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Underestimating Slips and Falls

The "simple" slip and fall turns out to be a complex safety issue that needs greater attention from industry.

They are so prevalent and so costly that you would think employers would be on constant guard against them. Slips and falls are the second leading cause of workplace injuries and a $5.7 billion problem, according to Liberty Mutual Research Institute for Safety. "In most industries, same level falls are the number one or two injury behind back injuries," noted Wayne S. Maynard, Liberty Mutual's director of ergonomics and tribology.

Moreover, said Maynard, the slip and fall injuries reported are a "small piece of what is really happening out there." He said if you follow Heinrich's accident model, then hundreds of slips and falls may be happening in organizations that are never reported.

"Slips, trips and falls are not considered a major problem because people are not looking at it," said Robert Pater, managing director of Strategic Safety Associates. "We've heard that minor slips and trips are rarely reported. People are embarrassed and they accept the fact they are falling. Often when people fall, they pop up right away and hope nobody saw them." They don't report the incident and so nothing is done to correct the problem.

This inattention to slips and falls was underscored by a study conducted by Liberty Mutual in 2001 to determine the gap between actual injury causes and perceptions. Company executives ranked slips and falls seventh, though they were actually the second leading cause of injury. "It validated what I knew, that slips and falls really are not on the radar screen," said Maynard.

Contributing Factors

"People think slips and falls are not preventable, they just happen," said Steven Di Pilla, a loss control expert with ESIS Inc. They often ignore slips and falls, he added, choosing to "focus efforts on what they think they can do something about."

Ironically, company officials can take a variety of very effective steps to reduce or eliminate slips and falls. Experts say a good first step is to stop blaming the victims. Many managers jump to the conclusion that slips and falls are the employee's fault, the result of horseplay or not paying attention. In reality, slips and falls can arise from a complex set of causes that may have much more to do with management practices than employee behavior.

For example, Di Pilla said an employee tripping over an electrical cord may on the surface appear to be just a matter of carelessness. But a closer examination could reveal that building managers were doing a poor job of maintaining electrical systems. As a result, electrical outlets did not work and employees began running extension cords from the remaining outlets. By tracing the incident back to the root cause, said Di Pilla, "You find out it is a maintenance issue and it was preventable."

According to Pater, slips occur because a person's upper body is not positioned over their lower body. "In a slip, people are walking forward with a certain amount of momentum and they suddenly reach ground which does not have the same purchase or coefficient of friction," he explained. "Their lower body then goes ahead of their upper body so they slip backward."

Contributing to the slip occurring may be a variety of factors in addition to simply a slippery walking surface. Those factors can include environmental factors such as worn flooring or shoes with worn-down soles, or the presence of grease, oil or water on a floor.

"When you perceive a slippery condition, you change your gait and you prepare accordingly. Slips and falls happen when you least expect it," said Maynard. "You don't see that spot on the floor, or you're on a carpeted floor and then you step onto a vinyl-composition tile floor. It's polished and waxed, there's a little water on it, you don't see it and there you go."

Human factors such as inattention, carrying objects, poor vision, bifocals and the use of over-the-counter medications can all contribute to slips and falls. "Having an untreated cold can affect the semicircular canals in the ears, which are one of the feedback mechanisms we use for maintaining our internal balance," Pater pointed out.

The elderly are particularly at risk for slips and falls. They don't see as well, their muscles are not as strong so they don't recover their balance as readily and their reaction time is slowed, noted Maynard. With the work force aging, said experts, there is even more incentive for companies to take a more proactive approach to preventing slips, trips and falls.

No One Answer

In Slip and Fall Prevention: A Practical Handbook, author Steven Di Pilla notes: "Each person takes an average of 18,000 steps a day, amounting to more than 6.5 million steps annually. This represents a tremendous exposure."

Because of the many organizational, environmental and personal factors that contribute to slips and falls, safety experts warn that attempts to prevent injuries with single remedies, such as slip-resistant shoes or improved maintenance, are much less likely to succeed than a comprehensive program that includes good design, maintenance, training, proper footwear, recordkeeping and other activities (see chart on p. 43).

Liberty Mutual's Maynard said senior managers need to instill a safety culture that has managers and supervisors take responsibility for understanding and providing working conditions that minimize or eliminate slip and fall hazards. He said they should promote reporting of close calls and hazardous conditions so that action can be taken before an injury occurs.

Flooring and finishes. Safety experts say flooring materials are too often chosen on the basis of initial cost and how they look, with little regard for how slippery they may be. "Any floor is slip-resistant when dry but add water or contaminants such as grease, oil or dirt and now you are dealing with an entirely different situation," said Maynard. He urged companies to look at the total cost of flooring, which includes its purchase price, durability, cleaning cost and its slip-resistance characteristics.

Slip-resistant footwear. Di Pilla said the best way to choose among the many brands of slip-resistant footwear is to conduct tests of different brands. Liberty Mutual said the two major components to consider when selecting appropriate slip-resistant footwear are tread design and tread material. Citing guidelines from the Shoe and Allied Trade Research Association Technology Centre in the United Kingdom, a Liberty Mutual document said the sole should have a raised-tread pattern on the heel and sole with a crosshatch design. As for the tread material, manufacturers usually employ a "proprietary softer rubber material with slip-resistance benefit arising from the heal and shoe sole conforming with the surface of the floor."

Di Pilla warned that slip-resistant soles are typically made of a softer rubber than regular street shoes, so companies should have a program to make sure they are replaced as they wear out.

Mats. Di Pilla recommends a three-step process for mats: 1) a porous mat outside to pull off as much contaminant as possible from footwear; 2) a smoother but still relatively rough mat in the foyer to pull off the next layer of contaminants and absorb moisture, and 3) walkoff mats to remove moisture so it doesn't get tracked into the building.

Keith Vidal, president of Vidal Engineering Inc. and chair of the American Society for Testing and Material's F-13 traction committee, warned that mats can create their own hazard if they slide around or fold up easily. He said good mats are made of a very dense material, are hard to move, have a slip-resistant backing and are very difficult to fold over on themselves.

Floor coatings and treatments. A variety of slip-resistant floor coatings are available to increase traction on slippery floors. They have an abrasive grit mixed into an adhesive base material. Di Pilla said companies have to consider if the treatment is applicable for their floor and if its properties are a match for the contaminants present. There are also etching treatments that put micro-grooves into tile. While they may require less maintenance than the reapplication of surface coatings, noted Di Pilla, they do impact the life of the tile because some of the floor surface is removed.

Warning signs. A variety of warning signs and cones are available to indicate wet floors or other hazards. Maynard said he prefers cones to sandwich board designs because they are taller and thus more visible.

Flooring, footwear, contaminants, weather and the work force all change with time, so it is vital that safety and facility managers audit the slip and fall prevention program routinely to make sure it is doing its job of keeping these costly and dangerous hazards at bay.

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