Balancing Safety: Overcoming Surprising Contributors to Slips, Trips, and Falls

Even with aging workforces, injuries can be greatly reduced with a blend of best engineering controls and practical training.

Have you, like me, experienced the mental rush, that fear-fueled surge of adrenaline when your balance becomes compromised and a fall seems imminent? Admittedly, I've still experienced this despite having practiced internal martial arts for several decades and having developed and transferred advanced balance skills to thousands. I assume that others have these moments as well, resulting in near-hits and even worse.

For on-the-move beings, with every step we take there's the inevitable risk of slipping or tripping. Now add in the sheer number of exposures; according to Steven Di Pilla in "The Slip, Trip and Fall Handbook": "Each person takes an average of 5,000 to 7,000 steps a day." (Note: Those wearing step trackers aspire to a minimum of 10,000/day.) Given that even just walking on a smooth surface is a process of risk and recovery, consider the more active you are—and I hope you are, to boost your health, safety, and longevity—plus the more cluttered, uneven, mushy, or slippery terrain you cross, the higher your risk of losing balance becomes.

I've written numerous articles overviewing practical methods for preventing slips, trips, and falls. But despite the ongoing efforts of uncountable Safety professionals and other company leaders—not to mention parents and relatives reminding their loved ones—slips, trips, and falls stubbornly persist in work-, home-, and recreational-places around the world. (The Liberty Mutual 2018 Workplace Safety Index list "Falls To Same Level" as the #2 leading cause of disabling workplace injury costs and "Slips or Trips Without Falling" as #7.)

I've read many sources that contend falling is the ultimate default fear, the first one everyone has as an infant. It turns out there are numerous medical studies on "Fear of Falling." (In fact, there's an accepted acronym for this in the literature: FoF.) Understandably, many subjects in these studies are older, likely for two reasons: First, falls become more prevalent as people age because physiological changes can weaken balance. These include: loss of sensitivity in the inner ear nerves that detect shifts in equilibrium, increased osteoporosis (lowered bone density), sarcopenia (age-related muscle loss) that decreases the physical strength required to maintain balance/counter pull of gravity, collagen breakdown and other factors that limit range of motion, diseases/age-related syndromes such as diabetes, reduced clarity of vision and lessened ability to see in dimly lit areas, brain changes that make it more difficult to quickly shift attention (to detect changes of upcoming hazards). Second, the repercussions of falls worsen with age: more severe injuries that often take longer to heal.

The well-regarded 2017 medical FISTAC study concluded that once someone had experienced a fall, the person was more likely to be afraid of another one. While this might seem obvious, another finding based on this study was less so. Young and Williams reported in the journal Gait & Posture that the very Fear of Falling can serve as a self-fulfilling prophecy, that someone afraid to fall is actually more prone to fall again. In other words, the fear leads to their acting in ways that make them less safe! This seems to go counter to what many leaders believe: that once someone is genuinely concerned about a risk, he's more likely to be motivated to actually reduce that risk. The researchers explained that fear "influences balance performance and fall-risk," attributing this to "stiffening behavior." In other words, FoF can lead to extra tension at the first sensation of losing balance. That this stiffening up makes it more likely a person will fall rather than be able to regain their balance, turning what would otherwise be a near miss into an actual impacting fall.

I can tell you from the experience of taking thousands (no exaggeration) of falls—mostly on a jujitsu mat, but regrettably, several which came as surprises on much harder, more unforgiving surfaces—that, first, controlled relaxing (not like a limp rag) with a trained mindset and simple physical skills are critical to recovering initial loss of balance and that, second, if you can't prevent the fall, that being calm and ready to position your body in best protective ways can significantly increase the likelihood of not becoming as injured (reduce potential severity). While these studies focused on older people, my experience is they also apply to everyone. So what can be done?

1. Understand that slips, trips and falls are complicated because physical balance has a wide range of components affecting it: environmental, physiological, and mental.

2. Recognize and accept that not every risk can be erased. Of course, employ the range of traditional engineering controls to prevent slips/trips/falls, but understand these have limits, whether due to environments that are uncontrollable (or it's cost-ineffective to do so), exposures off work, weather-related issues, attentional changes/distractions, changes in coefficient of friction from transitioning to different surfaces, and much more.

3. Put people more in control of their own Safety. The right training (with reinforcement) can transfer skills relatively quickly that dramatically enhance balance while on the move in a wide array of scenarios. Some organizations (e.g., U.S. Steel, Savannah River Remediation) are combining high-level training with practice on a mobile slip/trip simulator and employing props for stepping over objects to help enhance balance.

4. Reduce FoF. Not by talk or persuasion or showing pictures/videos, but by training muscle memory that builds the habit of relaxing and positioning to regain balance at the first internal sign of its being shaken. When done simply, clearly, and safely (not putting people at undue risk during Safety training), this can be extremely effective. In other words, replace fear with real skills. And enlist Mental Rehearsal to reinforce change.

Slips, trips, and falls persist as significant injuries affecting millions worldwide, resulting in severe losses. But even with aging workforces, these injuries can be greatly reduced with a blend of best engineering controls and practical training.

This article originally appeared in the December 2018 issue of Occupational Health & Safety.

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