consumer product-related injury (3): injury related to the … injury surveillance unit hazard 63...

VICTORIAN INJURY SURVEILLANCE UNIT HAZARD 63 page 1

Hazard(Edition No. 63)Winter 2006Victorian Injury Surveillance Unit (VISU)

www.monash.edu.au/muarc/visu

Monash University

The focus of this issue is ladder injury, a major cause of consumer product-related fatal and hospital-treated injury in Victoria.

Summary• Ladder use was related to at least 12

deaths and 5,004 hospital treatedinjuries over the two-year periodcovered by this study (2002/3-2003/4). Most ladder-related injuriesoccurred in the home.

• All 12 ladder-related deaths and 93%(n=4661) of the hospital-treatedinjury cases (admissions and E.D.presentations) were caused by falls.

• The all-person hospital admissionrate for ladder fall injuries increasedby 40% over the decade 1994-2004from 15.8 admissions per 100000 inthe period 1994/7 to 22.2 admissionsper 100000 in the period 2001/4.

• All ladder fall fatalities were maleand males comprised 81% ofhospital-treated ladder fall injurycases, probably reflecting higherexposure to ladder use among malescompared with females.

Consumer product-related injury (3):Injury related to the use of laddersErin Cassell and Angela Clapperton

• Ladder fall fatalities and injury casespeaked in middle-aged and oldermen. Persons aged 60 years andolder were more likely than theiryounger counterparts to be admittedto hospital for ladder fall injuries.Forty-three percent of hospitaladmissions for ladder falls were aged60 years and older compared withonly 25% of E.D. presentations (non-admissions).

• Most ladder fall fatalities occurredin the home, and involved men agedin their 60s-80s undertaking homemaintenance (repairs, painting,cleaning out gutters) or gardeningtasks (pruning, picking fruit).Because of their age and state ofhealth many of the deceased shouldnot have been working from a ladderat height. Several cases involvedunsafe ladders/scaffolding or unsafeladder use practices.

• Available data indicate that around70% of hospital-treated ladder fallinjuries occurred in the home,compared with around 20% in thework place.

• Common mechanisms of ladder fallinjuries in the home and theworkplace were ladder slideout andsideways tilting, user slip or misstep,user loss of balance and ladder fault/malfunction.

The strict work at height regulationsrecently introduced into Victorianworkplaces stand in stark contrast to thelack of controls and preventive actionon falls while working at height (mostlyfrom a ladder) in the home environment,where the majority of fatal and seriousfall from height injuries occur.

Vehicle jack injuriesA short report see page 16

Accident Research Centre


A multifaceted approach is needed toreduce ladder-related injuries that occurin the home including: innovations inladder accessories (eg. attachment pointson houses); design solutions to reducethe overall need to use ladders forcleaning and maintenance tasksperformed at heights (eg. the broaderadoption of self-cleaning glass, re-designed guttering and the use of roofgutter guards); design measures tominimise sliding or tipping risks andslipping on rungs or steps; socialmeasures to reduce ladder use by olderpersons for home maintenance tasks; andcommunity education and training onsafe ladder use for home maintenancetasks.

Introduction

This is the third consecutive edition ofHazard focused on groups of consumerproducts that make significantcontributions to hospital-treated injuryin Victoria. In Hazards 61 and 62 wehighlighted playground equipment injuryin children and mobility scooter injuriesin older adults respectively.

As stated previously, current injurysurveillance data collections cannotidentify the level of involvement of theproduct in the injury because of thelimited amount of data collected on eachcase. Products may be involved in injurycausation at a number of levels: physicalfailure (design or manufacturing faultsand lack of maintenance); inadequatedesign (for normal use, for use by targetage or ability groups, for foreseeablemishandling or misuse and for protectionof bystanders); inadequate instructions/safety warnings; and in ways notinfluenced by any shortcomings of theproduct due to misuse beyond theinfluence of the supplier and unforseenhuman and environmental factors (ACA,1989).

The level of evidence required to prove acausal relationship between product andinjury can only come through in-depthanalytical research studies.

Method

Ladder fall deaths in 2002 and 2003 wereextracted from the Australian Bureau ofStatistics Death Unit Record file (ABS-DURF) held by VISU, and obtained fromthe National Coroners InformationSystem (NCIS).

Hospital-treated ladder injury cases for theperiod July 2002 to June 2004 were extractedfrom two datasets held by VISU: the VAEDwhich records all Victorian public andprivate hospital admissions; and theVEMD which included presentations datafrom 28 of the 35 Victorian public hospitalemergency departments for 2002/3 and all37 hospitals with 24-hour EmergencyDepartments from the beginning of 2004.

Deaths were excluded from the VAED toavoid double counting fatalities on theABS-DURF (and NCIS). Deaths andadmissions were excluded from the VEMDto avoid double counting of fatalities andhospital admissions on ABS-DURF andthe VAED, respectively.

The method for extracting data is describedin more detail in Box 1 and relevant dataissues with respect to completeness andquality are discussed within the report andin Box 2.

Ladders provide convenient access toheights for the performance ofmaintenance duties in the home andworkplace but their use is associated withan injury risk, mainly due to falls fromheight. The aim of this study was toanalyse the latest available injurysurveillance data on ladder-relatedfatalities and hospital-treated injuries toinvestigate the size, pattern, contributoryfactors and circumstances of injury forprevention and research purposes.


Frequency, gender and age of all hospital-treatedladder injury cases, July 2002-June 2004 (n=5,004)

Table 1Results

All ladder-related injury

Over the two-year study period (2002and 2003 for fatalities and 2002/3-2003/4for hospital-treated injury), there were atleast 12 ladder-related deaths (all theresult of falls) and a further 5,004hospital-treated ladder injury cases.These figures are underestimatesbecause of a number of coding and othershortcomings of the datasets from whichdata were extracted (see Box 2).

All of the 12 ladder fall deaths recordedon ABS-DURF in the two-year period2002-3 were male and two-thirds wereaged 60 years and older. The alternativesource of injury fatality data is the NCIS.A word search for ‘ladder’ in reports onthe NCIS (Victorian cases only) found21 fatalities involving ladders (all falls)six of which were attributed by theCoroner to natural causes (coronaryartery atherosclerosis, ischaemic heartdisease and heart attack) rather than tothe ladder fall injuries. Of the 15remaining records there were threeunwitnessed cases where the fall mayhave been from scaffolding or a roofrather than from the ladder in use at thetime of death (Table 1).

Eighty-one per cent of hospital treatedladder injury cases were male (n=4,053)and 32% of all cases were aged 60 yearsand older (n= 1,608) (Table 1). Over three-quarters (78%) of the hospital treatedinjury cases (n=4,661) were caused byfalls. In the next section the fall and non-fall ladder injury cases are analysedseparately.

Source: VAED (admissions) and VEMD (non-admissions)

Ladder-related fall injury

Ladder fall deaths (n=12-15; 6-8per year)

During 2002 and 2003, there were 12ladder fall deaths recorded on ABS-DURF

and 15 cases recorded on NCIS fromreports to the Victorian Coroners Office.The difference in case numbers is theresult of differences in the period in whichthe death is registered and uncertaintyabout the circumstances of the fall (someunwitnessed fall deaths recorded onNCIS may have been from the roof orother high structure rather than from theladder in use at the time of death). Thelack of detail on ABS-DURF makes itimpossible to fully reconcile cases.

Most fatalities recorded on both systemswere the result of head trauma. All weremale. The 12 decedents recorded on theABS-DURF were aged between 37 and83 years, with a mean age of 65.3 years,two-thirds of whom were aged 60 yearsand older (n=8). Both data systemsshow that three fatalities occurred whenthe decedent was working for an income,the remainder (except one case recordedon NCIS) occurred in the decedent’shome.

The NCIS narratives provide more detailon the circumstances of the ladder falls(Table 2). At least two of the three work-related cases involved unsafe ladder practicesaccording to coronial findings. All fatal ladderinjury cases that occurred in the home involvedmales aged in their 60s, 70s and 80s undertakinghome maintenance (repairs, painting, cleaningout gutters) or gardening tasks (pruning,picking fruit). Because of their age and stateof health many of the decedents should nothave been working from a ladder at height.Several cases involved unsafe ladders/scaffolding or unsafe ladder use practices.

Hospital-treated ladder fallinjuries (n=4,661; yearly average2,330)

Falls are the major cause of hospital-treated ladder injury. In total there were4,661 ladder fall injury cases recorded onhospital injury surveillance databasesover the two-year period July 2002 toJune 2004: 2,197 hospital admissionsrecorded on the VAED; and 2,464

Hospital admissions

(n=2,231)

Hospital ED presentations (non-admissions)

(n=2,773)

All cases

(n=5,004) Falls

VAED n

Non-falls VEMD

n

Falls VEMD

n

Non-falls VEMD

n

n (%) Frequency Gender (n=4988) Male Female Age (n=5001) 0-14 15-29 30-44 45-59 60-74 75+ Mean age

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47 142 371 698 659 280

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1163(23) 1514(30) 1197(24)

408(8)


Details of ladder-related fatalities recorded on the NCIS (n=15 cases) Table 2

Source: National Coroners Information System. Cases reported to the Victorian Coroners Office, published with the permission of the VCO.

Demographics C ircum stances of ladder-related death M ale aged in his 30s, working for an income (painting)

The deceased, a self-employed painter, w as contracted to paint fascia o f building. He and his workmate constructed scaffo lding and ladder structure to reach required height o f 7 .8m . Deceased was pain ting from ladder p laced on scaffo lding when w orkmate heard yell and w itnessed scaffold ing collapsing and deceased sliding down wall, then tip and fall head first to the ground. He lost consciousness and suffered cardiac arrest. Worksafe inspectors later determined that scaffold ing had not been constructed correctly and d id not comply w ith Austra lian Standards.

M ale aged in 40s, working for an income (carpentry repairs)

The deceased was a self-employed carpenter, contracted to replace section o f w eatherboards and other maintenance on a tw o-storey residence. When the homeow ner returned home, he found the deceased on the ground seriously in jured . He either fell from the extendable ladder or the roof.

M ale aged in 40s, working for an income (painting)

The deceased, a sub-contracted painter, was contracted to paint the fascia o f a house under construction . A fter he failed to return home from work, family and police a ttended the construction site and found him on the ground with fata l injuries and a ladder lying underneath him . It appears that he w as attem pting to reach the mezzanine level by ladder and the ladder may have slipped due to saw dust on the concrete floor.

M ale, aged in his 70s, help ing out at his son’s p lace of business (structural alterations)

The deceased was assisting a t his son’s place of business removing a flue from the ceiling. He had successfu lly lowered flue from the roof using a rope and was observed measuring hole in roof. The witness left the room and when he returned he found the deceased lying on the ground after apparently fa lling from the ladder.

M ale aged in his 60s, home m aintenance

The deceased was found lying on the floor by his wife. Workmen, who w ere at the house earlier, to ld her that they had seen him climbing a ladder. A CT scan revealed a fracture o f the skull and extensive subdural b leeding. The deceased had a h istory of insulin-related fits and complained o f feeling unw ell on the day of h is death.

M ale aged in his 60s, home m aintenance (fixing shade clo th)

The deceased w as helping his son put up shadeclo th on h is front verandah. When descending from the ladder from the roof he fell (possibly slipped) and landed on a tiled surface. He was transported to hospital unconscious and died from the head in juries he received in the fa ll.

M ale, aged in his 60s, home m aintenance (working on roof)

The deceased w as located lying on the paving in the rear yard o f his home, with a 4-5 metre ladder lying beside h im in a position that indicated he had been working on the roof, which was four metres o ff the ground. He had suffered head in juries and a broken leg and died in hospital post-surgery. He had a history of falls.

M ale, aged in his 70s, pruning trees

The deceased had been out pruning trees and was located lying on the ground with the ladder underneath h im . He died a fter being conveyed to hospita l by ambulance.

M ale, aged in 70s, home maintenance

The deceased w as found on his back on the concrete garage floor next to a w orkbench w ith a m etal edging. In close proximity w as a 1.1 metre twisted and broken metal ladder. It appeared that the deceased had fallen from the ladder and h it his head on the metal edge of the bench. He died la ter in hospita l.

M ale, aged in his 80s, home m aintenance (painting)

The deceased fell from ladder while pain ting h is garage door. He was on the second rung w hen he felt unw ell and fell backwards lacerating his scalp . He had 10 su tures for the scalp w ound. Neurological exam and CT scan were normal but he d ied la ter in hospita l.

M ale aged in his 80s, activity not detailed

The deceased fell from the second rung o f a ladder, hitting his head on concrete. He d id not lose consciousness or seek immediate m edical assistance. Later that same evening, he was in intense pain and felt dizzy and vomited when being driven to hospita l. After being assessed by doctor he lapsed into unconsciousness, a CT scan revealing a right subdural haematoma and subarachnoid haemorrhage. He later died .

M ale aged in his 80s, home m aintenance (cleaning roof gutters)

The deceased fell from ladder suffering serious head injuries. Police inspected the ladder and reported it w as made of tim ber, was in a rickety condition and had fallen apart.

M ale, aged in his 70s, home m aintenance (repairing roof)

The deceased was repairing h is roof. H is wife found him lying on the concrete path below the roofline unconscious and bleeding.

M ale, aged in his 70s, p icking olives

The deceased, picking o lives with h is friend using two ladders tied to the tree from either side, fell from his ladder and struck his head on a paved path in his garden. He had undergone a procedure (to clear a blocked artery) 9 days prior to the accident and had been to ld not to over-exert h imself for tw o w eeks.


Yearly trend in ladder fall injury admission ratesby gender July 1994-June 2004

Emergency Department presentationsrecorded on the VEMD. The VAED onlyidentifies ladder falls, whereas the VEMDpotentially can capture data on all causesof ladder injury in the case narrative.Available VEMD data (which are notcomplete) indicate that falls cause 97%of ladder injury admissions and 89% ofE.D. presentations for ladder injury.

Yearly trendFigure 1 shows the trend in hospitaladmissions for fall injury from laddersover the decade July 1994 to June 2004.To reduce the effect of year-to-yearfluctuations, this analysis compares the3-year average admission rates at thestart of the decade to the 3-year averageat the end:• The all-person admission rate for

ladder falls increased by 40% overthe decade from 15.8 admissions per100,000 in the period 1994/7 to 22.2admissions per 100,000 in the period2001/4.

• The male admission rate increasedby 39% from 26.2/100,000 in theperiod 1994/7 to 36.3/100,000 in theperiod 2001/4.

• The female admission rate increasedby 48% from 5.7/100,000 in the period1994/7 to 8.4/100,000 in the period2001/4.

Age and genderFigure 2 shows the average annual rateof ladder fall injury admissions by ageand gender for the two-year period July2002 to June 2004. The hospitaladmission rates increased almostexponentially up to the age of 74. Malehospital admission rates were higherthan female rates in all age groups except0-4 year olds, with the highest ratesoccurring in males aged 65 to74 years.

Figure 1

0.0

10.0

20.0

30.0

40.0

1994/95 1995/96 1996/97 1997/98 1998/99 1999/00 2000/01 2001/02 2002/03 2003/04

year of admission

rate

per

100

,000

male

all persons

female

Source: VAED (admissions)

Average annual rate of ladder fall injury admission byage and gender July 2002-June 2004

Figure 2

Source: VAED (admissions)

0.0

20.0

40.0

60.0

80.0

100.0

120.0

age group

rate

per

100

,000

all persons

male

female

all persons 3.3 2.5 1.7 2.9 7.6 10.3 13.8 14.4 21.2 30.9 37.4 44.1 55.4 61.8 61.2 55.1 44.4 28.6

male 2.6 3.6 2.7 4.7 13.5 18.3 26.2 25.3 35.5 53.5 63.8 63.3 89.2 103.9 105.6 94.8 77.9 61.4

female 4.0 1.3 0.6 0.9 1.5 2.3 1.8 3.7 7.1 8.9 11.7 25.1 21.4 21.9 21.3 23.8 22.7 13.6

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+

Pattern of injuryTable 1 summarises the frequency andpattern of hospital admissions and E.D.presentations for ladder fall injuries.

• Males account for 81% of bothadmissions and E.D. presentations,probably reflecting their higherexposure to ladder use.


Frequency and pattern of hospital-treated ladder fall injury, July 2002-June 2004

Source: VAED (admissions) and VEMD (non-admissions)Notes: (1) In more than 40% of admitted cases the activity when injured was not specified. Analysis of activity for admissions excludes cases

coded to ‘unspecified activity’.(2) In almost half of admitted cases the location was not specified. Analysis of location for admissions excludes cases coded to

‘unspecified location’.(3) The ‘leisure’ code on the VEMD is used as a default code in some hospital systems. It is likely that a large part of the 34% of cases

coded to ‘leisure’ should have been coded to ‘Other types of work-unpaid’, which covers home maintenance and gardening.

Table 3

Ladder fall admissions

Ladder fall ED presentations

(non-admissions) All Ladder fall hospital-

treated injuries (n=2,197) (n=2,464) (n=4,661) Frequency Proportion Frequency Proportion Frequency Proportion Gender Male 1,776 80.8 2,001 81.2 3,777 81.0 Female 421 19.2 449 18.2 870 18.7 Missing 0 0 14 <1 14 <1

Age 0-14 years 47 2.1 98 4 145 3.1 15-29 years 142 6.5 335 13.6 477 10.2 30-44 years 371 16.9 667 27.1 1,038 22.3 45-59 years 698 31.8 740 30.0 1,438 30.9 60-74 years 659 29.9 505 20.5 1,164 25.0 75+ years 280 12.7 116 4.7 396 8.5 Missing 0 0 3 <1 3 <1 Mean age of injured persons 54.8 years 46.6 years 50.5 years

Body site injured Head/face/neck 322 14.6 307 12.5 629 13.5 Trunk 569 25.9 416 16.9 985 21.1 Upper extremity 652 29.7 783 31.8 1,435 30.8 Lower extremity 622 28.3 705 28.6 1,327 28.5 Other specified body region 29 <1 210 8.5 239 5.1 Unspecified body region 13 <1 43 1.7 56 1.2

Nature of injury Fracture 1,365 62.1 700 28.4 2,065 44.3 Open wound 144 6.6 316 12.8 460 9.9 Intracranial injury 138 6.3 43 1.7 181 3.9 Dislocation, sprain & strain 109 4.9 696 28.2 805 17.3 Superficial injury 91 4.1 236 9.6 327 7.0 Injury to internal organ 44 2.0 3 <1 47 1.0 Injury to muscle & tendon 28 1.3 152 6.2 180 3.9 Injury to nerves & spinal cord 21 1.0 5 <1 26 <1 Other specified injury 64 2.9 209 8.5 273 5.9 Unspecified injury 193 8.8 104 4.2 297 6.4

Activity (1) (n=1,278) Other types work- unpaid 549 43.0 360 14.6 Working for income 333 26.1 467 19.0 Leisure 4 <1 859 34.9 Other specified 392 30.7 447 18.1 Unspecified activity N/A 331 13.4

Location (2) (n=1,153) Home 956 82.9 1,638 66.5 Industrial & construction area 78 6.8 149 6.0 Trade & service area 37 3.2 246 10.0 School, public building 21 1.8 13 <1 Farm 15 1.3 21 <1 Residential institution 10 <1 5 <1 Other specified places 36 3.1 171 6.9 Unspecified places N/A 221 9.0

Length of stay Less than 2 days 1,012 46.1 N/A N/A N/A N/A 2-7 days 827 37.6 N/A N/A N/A N/A 8-30 days 324 14.7 N/A N/A N/A N/A 31+ days 34 1.5 N/A N/A N/A N/A


• Persons aged 60 years and olderwere more likely to be admitted tohospital than their youngercounterparts. Forty-three percentof hospital admissions for ladder fallinjuries were in this age groupcompared to 25% of E.D.presentations (non-admissions).The mean age of admitted personswas 55 years compared with 47 yearsfor non-admitted persons.

• The pattern of injury across bodysites was similar among admitted andnon-admitted hospital-treated caseswith injuries to the upper and lowerextremity predominating (60%).Trunk injuries formed a higherproportion of admissions than E.D.presentations (26% v. 17%).

• Fracture was the most commoninjury, accounting for 62% ofadmissions and 28% of E.D.presentations (non-admissions).Dislocations, sprains and strainswere more frequent among E.D.presentations (28%) than admissions(5%).

• Most ladder fall injuries occurred inthe home – four-fifths of admittedcases and two-thirds of E.D.presentations. (These figuresinclude a small proportion of casesthat were engaged in paid work inother person’s homes e.g. tradesmenand cleaners.)

Ladder fall injury by setting

For this analysis, ladder fall injuryadmissions and E.D. presentations weregrouped according to the injury setting(home, workplace and ‘other andunspecified’ settings). Over three timesas many persons were injured in ladderfalls in their own or another person’shome (n=2,549(1)) than in their place ofwork (n=800). A further 1,312 ladder fallcases were injured in ‘other andunspecified settings’.

Table 3 summarises and compares thepattern of hospital admissions and E.D.presentations for ladder fall injuries bysetting.

• Males comprised a higher proportionof persons injured while doing paidwork (92% of both admissions andE.D. presentations) than personsinjured in the home (76% and 78%)or in other and unspecified settings(82% for both groups).

• Persons injured in ladder falls in theirworkplace were on average younger(mean age admitted persons 43 yearsand non-admitted persons 38 years)than persons injured in the home(mean ages 61 years and 49 years) orin ‘other and unspecified settings’(mean ages 53 years and 44 years).

• The pattern of injury in relation tobody site injured was similar acrossthe three settings, except thatinjuries to the trunk region were morecommon and upper extremity injuriesless common among admitted casesthat occurred in the home comparedwith other settings.

• There was little difference in the typeof injury by setting. The mostcommon injury among admissionswas fracture, accounting for between58% and 62% of all injury admissionsfor ladder falls. Fractures andd i s l o c a t i o n s / s p r a i n / s t r a i nconsistently accounted for around56% of E.D. presentations across thethree locations.

• Persons injured at home had thelongest mean length of stay inhospital (5.2 days) compared withpersons injured in their workplaceand in other and unspecifiedsettings (both 3.8 days). Personsinjured in the home were generallyolder and therefore more vulnerableto injury.

Note: (1) Cases that occurred in thehome but activity was working for incomewere excluded (n=45).

Ladder falls in the home(n=2,549 hospital-treated injuries,average annual frequencyn=1,275)

Over the two-year period July 2002-June2004 there were 935 admissions and 1,614E.D. presentations to Victorian hospitalsfor ladder fall injuries that occurred inthe home (Table 4).

Gender and ageMales were overrepresented in homeladder fall injury cases (77%, n=1,970hospital-treated injuries). Admittedpersons were, on average, much olderthan non-admitted persons (mean age 60years for admissions compared with 50years for non-admissions).

ActivityThe specific activity the person wasengaged in at the time of injury waspoorly coded in both datasets.Examination of useful VEMD narrativesidentified that ladder fall injuries occurredduring the following outdoor and indooractivities:• outdoor activities- cleaning gutters,

painting, engaging in othermaintenance of the home andgardening including pruning.

• indoor activities- painting, changinglight bulbs, hanging pictures,cleaning and plastering.

Injury type and body siteThe most commonly occurring hospital-treated injuries were:• upper extremity fracture (17%,

n=427);• lower extremity fracture (14%, n=350);• fracture to the trunk region (10%,

n=257);• lower extemity dislocations, sprains

and strains (7%, n=183); and• upper extemity dislocations, sprains

and strains (7%, n=168).

Detailed circumstances of injuryExamination of available narrative dataidentified some common mechanisms ofinjury for home ladder falls includingladder slide out (where the top of the


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ladder slides down the wall when thebase of the ladder slides away from it),user slip or misstep, user loss of balanceand ladder malfunction.

Ladder instability (slide out andsideways tilting):• Presented following fall from a

ladder from roof level, ladderslipped in the wet and fell straightback on him.

• Male who has slipped off ladder,ladder fell away and he was lefthanging approx 12 feet by his arm.

• In the garden cleaning gutters,injury caused when ladder slippedand he fell off.

User slip or misstep:• Location back yard, climbing

ladder caused by lost balance whenhe missed the step.

• Outside pruning roses fell off ladderwhen missed rung.

• In the garden doing homerenovations, injury caused when heslipped from ladder.

User loss of balance:• In the backyard cleaning the gutter,

fell forward from ladder.• In the garage on a ladder putting

chairs in the roof, lost balance whenclimbing the ladder.

• In the yard, up a ladder painting,lost balance and fell.

Ladder fault/malfunction:• Patient on stepladder that broke,

fell hard onto both feet, unable toweight bear since.

• Outside doing hammering, causedby ladder rung broke and heslipped.

• Sore left lower leg after 6 feet fallfrom roof after ladder collapsed.

Admissions: Length of stayThirty-nine percent of admitted persons(n=366) stayed in hospital for less than 2days, 40% for between 2 and 7 days(n=370) and 19% for between 8 and 30days (n=180). The average length of stayin hospital was 5.2 days (Table 4).

The following are descriptions of injuriesand treatment for three of the mostserious cases constructed from codeddata on the VAED:

• Person aged in their 60s had a 3month hospital stay after sustainingintracranial injuries, and multiplefractures of the skull, facial bonesand ribs. The injury was a result ofa fall from a ladder in the home.The injuries required allied healthinterventions such as occupationaltherapy, social work,physiotherapy, psychology andspeech pathology.

• Person aged in their 40s, sustainedmultiple injuries after falling from aladder at home. Injuries included;complete lesion of thoracic spinalcord, multiple open wounds of thehead and multiple fractures of thethoracic vertebra, the base of theskull and the ribs. These injuriesrequired a hospital stay of manymonths. Procedures she requiredincluded spinal surgery involvingan open reduction of fractures anddislocations of the spine, bloodtransfusions, multiple brain scansand multiple allied healthinterventions including, but notlimited to, physiotherapy, socialwork, occupational health anddietetics.

• Person aged in their 40s had ahospital stay of nearly 4 weeks aftersustaining the following injuries;traumatic haemothorax, fracturedscapular, multiple rib fractures andfractures of the lumbar vertebrae atlevels 1, 2 and 3. The injury was aresult of a fall from a ladder in thehome. These injuries requiredextensive surgery and many alliedhealth interventions such asoccupational therapy, social work,pharmacy and physiotherapy.

Ladder falls in the workplace(n=800 hospital-treated injuries,average annual frequency n=400)

Over the two-year period July 2002-June2004 there were 333 admissions and 467E.D. presentations to Victorian hospitalsfor ladder fall injuries that occurred inworkplaces (when the injured person wasworking for income) (Table 4).

Gender and ageMales were grossly over-represented inworkplace-related ladder fall injury cases(92%, n=735 hospital-treated injuries).Cases were fairly evenly spread across15-year age groups from age 15 to age59. On average, admitted cases tendedto be a few years older than non-admittedcases (Mean age 42.9 years foradmissions years cf. 38.4 years for non-admissions).

Industry involvedData on industry in which the injuryoccurred was poor. One-third of admittedcases were not coded for industry (33%,n=111) and an additional 27% were codedto ‘other specified industry’ (n=91). Ofcases given a specific code (n=142),construction (54% of specified cases,n=71), agriculture/forestry/fishing (16%,n=21) and wholesale/retail (12%, n=16)accounted for most of the specifiedcases. Information on the occupation/industry of injured person was notgenerally included in narrative data forE.D. presentations (non-admissions).Industries mentioned included building,construction, factory work, plasteringand painting.

Specific location of injury eventThere is sparse information on thespecific location of these incidents. Halfof all workplace ladder falls admissionsrecorded on the VAED were coded to‘unspecified location’ (n=168). Of theremaining admissions (n=165), 41%(n=56) occurred in industrial andconstruction areas, most commonlyconstruction areas and factories, 18%(n=29) occurred in trade and servicesareas, most commonly shops and stores,


and 13% occurred in private home whilethe person was working for an income(n=21). Few VEMD narratives gaveinformation on the specific location ofthe ladder fall injury event.

Injury type and body siteThe most commonly occurring hospital-treated injuries were:• upper extremity fracture (18%,

n=146);• lower extremity fracture (12%, n=99);• dislocation, sprains and strains of

the lower extremity (9%, n=74); and• fractures to the trunk region (7%,

n=55).

Contributory factors/circumstances ofinjuryExamination of narratives identified thesame common mechanisms of injury forworkplace-related ladder falls as for ladderfalls in the home, namely ladder slide out(where the top of the ladder slides downthe wall whilst the base of the ladderslides away from it), user slip or misstep,user loss of balance and laddermalfunction. Lack of a safety latch onthe ladder was also mentioned in a fewnarratives.

Admissions: Length of stayFifty-four percent of admitted persons(n=180) stayed in hospital for less than 2days, 33% for between 2 and 7 days(n=111) and 12% for between 8 and 30days (n=12). The average length of stayin hospital was 3.8 days. The followingare descriptions of injuries and treatmentfor three of the most serious casesconstructed from coded data on theVAED:• Person aged in their 40s sustained

multiple fractures and dislocationof vertebra with a complete lesionof the spinal cord resulting inparaplegia. These injuries occurredin a fall from a ladder whileworking for income and required ahospital stay of 3 months. Injuriesrequired open reduction offractures and dislocations of thespine, and internal fixation of thespine. Multiple allied health

interventions such as occupationaltherapy, social work,physiotherapy, dietetics,psychology and speech pathologywere also required.

• Person aged in their 50s, sustainedmultiple injuries after falling from aladder while working inconstruction. Some of the moreserious injuries included: a focalbrain injury, multiple fractures ofthe femur, multiple facial fractures(including the jaw) and multiplefractures and dislocations of thefoot, humerus and radius. Theseinjuries required a hospital stay ofseveral weeks and treatments andprocedures such as reduction offracture of the pelvis, openreduction of fracture of humerus,open reduction of fracture of foot,hyperbaric oxygen therapy andmultiple allied health interventionsincluding physiotherapy andoccupational health assessment.

• Person aged in their 50s had a 2week hospital stay after sustaininga fractured heel and injuries to thetibial artery and the lateral plantarnerve. The injury was a result of afall from a ladder when working forincome in the manufacturingindustry. Treatments involvedsurgery to reduce the fracture andinternal fixation was required.

‘Other and unspecified’ ladderfalls (n=1,312 hospital-treatedinjuries, average annual frequencyn=656)

Over the two-year period July 2002-June2004 there were 929 admissions and 383E.D. presentations to Victorian hospitalsfor ladder falls that occurred in other andunspecified settings (Table 4).

Frequency, age and genderMales were also over-represented inladder fall cases (82%, n=1,072 hospital-treated injuries). Admitted persons were,

on average, approximately 10 years olderthan non-admitted persons (mean age ofadmitted persons 53.4 years cf. mean ageon non-admitted persons 43.9 years).

Injury type and body site• The most commonly occurring

hospital-treated injuries were:• upper extremity fracture (21%,

n=278);• lower extremity fracture (17%, n=227);

and• fractures to the trunk region (12%,

n=155).

Activity and locationAnalysis of these variables produced noreliable information on the location ofthese incidents and the activity beingengaged in at the time of injury due tomissing data.

Admissions: Length of stayHalf of admitted persons (n=466) stayedin hospital for less than 2 days, 37% forbetween 2 and 7 days (n=346) and 11%for between 8 and 30 days (n=105). Theaverage length of stay in hospital was3.8 days.

Other (non-fall) causes ofladder injury

The VEMD was used to source data onnon-fall ladder injuries for bothadmissions and E.D. presentations, asthere are no codes to capture ladderinjuries from causes other than falls inthe VAED. There were 343 identified non-fall ladder injury presentations toVictorian emergency departments overthe two-year period July 2002-June 2004,34 admissions and 309 E.D. presentations,non-admissions (Table 5). The majornon-fall causes of hospital treated ladderinjuries were struck by/collisions withobject (51%) and cutting/piercing (22%).


Major causes of other hospital-treated ladderinjuries excluding falls, July 2002-June 2004

Table 5

Source: VEMD July 2002-June 2004, admissions and non-admissions included

Ladder injuries caused by struckby/collision with object (n=176)

More than three-quarters of ladderinjuries caused by struck by/collisionwith objects occurred among personsaged between 15 and 59 years (78%,n=138), particularly those aged 30-44years (n=66). The overall male: femaleratio was 75:25 and males were over-represented in all 15-year age groupsexcept 75 years and older.

The most frequently injured body sitewas the head (21%, n=37), followed bythe hand (15%, n=27), foot (10%, n=18)and face (10%, n=18). The most commonspecific injuries were open wounds ofthe head (11%, n=20), sprains and strainsof the lower extremity (7%, n=12), openwounds of the hand (6%, n=11), fracturesof the wrist and hand (6%, n=10), andopen wounds of the lower leg and foot(6%, n=10).

Forty-five percent of injuries occurred inthe home (n=79) and 22% occurred intrade or service areas (n=38). Only 7%of struck by/collision with ladder injurycases were admitted to hospital (n=13).

The following narratives detail thecircumstances of some of the moreserious injuries (admitted cases):• Up a ladder with a chainsaw fell off

the ladder and landed on left wrist,

Ladder injuries caused by cuttingand piercing (n=77)

Nearly two-thirds of ladder-related cuttingand piercing injuries occurred to personaged between 25 and 54 years (65%, n=47),particularly those aged 35-49 years (n=30).Ninety-four per cent of injury cases weremales. The most common specific injurieswere open wounds of the hand (38%,n=29), forearm (10%, n=8) and lower leg(10%, n=8). Sixty-eight percent of injuriesoccurred at home (n=52) and 14% ofinjuries required admission to hospital(n=11).

Narratives detailing circumstances of someof the more serious injuries (admittedcases):

• 1 metre fall from ladder landing onknees both arms through glass,lacerations to left and right arms,left arm laceration to belly of muscle

• Partial amputation/avulsion to leftmiddle finger in step ladder

• Fell off ladder landing on plate glasswindow causing lacerated ulna artery

Some descriptions indicated that the laddermay have been faulty or that design solutionscould be sought to reduce these injuries:

• Working up a ladder that collapsed(multi-joint ladder), patient caughthold of fixed metal ribbon cuttingungloved hand

Ladder injuries by other andunspecified causes (n=90)

Just over half of the cases classified under‘other and unspecified’ causes were agedbetween 25 and 49 years (57%, n=51).Males were over-represented (73%). Themost frequently injured body site was thehand (18%, n=16), followed by the ankle(13%, n=12) and knee (12%, n=11). Themost common specific injuries were sprainsand strains of the ankle (9%, n=8), and theknee (7%, n=6) and open wounds of thehand (7%, n=6).

Forty-seven percent of injuries occurred athome (n=42) and 22% occurred in trade orservice areas (n=20). Eleven percent ofinjuries required admission to hospital(n=10).

Discussion

Ladders are associated with a considerablenumber of fall from height injuries thatrequire hospital treatment each year inVictoria. Recent data indicate that onaverage there are at least 6 fatalities and2,500 hospital-treated ladder injuries eachyear in Victoria.

All 12 fatalities recorded in 2002 and 2003and 93% of the 5,000 hospital-treated injurycases recorded over the two-year period2002/3 to 2003/4 were caused by falls.

Departure Class

Injury cause Admissions Presentations, non-admissions

Total

n % n % n %

Struck by collision with object

13 38.2 163 52.8 176 51.3

Cutting/piercing object 11 32.4 66 21.4 77 22.4 Other specified external causes

7 20.6 63 20.4 70 20.4

Unspecified causes 3 8.8 17 5.5 20 5.8 Total 34 100.0 309 100.0 343 100.0

then fell on running chainsaw andlacerated right forearm

• Felling tree, branch fell onto ladderpinning leg between ladder andtree

Some descriptions seem to indicate thatthe ladder may have been faulty or thatdesign solutions could be sought to reducethese injuries:

• Caught right arm in folding ladder,fractured radius and ulna

• Laceration to left middle finger,jammed between ladder

• Laceration to left leg while climbing up metal step-ladder


Between 1994 and 2004, the hospitaladmission rate for ladder fall injuriesincreased by 40%. Older males were over-represented in ladder fall injury cases.Eight of the twelve ladder-related fatalitiesrecorded on the ABS-DURF (67%) weremales aged 60 years and over, and all thesecases were due to falls from ladders thatoccurred in the home. There was alsosignificant representation of persons aged60 years and older among hospitalisations(43%) and E.D. presentations (25%) forladder fall injuries. Most of these casesoccurred in the home. The average age ofladder fall injury hospitalisations was 55years compared to 47 years for E.D.presentations.

Tsipouras et al (2001) reported similarfindings from a case series of 163 patientswith occupational and non-occupationalladder-related injury who presented to theemergency department of the AustinHospital in Melbourne between 1994 and

1997. Cases were predominantly male(83%) and the mean age in years of non-occupational ladder injury cases was 52years compared with a mean age of 36years for occupational ladder injury cases.In the only other published Australianstudy that reported on ladder injury, Driscollet al. (2003) utilised Coroners’ records from1989-92 to identify and study 296 fatalincidents arising from unpaid work at home(“home duties deaths”). The authorscommented that elderly persons, usuallymales, were most commonly involved inthe fatal home duties incidents thatinvolved ladder use (n=~53 cases). Someoverseas case series also report over-representation of older males in home ladderinjury cases (Faergemann & Larsen, 2000;Faergemann & Larsen, 2001; Muir &Kanwar, 1993)

Although the data on location of injury inour study was incomplete, the availabledata indicated that 71% of ladder-relatedinjuries occurred in the home, mostly when

the householder was doing indoor andoutdoor home maintenance, gardening(including pruning) and cleaning tasks.Tsipouras et al. (2001) also reported a highproportion of home ladder injuries (78%)and a similar set of documented reasonsfor using the ladder in non-occupationalsettings: home maintenance includingrepairs, cleaning gutters and painting(51%); gardening, including picking fruitand pruning (19%); and ‘other’ (30%).Other published small retrospective studiesof serious ladder injuries presenting tohospitals or fracture clinics in Sweden,Denmark, the U.K. and the U.S. report smallerproportions of ladder injuries occurring inthe home, ranging between 50% and 68%(Bjornstig & Johnsson, 1992; Faergemannet al., 2001; Muir & Kanwar, 1993; Partridgeet al, 1998).

Older persons (aged 65 years and older)should be discouraged from climbingladders to do home maintenance tasks. Animportant approach to achieving adownturn in ladder injury among this agegroup is the provision of alternative reliableand low-cost home maintenance servicesfor tasks performed at height. In a recentqualitative study, MUARC researchersconducted 15 focus groups involving 118persons aged 60 years and older in twoMelbourne communities to explore theirlevel of involvement and motivations forengaging in Do-It-Yourself (DIY) homemaintenance tasks (Ashby et al., 2005).The motivations for doing DIY tasksranged from necessity (for economicreasons) to personal preference to enhancefitness levels, and for the satisfaction andpride that came with successfullycompleting DIY tasks. Knowing when togive up DIY tasks appeared to be a complexand emotive issue.

This study, the Austin hospital case seriesand overseas studies all report that theextremities were most commonly injured,most frequently resulting in sprains andfractures of the wrist, ankle or foot (Muir &Kanwar 1993; Tsipouras et al. 2001;Faergemann & Larsen, 2001; O’Sullivan etal., 2004;). Precise height of fall data wereavailable for 139 of the 163 Austin Hospitalladder injury cases.


Fall heights ranged from 0-6 metres with amean of 2.1 metres (2.6 metres foroccupational and 2.0 metres for non-occupational ladder cases). Multipleregression analyses performed by theauthors showed that injury severityincreased significantly with increasingheight of the fall, and increasing age (P<0.05for both).

Although the mechanisms of injury werenot well or consistently reported in theVEMD case narratives analysed for ourstudy, they appear similar to thosecommonly reported in the research literature.Mechanisms include ladder slide out andsideways tilting; user slip, trip or misstep;user loss of balance including backwardfalls; and ladder or ladder support collapse(Bjornstig & Johnsson, 1992; Hakkinen,1988; Faergemann & Larsen, 2001;Tsipouras et al. 2001).

A number of preventive measures toaddress ladder falls have been suggestedand some have been implemented, howeverno publications were found evaluating theeffectiveness of any ladder injuryprevention measure. One implementedmeasure is the use of a ‘stay’ or a ‘stand-off’ that can be bolted to the existing ladderand used against surfaces that are toobrittle or weak to support the top of theladder (such as gutters or plastic features).Other safety design features incorporatedinto portable ladders include improved non-slip rubber tread for ladder footings, awooden/metal crossbar for extra supportat the top of the ladder, and angled rungsthat lie horizontally (and feel morecomfortable) when the ladder is positionedcorrectly. Slip-resistant rung covers areavailable commercially and study authorsalso suggest that ladders should beconstructed in such a way that they areautomatically placed at the optimaltouching angle, an inclination ofapproximately 1:4 (Bjornstig & Johnsson,1992).

Safe design and manufacture of portableladders and guidance on their safe use andcare are addressed in the Australian andNew Zealand four-part Standard for

Portable Ladders (AS/NZS 1892).Compliance with the Standard bymanufacturers is voluntary. The Standardspecifies the minimum safety requirementsfor the design and manufacture of portablemetal (AS/NZS 1892.1:1996), timber ladders(AS/NZS 1892.2:1992) and reinforcedplastic ladders (AS/NZS 1892.3:1996) ratedfor industrial or domestic use includingtest methods, and it provides a set ofguidelines for the selection, safe use andcare of portable ladders (AS/NZS1892.5:2000). Portable ladders - Part 6: Othermaterials, is currently in preparation (DR05081) to cover alternatives to traditionalmaterials, including laminated timber stiles,which are becoming more common. TheStandards for metal and reinforced plasticportable ladders are also currently underrevision, mainly to clarify points in the testmethod (Standards Australia, 2002). AS/NZS 1892 does not cover ladderaccessories such as ladder levellers,stabiliser or standoff devices, ladder jacks,straps or hooks.

The guidelines in the Standard and authorsof research articles consistentlyrecommend a number of safe practices forladder use including:• having someone stand at the base of

the ladder to both brace the ladderand observe the climber;

• securing the ladder by tying the endsto structures;

• avoiding dangerous behaviour suchas over-reaching, carrying excessiveloads or moving the ladder duringascent; and, importantly,

• pitching the ladder so that the angleof the ladder is no steeper than 4 unitsof height per unit of width.

There is disagreement in the literature onthe optimal angle of placement of the ladderwith laboratory experiments indicating thatthe often recommended angle of 76o

relative to the ground (Bjornstig &Johnsson, 1992) is too steep and thatan angle between 66o and 70o providesgreater resistance to both slipping andclimber instability (Hakkinen, 1988). In theUnited States, ladders are designed andtested on an angle of 75.52o, which is alsorecommended as the limiting ladder set-up

angle to avoid slide out (Barnett, 1996;Switalski & Barnett, 2003). The guidelinesin the Australian Standard endorse the 1:4pitch angle ‘rule of thumb’—the horizontaldistance between the support point of theladder and foot of the ladder isapproximately one quarter of the supportedlength of the ladder. (See diagram)

Available data indicated that about 20%of hospital-treated ladder injury cases inour study were injured in the workplace,similar to the proportion reported fromthe Austin Hospital case series (22 %)but less than reported in overseasstudies (33-53%) (Bjornstig & Johnsson,1992; Muir & Chester, 1993; Partridge etal., 1998; O’Sullivan et al, 2004).Prevention of injuries from falls fromheight is a current priority of WorkSafeVictoria (WorkSafe, 2005). The failure ofindustry-based guidelines to preventfalls from height resulted in WorkSafeand the Victorian government switchingto a regulatory approach.

The Occupational Health and Safety(Prevention of Falls) Regulations were passedin Victoria in 2003 and apply to fall hazards ofmore than 2 metres. Under the new regulations,ladder use to undertake tasks at height is notprohibited but ladder use is placed in thelowest level of the hierarchy of control of fallsrisks, behind undertaking work on the groundor on a solid platform; undertaking work usinga passive fall prevention device (e.g.temporary work platform, scaffolding roofsafety mesh or guard railing); undertakingwork using a work positioning system (e.g.industrial rope access system or a travelrestraint system that enables a person to bepositioned and safely supported at a worklocation); and undertaking work using a fallinjury prevention system (e.g. industrial safetynet or catch platform) (WorkSafe, 2005).

Employers are advised that ladders mayonly be used until a safer alternative isavailable and that new and practicalalternatives are appearing frequently inresponse to the need to prevent injuriousfalls and to the new regulations. Wheretasks must be done with a ladder and thereis a risk of falling more than two metres, thelaw now requires that a risk assessment ofthe task must be undertaken and that


Potential falls from heights of 2 metres orless are not covered by theseRegulations but the general safetyprovision of the revised OccupationalHealth and Safety Act (2004), which cameinto force in July 2005, applies (WorkSafe,2004). Under the revised Act, employeeshave a duty to provide and maintain, sofar as reasonably practicable, a safeworking environment, and therefore therisks of falling from heights of up to 2metres must be controlled.

The information covered in the WorkSafepublication Prevention of falls-Ladderson the safe use of ladders is relevant toboth workers and persons doing homemaintenance and can be downloadedfrom the Victorian WorkCover AuthorityWorkSafe websitewww.workcover.vic.au. The strict newfall from height regulations in theworkplace stand in stark contrast to the

lack of controls and action on falls fromheight (mostly involving ladder use) inthe home environment, where most fataland serious ladder injuries occur.

The future direction for injury preventionin the area of ladder fall injuries appearsto be best done through innovations inladder accessories (eg. attachment pointson buildings); design solutions to reducethe overall need to use ladders forcleaning and maintenance tasksperformed at heights (eg. the broaderadoption of self-cleaning glass, re-designing guttering to eliminate the needfor cleaning or the application of safergutter cleaning methods); designmeasures to minimise sliding or tippingrisks and slipping on rungs or steps;measures to reduce ladder use by olderpersons for home maintenance tasks; andcommunity education and training onsafe ladder use for home maintenancetasks.

Further research is needed to determinewhether any tangible real-world benefitswould flow from broader adoption of

available technologies and newpreventive measures. Initiatives to betteridentify and describe ladder injury caseson existing hospital Injury surveillancedatasets should focus on improving casenarrative data on the VEMD so thatproduct involvement is better specified.The structure of ICD-10-AM precludesthe identification of non-fall ladder caseson the VAED and is not geared tosystematically identify consumerproduct involvement in injury causation.

Recommendations

• Investigate and promote acceptableand effective alternatives to theperformance by older persons of homemaintenance tasks at height thatrequire the use of ladders.

• Design and implement communityeducation (including practicaldemonstrations) and training in safeladder use targeted to adulthouseholders of both sexes anddelivered in community and hardware/gardening retail settings.

• Monitor the effectiveness of the newVictorian Occupational Health andSafety (Prevention of Falls)Regulations in reducing injury due tofalls from height in the workplace.Investigate the translation of similarsafety measures to householders.

• Conduct research into the efficacy ofrecent safety innovations in ladderdesign (including ladder accessories)in preventing ladder fall injuries, andsupport the wider adoption of usefulmeasures.

• Conduct research to identify designsolutions to reduce or eliminate theneed for access to height for homemaintenance purposes.

• Develop initiatives to improve theidentification and description ofladder-related injury cases on existinghospital Injury surveillance datasets.The focus should be on improvingcase narrative data on the VictorianEmergency Minimum Dataset (VEMD)so that consumer product involvementis better specified.

workers are provided with sufficientinformation, instruction and training toenable them to work safely (WorkSafe2005).


References

Barnett RL. Ladder slide out - first orderanalysis. Safety Brief 1996; 12(1):1-15.

Bjornstig U, Johnsson J. Ladder injuries:mechanisms, injuries and consequences. Journalof Safety Research 1992;23:9-18.

Driscoll TR, Mitchell RJ, Hendrie SH et al.Unintentional fatal injuries arising from unpaidwork at home. Injury Prevention 2003;9:15-19.

Faergemann C, Larsen LB. Non-occupationalladder and scaffold fall injuries. AccidentAnalysis and Prevention 2000; 32:745-50.

Faergemann C, Larsen LB. The mechanismsand severity of non-occupational ladder fallinjuries. Journal of Safety Research 2001;32:333-43.

Hakkinen K, Pesonen J, Rajamaki E.Experiments on safety in the use of portableladders. Journal of Occupational Accidents1988;10:1-19.

Muir L, Kanwar S. Ladder injuries. Injury 1993;24(7):485-7.

National Coroners Information System.www.NCIS.org.au

O’Sullivan J, Wakal A, O’Sullivan R et al.Ladder fall injuries: patterns and cost ofmorbidity. Injury, International Journal ofthe Care of the Injured 2004; 35:429-431.

Partridge R, Virk A, Antosia R. Causes andpatterns of injury from ladder falls. AcademyEmergency Medicine 1998;5(1):31-4.

Standards Australia. AS/NZS 1892.1 Portableladders – Metal: 1996. Standards Association ofAustralia

Standards Australia. AS 1892.2 Portableladders – Timber: 1992. Standards Associationof Australia

Standards Australia. AS/NZS 1892.3 Portableladders - Reinforced plastic: 1996. StandardsAssociation of Australia

Standards Australia. AS/NZS 1892.5 Portableladders - Selection, safe use and care: 2000.Standards Association of Australia

Standards Australia. In the pipeline In: TheAustralian Standard. Volume 23, Number 2,March 2002Switalski WG, Barnett RL. Auto-setting ladderinclination. In: 2003 ASME DesignEngineering Technical Conference andComputers and Information in EngineeringConference; 2003 Sep 2-6; Chicago, IL, UnitedStates: American Society of MechanicalEngineers; 2003. p. 1045-1054.

Tsipouras S, Hendrie J, Silvapulle M. Ladders:accidents waiting to happen. Medical Journalof Australia 2001; 174:516-9.Worksafe Victoria. Prevention of falls —Ladders. 1st Edition June 2005.www.workcover.vic.gov.au

Box 1Methods of extracting ladder injuries from injuryfatality files and hospital injury surveillance datasetsAustralian Bureau of Statistics Death Unit Record File (ABS DURF): The ABS DURF is a recordof unnatural deaths and data are coded to ICD version 10. Cases were selected if the cause ofdeath was recorded under code W11 ‘Fall on or from ladder’.

NCIS staff supplied national Coroners’ Information System (NCIS) summary data. Cases wereselected by using a word search of the all reports on Victorian cases recorded on the NCISdatabase for the terms ‘ladders’ and ‘scaffolding’ and cases were manually checked to determineeligibility.

Hospital-treated ladder injury data were extracted from the Victorian Admitted Episodes Dataset(VAED) and the Victorian Emergency Minimum Dataset (VEMD) using different methods dueto coding differences.

Victorian Admitted Episodes Dataset (VAED): The VAED records hospital admissions for allVictorian hospitals, both public and private. Up to June 1998 data were coded to theInternational Classification of Diseases (ICD) version 9. From July 1998 forward, data are codedto ICD version 10 with Australian modifications (adequacy of coding is reviewed every two yearsand improvements introduced). There is only one code for ladder related injury: W11 ‘Fall onand from ladder’. For the trend analysis, the ICD9 external cause code 881.0 ‘Fall from ladder’was used as it matches W11.

Victorian Emergency Minimum Dataset (VEMD): The VEMD records presentations to 28 ofthe 35 Victorian public hospital emergency departments for 2003-4 and to all 37 hospitals with24-hour emergency services from the beginning of 2004. Admissions were excluded to preventdouble counting. There is no separate code for ladder injuries in VEMD. Cases were extracted byword search in narrative data. This strategy identified ladder injury cases from any cause,including falls. Records were checked and wrongly coded cases excluded.

Box 2Issues affecting the quality and completeness of ladder-related injury data extracted from VISU-held datasets

Australian Bureau of Statistics Death Unit Record File (ABS DURF) and the VictorianAdmitted Episodes Dataset (VAED)The ABS DURF and the VAED contain only coded data using the WHO InternationalClassification of Diseases (ICD) system, Version 10 (ICD-10). Australian Modifications to ICD-10 provide additional sub-codes in the VAED. Neither of the two datasets contains casedescriptions (narratives) to provide additional information on the mechanism and circumstancesof the injury, including the level of product involvement. There is only one code for ladderinjury in ICD-10: W11 ‘Fall on and from ladder’, therefore ladder-related injury frequency dataextracted from both of these datasets underestimate the size of the problem due to lack ofcapture of cases due to other causes, such as cutting/piercing or hit/struck/crush.

Victorian Emergency Minimum Dataset (VEMD)Two major issues affect the quality and completeness of ladder injury data in the VEMD are:(1) There is no specific code to separately identify ladder injury records on the dataset. Injuries

involving ladders can only be identified by text searching the ‘description of injury event’narratives. Unfortunately, VEMD narrative data are incomplete and their quality variesacross and within participating hospitals. A recent quality check by VISAR on VEMD datasubmitted for the period July-December 2004 identified that, on average, only 34% ofnarratives collected by hospitals are graded ‘good to excellent’, meaning they provide twopieces of information over and above what is known from the coded data. Therefore,beyond mention that the injury involved a ladder, narratives were unlikely to providefurther useful detail on the precise mechanism and circumstances of the injury; and

(2) The VEMD only contained presentations data from 28 of 35 public hospitals with 24-hourEmergency Departments for 18 months of the two-year period covered by this study.


Vehicle jack injuriesErin Cassell, Karen Ashby

Working under a vehicle supported by ajack can cause death or severe crushinginjury. There is a mandatory Australiansafety standard for vehicle jacks butrelated injuries continue to occur. TheAustralian Competition and ConsumerCommission (ACCC) reports that 19Australians were crushed and killed by avehicle they were working under in thefour years up to 2004. All the deathswere men and involved the vehicle beinglifted or supported in the wrong way.

This short report covers hospital treatedinjury related to the use of vehicle jacksutilising hospital emergency departmentinjury surveillance data extracted fromthe Victorian Emergency MinimumDataset (VEMD). These dataunderestimate the size of the injuryproblem because there is no specific codefor injuries related to vehicle jacks onthe VEMD and data were extracted usinga word search of the case narratives thatare of variable quality. The search didnot include trolley jacks.

• There were 178 ED presentations toVictorian hospitals for vehicle jackinjuries over the 5-year period 2001-5.Of these, 16 (9%) were admitted tohospital and the other 162 (91%) weretreated in the ED and discharged.

• All injured persons were male and 70%were aged between 15 and 44 years.

• Over half of the injuries occurred inthe home including the garage, gardenand driveway (n=97, 55%), a further30% (n=36) happened in the workplaceand 10% (n=17) occurred on the road,street or highway.

• The most common types of injury wereopen wounds (20%), fractures (20%),sprain/strain (17%) and crushinginjury (16%). One third of all injuries(and one-third of serious injuries) wereto the hand (n=61, 34%). Other bodysites commonly injured were the chest(n=16, 9%), foot (n=14, 8%), face(n=13, 7%) and shoulder (n=13, 7%).

• Most injuries (62%) were caused bythe person being hit/struck/crushedby an object – either the jack or thevehicle being supported by the jack.

The narrative (free text) descriptions ofthe injury events provide some additionalinformation on the mechanism andcircumstances of injury. Eleven of the 16hospitalisation admissions (68%) and atleast 79 of the 168 non-admitted cases(47%) were injured when the jackreportedly ‘slipped’, ‘collapsed’ or ‘gaveway’ and the vehicle fell on the person.In 38 of all these cases (42%) the injuredperson was described as working underthe vehicle at the time the jack shifted/collapsed or the description of the injurysite (chest, leg, shoulder, head) indicatedthat the person had a substantial part oftheir body under the vehicle. The othercommon injury scenarios were that theperson’s hand or finger got caught inthe mechanisms of the jack when it wasbeing used or the person’s finger wascrushed between the jack and a part ofthe vehicle.

Short report

A vehicle specific jack is supplied withthe vehicle for the sole purpose ofchanging a flat tyre. It should match themodel of the vehicle it is used with. Alljacks sold in Australia including thosethat come with new cars are required bylaw to comply with the AustralianStandard, AS/NZS 2693, which specifiesdesign, construction, performance andlabelling requirements.

A trolley jack (that conforms to themandatory safety standard AS/NZS2615) and safety stands (that conform tothe mandatory safety standard AS/NZS2538) that have sufficient capacity to liftand bear the weight of the vehicle,respectively, should be used by the homemechanic when doing repairs or to getunder a vehicle. Vehicle ramps providean alternative method for raising avehicle. Further safety guidelines onraising a vehicle using a trolley jack areavailable in a ACCC safety alert pamphlet‘Working under a vehicle – vehicle jacksafety’ that can be downloaded from theACCC’s website: www.accc.gov.ausearching through the ‘publications’page.

Discussion

Home and professional mechanics riskserious injury if they get underneath acar supported by a vehicle jack or jacks.

ReferencesStandards Australia. AS/NZS 2615:2004:Vehicle jacks. Sydney, March 2003.

Standards Australia. AS/NZS 2693:2003/Amdt1:2004: Vehicle jacks. Sydney, April 2004.

Standards Australia. AS/NZS 2615: 2004:Hydraulic trolley jacks. Sydney, May 2004.

Standards Australia. AS/NZS 2538:2004:Vehicle support stands. Sydney, June 2004

.

Standards Australia. AS/AS/NZS 2640:1994:Portable ramps for vehicles, Sydney, April1994.


Community Safety Month 2006 is being led by Department of Justice (DOJ) and coordinated by the StrategicCommunications Branch and in partnership with the VSCN. Planning is well underway, with registration of activitiesalready taking place. Keep an eye out for regular updates through various mediums or go to the CSM website:www.communitysafetymonth.com.au to register your activities or VSCN website: www.vscn.org.au

For further information contact:Lisa Purchase, Manager, Community Safety Month via [email protected] or Barbara Minuzzo, VSCNExecutive Secretary via [email protected]

Announces theAnnounces the44thth VSCN Annual ConferenceVSCN Annual Conference

““What is your local solution?”What is your local solution?”Darebin Arts and Entertainment CentreDarebin Arts and Entertainment Centre

Wednesday 15Wednesday 15thth Nov 2006Nov 2006


- INDEX -ubjectition Pages

Subject ..................................................................................................................................................... Edition ...................................... PagesAsphyxia........................................................................................................................................................60........................................ 1-13Babywalkers, update.........................................................................................................................16,20,25,34............... 1-4,12-13,7-8,7-8Baseball .................................................................................................................................................................................. 30 ............................................ 10-12Boating-related recreational injury ................................................................................................................................... 56 .............................................. 1-16Bunkbeds ............................................................................................................................................................................... 11 .................................................. 12Bicycles - Bicycle related ............................................................................................................................... 6,31,34,44 .......... 1-8,9-11,8-12,7-8,10-11

- Cyclist head injury study ................................................................................................................... 2,7,8,10 ....................................... 2,8,13,9Burns - Scalds, Burns prevention .................................................................................................................... 3,12,25 ............................... 1-4,1-11,4-6

- Unintentional burns and scalds in vulnerable populations ..................................................................... 57 .............................................. 1-17Child care settings ................................................................................................................................................................ 16 .............................................. 5-11Client survey results ............................................................................................................................................................ 28 .................................................. 13Cutting and piercing (unintentional) asasultive ....................................................................................................... 52, 55 .................................. 1-17,14-17Data base use, interpretation & example of form ............................................................................................................ 2 ................................................ 2-5Deaths from injury (Victoria) ....................................................................................................................................... 11,38 .................................... 1-11,1-13Dishwasher machine detergents - Update ....................................................................................................................... 18 .................................................. 11DIY maintenance injuries ................................................................................................................................................... 41 .............................................. 1-12Dog bites, dog related injuries ........................................................................................................................ 3,12,25,26,34 .................... 5-6,12,13,7-13,2-5Domestic architectural glass ..................................................................................................................................... 7,22,25 ................................. 9-10,1-5,12Domestic Violence .......................................................................................................................................................... 21,30 ......................................... 1-9,3-4Drowning/near drowning, including updates ............................................................................................... 2,5,7,30,34,55 ................. 3,1-4,7,6-9,5-7,1-13Elastic luggage straps ........................................................................................................................................................... 43 ................................................ 2-6Escalator ............................................................................................................................................................................... 24 .............................................. 9-13Exercise bicycles, update ................................................................................................................................................... 5,9 ........................................ 6,13-14Falls - Child, Older Persons, Home .................................................................................................................. 44,45,48,59 ................. 1-17,1-15,1-12,1-21Farm, Tractors ..................................................................................................................................................... 30,3324,47 ......................... 4,1-13,1-8,8-10Finger jam (hand entrapment) .................................................................................................................... 10,14,16,25,59 ................ 5,5-6,9-10,9-10,1-21Fireworks ............................................................................................................................................................................... 47 ................................................ 2-7Geographic regions of injury .............................................................................................................................................. 46 .............................................. 1-17Home .......................................................................................................................................................................... 14,32,59 ......................... 1-16, 1-13,1-21Horse related ...................................................................................................................................................................... 7,23 ...................................... 1-6,1-13Infants - injuries in the first year of life ............................................................................................................................ 8 .............................................. 7-12Injury surveillance developments, includes ICD10 coding ....................................................................................... 30,43 ...................................... 1-5,8-13Intentional ............................................................................................................................................................................ 13 .............................................. 6-11Latrobe Valley - First 3 months, Injury surveillance & prevention in L-V ....................... 9, March 1992, Feb 1994 .......................... 9-13, 1-8, 1-14Ladders .................................................................................................................................................................................. 63 .............................................. 1-14Lawn mowers ........................................................................................................................................................................ 22 ................................................ 5-9Marine animals ..................................................................................................................................................................... 56 ............................................ 18-20Martial arts ........................................................................................................................................................................... 11 .................................................. 12Mobility scooters ................................................................................................................................................................. 62 .............................................. 1-12Motor vehicle related injuries, non-traffic, vehicle jack injuires ............................................................................ 20,63 .......................................... 1-9,16Needlestick injuries ................................................................................................................................................... 11,17,25 .................................. 12,8,10-11Nursery furniture ............................................................................................................................................................. 37,44 .................................. 1-13,11-13Older people ......................................................................................................................................................................... 19 .............................................. 1-13Off-street parking areas ...................................................................................................................................................... 20 ............................................ 10-11Playground equipment ................................................................................................................... 3,10,14,16,25,29,44,617-9,4,8,8-9,13,1-12,13-14,1-21Poisons - Domestic chemical and plant poisoning .................................................................................................. 28 ................................................ 1-7

- Drug safety and poisons control ................................................................................................................. 4 ................................................ 1-9- Dishwasher detergent, update .................................................................................................................. 10,6 .......................................... 9-10,9- Early Childhood, Child Resistant Closures ...................................................................................... 27,2,47 ............................... 1-14,3,11-15- Adult overview ............................................................................................................................................. 39 .............................................. 1-17

Power saws, Chainsaws ................................................................................................................................................... 22,28 .................................. 13-17,8-13Roller Blades, Skateboards ................................................................................................................................ 2,5,25,31,44 .............. 1-2,11-13,12,12 3-7,8School .................................................................................................................................................................................... 10 ................................................ 1-8Shopping trolleys ...................................................................................................................................................... 22,25,42 ............................... 10-12,8-9,12Smoking-related .................................................................................................................................................. 21,25,29,44 ................................. 10-12,6-7,8Socio-economic status and injury ...................................................................................................................................... 49 .............................................. 1-17Sports - child sports, adult sports, surf sports ......................................................................................... 8,9,44,15,51,561-6,1-8,15-16,1-10,1-25,16-18Suicide - motor vehicle exhaust gas ................................................................................................................. 11,20,25,41 ............................ 5-6,2-4,3-4,13Trail bikes ............................................................................................................................................................................. 31 ................................................ 7-9Trampolines .............................................................................................................................................................. 13,42,61 ............................. 1-5,1-11,1-21Trends in road traffic fatality and injury in Victoria ..................................................................................................... 36 .............................................. 1-13Vapouriser units ................................................................................................................................................................... 43 ................................................ 7-8Venomous bites and stings .................................................................................................................................................. 35 .............................................. 1-13VISS: How it works, progress, A decade of Victorian injury surveillance .......................................................... 1,26,40 ............................... 1-8,1-5,1-17VISAR: Celebration of VISAR's achievements, VISAR name change to VISU ..................................................... 50,61 .......................................... 1-25,1Work-related ............................................................................................................................................................. 17,18,58 ........................... 1-13,1-10,1-17


VISU Executive /Editorial BoardProf Joan Ozanne-Smith, Monash University Accident Research CentreProf Ian Johnston, Monash University Accident Research CentreAssoc. Prof James Harrison, Research Centre for Injury Studies (SA)Assoc. Prof David Taylor, Royal Melbourne HospitalMs Erin Cassell, Director, Victorian Injury Surveillance Unit

Guest Editor:Barry Naismith, Construction Branch, WorkSafe Victoria

VISU StaffDirector: Ms Erin CassellCo-ordinator: Ms Karen AshbyResearch Fellow: Ms Angela Clapperton

General AcknowledgementsParticipating hospitals

From October 1995Austin & Repatriation Medical CentreBallarat Base HospitalThe Bendigo Hospital CampusBox Hill HospitalEchuca Base HospitalThe Geelong HospitalGoulburn Valley Base HospitalMaroondah HospitalMildura Base HospitalThe Northern HospitalRoyal Children's HospitalSt Vincents Public HospitalWangaratta Base HospitalWarrnambool & District Base HospitalWestern Hospital - FootscrayWestern Hospital - SunshineWilliamstown HospitalWimmera Base HospitalFrom November 1995Dandenong Hospital

From December 1995Royal Victorian Eye & Ear HospitalFrankston Hospital

From January 1996Latrobe Regional Hospital

From July 1996Alfred HospitalMonash Medical Centre

From September 1996Angliss Hospital

From January 1997Royal Melbourne Hospital

From January 1999Werribee Mercy Hospital

From December 2000Rosebud Hospital

Coronial ServicesAccess to coronial data and links withthe development of the Coronial Servicesstatistical database are valued by VISU.

How to access VISU

data:VISU collects and analyses informationon injury problems to underpin thedevelopment of prevention strategiesand their implementation. VISU analysesare publicly available for teaching,research and prevention purposes.Requests for information should bedirected to the VISU Co-ordinator or theDirector by contacting them at the VISUoffice.

Contact VISU at:MUARC - Accident Research CentreBuilding 70Monash UniversityVictoria, 3800

Phone:Enquiries (03) 9905 1805Co-ordinator (03) 9905 1805Director (03) 9905 1857Fax (03) 9905 1809

Email:[email protected]

From January 2004Bairnsdale HospitalCentral Gippsland Health Service (Sale)Hamilton Base HospitalRoyal Women's HospitalSandringham & District HospitalSwan Hill HospitalWest Gippsland Hospital (Warragul)Wodonga Regional Health Group

From April 2005Casey Hospital

All issues of Hazard and otherinformation and publications of theMonash University Accident ResearchCentre can be found on our internet homepage:http://www.monash.edu.au/muarc/visu

National InjurySurveillance UnitThe advice and technical back-upprovided by NISU is of fundamentalimportance to VISU.


VISU is a project of the Monash University Accident Research Centre, funded by theDepartment of Human Services

Hazard was produced by the Victorian Injury Surveillance Unit (VISU)

with layout assistance of Christine Chesterman, Monash University Accident Research Centre

Illustrations by Debbie Mourtzios & Jocelyn Bell*

ISSN-1320-0593

Printed by Work & Turner Pty Ltd, Tullamarine

* Copyright clause: Copyright for all creative property as commissioned including sketches,remains under the exclusive ownership of Jocelyn Bell

consumer product-related injury (3): injury related to the … injury surveillance unit hazard 63...

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