When I read that "slips, trips, and falls" are a common reason for injuries, I picture someone hitting a banana peel and falling. They dust themselves off, look around to see if anyone saw such silliness, and keep on going. Each of us has done just that. During my career, I have investigated people who fell and will never work again, those who fell and died, and people who slipped and will never walk right. This article is on falling, how common a fall is, and perhaps, how to stop the next one.
We have a tendency to downplay falls since we all fall and rarely get hurt. Last night, someone told me a story in which he slipped while roofing—on a piece of steel roofing and rode it down over a lower porch roof to the ground like a surfboard, unhurt. Flashing through my mind was the ride and a great story to tell at a bar; I did not consider him lying dead and his family living out their lives without him. That is not how we think, and that is why we tend to downplay fall hazards and why we might tolerate them.
Certainly safety professionals must target the elimination of falls, but, in my opinion, not all falls will stop, regardless of efforts—what we need to do is minimize the distance of any remaining falls. William Haddon Jr. figured out in the 1970s that it is the energy created in a fall that causes the damage. Fall far—hurt more. We must also relearn how to fall, for I think, as a society, we have forgotten how to do that. One the few things I excelled in during high school was "tumbling." I am not sure how widespread that was or if it's still taught in the United States, but Mr. Spurr, our gym teacher in Valatie, New York, taught us all that, if you are going to fall, there's a good way to do it. That lesson stuck. If I am chasing my grandson down a hill, and gravity prevails, I will still drop and roll to a stop. More on how we should learn to fall later.
How Common Are Falls to You and Me?
I consider myself an average male (my wife would argue that is a rather high mark), so I began to chart my life injuries. Not difficult because our scars mark our mistakes. So, now I challenge my readers to do the following:
Outline a person on a piece of paper. It should look like the guy on the Operation game.
Locate all your scars and injury points and number them.
Put an F near each injury resulting from a fall from height.
Put a G near each injury where you fell at grade.
Put an S on anything else that caused a scar (no … you can skip that one).
Determine what percentage of your life injuries were from falls.
What Did I Learn from My 15 Injuries?
Ten falls created 75 percent of my scars.
Five of the 10 falls required a trip to the emergency room for medical attention.
Seven of the overall incidents required a trip to a hospital or clinic.
Two falls could easily have resulted in my death.
Two falls required surgery that kept me out of work.
One fall required overnight hospitalization.
One fall left a permanent dent in my behind from falling on a hay elevator.
One fall required medical transport.
Two incidents were not related to a fall. They just a left permanent dent in my shin and resulted from my brother Frank's braces.
One left a piece of steel in my finger, so I can explain why gloves are important when grinding.
Did the Injuries Reflect My Age?
The highest frequency of injuries (43 percent) occurred in my late teens, but none of these required hospitalization. I was never injured in my 20s or 30s. Only after I turned 40 did my injuries require hospitalization or surgery. When young, I repaired easily. During my prime years, I rarely got hurt, but now when I get hurt, it's costly.
What Were My Injuries?
Fall at grade
Fall from height
Lack of personal protective equipment
Horseplay or haste
What Does This Tell Me?
Though falls from grade were more common, the two falls from height were the ones that could have killed me, confirming Haddon's work. The saying, "It's not the fall that kills you … it's the sudden stop" makes a lot of sense. One of my falls could also have been fatal (impalement) but only cost me a tooth. I guess it was just not my time. That's why we need to reduce the remaining fall-from-height hazards at work. It is best to fall to the floor of your scissor lift than to fall off a ladder.
Why Is This of Interest?
My injuries confirm what safety professionals already know—if you're going to fall, it's from a trip; the farther you fall, the greater the injury potential; and, as one ages, injury severity increases.
Four of my injuries were the accumulation of little contributors that led to the events. In one example, I removed protective stair coverings to show off the beautiful 120-year-old treads in my home, and I left in an ambulance. In three incidents, chance came into play. For example, when I was 14, my horse (Shamrock) was spooked and gave me a toss. I landed head first on a steel post rather than on either side of the fence or just falling off the other side of the horse. The next fence post was 20 feet away.
And … What Does This Mean for the Reader?
You must anticipate that people will fall, whether walking by your job site or working on it. Plan from there. No one should fall from any height, and, if they do, it cannot be far.
Ladders must be publicly recognized for the common hazard they present across the population. They are unsafe to use, and this has been confirmed by the Centers for Disease Control:
Falls remain a leading cause of unintentional injury mortality nationwide, and 43 percent of fatal falls in the last decade have involved a ladder. Among workers, approximately 20 percent of fall injuries involve ladders. Among construction workers, an estimated 81 percent of fall injuries treated in US emergency departments involve a ladder.
(Occupational Ladder Fall Injuries—United States, 2011)
If there is any kind of ramp for walking, don't install cleats on it. When those are hidden under the snow, they will catch work boots, and someone will fall.
Ice cannot be allowed to accumulate on any walking surface. There is no easy answer, but this is critical. Elevate walkways, install grating or a grated surface on which to walk, or cover the walkways so ice and snow can't accumulate.
Figure 1: Covered Walkway
Industrial facilities install grated walkways as shown to prevent falls during all kinds of weather. We should have these on our construction sites wherever possible.
Figure 2: Grated Walkway
Photo courtesy of Eberl Iron Works, Inc.
If you provide access to anything, make sure its surface is slip resistant. Contractors will choose simple mason's-mesh screen for a walking surface, but that will soon fail and curl up, reaching for the cuff of someone's pants. Use stamped metal sheeting. It's durable, and you can sweep and shovel on it and roll a wheelbarrow up and down it. Try that on a cleated surface.
Figure 3: Stamped Metal Sheeting
Put the same stamped metal sheeting on each stair tread to buildings under construction so your muddy boots will not slip when they are wet. Install on every step and every landing.
Keep punched metal scaffolding planks intact. When those raised gripping surfaces wear off, replace the plank, especially on stair towers. When you can see a lot of light through the holes, it is time to replace them.
Figure 4: Worn Punched Metal Scaffolding Planks
Ensure those adhesive grip-strips are installed and maintained on the floor of your equipment. Smooth steel is slippery; wet smooth steel is deadly.
Figure 5: Poorly Maintained Adhesive Stripping
Think about what the world will look like after it snows, and remove anything that will trip someone up—before it starts snowing. Consider going down these stairs at night after 6 inches of snow.
Figure 6: Snow Hazard
Railings are perfect for preventing a fall. Put in more than you need. Picture someone taking a stumble on the stairs shown below. There is no excuse for this lack of protection. Someone falling on those stairs may not die, but they would be badly broken.
Figure 7: Improperly Maintained Railing
Pay special attention to transition entrances. These are spaces where you go from light to dark areas, such as into a building under construction, or cold to warm, such as into and out of a building under construction. Install some simple floor mats (like those that you find at store entrances across the United States) to keep people from falling. The solution is rather simple.
Figure 8: Transition Entrance
Never allow an impalement hazard to remain unprotected—no matter how far from a walking path. I have a plastic tooth because of my error, and that happened at my home.
Back to Mr. Spur's Gym Classes on How To Fall
I am advocating that we should reteach these skills on how to fall in the workplace. I'm not sure how to do this, but I feel it is critical. Some of these simple tips, if taught by a professional, can be used by workers not only on the job but also at home and at play.
As I said, during the 1970s at the Ichabod Crane Central School High School (remember, the electronic keyboard was not yet invented), we were taught the fundamentals of falling to keep from getting hurt—first on soft mats but then on the hardwood floors and on hills.
When falling forward, the idea was always to "tuck and roll," protecting your head and rolling to a stop rather than a straight shot, arms out to the ground. You would just tuck your chin to your chest, take the hit on your back and shoulder, and, more often than not, roll right back onto your feet. I have done this dozens of times in my life, and it's natural.
When we later tumbled on the hard wooden floors, we also were taught that if you felt like you were going to fall (like fainting), you should just collapse your knees and fall in place or try to fall forward. The front of your head is harder than the sides or back, as proven by the head butt.
So I took a look today at what guidance on falling is out there. There is some and here's a snippet from How to Fall Safely:
Keep your head up. This is the primary location of the body that you do not want to have damaged. You do not want to have your head connect with the ground, particularly if you are falling onto pavement or another hard surface. It is better to bruise your arms than to bruise your head.
Slap your palms off the ground if falling forward. Make sure your whole palm slaps the ground. This is done only for a second to slow your fall the slight bit that it will, and to prevent breaking your wrists (it may also help to learn How to Strengthen Your Wrists. It is not meant to absorb all your weight like a spring, or "catch" you. Do this also if falling sideways (use left palm if falling left, right if falling right). **Note: Never try to slap the back of your hand against the ground. Always use the palm or edge of your hand. It is easy to break your wrist if you use the back of your hand. Don't lock your elbows.
Breathe out. Some people will tell you to breathe out as much as possible, which will tense up your body thus allowing you to "absorb the impact of the fall". It is more likely, however, that you will damage your body if it's tense. Instead, breathe out normally, just as much as the task of going to the ground requires. This will keep your body flexible and relaxed, and greatly reduce the risk of injury.
Fold your body like an accordion. Bend your ankles, then your knees, then your hips. Fold your body into itself. This decreases the height of your fall. Just imagine: You're 6' tall. Someone pushes you. What's better? Toppling and risking slamming your head from about 6' height into the ground, or folding into yourself and risking slamming your head from about 2 feet into the ground?
If falling from a height, roll as you hit the ground. This will distribute the force of the impact throughout your body, instead of just on one place. If falling backwards, try to bend at the knees and squat before the fall. Curl your back and roll on it. Don't try to break the fall with your arms.
Practice falling on a soft surface (like a mat) when you aren't actually falling. This will teach your body the right thing to do and then it becomes a reflex.
Take a moment to think about yourself, your injury history, and your workforce. The whole idea of injury mapping would make a great exercise at your next safety committee meeting. It would raise the conversation on how often people are injured and how many. Then explore some of the incidents and let those who have been injured tell their stories. You will find them of interest, for each injury is very relevant to the person sharing his or her misadventure or mistake. Somewhere in that conversation though is the remedy so the next person does not fall. That is worth listening for.
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