Falling Like Dominoes
The perils of slips trips and falls
Last month, as I headed towards my flight home a terrible thing happened. As I walked up the stairs to Departures, I watched a game of human pinball play out on the escalator next to me.
An elderly lady lost her balance on the moving walkway and tumbled backwards. She fell, causing a domino effect as four other people toppled, each knocking the next person down. By the time the emergency stop button was hit, a mess of passengers was intertwined on the floor, suitcases and laptop bags all piled on top.
A cursory search of the internet reveals myriad videos showing ‘escalator fails’, indicating that falls from moving walkways are perhaps more prevalent than we imagine. But beyond the laughter, such events can have grave consequences. This airport happens to be one of our consulting clients, so today I politely enquired as to the outcome of their accident investigation. With a sombre look the Operations Manager told me the lady had died from head injuries sustained during the fall. Witness statements indicated that she was not holding the handrail, and she appeared to be trying to retrieve something from her suitcase at the moment she fell. The four other people involved in the accident suffered a range of injuries from minor scratches to a broken arm. A very bad day indeed for this international transport hub.
Accounting for falls
Slips, trips and falls are a frequent cause of accidents, both at work and at home. The British health and safety regulator, the Health and Safety Executive reported that slips and trips are the most common cause of injuries to employees, typically accounting for more than half of all major/reportable injuries, and around 30% of over-seven-day injuries to employees.
Recent data from the Labour Force Survey estimates that the rate of injuries due to slips and trips is around 190 per 100,000 workers. The highest risk sectors include recycling and waste disposal, transportation, telecoms, utilities, construction, and food and beverage manufacturing. In the UK slips, trips and falls have a combined estimated number of working days lost standing at 1.5 million. Slips and trips claim an estimated 986,000 lost working days and falls are estimated to account for 567,000 lost working days.
In the UK each year there’s around 45,000 injuries reported under RIDDOR (Reporting of Injuries Diseases and Dangerous Occurrence Regulations). The severity of injury varies between the type of accident. Falls from height are the most common cause of fatal accidents, accounting for nearly three in every 10 workplace deaths, or around 50 deaths per year. Around 90% of these fatalities were attributed to falls, 60% of them involve falls from heights in excess of two metres, with the remaining fatalities being caused by slips or trips. Of the fatalities, 95% were sustained by male workers, often in the largely male-dominated construction industry where work at height is common. Roofing activities and painting / decorating are found to be at particularly high risk. Overall around 60% of all fatalities occur in the construction industry and there are usually twice as many non-fatal major fall injuries in this sector as the next highest sector.
It’s important to keep in mind that slips, trips and falls don’t just occur at height. The United States Bureau of Labor Statistics advises that the annual rate of lost-workday injuries from same level slips, trips and falls in hospitals is around four per 1,000 employees. Remarkably this rate is nearly double the average for all other industry sectors combined.
In 2015 the European Agency for Safety and Health at Work (EU-OSHA) confirmed that slips, trips and falls had become the largest cause of accidents in all sectors from office work to heavy manufacturing. It’s a position that hasn’t changed today.
Vulnerability and risk perception
Each year in the United States there are a reported 8,240 injuries sustained on escalators. Analysis of these events tells us that misperception of risk is a key theme. It’s easy for our attention to be diverted as we stand still and let the moving staircase do the work for us, but a quick check of our mobile devices, a bit of people-watching or just a moment of calm all serve to ramp up the risk factor.
While research shows us that older persons are at higher risk of falls on escalators (and many other slips, trips and falls risks), accidents are not confined to senior age groups. On Valentine’s Day this year a young 20-something chap decided to impress an attractive girl in a British shopping mall by balancing full-length on the handrail of a descending escalator. As he stretched out and lay back a mix of movement, gravity and his lack of equilibrium put paid to his attempt and sent him crashing several metres to the ground. Likely not the most seductive of moves the young lady had witnessed that day.
Broadening our view from just considering escalators, we see that the incidence and severity of injury in slips, trips and falls accidents typically increases in line with the age of the person involved. For example, in the UK there are approximately twice as many incidents in the 60-64 age group as in the 16-19 year old age group. Interestingly, one-third of all worker fatalities occur in the 60-64 age group – even though they comprise only 13% of the workforce.
Sensory perceptions of risk
Older adults may rely more on visual information for balance and direction when moving around. Returning to the international airport mentioned at the beginning of this article, following their fatal accident a range of measures were installed, including clear signage reminding people to hold the handrail, the installation of LED lighting on the escalator and edge-painting of the steps. Such measures provide robust visual cues for everyone: from those with increased vulnerability from age or mobility, to others who may be prone to distraction, caught up on their mobile devices, or just ‘zoning out’ for a moment.
Recognising the need for helping people to really see risks more clearly, in 2014, after a spate of escalator and staircase falls, British railway operator Network Rail released series of CCTV clips showing falls on their premises that injured passengers. The impact was significant, with a rapid reduction in accidents, presumably caused by an ‘it could be me’ reaction in passengers seeing the films.
Sensory cues can be creative. Walking recently along a busy street in the heart of Sydney, Australia, I was enjoying a bit of people-watching. Captivated by the buzz of being in a new city and with a bit of free time on my hands I paid little attention to my surroundings. My brain suddenly registered something unusual beneath my feet and, stopping suddenly, I looked down to notice that the pavement was covered in little concrete half-domes about the size of a golf ball cut through the middle, and in large white letters the words ‘LOOK RIGHT’ were painted on the floor. I immediately complied with the instructions just as a large delivery truck shot up the road in front of me. The change in texture was deliberate. I had reached a point in the street where delivery alleys met the main thoroughfare at right angles and city planners recognised the risk of distracted shoppers being hit by vehicles emerging from the lanes and found a novel way of attracting their attention.
Don’t fall for it: Big Data
What happens when we fall over? The answer is that usually it’s nothing. We stand up, dust ourselves off, hope no-one saw us and get on with things. Sometimes, however, it’s different: we land badly and break a wrist; or really badly and pop a collar bone; or really, really badly and knock ourselves out. Sometimes we even die.
In fact, if we’re on the stairs at the time we trip then quite often we die. (Falling down the stairs kills more people each year in the UK than road accidents: about 3,000 to 2,500).
Would you be surprised to know that on off-shore oil platforms in the North Sea as many people have been killed in falls as in explosions? The stairs on these platforms are steep, made of metal, often wet and used frequently (there are usually no escalators on oil rigs). We can estimate the likelihood of falling is about 100,000 to one.
Consider the data a bit more. The stairs on an oil platform may be used about a million times a year – so if no-one holds the handrail then around 10 will fall. And one or two of these 10 are going to really hurt themselves. Now let’s flip this over. If 90% of the people do hold the handrail, then with these same numbers it’s likely we’ll have just one fall per year. And if 99% of people hold the handrail then we can reduce this frequency further to just one fall only every 10 years or so.
The first rule of Fight Club?
David Fincher’s 1999 blockbuster movie Fight Club gripped us all with its tough young dudes knocking seven bells out of each other. Brad Pitt spent months in training – building the perfect body and learning his knockout fighting skills.
But when the superstar actor arrived at a concert in Los Angeles one Saturday night in April 2015 with a savagely beaten-up face, it wasn’t because of some hardcore stunt he was doing for his latest film. It was because the 51-year-old couldn’t handle a flight of stairs. “This is what happens when you try to run up steps in the dark, with your arms full, wearing flip flops,” Brad nervously explained. “Turns out if you then try to stop your forward momentum with your face, the result is facial road rash.” Let’s not lose the opportunity to run a quick root cause analysis here for Brad - can you spot the causative factors? Inadequate lighting, poor choice of footwear and not holding the handrail all contributed, right?
So, recalling the prevalence of slips, trips and falls accidents around the world, the attendant severity, and the fact that once we start falling it’s often a matter of luck whether the outcome is a bump, bruise, break – or worse. Even Hollywood A-listers aren’t immune to the risks.
Involving the workforce is a great place to start to identify problem areas in the workplace, focus attention on risks and increase the reporting of near misses. One of our clients, a large international construction company recently targeted workplace slips, trips and falls with an initiative where everyone could make a contribution to reducing risks. They called it ‘See it, Say it, Sort it’, and empowered workers to take immediate action. The result? STF accidents fell by almost 40% and employee engagement in safety activities soared. Analysis of that organisation’s ‘See it, Say it, Sort it’ reports showed some key themes – let’s take a look at how they responded to them:
Wet or slippery surfaces
Construction sites can often become wet or slippery due to inclement weather:
- Ensure suitable footwear with good grip is provided and worn
- Treat slippery surfaces to provide extra grip; muddy pathways can be overlaid with gravel, grit and salt applied to iced areas, or temporary covering
- Signpost slippery areas
During internal fit-out work, trailing cables caused many trip accidents:
- Consider replacing tools that have trailing cables with cordless power tools
- Where cables are unavoidable, for example to run power to temporary lighting, run these cables at high level
Other slips and trips occurred due to the working environment being blocked or obstructed, with building materials, equipment or waste. Three themes were noted:
- Housekeeping – teams took responsibility to keep work and storage areas tidy
- Deliveries – delivery times were planned to minimise the volume of materials on site
- Waste – designated areas for waste collection were identified and small mobile skips were provided in work areas
A large number of slips and trips occurred when people were walking on uneven surfaces. Risks were reduced by:
- Identifying and clearly designating pedestrian walkways
- Where uneven surfaces persisted or could not be immediately remedied, risks were signposted and additional lighting installed
- Small changes in level, such as at scaffold platform interconnections, were highlighted with a bright yellow paint strip
If you’d like to think more systematically about slips, trips and falls risks in your workplace there’s a fantastic checklist available online, without charge from the Health and Safety Executive. You’ll find the Slips, Trips and Falls Hazard Checklist CK4 at www.hse.gov.uk/pubns/ck4.pdf
Most serious accidents are caused by a chain of events, which has come to be known as the ‘Domino Theory’. Considering accidents in this way provides a great opportunity to stop them occurring. Let’s consider for example, an injury where someone is hit on the head by something that falls from a work platform or from an overhead crane.
Taking scaffolding as a simple example the chain of events (or ‘dominoes’) might look like this:
- Poor housekeeping up on the working platform, plus
- Someone not noticing where their feet are going and/or rushing, plus
- A missing kickboard or edge protector, and
- A lack of pedestrian isolation areas under the scaffold, and
- A pedestrian walking past below without a hard hat
If it’s the hard hat that breaks the chain, you’ll know all about it – but you’ll survive. What often happens up there on the scaffold is that someone will accidentally kick a power tool, a brick, or even just a metal clip that bounces off a kick board and they’ll look over at the group underneath with hard hats in their hands and muse ‘that could’ve been nasty’ before carrying on to the next task. The group underneath probably never even knew this event occurred - but without that toe-board to break the chain the dominoes would have all fallen, and one of the group of pedestrians would have paid the ultimate price.
Slips, trips and falls tend to dominate accident reports around the world. No organisation in any sector can achieve an accident-free year without a systematic approach to gravity-related behaviours. It doesn't need to be complicated, so here are five quick ideas to keep you safe and avoid you playing dominoes:
- Hold the hand rail
- Step down squarely
- Wear appropriate footwear
- Don’t stand under there
- Don’t stand on that