Effects of extension ladder fly configuration on climbing safety

Fall injuries often occur on extension ladders. The extendable fly section of an extension ladder is typically closer to the user than the base section, though this design is minimally justified. This study investigates the effects of reversing the fly on foot placement, frictional requirements, adverse stepping events (repositioning the foot or kicking the rung), and user preferences. Participant foot placement was farther posterior (rung contacted nearer to toes) in the traditional ladder compared to the reversed fly condition during descent, with farther anterior foot placements during ascent. The reversed configuration had similar friction requirements during early/mid stance and significantly lower frictional requirements during late stance. Increased friction requirements during late stance were associated with farther anterior foot placement and further plantar flexed foot orientation. The reversed fly had 5 adverse stepping events versus 22 that occurred in the traditional configuration. Users typically preferred the reversed fly. These results suggest that a reversed extension ladder configuration offers potential benefits in reducing fall-related injuries that should motivate future research and development work.

Ladder Use Ability, Behavior and Exposure by Age and Gender

This study aimed to quantify and compare ladder use ability and behavior in younger and older men and women from three ladder use behavior experiments. The experimental tasks comprised (1) changing a lightbulb on a household stepladder under two cognitive demands (single and dual task), (2) clearing a simulated roof gutter on a straight ladder and (3) querying ladder choice in different exigency scenarios. Ladder use ability and behavior data were captured from recorded time, performance, motion capture and user choice data. In addition, this study surveyed ladder use frequency and habitual behaviors. The experimental findings indicate that older adults require more time to complete ladder tasks; younger adults display riskier ladder use behaviors; men and women display similar ladder use ability; and men are more willing to climb riskier ladders. The survey found older adults to report more frequent ladder use than younger adults, and men use straight ladders more frequently than women. These results suggest that the reported higher ladder fall rates experienced by older adults and men are linked to increased ladder use exposure and riskier ladder choice. This knowledge can help guide population-specific interventions to reduce ladder falls in both young and older people.

Correlations between reach, lean and ladder tipping risk

Overreaching is a common cause of ladder falls, which occur frequently among older adults in the domestic setting. Reaching and body leaning during ladder use likely influence the climber-ladder combined center of mass and subsequently center of pressure (COP) position (location of the resultant force acting at the base of the ladder). The relationship between these variables has not been quantified, but is warranted to assess ladder tipping risk due to overreaching (i.e. COP traveling outside the ladder's base of support). This study investigated the relationships between participant maximum reach (hand position), trunk lean, and COP during ladder use to improve assessment of ladder tipping risk. Older adults (n = 104) were asked to perform a simulated roof gutter clearing task while standing on a straight ladder. Each participant reached laterally to clear tennis balls from a gutter. Maximum reach, trunk lean, and COP were captured during the clearing attempt. COPwas positively correlated withmaximum reach(p < 0.001; r = 0.74) and trunk lean (p < 0.001; r = 0.85). Maximum reach was positively correlated with trunk lean (p < 0.001; r = 0.89). The relationship between trunk lean and COP was stronger than that between maximum reach and COP, denoting the importance of body positioning on ladder tipping risk. For this experimental setup, regression estimates indicate reaching and lean distance of 113 cm and 29 cm from the ladder midline, respectively, would lead to ladder tipping on average. These findings assist with developing thresholds of unsafe reaching and leaning on a ladder, which can aid in reducing ladder falls.

Falls From Height, Facial Injuries and Fatalities: An Institutional Review

Study Design

Retrospective cohort review.

Objective

To investigate the relationship between falls from height and facial injuries.

Methods

This is a retrospective cohort study, conducted over a 7-year period, of the medical records of all patients who presented to hospital for a maxillofacial injury following a fall from height. Fall heights were classified as low falls (1-3 m), high falls (3-10 m) and very high falls (≥10 m).

Results

A total of 111 patients with 218 facial bone fractures were identified (78 men, 33 women and mean age 50.3 years). High falls were the most common (n = 58, 52.3%). Multiple fractures were identified in 51 (46.0%) patients. Orbital and middle third fractures were the most prevalent. Nasal, mandible, bilateral and fractures involving more than one facial third, increased as fall height increased, as did the requirement for operative fixation. The majority of patients had an associated injury (n = 100, 90.1%) and overall mortality was 6.3%.

Conclusions

Falls from height are prevalent and there is a trend towards increased severity of facial injury, surgical intervention and associated morbidity as fall height increases. Falls from height are a significant public health concern and an important facet of maxillofacial trauma to recognise, as is the requirement for an interdisciplinary approach as they present to hospital.

Situational factors that influence overreaching on a ladder during a gutter clearing task among older adults

Ladder falls from overreaching are a problem in older adults. Evidence suggests ladder use behavior to be dependent on interfacing user and environmental circumstances (i.e. situational factors). This study investigates the effects of situational factors (remaining debris, ladder position, time into task, hand dominant reach, reaching disposition) on reaching during a gutter clearing task on a ladder in 104 older adults. Reaching was quantified as the maximum lateral center of pressure (COP) displacement from the ladder's center. A reach was classified as an overreach when the COP displaced outside the ladder width, indicative of a ladder tip. Reaching disposition, remaining debris, ladder position, and the interaction of reaching disposition and remaining debris predicted 20% of the reaching variability during the ladder task. Overreaching was observed in 40% of participants accounting for 13% of all extended reaches (beyond ladder). This work can guide interventions on mitigating overreaching and improving ladder safety.

Falls from Ladders: Injury Patterns and Outcomes

BACKGROUND

Our contemporary understanding of the impact of falls from ladders remains limited. The purpose of this study was to examine the injury patterns and outcomes of falls from ladders. Our hypothesis was that age affects both injury type and outcomes.

METHODS

The NTDB was queried for all patients who fell from a ladder (01/2007-12/2017). Participants were stratified into 4 groups according to age: ≤15, 16-50, 51-65, and > 65 years. Univariate and multivariate analyses were performed to compare the injury patterns and outcomes between the groups.

RESULTS

A total of 168,227 patients were included for analysis. Median age was 56 years (IQR: 45-66), 86.1% were male, and median ISS was 9 (IQR: 4-13). Increasing age was associated with a higher risk of severe trauma (ISS > 15: 8.8% vs 13.7% vs 17.5% vs 22.0%, p < 0.001). Head injuries followed a U-shaped distribution with pediatric and elderly patients representing the most vulnerable groups. Overall, fractures were the most common type of injury, in the following order: lower extremity 27.3%, spine 24.9%, rib 23.1%, upper extremity 20.1%, and pelvis 10.3%. The overall ICU admission rate was 21.5%; however, it was significantly higher in the elderly (29.1%). In-hospital mortality was 1.8%. The risk of death progressively increased with age with a mortality rate of 0.3%, 0.9%, 1.5%, and 3.6%, respectively (p < 0.001). Strong predictors of mortality were GCS ≤8 on admission (OR 29.80, 95% CI 26.66-33.31, p < 0.001) and age > 65 years (OR 4.07, 95% CI 3.535-4.692, p < 0.001). Only 50.8% of elderly patients were discharged home without health services, 16.5% were discharged to nursing homes and 15.2% to rehabilitation centers.

CONCLUSION

Falls from ladders are associated with considerable morbidity and mortality, especially in the elderly. Head injuries and fractures are common and often severe. An intensified approach to safe ladder use in the community is warranted.

LEVEL OF EVIDENCE

IV.

Evaluation of injury patterns and accident modality in step ladder-related injuries

Step ladders are commonly found in homes and are used for a variety of tasks. While ladders are often associated with fall-related injuries, other accident modes that do not result in a fall can be observed in real-world data. In this study, the available data from the National Electronic Injury Surveillance System database involving step ladder-related injuries was supplemented by a biomechanical consideration of kinematics and injury mechanism to further understand accident modes and injury patterns. Results of this study demonstrated that the most common accident mode was falling (91%), followed by non-fall errors in execution of intended kinematics (non-fall execution errors) (4%) and pinching (1%). Falls were commonly associated with fractures, non-fall execution errors were commonly associated with a strain or sprain, while pinches were commonly associated with lacerations. The results of this study show that during step ladder use in a non-occupational setting, the accident mode is associated with an injury pattern.

Ladder Use in Older People: Type, Frequency, Tasks and Predictors of Risk Behaviours

Ladder fall and injury risk increases with age. People who present to a hospital after an injurious ladder fall have been surveyed, but little is known about ladder use in the community. The purpose of this study was to: (1) document salient factors related to ladder safety, and (2) determine physical, executive function, psychological and frequency-of-use factors associated with unsafe ladder use in older people. One hundred and two older people (aged 65+ years) were recruited. Participants completed questionnaires on demographics, health, and ladder use (type, frequency, task, behaviours) and underwent assessments of physical and executive function ability. Results showed both older men and women commonly use step ladders (61% monthly, 96% yearly), mostly inside the home for tasks such as changing a lightbulb (70%) and decorating (43%). Older men also commonly use straight ladders (27% monthly, 75% yearly), mostly outside the home for tasks such as clearing gutters (74%) and pruning trees (40%). Unsafe ladder use was more common in males and individuals with greater ladder use frequency, greater quadriceps strength, better upper limb dexterity, better balance, better stepping ability, greater self-reported everyday risk-taking, a lower fear of falling, and fewer health problems compared to their counterparts (all p < 0.05). These findings document ladder use by older people and provide insight into unsafe ladder behaviours that may be amenable to interventions to reduce ladder falls and associated injuries.

Individual factors that influence task performance on a straight ladder in older people

Older adults have the highest incidence of domestic ladder falls, but little investigation has been given to this important injury issue. There is therefore a need to understand the influence of individual factors like physical and cognitive ability and psychological status on safe and effective ladder use in this population. This study investigated associations between vision, lower and upper limb sensation, upper limb control, strength, balance, cognitive function and psychological status with task completion time and number of ladder moves taken in a simulated roof gutter clearing task on a straight ladder in 97 older adults. Several measures from upper limb control, strength, balance, processing speed, executive function and psychological domains were significantly associated with the two ladder task performance measures. Upper limb bimanual coordination, knee extension strength, coordinated leaning balance, and self-reported risk-taking were identified as independent and significant predictors of task completion time in a multiple regression model, predicting 56% of the variability in ladder task completion time. Upper limb bimanual coordination and proprioception, simple reaction time and coordinated leaning balance were independent and significant predictors of the number of ladder moves in a separate multiple regression model, predicting 38% of the variability in ladder moves taken. These findings help identify individuals at greater ladder fall risk and can guide ladder fall interventions, such as strength and balance training, ladder design and targeted safety instructions.

Non-occupational falls from ladders in men 50 years and over: Contributing factors and impact

BACKGROUND

Research into falls from ladders in older men in the non-occupational setting is limited, yet such falls are increasing.

AIM

To explore non-occupational falls from ladders in older men presenting to a major trauma centre; identify factors influencing ladder climbing behaviour and explore the post fall impacts.

METHODS

We conducted a retrospective review of medical records of men aged 50 years and older admitted to a major trauma centre following a non-occupational ladder fall between February 2011 and December 2013. Interviews were conducted with a sample of men (and their partners where possible) after discharge from hospital. The Late Life Functional Disability Instrument-computer adaptive testing (LLFDI-CAT) was administered to determine pre-and post-fall function. Basic descriptive analysis was undertaken on medical record data. Thematic analysis was used with the socioecological (SE) model as an interpretive frame.

RESULTS

Of 86 men included in the study (range 50-85 years, mean age 64.7 years), 27% sustained severe trauma. The median length of stay was 4 days. Fourteen interviews were conducted with 19 participants (12 men, 7 spouses). The most salient pre-fall factor was a lack of assessment of risk, reflecting individual and community factors. Post fall impacts were identified in all domains of the SE model. A statistically significant decrease in self-reported post-fall compared with pre-fall LLFDI-CAT scores for interviewed men was found, despite seven having minor trauma (Injury Severity Score [ISS]<12) on admission.

CONCLUSION

Ladder fall injuries cause marked morbidity, often with life changing impacts, even with minor trauma. Contributing factors are multifactorial. Injury prevention strategies should address these factors.

Long term impact of ladder-related injuries as measured by the AQoL instrument

Introduction

Ladder-related falls are a common cause of patients presenting to emergency departments (ED) with serious injury. The impacts of ladder-related injuries were assessed at six-months post-injury using the quality of life, AQoL 4D Basic (AQoL) instrument.

Materials and methods

This was a prospective observational study, conducted and reported according to the STROBE statement. All adult patients with ladder-related injuries who presented to two EDs in southeast Queensland, Australia between October 2015 and October 2016 were approached. Initial participant interviews took place at the time of ED presentation or shortly thereafter, with follow-up telephone interview at six-months.

Results

There were 177 enrolments, 43 (24%) were lost to follow up. There were statistically significant changes post-injury for three of the four AQoL dimensions: independence, social relationships and psychological wellbeing, as well as the global AQoL. Twenty-four (18%) participants reported a clinically significant deterioration in independence, 26 (20%) participants reported a clinically significant deterioration in their social relationships, and 34 participants (40%) reporting a clinically significant deterioration in their psychological wellbeing. Nine of the twelve individual items (in AQoL dimension) deteriorated after injury, there was no change in two items (vision and hearing) and an improvement reported in one (communication). The largest changes (> 25% of participants) were reported with sleeping, anxiety worry and depression, and pain. Across the global AQoL dimension, 65 (49%) participants reported a clinically significant deterioration. The severity of injury as measured by the ISS was an independent predictor of the change in AQoL scores (p<0.001).

Conclusions

Injuries related to falls from ladders continue to have a profound impact on patients at six-months post-injury as measured using the AQoL instrument. This adds to previous research which has demonstrated considerable morbidity and mortality at the time of injury.

Prevention

Older males using ladders at home are at high risk for serious long-term injury. Injury prevention strategies and the safety instructions packaged with the ladder need to be targeted to this at-risk community group. There may also be a role for regulatory bodies to mandate a stabilising device to be included with the ladder at the time of purchase.

Characteristics of stepladder fall injuries: a retrospective study

BACKGROUND

Stepladders are used to work at heights in daily life, but their structure and usage differs from that of a ladder; stepladders can fold and stand without support, whereas ladders cannot fold and, thus, require support from other objects. We hypothesised that this difference made ladder and stepladder fall injuries to differ in characteristics. To clarify this hypothesis, we performed a retrospective cohort study on the stepladder fall injuries and compared their characteristics with that of ladder fall injuries.

MATERIALS AND METHODS

We conducted a retrospective cohort study of injuries sustained from either ladder or stepladder falls. In this study, data were retrieved from the computerised database of Teikyo University Chiba Medical Center. Patients admitted to the orthopaedic department because of injury from ladder or stepladder fall were included. The following data were retrieved from the patient records: sex, age, height, body weight, body mass index (BMI), injury severity score (ISS), season, number of injury sites, details of injury and treatment option.

RESULTS

One hundred thirty-two patients were included in this study. 101 patients were injured from stepladder falls, and 31 patients were injured from ladder falls. The number of females sustaining injuries due to a stepladder fall was significantly higher than those due to a ladder fall. The most frequent type of injury after fall from stepladder was fracture (48.9%), whereas the most frequent type of injury after fall from ladder was contusion/sprain (56.4%). The most frequently injured body part from stepladder fall was lower extremity (32.6%). In contrast, the most frequently injured body part due to a ladder fall was spine (27.3%).

CONCLUSION

The current study found that the number of females sustaining injuries due to a stepladder fall was significantly higher than those due to a ladder fall. Furthermore, the most frequent body parts that needed surgery following a ladder fall injury were spine and upper extremity, whereas the most frequent body parts that needed surgery following a stepladder fall injury was lower extremity. Our study indicated that stepladder falls cause severe injuries and physical disability and can be a huge financial burden.

Accidental adult deaths involving ladders: A forensic perspective

A retrospective study was undertaken of autopsy cases at the Forensic Science South Australia state mortuary over a 20-year period from January 1999 to December 2018 for all cases aged ≥18 years where a ladder was mentioned in the death scene description and/or police reports. Twelve cases were identified, all of whom were male, with an average age of 56 years (range 21–83 years). The most frequent cause of death was a fall from a ladder ( n = 8; 66%), followed by electrocution ( n = 4; 33%). The falls were associated with deaths from blunt injuries, impalement and laceration. The age range of those who fell was 47–83 years (average 66 years). The three of the four deaths associated with electrocutions involved contact with power lines or live electrical wires; the remaining case involved a sharp metal ladder base cutting through a live power lead. The age range of those who were electrocuted was 21–43 years (average 35 years) – significantly younger than those who had died from falls ( p < 0.05). The increase in mean age of the population with increasing popularity of home maintenance activities may result in more cases of lethal falls involving ladders presenting for forensic assessment.

The epidemiology of emergency presentations for falls from height across Western Victoria, Australia

BACKGROUND

In order to implement intervention strategies to prevent falls from height, epidemiological data are needed. The aim of this study was to map emergency presentations for falls from height in residents aged ≥40yr of the western region of Victoria, Australia.

METHODS

Emergency presentations following a fall from height (≥1m) were obtained from electronic medical records for 2014-2016 inclusive. For each Local Government Area, age-standardised incidence rates (per 10,000 population/year) were calculated.

RESULTS

The age-standardised incidence rate was lowest in the Northern Grampians (3.4 95%CI 0.8-5.9), which has several main industries including health care, agriculture and manufacturing. The highest rates occurred in Corangamite (26.0 95%CI 19.9-32.0), Colac-Otway (23.7 95%CI 18.5-28.8) and Moyne (22.5 95%CI 16.8-28.3), which are sparsely populated (15,000-20,000 people each). Patterns were similar for men and women. Most falls occurred during "leisure" (38.0%), followed by "other work" (15.4%). Men were more likely than women to experience a fall from height while undertaking work activities. Many falls occurred in the home (53.2%).

CONCLUSION

Future research should inform strategies to prevent falls from height in the region. This could include specific locations such as the home or farm, and during leisure activities or work.