Falls from Ladders: A Seasonal Hazard

Contents

I Introduction
II Not Our Typical Fallers
III A Campaign for Change
IV Key Prevention Messages and Resources
V Conclusion
VI References

--Submitted by Stephanie Cowle, Ontario Injury Prevention Resource Centre (OIPRC)

I Introduction

Falls data consistently identifies two high-risk age groups – young children and older adults. Accordingly, fall prevention efforts focus heavily on these populations. Within the past year, the Ontario Injury Prevention Resource Centre’s (OIPRC) discussions with injury prevention staff from Ontario’s public health units and lead trauma hospitals have revealed an interest in addressing falls among the “ignored” age group – young and middle-aged adults. This summer, the OIPRC was thrilled to partner with the Ontario Neurotrauma Foundation (ONF) and University of Toronto to present a webinar on adult falls, examining the scope of the issue and approaches to prevention.

One category of falls that disproportionately affects adults is falls from ladders. While we may naturally assume this is largely an occupational safety issue, significantly more ladder falls occur at home than in the workplace. These falls also occur in higher numbers between July and December. Particularly at this time of year, when Ontarians are bringing out their ladders to hang seasonal decorations or clear away rooftop snow, this issue deserves a closer look.

II Not Our Typical Fallers

The majority of injurious falls occur among young children (0–6 years) and older adults (aged 65 and over). And, as age increases, we know that fall risk ultimately becomes higher for females than for males. Yet, in the specific case of falls from ladders, those at highest risk are a completely different population; the typical faller in this scenario would most likely be male and in middle adulthood.

Sex
Males are overrepresented among those seeking medical care after ladder falls. In 2014/15, males accounted for 82% of hospital admissions and 81% of emergency visits in Ontario.

Age
The rates of falls from ladders start to rise much earlier in adulthood than other types of falls. Whereas rates for falls typically continue to increase with age, the rates for ladder falls begin to decrease again in the later years. This rise and fall creates a peak in middle age. When we look over the last five years of data in Ontario, emergency visits peaked in 50–54 year olds, and hospital admissions in 60–64 year olds.  According to 2009/10 Ontario trauma data, trauma hospitalizations for these injuries peaked in 55–64 year olds (CIHI, 2011).

Looking at injury counts, these are heavily concentrated in middle adulthood as well. Ontario saw 8,678 emergency department visits for ladder falls in 2014/15, with 3,913 of the patients (45%) being between the ages of 45 and 64. Additionally, 486 of the 1,112 patients admitted to hospital (44%) were in this same age range.

III A Campaign for Change

Resources, training, and education about ladder safety in the workplace are widely available (Volpe, 2014). We do not find the same level of awareness and intervention for home ladder use. The home environment certainly presents unique challenges compared with the workplace, not having systems of supervision, training, policy, and enforcement in place. That said, the injury prevention field could consider adapting resources already generated by the occupational sector for a broader audience.

Dr. Richard Volpe’s (2014) research on mid-life fall prevention highlights a successful initiative from New Zealand, a campaign titled DIY Falls: Take Time Before You Climb. The campaign was built on multiple components, including media coverage, event and trade show participation, point-of-sale training (at hardware stores, for instance), and a ladder amnesty where community members could trade in shoddy ladders for new ones at a discount. The impact evaluation of the campaign showed an 86% commitment to behavioural change in respondents. In addition, 58% reported they had spoken to others about the issue.

Read more about the DIY Falls campaign: www.onf.org/system/attachments/294/original/MLF_COMBO_RS_Fin_Dec_14.pdf  

IV Key Prevention Messages and Resources

As a start, there are some key tips we can promote – and use ourselves at home – for safer ladder use in any season:

  • Select an appropriate, CSA approved ladder for the task you are performing.
  • Check the ladder for any defects, such as loose screws or cracks, and make sure the rungs are dry.
  • Place the ladder where access is not obstructed, and especially away from unlocked doors.
  • Place the ladder on level ground and open it completely, making sure all locks are engaged.
  • When using a ladder outdoors, choose a location that is well away from all power lines.
  • Always face the ladder when climbing and wear slip-resistant shoes.
  • Ensure hands and feet are free from oil, grease or other substances before climbing a ladder.
  • Stand at or below the highest safe standing level on a ladder. For a stepladder, this is the second rung from the top. For an extension ladder, it’s the fourth rung from the top.
  • Take the time to move the ladder as necessary to avoid overreaching. If your belt buckle crosses either side of the ladder you are reaching too far.
  • The distance from the feet of an extension ladder to the wall should be no more than 1/4 to 1/3 of the height on the wall it is reaching. (OIPRC, 2009)

For further information, the following resources are freely available:

Adult Falls in Ontario (webinar slides, audio recording, and related resources)
http://www.oninjuryresources.ca/webinars/item/everyones-falling-but-me-a...

Diagram: Ladder Safety at Home (Preventable)
http://preventable.ca/media/Holiday-Ladder_Safety.pdf

Portable Ladders Fact Sheet (Canadian Centre for Occupational Health and Safety)
http://www.ccohs.ca/oshanswers/safety_haz/ladders/portable.html

Step Ladder Fact Sheet (Canadian Centre for Occupational Health and Safety)
http://www.ccohs.ca/oshanswers/safety_haz/ladders/step.html

Posters: Ladder Falls (Preventable)
Version 1: http://preventable.ca/media/preventable_poster_falls_extrafoot.pdf
Version 2: http://preventable.ca/media/preventable_poster_falls_ladder.pdf

V Conclusion

Fall prevention targeted to adults under the age of 65 is an area still in need of exploration, particularly for identifying effective interventions. Based on the needs of Ontario’s practitioners, the OIPRC will continue to work with our partners to add to this knowledge base.

Additional data on injuries from ladder falls in Ontario will be released in the OIPRC’s December Ontario Injury Compass report.  Visit the OIPRC website (http://oninjuryresources.ca/compass) or subscribe to receive the Compass automatically by emailing [email protected].

VI References

Canadian Institute for Health Information. (2011). Ontario Trauma Registry 2011 Report: Major Injury in Ontario, 2009-2010 Data. Ottawa: CIHI.

OIPRC. (2009). Falls from ladders. Ontario Injury Compass, 6(12). Toronto: SMARTRISK.

Ontario Ministry of Health and Long-Term Care: IntelliHEALTH Ontario.

Volpe, R. (2014).  Best Practices in the Prevention of Mid-life Falls in Everyday Activities. Toronto: Ontario Neurotrauma Foundation.


The Ontario Injury Prevention Resource Centre, housed at Parachute, supports practitioners to reduce injury in Ontario.

The OIPRC is supported by Public Health Ontario, the Ministry of Health and Long-Term Care, and the Province of Ontario. The views expressed in this article are the views of the OIPRC and do not necessarily reflect the views of Public Health Ontario, the Ministry of Health and Long-Term Care or the Province of Ontario.