Slips, Trips, Missteps and Their Consequences, second edition

Gary Bakken, Ph.D., H. Harvey Cohen, Ph.D., C.P.E., John Abele, Esq., Alvin S. Hyde, Ph.D., M.D., and Cindy LaRue, M.S., C.P.E

Detailed Table of Contents (Return to book page and ordering link)

Part I: Forensic Human Factors and Ergonomics and Safety
Overview 3

Chapter 1: Standing, Walking, Environment 5
1.1 Introduction 5
1.2 Standing and Swaying 5
1.3 Walking Cycle 6
1.4 Environment 8
References 10
1.5 The Senile Gait (Prepared by Alvin S. Hyde) 11
1.6 Aging, and the Pathophysiology of "Normal" Central Nervous System Changes (Prepared by Alvin S. Hyde) 11
References (sections 1.5 and 1.6) 12

Chapter 2: Walkway Hazards 13
2.1 Introduction 13
2.2 Slip Hazard 13
2.3 Coefficient of Friction 16
2.4 SCOF: The Tangent of the Angle of the Incline with Respect to the Horizontal 18
2.5 Traction Demand 20
2.6 Other Pedestrian Slip Causality Factors 21
2.7 Footwear 21
2.8 Ramps or Other Inclined Surfaces 22
2.9 Slipping During Walking 23
2.10 Preventing Slips 24
2.11 Measuring Coefficient of Friction-Equipment 24
2.12 Measuring Coefficient of Friction-Test Specimens 26
2.13 Measuring Coefficient of Friction-Human-Based Approaches 27
2.14 Slip Hazard Standards and Regulations 27
2.15 Trip Hazard 32
2.16 Vertically Oriented Projecting Object Surface 33
2.17 Projecting Object Location 33
2.18 Height of the Projecting Object 34
2.19 Trip Hazard Standards and Regulations 34
2.20 Misstep Hazard 35
2.21 Misstep Hazard Change in Elevation 35
2.22 Misstep Hazard Expectations 35
2.23 Misstep Hazard Neuromusculoskeletal Response 36
2.24 Single Step, a Hazardous Condition 36
References 38

Chapter 3: Information Processing 41
3.1 General 41
3.2 Detection 41
3.3 Perception 41
3.4 Analysis 42
3.5 Decision Making 42
3.6 Response 43
3.7 Action 43
3.8 Human Error 43
3.9 Risk Perception 43
3.10 Risk Information Processing 45
References 48

Chapter 4: How We Fall and Why We Fall 49
4.1 Introduction 49
4.2 Fall Types 49
4.3 Free Falls 49
4.4 Rotational Falls 49
4.5 Crumple Falls 50
4.6 Tumble Falls 50
4.7 The Fall Event 51
A. Fall initiation 51
B. Fall prevention responses 51
C. Injury prevention or mitigation responses 52

Chapter 5: Falls and Their Causes: On Who Falls and Who Is Injured 53
Alvin S. Hyde
5.1 General 53
5.2 The Incidence of Accidental Falls 53
5.3 The Incidence of Accidental Fall Injuries and
Deaths 54
5.4 The Influence of Age on Accidental Falls and the Injuries and Deaths They Cause 54
5.5 The Influence of Race and Sex on Accidental Falls and the Injuries and Deaths They Cause 58
5.6 Summary 58
Endnotes 59

Chapter 6: On Gravity: A Relentless Force That Would Cast Us to the Ground (How We Detect, Use and Resist the Force of Gravity) 61
Alvin S. Hyde
6.1 General 61
6.2 "G" (The Gravitational Constant) and "g" (The Acceleration Due to the Pull of the Earth's Gravity) 61
6.3 Mass Versus Weight 62
6.4 How We Tell Where We Are Positioned in Earth's Gravitational Field; (or) Where Is Up and Where Is Down? And How Do We Know This Is So? 63
6.5 How We Tell Our Position in Space 64
6.6 How We Continuously Interpret and Modify Our Position in Space 64
6.7 Generalizations Concerning the Control of Posture and of Movement 65
6.8 Summary 68
Endnotes 69

Chapter 7: Biomedical Factors That Cause Falls: Senescence and Diseases 71
Alvin S. Hyde
7.1 Introduction 71
7.2 General 71
7.3 Diseases and Changes of Aging That Either Cause Falls or Increase the Chance of Accidentally Falling 72
A. Peripheral sensors and nerves: their age-related changes and diseases 72
B. Central nervous system age-related changes and diseases 78
C. Cardiovascular aging and diseases 81
D. Musculoskeletal system diseases affecting falling 84
Endnotes 89

Chapter 8: Biomedical Factors That Cause Falls: Medications and Iatrogenic Causes 93
Alvin S. Hyde
8.1 General 93
8.2 The Relationship Between Accidental Falls and the Type, Absolute Number, and Amount of Drugs Taken 93
8.3 The Relationship (if any) Between Age and Adverse Drug Reactions 94
8.4 What Factors Determine a Drug's Dose? How Do These Factors Change with Increasing Age? 95
8.5 Adverse Drug Reactions and Polypharmacy 96
8.6 Summary 97
Endnotes 98

Chapter 9: Environmental Factors That Cause Falls 99
Alvin S. Hyde
9.1 General 99
9.2 Introduction 99
9.3 Environmental Factors: Ambience, Design Standards, and Pedestrian Traffic 100
A. Ambience 100
B. Pedestrian traffic 103
9.4 Falls at Home and Work 104
A. General 104
B. Falls at home 104
C. Falls at work 106
Endnotes 107

Chapter 10: Fall Injury Information 109
10.1 Introduction 109
10.2 Fall Incidence 109
10.3 Death and Death Rates by Age and Sex 109
10.4 All Deaths Due to Injury 110
10.5 Unintentional-Injury Deaths by Month and
Type 110
References 112

Part II: Injuries

Chapter 11: Stability, Fall and Injury 117
11.1 Introduction 117
11.2 Stability 117
11.3 Fall Definition 118
11.4 Fall Injuries 119
11.5 Impact Surfaces 120
References 120

Chapter 12: A Brief View of Osteoporosis: A Biomedical Factor That Makes Fractures from Falling More Probable 121
Alvin S. Hyde
12.1 General 121
12.2 Osteopenia 122
12.3 Osteoporosis Further Defined and
Characterized 122
12.4 The Rates of Bone Loss in Women and Men with Age 123
12.5 The Prevention and Treatment of Osteoporosis 124
12.6 Summary 124
Endnotes 125

Chapter 13: Fall Injuries 127
Alvin S. Hyde
13.1 Introduction 127
13.2 Factors That Determine Response to Falls 127
A. Fall height and same-level falls 128
B. Impact direction (position at landing) 129
C. Protective reflexes for falls 129
D. Impacted surface material 130
E. Individual disposition, or, the age, size, sex, and health of fall victims 131
13.3 The Distribution of Injury Sites Resulting from Same-Level Falls 131
A. Head injuries from same-level falls 132
B. Injuries of the spine from falls 136
C. Fall injuries of the extremities 139
13.4 Summary 142
Endnotes 143

Part III: Legal Considerations

Chapter 14: Premises Liability 149
14.1 Preparing a Slip, Trip, or Misstep and Fall Case 149
14.2 Duty Owed 150
14.3 Classification of Plaintiff as Trespasser 150
14.4 Duty Owed to Licensee 151
14.5 Duty Owed to Invitee 152
14.6 Potential Defendants 153
14.7 Breach of Duty 153
14.8 Violation of Statute 154
14.9 Notice of Dangerous Condition 155
14.10 Actual Notice 155
14.11 Plaintiff's Attention Diverted 156
14.12 Constructive Notice 156
14.13 Activities on Premises 158
14.14 Illumination 158
14.15 Proximate Cause 159
14.16 Actions by Third Parties 159
14.17 Self-Service Activities 160
14.18 Damages 160
14.19 Enhancement Factors 160

Chapter 15: Defenses in a Slip, Trip, or Misstep and Fall Case 163
15.1 Introduction 163
15.2 Not Proper Party Defendant 163
15.3 No Duty Owed to Plaintiff 163
15.4 No Prior Accidents 165
15.5 Knowledge of Observable Dangers 165
15.6 Snow and Ice 166
15.7 No Breach of Duty 167
15.8 Proximate Cause 167
15.9 Trivial Defect 167
15.10 Static Condition 168
15.11 Failure to Prove Cause of Accident 168
15.12 Damages 169
15.13 Affirmative Defenses 170
A. Assumption of the risk 170
B. Comparative fault/contributory negligence 170
15.14 Case Preparation 171
A. Witnesses 171
B. Expert witnesses 171

Chapter 16: Slip and Fall Fact Circumstances 173
16.1 Slip in Parking Lot 173
16.2 Slip on Spilled Drink 173
16.3 Slip on Ramp 174
16.4 Fall on Stairs 174
16.5 Slip in Shower 175
16.6 Absorbent Floor Mats 175
16.7 Slip on Packing Band 175
16.8 Slip on Hardwood Floor 175
16.9 Hazard Created by Other Customer 176
16.10 Self-Service Activity 176

Chapter 17: Table of Cases 177
Sample Deposition Slip and Fall Case 181

Part IV: Applications

Chapter 18: Level Surfaces 187
18.1 Introduction 187
18.2 Common Walkway Surfaces 187
A. Natural stone 187
B. Terrazzo 187
C. Tile 188
D. Carpeting and wood flooring 188
E. Bathing surfaces and showers 188
F. Sidewalks and concrete flooring 189
References 190

Chapter 19: Stairways and Handrails 191
19.1 Introduction 191
19.2 Stairway Definitions 191
19.3 High-Risk Stairs 192
19.4 Step Geometry 192
19.5 Winder, Circular, and Spiral Stairs 193
19.6 Single steps 193
19.7 Stair Landings 193
19.8 Handrails 194
19.9 Human Factors in Using Stairs 195
19.10 Staircase Fall Patterns 196
19.11 Summary 196
References 197

Chapter 20: Ramps 199
20.1 Introduction 199
20.2 Ramp Requirements 199
20.3 Fall Patterns on Ramps 199
References 200

Chapter 21: Ladders 201
21.1 Introduction 201
21.2 Ladder Types 201
A. Portable wood ladders 201
B. Portable metal ladders 201
C. Fixed ladders 202
21.3 Common Ladder Fall Patterns 202
21.4 Ladder Hazard Warnings 202
21.5 Safe Ladder Use 203
A. Ladder placement 203
B. Ascending or descending ladders 204
C. Other recommended practices 204
21.6 Electrical Hazards and Metal Ladders 204
21.7 Ladder Inspection and Maintenance 204
21.8 Ladder Storage 204
References 205

Chapter 22: Vehicle Ingress and Egress 207
22.1 Introduction 207
22.2 Car Haulers 207
22.3 Cab-Over-Engine Tractors 207
22.4 Conventional Tractors 208
22.5 General Trailers 209
22.6 Conclusions and Recommendations 209
References 210

Chapter 23: Elevated Walking and Working Surfaces 211
23.1 Introduction 211
23.2 The Hazard 211
23.3 Hazard Exposure 211
23.4 Utility Value 212
23.5 Risk of Injury 212
23.6 Hazard Awareness and Exposure Magnitude 212
23.7 Hazard Avoidance 212
23.8 Laws, Codes, Standards, and References 213

Chapter 24: Elevators and Escalators 217
24.1 Introduction 217
24.2 The Hazards 217
24.3 Hazard Exposure 220
24.4 Utility Value 220
24.5 Risk of Injury 220
24.6 Hazard Awareness and Exposure Magnitude 221
24.7 Hazard Avoidance 221
24.8 Laws, Codes, Standards, and References 222

Chapter 25: Skylights 227
25.1 Introduction 227
25.2 The Hazard 228
25.3 Hazard Exposure 228
25.4 Utility Value 229
25.5 Risk of Injury 229
25.6 Hazard Awareness and Exposure Magnitude 229
25.7 Hazard Avoidance 229
25.8 Laws, Codes, Standards, and References 231

Chapter 26: Warnings for Safe Pedestrian Use 233
26.1 Introduction 233
26.2 Scope of the Problem 233
26.3 Perceptual-Cognitive Factors in Warning
Adequacy and Effectiveness 234
A. Unexpected impediment in a level walking surface 235
B. Unexpected change in level 236
C. Unexpected change in traction 236
26.4 Stairways 237
A. Unexpected variation in step geometry 237
B. Marking of handrails 237
C. Marking of stair treads 238
26.5 Ramps 238
26.6 Sidewalks 238
26.7 Driveways and Parking Lots 239
26.8 Curbs in Parking Garages 240
26.9 Pathways Through Landscaped Areas 240
26.10 Walkways in and Around Residences 240
26.11 Aisles in and Around Commercial Establishments 241
26.12 Other Elevated Walkway or Working Surfaces 241
26.13 Conclusions 242
References 242

Part V: The Fall Prevention Manual

The Fall Prevention Manual 245
Appendix A: Friction and Slipperiness 349
Appendix B: Lighting 351
Appendix C: Walking Kinematics and Biomechanics: How Falls Occur 353
Appendix D: Perception: Why Don't We See What Is There? 355
Appendix E: Common Fall Incident Patterns 357
Appendix F: Preventive Actions 359
Appendix G: Premises Fall Incident Investigation 361
Appendix H: References and Bibliography for Codes, Standards and Guidelines 363
About the Authors 365
Index 367

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