Slips, Trips

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Slips, Trips Falls

• Getting a Grip on the Problem and How to Control
  It

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Yall Move South!
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STF Are Notoriously Underreported
Slip/trip/fall injury/claim
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Reactive Response
S/T/F - no injury Identified and reported
?
S/T/F - no injury - not aware/no report
??
Potentials - design for slips, unsafe conditions,
improper work practices at-risk behaviors,
co-related incidents, e.g. MH/Patient H
Pro-active Control
???
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Myth or Reality?
The human organism is basically unstable
because mankind has not evolved sufficiently from
a quadrupedal configuration, and in ambulation
people are constantly walking in a state of
controlled fall. Carlsoo, Streindler, 1955
Shadows of the Neanderthal permission to
reprint from Pegasus Communications
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• Posture
• Balance
• Foot trajectory
• .
• .
• .

COM
Gravity Line
AFr gt RFr

• Critical Stages
• Touchdown (heel strike)
• Full Load
• Push off
• Swing phase

BOS
GRF
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Fall Response Factors

• Fall height
• Impact direction
• Fall protection reflexes
• Impact surface
• Force distribution
• Personal characteristics

BOS
COM
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Classifications of Same Level Falls

• Slip
• Trip
• Stumble
• Tumble
• Crumple

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Main Contributing Factors for Slips, Trips, and
Falls

• Walkway surface
• Footwear
• Surface contaminants
• Gait dynamics

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Three Simple Laws
Force Momentum Gravity
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More Variables
C
T
STF F M G E
Chance is more Fundamental than Causation
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When Baby Boomers Go Boom!

• Number of 65 workers will double between 2000
  and 2040
• Number of workers aged 25-54 years will increase
  by only 12 over same period
• Over the next 25 years, 1 million people will
  turn 65 every month
• GL STF claims rising

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Disorder of Balance and Vestibular Function in US
Adults

• Agrawal, Carey, Della Santina et. al. Archives
  of Internal Medicine. V 169, n 10, May 25, 2009
• Inner ear vestibular system is an important
  contributor to balance control
• Prevalence of vestibular disorders and associated
  increase in risk for falls
• Survey period 2001 2004
• Used simple balance metric Romberg Test
• Results
• 35 of US adults 40 had vestibular disorder
• Odds of VD increased significantly with age
• Odds 70 higher for those with diabetes
• Participants with VD who reported dizziness had a
  12x increase in odds of falling

• Emphasizes importance of diagnosing, treating and
  potentially screening for VD to reduce
  fall-related injuries, fatalities and costs

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Human Element
P(STF) F x M x G x E x T x C x H x A x
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Striving for a More

• Acceptable Level of Control

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The most effective STF control efforts address
these major elements

• Slip resistant walking surface
• Slip resistant footwear
• Design/Selection/Purchasing standards
• Maintenance
• Repair
• Cleaning standards
• Cleaning chemistry
• Inspection/Audit conformance
• Measurement/Monitoring

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Tribometers
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Interpreting Slip Index Readings
Increasing risk for slip fall
Minimum Level For Walking
Consensus Standard Safe Floor (dry)
Wet Ice
1.0
0.50
0.17
0.25
Based on the English XL Variable Incidence
Tribometer No standard for wet slip resistance.
The closer the slip index is to the 0.50-1.0
range the better
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Advocates

• Falls Free Coalition
• State coalitions on STF prevention
• Minnesota Falls Prevention Initiative
• Affiliates
• Minnesota Board of Aging (Kari Benson
  651-431-2566)
• Dept of Health Human Services (Pam Van Zyl York
  651-201-3616
• Stratis Health
• MN Chapter of the American Physical Therapy
  Assoc.
• Home Healthcare Assoc
• Council on Health Plans
• U of Minnesota
• Mayo Clinic
• www.stopfalls.org
• Safety of Seniors Act of 2007 (PL 110-202)
• CDC, CSPC
• ACOA
• ADAAG
• AGA, ASTM, ANSI, NSC
• Building Codes

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Does ADA Require.?

• Walking surface CoF of 0.60
• Ramp CoF of 0.80
• NO! Not any more
• Removed 11/16/1999
• . 2003 bulletin It is impossible to correctly
  specify a slip-resistance rating without
  identifying the test method, test device, and
  sensor material.and equally invalid to compare
  values obtained through one methodology to those
  resulting from different testing protocols

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ADA Accessibility Guidelines

• 4.5.1 - Ground Floor Surfaces
• - Must be stable, firm and slip resistant
• 4.5.2 Changes in Level
• - Up to ¼ (6 mm) no treatment needed
• - gt ¼ and lt ½ bevel with slope 12
• - gt ½ (13 mm) ramp with slope 112

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Does OSHA Require.?

• Walking surfaces must have CoF of 0.50 or
  higher No!
• Interpretation 3/21/03 OSHA does not have
  any standards that mandate a particular CoF for
  walking/working surfacesno OSHA standard
  specifically requires employers to use (slip
  meters/tribometers) or have them

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ANSI/ASSE A1264.2-2006/NFPA

• Provision of Slip Resistance on Walking Surfaces
• Provisions for reducing hazards
• Test procedures and equipment
• Slip resistance guideline
• Specifies a minimum numeric threshold of safety
  for walking 0.50
• NFPA 1901 Standard for Automotive Fire
  Apparatus specifies minimum average slip
  resistance
• Exterior surface wet 0.68 with XL (VIT)
• 0.52 wet with Mark II (PIAST)
• NFPA 101/5000 (2006) specify the VIT and PIAST as
  acceptable methods for measuring slip resistance
  of walkway surfaces and stairs

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Injuries on Stairs

• Overriding design fault is dimensional
  inconsistency
• More than 70 on top 3 steps and bottom 3
• 80-92 during descent
• Ascent trips attributed to variation in riser
  height and
• Other variables
• Carrying
• Clothing
• Obstacles in path

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Optimal Stair/Walkway Design

• In ascent
• Risers 6.3 (16 cm) 8.9 (23 cm) and
• Treads 7.7 (20 cm) to 14.2 (36 cm) had fewest
  missteps
• 7-11
• In descent
• The larger the tread the fewer the missteps
• Risers 4.6 (12 cm) 7.2 (18 cm) had the fewest
  missteps
• Avoid treads lt 9 (23 cm)
• Missteps increased with steepness
• Optimum 30-35º
• No deviations gt 3/8 (9.5 cm) across entire
  flight
• Visibility/visual clues 10-20 fc
• Contrasting/slip resistant nosing
• Not protrude gt 1.5 (38 mm)
• Beveled or rounded

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Handrails

• Ease of Grasp
• Allows continuous holding
• Not obstructed by supports of other obstacles
• Circular cross section 1.5 2 dia. (32-51 mm)
• Extend 12 past end of stairs at top bottom
• Reachable within 30 all directions
• Code conformance IBC/NFPA/BOCA

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Floor Surfaces

• Slip Resistant
• Balance safety with aesthetics

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Mats/Entrances

• Typically too short
• Additional mats during inclement weather
• Edges remain flat
• Door open/close force
• And speed
• Security cameras

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Contaminants/Hazards
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Parking Lots

• Adequate drainage
• Potholes/cracks
• Debris
• Puddles/ice
• Tire stops/speed bumps
• Change in levels
• Air step
• Adequate lighting

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Keeping Fit/In Control
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