Ladders: accidents waiting to happen

Real-time monitoring unsafe behaviors of portable multi-position ladder worker using deep learning based on vision data

INTRODUCTION

Fatal fall from height accidents, especially on construction sites, persist, underscoring the importance of monitoring and managing worker behaviors to enhance safety. Deep learning showed the possibility of substituting the manual work of safety managers. However, applying detection results to determine compliance with safety regulations has limitations.

METHOD

This study estimated the actual working height depending on the height of the object detection bounding box by specifying the consistent hinge part as a target marker based on ladder manufacturing regulations. Furthermore, an attempt was made to improve the separation between workers, coworkers, and persons unconnected to ladder activities by applying an optimized loss function alongside an attention mechanism.

RESULTS

The experimental results showed that an average precision increased from 87.60% to 90.44%. The performance of the monitoring unsafe behavior of ladder worker following the Korea Occupational Safety and Health Agency (KOSHA) guide was evaluated by 91.40 F1-Score, which accumulated sorted according to the working height.

CONCLUSIONS

Experimental results show the feasibility of the real-time automate safety monitoring in ladder work.

PRACTICAL APPLICATIONS

By linking the estimated working height and deep learning multi-detection results to established safety regulations, the proposed method shows the potential to automatically monitoring unsafe behaviors in construction site.

Falls from ladders in New South Wales: A data-linkage study

INTRODUCTION

Fall from ladders is increasingly identified as a significant cause of injury and mortality, yet large-scale research into ladder fall outcomes and trends is limited.

OBJECTIVES

To explore the nature and severity of injuries resulting from ladder falls and to determine predictors of Injury Severity Score (ISS) and 6-month mortality.

METHODS

Data were obtained from the New South Wales (NSW) Trauma Registry, Admitted Patient Data Collection and Registry of Births, Deaths, and Marriages on patients aged 15 and over who had major trauma from a ladder fall and were admitted to hospital between January 1st, 2012, and July 31st, 2019. Data linkage and descriptive statistics were carried out alongside bivariate and multivariable regression analysis.

RESULTS

963 patients injured after ladder falls were identified. The mean age was 61.9 years (SD 14.2), 91.0% were male, and 489 (50.8%) were born in Australia. The height of fall was between one and five meters in 827 (86.2%) patients, and the place of fall was home and residential places in 27.5%. The most common body areas injured were the head (26.5%), spine (21.2%) and thorax (20.6%), and the median injury severity score was 17. The median length of stay of patients' in-hospital and intensive care unit was six days and two days, respectively. Six months post-discharge mortality was 6.4%. The unadjusted association between the presence of comorbidities or socio-economic class and ISS or mortality was not statistically significant. Increasing ISS was found to be associated with increasing age (Estimate (Est), 15.2; 95% Confidence Interval (CI), 12.3-18.1) and a fall height greater than five metres (Est, 5.8; CI, 3.2-8.4). Mortality was found to be associated with increasing age (Odds ratio (OR), 1.06; CI, 1.03-1.08) and increasing ISS (OR, 1.19; CI, 1.15-1.24).

CONCLUSION

People presenting to the hospital after falling from a ladder were predominately male, aged over 60 and had fallen in a residential setting. Increasing age and fall height are associated with more severe injuries.

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.

Use of portable ladders - field observations and self-reported safety performance in the cable TV industry

Portable ladders incidents remain a major cause of falls from heights. This study reported field observations of environments, work conditions and safety behaviour involving portable ladders and their correlations with self-reported safety performance. Seventy-five professional installers of a company in the cable and other pay TV industry were observed for 320 ladder usages at their worksites. The participants also filled out a questionnaire to measure self-reported safety performance. Proper setup on slippery surfaces, correct method for ladder inclination setup and ladder secured at the bottom had the lowest compliance with best practices and training guidelines. The observation compliance score was found to have significant correlation with straight ladder inclined angle (Pearson's r = 0.23, p < 0.0002) and employees' self-reported safety participation (r = 0.29, p < 0.01). The results provide a broad perspective on employees' safety compliance and identify areas for improving safety behaviours. Practitioner Summary: A checklist was used while observing professional installers of a cable company for portable ladder usage at their worksites. Items that had the lowest compliance with best practices and training guidelines were identified. The results provide a broad perspective on employees' safety compliance and identify areas for improving safety behaviours.

Danger at every rung: Epidemiology and outcomes of ICU-admitted ladder-related trauma

INTRODUCTION

The incidence of ladder-related falls is increasing, and this represents a disturbing trend, particularly in the context of increased life expectancy and the impending retirement of the populous 'baby-boomer' generation. To date, there have been no critical illness-focused studies reporting on the incidence, severity and outcomes of severe ladder-related injuries requiring ICU management.

METHODS

Major trauma patients admitted to ICU over a 5year period to June 2011 after ladder falls >1m were identified from prospectively collected trauma data at a Level 1 trauma service. Demographic and ICU clinical management data were collected and non-parametric statistical analyses were used to explore the relationships between variables in hospital mortality/survival.

RESULTS

There were 584 ladder fall admissions, including 194 major trauma cases, of whom 29.9% (n=58) fell >1m and were admitted to ICU. Hospital mortality was 26%, and fatal cases were almost entirely older males in domestic falls of ≤3m who died as a result of traumatic brain injury. Non-survivors had lower GCS at the scene (p=0.02), higher AIS head code (p=0.01), higher heart rate and lower mean arterial pressure (p<0.01) in the initial 24h period in ICU, and were ≥55years of age (p=0.05). Only 46% of patients available for follow-up were living at home at 12months without requiring additional care.

CONCLUSIONS

The incidence of ladder falls requiring ICU management is increasing, and severe traumatic brain injury was responsible for the majority of deaths and for poor outcomes in survivors. In-hospital costs attributable to the care of these patients are high, and fewer than half were living independently at home at 12months post-fall. A concerted public health campaign is required to alert the community to the potential consequences of this mechanism of injury. The use of helmets for ladder users in domestic settings, where occupational health and safety regulations are less likely to be applied, is strongly recommended to mitigate the risk of severe brain injury. The benefits of this simple strategy far outweigh any mild inconvenience for the wearer, and may prevent catastrophic injury.

Bicycle helmet use to reduce the impact of head injuries in ladder users

BACKGROUND

The aim of this study was to determine if wearing a bicycle helmet during ladder use could reduce the incidence and severity of head injury in the event of a fall.

METHODS

A headform model with inbuilt accelerometers was used to determine the Head Injury Criterion (HIC) score of head impact by dropping 41 helmeted and unhelmeted headforms from eight heights. These results were compared.

RESULTS

There was a statistically significant difference between averaged HIC scores in helmeted and unhelmeted drops (P < 0.001). Unhelmeted HIC scores ranged from 387 at 0.25 m to 2121 at 0.6 m. Helmeted HIC scores ranged from 29 at 0.25 m to 1199 at 2.5 m. At a height of 0.5 m, the risk of severe brain injury (AIS ≥4) from direct frontal head impact is predicted to reduce from >50% to <5% with helmet use.

CONCLUSION

There was a significant decrease in the HIC scores when helmets are used and it is likely that the benefits would be seen in the clinical setting. These results provide an argument for the use of a bicycle helmets by all ladder users, in particular those over age 50 who are at increased risk of head injuries. We recommend that bicycle helmet use be incorporated into ladder injury prevention strategies.

A Multi Factorial Analysis of the epidemiology of Injuries from Falls from Heights

Background:

Fall from height is a common cause of morbidity and mortality in suburban population in India. These cases are either domestic or workplace injuries with different causative factors. We analyzed different aspects of these falls to identify their risk factors.

Materials and Methods:

We conducted prospective and retrospective epidemiological study to identify various causative, contributory factors, and resultant injuries in cases of fall from height. The study group comprised of semiurban population and involved both domestic and workplace injuries presenting to a tertiary care hospital.

Results:

There were 208 cases of workplace (112) and domestic (96) fall from height. In domestic cases absence of parapet on roof was the commonest cause, most of falls occurred during summer and rainy season. Alcohol consumption prior to fall was commonest associated factor in adult males. Children mostly fell while playing on roof and climbing trees. Among workplace cases, civil construction site injuries were commonest and absence of any protective gear and long working and evening hours were commonest associated factors. Mean injury severity score was 10.86 in domestic cases and 14.87 in workplace cases. There were 17 mortalities with head injury being commonest associated cause. Only difference in incidence of alcohol consumption and permanent disability was statistically significant between workplace and domestic falls.

Conclusion:

Different factors are responsible for domestic and workplace cases of fall from height. Most of these cases are potentially preventable.

Ladder-related injuries treated in emergency departments in the United States, 1990-2005

BACKGROUND

Ladder use is involved in many occupational and non-occupational activities. Falls from ladders can result in serious injury and affect people of all ages. The purpose of this study was to comprehensively examine nonfatal ladder-related injuries on a national level.

METHODS

Using the National Electronic Injury Surveillance System (NEISS) database, cases of nonfatal ladder-related injuries treated in U.S. emergency departments (EDs) from 1990 through 2005 were selected using NEISS ladder product codes. Analysis was conducted from June 2006 to August 2006.

RESULTS

An estimated 2,177,888 (95% confidence interval [CI]=1,885,311-2,470,466) individuals ranging in age from 1 month to 101 years were treated in U.S. EDs for ladder-related injuries during the 16-year study period, yielding an average of 136,118 cases annually, an average of 49.5 per 100,000 people. Males predominated in ladder-related injuries (76.5%, 95% CI=75.8-77.2). Fractures were the most common type of injury (31.5%, 95% CI=30.5-32.6). The body parts most frequently injured were the legs and feet (30.4%, 95% CI=29.5-31.2). Nearly 10% of injuries resulted in hospitalization (8.5%, 95% CI=7.4-9.6) or transfer to another hospital (1.4%, 95% CI=1.1-1.8), approximately twice that of consumer product-related injuries overall. The number of ladder-related injuries increased by more than 50% from 1990 to 2005. Ladder-related injuries per 100,000 people rose almost 27% during the 16-year study period. Of the cases for which locale of injury was recorded, 97.3% occurred in non-occupational settings, such as homes and farms.

CONCLUSIONS

Given the 50% increase in ladder-related injuries during the study period, the relatively high likelihood of hospital admission, and the predominance of injuries in non-occupational settings, increased efforts are needed to prevent ladder-related injuries.

Ladders revisited

OBJECTIVE

To describe the epidemiology of falls from ladders in a state-wide population.

DESIGN AND SETTING

Retrospective review of data from the the Victorian State Trauma Registry and the Victorian Emergency Minimum Dataset on patients presenting to public hospital emergency departments (EDs) with injuries due to a fall while climbing a ladder, from 1 July 2001 to 30 June 2005.

MAIN OUTCOME MEASURES

Overall trends in the incidence of ladder-related ED presentations, and in cases of major trauma, trends according to age, and trends according to activity at the time of the fall.

RESULTS

4553 patients presented to EDs after falls from ladders in Victoria during the study period; 160 patients had injuries classified as major trauma. There has been a significant rise in the number of presentations to EDs following falls from ladders in Victoria, with a marked increase in the number of cases involving patients aged over 50 years and those climbing ladders outside of paid working conditions. Deaths occurred predominantly in the elderly after falls from heights above 1 metre.

CONCLUSIONS

Despite knowledge of the dangers of falls from ladders, there has been a significant increase in the number of patients presenting to hospitals after ladder falls. Middle-aged to elderly patients undertaking unpaid work account for this increase. A targeted public health initiative is required to curb this trend.

Review of morbidity and mortality associated with falls from heights among patients presenting to a major trauma centre

OBJECTIVE

To compare differences in demographics and injuries of patients presenting after falls from heights at home and at work.

METHOD

A retrospective case series review of patients treated by the Royal Adelaide Hospital (RAH) Trauma Service following a fall from a ladder, scaffold, building, or tree between July 2000 and December 2003.

RESULTS

Two hundred and eighty-two patients fulfilled study criteria. The 162 (57.4%, 95% confidence interval [CI] 48.9-60.5) injured at home were significantly (P < 0.001) older (mean age 53.9 years, 95% CI 51.3-56.7) than those injured at work (mean age 41.2 years, 95% CI 38.6-43.8). Injury severity score (ISS) was similar in the two groups. Those injured at home were more likely to be admitted to hospital and have significantly longer hospital stays (P = 0.003). Thirteen deaths were recorded, eight (61.5%) from home, all over 49 years old. Ladders were implicated in seven (53.8%, 95% CI 26.7-80.9) of the deaths. A 67% (95% CI 55.4-79.0) increase in the number of presentations following falls at home over the study period was significantly greater than the 12.2% (95% CI 10.7-13.7) increase in total trauma presentations during this time (P = 0.0007).

CONCLUSIONS

Injuries resulting from falls at home are increasing. This group tends to be elderly and at risk of significant injury and prolonged hospital stays. Causes are multifactorial and might be related to increased popularity of home renovations. Ladders are implicated in many of these accidents. As emergency physicians we should target this population to educate them in safe ladder use.

Work-related ladder fall fractures: identification and diagnosis validation using narrative text

OBJECTIVE

To identify ladder-related fracture injuries and determine how ladder fall fractures differ from other ladder-related injuries.

METHODS

Ladder-related fracture cases were identified using narrative text and coded data from workers' compensation claims. Potential cases were identified by text searches and verified with claim records. Injury characteristics were compared using proportionate injury ratios.

RESULTS

Of 9826 ladder-related injuries, 7% resulted in fracture cases. Falls caused 89% of fractures and resulted in more medical costs and disability days than other injuries. Frequent mechanisms were ladder instability (22%) and lost footing (22%). Narrative text searches identified 17% more fractures than injury codes alone. Males were more likely to sustain a fall fracture than other injuries; construction workers were most likely, and retail workers were the least likely to sustain fractures.

CONCLUSIONS

Fractures are an important injury from ladder falls, resulting more serious consequences than other ladder-related injuries. Text analysis can improve the quality and utility of workers compensation data by identifying and understanding injury causes. Proportionate injury ratios are also useful for making cross-group comparisons of injury experience when denominator data are not available. Greater attention to risk factors for ladder falls is needed for targeting interventions.

Available friction of ladder shoes and slip potential for climbing on a straight ladder

Straight ladder accidents are a major safety problem. As a leading cause of injuries involving straight ladders, slips at the ladder base occur when the required friction exceeds the available friction at the ladder shoe and floor interface. The objectives of this experiment were to measure the available friction at the base of a portable straight ladder in contact with a floor and to estimate the slip potential of the ladder. The results of friction measurements indicated that the measured friction coefficient on the oily surfaces differed among the six commercially available ladder shoes evaluated. A statistical model was used to compare the available friction results from the current study with the friction requirements under different climbing conditions from a previous study based on their stochastic distributions to estimate the slip potential at the base of the ladder. The results showed that different climbing conditions used in the previous study could be supported by available friction on dry surfaces. However, when the ladder was put onto oily surfaces, resulting in a significant reduction in the available friction due to contamination, slip potential was significantly increased.