The 'Surprising' Realities of Slips, Trips & Falls: What It Takes to Actually Make Significant Improvements

What you think helps actually can make things worse. For example, increasing coefficient of friction can increase trips when footing "sticks" on a surface.

• By Robert Pater
• Dec 01, 2017

Along with seasonal greetings, many companies think this is prime time for slips, trips, and falls (ST&F). However, while wet and cold weather can certainly contribute to these problems, ST&F are universal anywhere and any time people step. For all ages, in all occupations, all locales, indoors and out—not just slippery or object-strewn sites. But despite lots of attention, time, and resources directed toward reducing these, ST&F persist as a significant problem for innumerable companies and for many people personally, throughout the world.

In fact, some organizations seem to have "fall prevention fatigue," as if weary and frustrated from trying different approaches with few tangible improvements (though many of these interventions are variations on a similar approach). They focus on cleaning up walking surfaces, improving lighting, covering cords and cracks, mandating better footwear, repairing stairs and secured matting, increasing coefficient of friction and more. Yet people still continue to fall. The "fatigue" emerges from the frustration they've tried everything they know and that just doing more of the same won’t make a difference.

So what's next for them? Some place ST&F prevention efforts on the back burner. Others sadly accept these pervasive problems as inevitable. Some, attempting to do "something," settle for band aid approaches, like putting up posters or other reminders to "pay attention" or "slow down" when walking.

While all above have merit, they clearly aren't enough to make sizable reductions in ST&F. And there are real reasons why. First, it's not possible or cost-effective to control and keep spotless all walking surfaces. Change happens, whether weather or spills or just because we don't all live and cross through perfectly smooth, even dry surfaces—or even always indoors. And people even fall in "safe" areas. Further, reminders alone have clearly proven not to be enough. But I can tell you that ST&F do have solutions. However, this requires moving beyond "same-old" strategies that may have likely helped, but only to a point of plateau.

The leader's necessary starting point is being willing to consider a different approach. Consider these:

• Same-level falls and others below "height" can have serious, even fatal, repercussions. Do you, like me, know of anyone who has sustained serious injury from falling onto a same-level surface or from just a few stairs up?
• Balance loss occurs so frequently that many high-level Safety leaders have privately acknowledged these are among their most under-reported injuries. Perhaps because people feel embarrassed from having fallen? Or because there's a long history of "pratfalls" being good for an easy laugh in movies?
• Slips and trips don't necessarily cause falls. Have you ever skidded on a slippery surface but not fallen? That's because . . .
• . . . what actually causes falls is NOT slippery surfaces or trip hazards. The only reason people ultimately fall is because of their upper body not being aligned over their lower body while they're on the move. People rarely fall when just standing still (if this happens, it's likely a medical rather than Safety issue). So the key to prevention is alignment while in motion. A poster campaign is very unlikely to transfer the skills required to maintain balance while on the move, but most people can learn these to a higher degree relatively easily.
• In trips, it's often the "little things" that get you. Making contact with a waist-high obstacle may hurt, but it's unlikely to create a trip—these are more due when a moving foot is even momentarily stopped (or slowed) by an obstacle that's knee-level or below.
• What you think helps actually can make things worse. For example, increasing coefficient of friction can increase trips when footing "sticks" on a surface. Similarly, non-skid mats can wear down and actually become a slip hazard. Or, if they are sporadically placed, they require ongoing adjustments in walking over multiple changes in friction, which can contribute to balance loss. Such mats can help—when strategically placed and well maintained.
• ST&F are related to other problems, such as drops and bodily reaction injuries.
• Aging can make ST&F worse. Vision changes can translate into lowered ability to see well on stairs or in lower-light settings. Sway studies reveal that older brains and nervous systems tend not to react/compensate as quickly for reductions in balance. And stiffness (due to age-related collagen breakdown) can also contribute to ST&F. Further, sarcopenia (age-related muscle loss) is also a factor. And if they do fall, aging workers tend to take longer to heal. However, even older workers can also greatly improve balance with the right practice. For those inclined to a great deal of practice, tai chi can significantly help. But much shorter-term training can quickly impart balance-strengthening skills.

Like many other companies, US Steel, Gary Works (Indiana) has an aging workforce. They've developed groups of selected US Steelworkers, Local 1066 as peer Instructor-Catalysts who have trained co-workers in balance skills. To make this as practical as possible (without increasing risk of injury during training), they constructed props to simulate different forms of real-life balance pitfalls, including stepping over and under and walking and carrying up and down ramps. Participants in their training have the opportunity to practice specific balance principles and techniques, for example, while ducking under a limbo rack—allowing them to learn, feel, and practice a more comfortable approach to stepping under an obstacle, on stairs, and while walking through a simulated spill. They also built a wood mock bathtub wall to demonstrate the balance principles necessary to exit a bathtub safely, extending their work site training to family and at-home situations. (And they presented their excellent safety results at the 2017 National Safety Congress.)

The default of seeking to finely control external environments only takes you so far. To make significant and lasting improvements in tenacious ST&F, it's essential to also transfer the rights skills that actually place people in better control by upgrading their decisions and own balance.

This article originally appeared in the December 2017 issue of Occupational Health & Safety.