Article 2: April-June 2015
What to do in case of a strain or sprain?
Follow these steps right away if you think you have a strain or a sprain injury.
1. Control the swelling
An easy way to remember how to control the swelling is to think of the
word RICE. RICE stands for:
• Rest the sprained or strained area for 2 days
• Ice the area as soon as possible after the injury
• Compress the area by wrapping an elastic bandage or sleeve around
the injured area
• Elevate the area above the level of your heart
2. Treat your pain and swelling
Take over-the-counter medicine that can help relieve your pain and swelling, like ibuprofen (brand
names Advil or Motrin) or acetaminophen (brand name Tylenol). Follow the instructions on the label
when taking these medicines.
3. Use the injured area
As the pain and swelling get better, start using the area that is injured little by little.
Visit your doctor if your sprain or strain is not getting better after two or three days of
doing these things.
When should you go see a doctor right away?
Make an appointment to see a doctor right after the injury happens if:
• You feel a lot of pain when you move or touch the injured area
• You feel that the area is numb or you feel like “pins and needles”
• You have no strength in the part of your body that is injured
• There is a lot of swelling and pain, the area feels hot, and you get a fever
(these could be signs of infection)
This publication was made possible through grant number U30CS0 9737 from the Bureau of Primary Health Care, Health Resources and
Services Administration, U.S. Department of Health and Human Services. Its contents are solely the responsibility of the authors and do not
necessarily represent the official views of the HRSA.
A Publication of the National Center for Farmworker Health
Broken Bones: What to Do and What Not To Do
nother common injury at the workplace is breaking a bone, also called a bone fracture. Fractures
usually happen because of a fall from high places, like vehicles, equipment, loading docks,
buildings or ladders. So let’s learn about the types of fractures that can happen and what to do
when helping someone who has a fracture.
About fractures
There are two types of fractures:
Closed fracture
Open fracture
When the broken
bone has not come
out through the skin
and is not showing.
When the broken
bone has come out
through the skin
and is showing.
In the case of an open fracture, it will be easy to know that a fracture has happened. If it is a closed
fracture, you won’t know for sure, but you should treat the area as if it is a fracture.
Article 3: April-June 2015
First aid in case of fractures
All fractures need medical attention, so make sure you call 911 or get the
person to a doctor, urgent care facility or hospital as soon as possible. But
before moving the person, or while you wait for emergency services, follow
these first aid steps to avoid making the injury worse:
1. If there is an open fracture, try to stop the bleeding. If available, use
gloves to avoid contact
with the blood.
a. Apply pressure over the broken skin with a piece of clean cloth.
b. Then wrap the wounded area with more clean cloth.
Apply pressure
2. Put a splint in the injured area. A splint is any strip or stick made with a
strong material, like wood, to give support to a broken bone and prevent it
from moving.
a. If your first-aid kit does not have a splint, you can make one from
materials that are easy to find.
For example:
• For splint: use two strong objects such as poles, sticks, or tree
• For padding: use a blanket, soft leaves, or a shirt filled with grass
• For ties: use belts or strips of clothing, towels or blankets
b. Place and secure the splint:
• Place one tie over the closest joint that is above the area of the fracture. Do not wrap yet.
• Place another tie between the upper joint and the fracture. Do not wrap yet.
• Place another tie over the closest joint that is below the fracture area. Do not wrap yet.
• Place one more tie between the fracture and the lower joint. Do not wrap yet.
• Place the two objects that you will use for the splint on each side of the injured area.
• Place padding between the injured area and the splint.
• Now, wrap the ties around the splints to prevent from moving.
Careful! In fracture cases DO NOT:
massage the affected area
try to straighten the broken bone
move the person unless it is necessary to avoid
further injury
move the person if you think the injury is to the
spine (on back or neck)
let the injured person have anything to drink or
eat until they are under medical care
Call 911 right away if…
• The person had a major accident, like a truck
• The person is not breathing or moving
• The person is bleeding a lot
• You think a bone is broken in the neck,
head or spine
• The bone has broken the skin
• The toes or fingertips of the injured arm or
leg are numb or turning blue
This publication was made possible through grant number U30CS0 9737 from the Bureau of Primary Health Care, Health Resources and
Services Administration, U.S. Department of Health and Human Services. Its contents are solely the responsibility of the authors and do not
necessarily represent the official views of the HRSA.
A Publication of the National Center for Farmworker Health
Let’s Check What You Have Learned...
A. Select the correct word from the word bank below and fill in the blank:
1. A strain is an injury to a ______________ or a ______________.
2. A sprain is an injury of the ______________ of a joint.
Word bank: bone, ligament, muscle, tendon
• • • • •
B. Put the steps to treat a strain or sprain in order from 1 through 4:
___ Elevate
___ Ice
___ Rest
___ Compress
• • • • •
C. Mark with an X the statements that are true:
____ 1. First aid can help prevent an injury from becoming more serious.
____ 2. All fractures need medical attention.
____ 3. Not being able to move the area is a sign of a fracture.
____ 4. You do not need to call 911 if the fracture causes heavy bleeding.
____ 5. You should not move the person if you believe there is a possible injury of the neck.
Answers: a) 1) muscle, tendon 2) ligament; b) 1: Rest, 2: Ice, 3: Compress, 4: Elevate,
c) All are true except #4
Article 4: April-June 2015
D. Fill in the crossword:
1. A break on a bone
2. Emergency medical services
3. Medicine to relieve pain
4. It happens when you twist, pull
too much or tear a muscle or a
5. Care given to an injured person
before medical care is available
1. Fracture 2. EMS 3. Advil 4. Strain 5. First aid
In our next edition…
First Aid at Work:
Accidents and Illness
This publication was made possible through grant number U30CS0 9737 from the Bureau of Primary Health Care, Health Resources and
Services Administration, U.S. Department of Health and Human Services. Its contents are solely the responsibility of the authors and do not
necessarily represent the official views of the HRSA.
A Publication of the National Center for Farmworker Health
Abril-Junio 2015
Primeros Auxilios en la Agricultura
Mario trabaja en Orange Peel Farm. Su trabajo es agacharse, recoger cajas de naranjas, y
ponerlas en un camión. Hace unos días, se torció la rodilla mientras levantaba una caja.
Sintió un dolor agudo, y luego su rodilla se hinchó y se le puso morada. El líder de cuadrilla,
capacitado en primeros auxilios, le dijo que descansara la pierna, le puso hielo, le envolvió la
rodilla con un vendaje y le levantó la pierna. Luego, envió a Mario a su casa con algunas
instrucciones sobre cómo cuidar su rodilla. Ayer, Mario estaba moviendo su rodilla otra vez y
no le dolía tanto. Él podrá regresar a trabajar pronto.
b b b b b b
Pedro es un pizcador de frutas en Onion Creek Farm. Él tiene que subirse en
una escalera para hacer su trabajo. Ayer, el viento estaba muy fuerte y al ir
subiendo la escalera, Pedro perdió el equilibrio, se cayó junto con la escalera y
se rompió una pierna. Pedro tenía un dolor muy fuerte, pero su compañero
de trabajo sabía de primeros auxilios para huesos rotos. Primero, para evitar
que moviera la pierna y se hiciera más daño, le puso un entablillado. Luego llevó
a Pedro al centro de urgencias.
v v v v v v v v v v v v
Lesiones como estas ocurren todo el tiempo en la agricultura. De hecho, la agricultura es una de las
ocupaciones más peligrosas. Las lesiones pueden ocurrir por diferentes razones:
• Los accidentes pueden suceder debido a las condiciones del tiempo, o al uso de maquinarias,
equipo o vehículos.
• Algunos trabajos pueden ser muy duros para el cuerpo, como doblarse y levantar cosas una
y otra vez.
• No saber o no seguir las normas de seguridad puede causar lesiones.
No importa qué peligros puedan haber en su lugar de trabajo, usted debe estar preparado en caso de
que sucedan lesiones o accidentes. La mejor manera de estar preparados es aprender primeros auxilios.
Para bajar esta edición de Consejos de Salud visite
Entonces, ¿qué son los primeros auxilios?
Los primeros auxilios son los cuidados que usted le da a una persona que se
lesiona o que de repente se enferma, antes de que esté disponible la atención
médica de emergencia. Los primeros auxilios pueden incluir muchas cosas,
desde la limpieza de una cortadura hasta ayudar a alguien que esté teniendo
un ataque al corazón. Los primeros auxilios pueden:
• salvar la vida de la persona si está gravemente herida o enferma
• evitar que una lesión se ponga peor, como en el caso de Mario
• reducir la cantidad de atención médica que necesite la persona y el tiempo que tomará para
• reducir el tiempo de trabajo perdido
La persona que presta los primeros auxilios debe siempre primero asegurarse de estar a salvo. Luego,
debe llamar a alguien para pedir ayuda o llamar al 911, si es necesario. Luego, puede atender a la
persona lesionada, mientras la ayuda viene de camino.
Lo que debe saber sobre los primeros auxilios en el trabajo
El Departamento del Trabajo de los Estados Unidos exige que todo patrón
tenga por lo menos una persona capacitada para prestar primeros auxilios si el
lugar de trabajo no está cerca de un hospital o clínica. El patrón también debe
tener botiquines de primeros auxilios disponibles con las cosas adecuadas
para las lesiones más comunes que puedan suceder. Así que asegúrese de
preguntar a su patrón:
• quiénes son las personas capacitadas en primeros auxilios,
• qué debe hacer si un compañero de trabajo se lesiona o enferma, y
• dónde están los botiquines de primeros auxilios en caso de que los necesite.
Tambien asegúrese de tener los números de teléfono de los servicios médicos de emergencia, tales
como los bomberos, la policía, o la ambulancia (EMS en inglés).
Ahora que ya conoce la importancia de los primeros auxilios en el trabajo, siga leyendo para aprender sobre tres de
las lesiones de trabajo más comunes en la agricultura. Los próximos artículos le mostrarán los pasos de primeros
auxilios a seguir para estas lesiones, pero RECUERDE, tomar clases de primeros auxilios y practicar con un
instructor capacitado es la mejor manera de estar bien preparado. Busque clases que ofrezcan centros de salud,
hospitales, colegios comunitarios u otras organizaciones en su comunidad.
Esta publicación se hizo posible gracias a la subvención número U30CS0 9737 de la Oficina de Cuidados Primarios de Salud, Administración
de Recursos y Servicios de Salud, del Departamento de Salud y Servicios Humanos de EEUU. Su contenido es de la exclusiva responsabilidad
de los autores y no necesariamente representa los puntos de vista de HRSA.
A Publication of the National Center for Farmworker Health
First Aid for Strains and Sprains
os de las lesiones más comunes que ocurren en la agricultura o en cualquier tipo de trabajo físico, son los
desgarres (o distención muscular) y las torceduras (o esguinces). Estas lesiones pueden suceder cuando
sufre una caída, levanta objetos pesados, o hace los mismos movimientos una y otra vez. Usualmente estas
lesiones son menores pero si usted no las cuida bien, se pueden poner peor. Los primeros auxilios pueden ayudar
a curar la lesión mucho más rápido y a asegurarse de que usted no pierda tanto tiempo de trabajo. Vamos a
aprender más sobre los desgarres y las torceduras, qué hacer si estas lesiones le pasan a usted o a otra persona, y
cuándo usted debe ir al doctor.
¿Qué es un desgarre?
Un desgarre es cuando se lesiona un músculo o un tendón. Un tendón
es como una cuerda gruesa que une el músculo al hueso. Un desgarre
pasa cuando usted tuerce, jala mucho, o rompe un músculo o un
tendón. Usted sabe que tiene un desgarre en un músculo o tendón
• Siente dolor y/o tiene hinchazón
• Tiene problemas para mover el músculo
• Siente debilidad en el músculo
• Siente calambres en el músculo
¿Qué es una torcedura?
Una torcedura es una lesión en los ligamentos de una coyuntura.
Los ligamentos son bandas cortas de tejido fuerte y flexible que
conectan dos huesos. Una torcedura pasa cuando usted estira
demasiado o desgarra un ligamento. Usted sabe si tiene una torcedura cuando:
• Tiene dolor y/o hinchazón
• Ve un moretón morado alrededor del área lesionada
• No puede mover la coyuntura donde el ligamento está lastimado
Artículo 2: Abril-Junio 2015
¿Qué hacer en caso de un desgarre o torcedura?
Siga inmediatamente los siguientes pasos si piensa que tiene un desgarre o una torcedura.
1. Controle la hinchazón
Una forma fácil de recordar cómo controlar la hinchazón es pensando
en la palabra DICE. DICE quiere decir:
• Descanso: descanse el área donde tiene el desgarre o torcedura
por 2 días
• HIelo: Póngase una bolsa de hielo tan pronto como pueda después
de la lesión
• Compresión: Haga presión al envolver el área lesionada con una
venda o con una manga
• Elevación: Suba el área afectada por encima del nivel de su corazón
2. Trate su dolor e hinchazón
Tome medicina sin receta médica que le pueda ayudar a aliviar su dolor e hinchazón, como
ibuprofeno (marcas Advil o Motrin) o acetaminofeno (marca Tylenol). Siga las instrucciones en la
etiqueta cuando tome estas medicinas.
3. Use el área lesionada
Al ir mejorando el dolor y la hinchazón, empiece a usar el área que
esta lesionada poco a poco. Visite a su doctor si su desgarre muscular
o torcedura no mejora después de dos o tres días de hacer estas cosas.
¿Cuándo debe ver al doctor inmediatamente?
Haga una cita para ver al doctor inmediatamente después de
que suceda la lesión si:
• Siente mucho dolor cuando mueve o toca el área lesionada
• Siente que el área está como dormida o tiene una sensación de
“pinchazos y agujas”
• No tiene fortaleza en la parte de su cuerpo que está lesionada
• Hay mucha hinchazón y dolor, el área se siente caliente, y le da
fiebre (éstas pueden ser señales de infección)
Esta publicación se hizo posible gracias a la subvención número U30CS0 9737 de la Oficina de Cuidados Primarios de Salud, Administración
de Recursos y Servicios de Salud, del Departamento de Salud y Servicios Humanos de EEUU. Su contenido es de la exclusiva responsabilidad
de los autores y no necesariamente representa los puntos de vista de HRSA.
A Publication of the National Center for Farmworker Health
Huesos Rotos: Qué Hacer y Qué no Hacer
tra lesión común en el trabajo es cuando un hueso se rompe. A esto también se le llama
fractura de hueso. Las fracturas usualmente suceden por caídas de lugares altos, como
vehículos, equipos, plataformas para carga, edificios, o escaleras. Así que vamos a aprender
sobre los tipos de fracturas que pueden suceder y qué hacer para ayudar a alguien que tenga una fractura.
Sobre fracturas
Hay dos tipos de fracturas:
Cuando el hueso
partido no rompe
la piel y no se
puede ver.
Cuando el hueso
partido rompe la
piel y se puede ver.
En el caso de la fractura abierta, será fácil saber que ha sucedido una fractura. Si es cerrada, no lo sabrá
con seguridad, pero debe tratar el área como si fuera una fractura.
Artículo 3: Abril-Junio 2015
Primeros auxilios en caso de fracturas
Todas las fracturas necesitan atención médica, así que asegúrese de llamar al 911 o
llevar a la persona al doctor, al centro de urgencias, u hospital tan pronto como sea
posible. Pero antes de mover a la persona o mientras espera por servicios médicos
de emergencia, siga los siguientes pasos de primeros auxilios para evitar que la
lesión se ponga peor:
1. Si es una fractura abierta, trate de parar el sangrado.
Si puede, use guantes para no tocar la sangre.
a. Ponga presión sobre la piel rota con un pedazo de tela limpia.
b. Luego envuelva el área de la herida con más tela limpia.
Aplique presión
2. Ponga un entablillado en el área lesionada. Un entablillado es cualquier palo o tablilla hecha de un
material fuerte, como madera, para darle soporte al hueso roto y evitar que se mueva.
a. Si su botiquín de primeros auxilios no tiene un entablillado, puede hacer uno de materiales que son
fáciles de encontrar. Por ejemplo:
• Para el entablillado: Use dos objetos fuertes como palos, tablillas o
ramas de árboles
• Para el relleno: use una manta, hojas suaves, o las mangas de una
camisa llena de zacate
• Para amarrar: use correas, o tiras de tela, toallas o mantas
b. Ponga y asegure el entablillado:
• Ponga una tira sobre la coyuntura más cercana que esté arriba del área
de la fractura. No amarre la tira todavía.
• Ponga otra tira entre la coyuntura de arriba y la fractura.
No amarre todavía.
• Ponga otra tira sobre la coyuntura más cercana que esté debajo de la
fractura. No amarre todavía.
• Ponga una más entre la fractura y la coyuntura de abajo. No amarre todavía.
• Ponga los dos objetos que va a usar como entablillado, a cada lado del área lesionada.
• Ponga el relleno entre el área lesionada y el entablillado.
• Ahora, amarre las tiras alrededor del entablillado para evitar que se mueva.
¡Cuidado! En casos de fractura NO:
• masajee el área afectada
• trate de enderezar el hueso partido
• mueva a la persona a menos de que sea necesario
para evitar una lesión mayor
• mueva a la persona si cree que la lesión está en la
espina dorsal (en la espalda o cuello)
• deje que la persona lesionada tome o coma nada
hasta que esté bajo cuidado médico
Llame rápido al 911 si…
• La persona tuvo un accidente grave, como un
accidente con un camión
• La persona no está respirando o moviéndose
• La persona está sangrando mucho
• Usted cree que hay un hueso roto en el cuello,
la cabeza o la espina dorsal
• El hueso ha roto la piel
• La punta de los dedos de los pies o manos
están dormidos o poniéndose azul
Esta publicación se hizo posible gracias a la subvención número U30CS0 9737 de la Oficina de Cuidados Primarios de Salud, Administración
de Recursos y Servicios de Salud, del Departamento de Salud y Servicios Humanos de EEUU. Su contenido es de la exclusiva responsabilidad
de los autores y no necesariamente representa los puntos de vista de HRSA.
A Publication of the National Center for Farmworker Health
¡Vamos a Ver lo que Ha Aprendido!
A. Escoja la palabra correcta del banco de palabras que se encuentra abajo y escríbala en el espacio en
1. Un desgarre es cuando se lesiona un _______________ o un __________________.
2. Una torcedura es una lesión en el _________________ de una coyuntura.
Banco de palabras: hueso, ligamento, músculo, tendón
• • • • •
B. Ponga los pasos para tratar un desgarre o torcedura en orden
del 1 al 4:
___ Elevación
___ HIelo
___ Descanso
___ Compresión
• • • • •
C. Marque con una X las declaraciones que son verdaderas:
____ 1. Los primeros auxilios pueden evitar que una lesión se ponga peor.
____ 2. Todas las fracturas necesitan atención médica.
____ 3. No poder mover el área es señal de una fractura.
____ 4. Usted no necesita llamar al 911 si la fractura produce mucho sangrado.
____ 5. Usted no debe mover a la persona si cree que hay una posible lesión en el cuello.
Respuestas: a) 1) músculo, tendón 2) ligamento; b) 1: Descanso, 2: HIelo,
3: Compresión, 4: Elevación, c) Todas son verdaderas excepto #4
Artículo 4: Abril-Junio 2015
D. Llene el crucigrama:
1. Un tipo de servicio médico de
2. Pasa cuando usted estira
demasiado o rompe el
3. Un hueso roto
4. Medicina para quitar el dolor
5. Cuidado que se le da a
una persona antes de que
la atención médica de
emergencia esté disponible
1. Ambulancia 2. Torcedura 3. Fractura 4. Advil 5. Primeros Auxilios
En nuestra próxima edición…
Primeros Auxilios en el Trabajo:
Accidentes y Enfermedades
Esta publicación se hizo posible gracias a la subvención número U30CS0 9737 de la Oficina de Cuidados Primarios de Salud, Administración
de Recursos y Servicios de Salud, del Departamento de Salud y Servicios Humanos de EEUU. Su contenido es de la exclusiva responsabilidad
de los autores y no necesariamente representa los puntos de vista de HRSA.

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