Fatal Fall Research Articles

A Study of Pattern of Injuries of Fatal Fall from Heights

A Study of Pattern of Injuries of Fatal Fall from Heights

Increasing Trend of Fatal Falls in Older Adults in the United States, 1992 to 2005: Coding Practice or Reporting Quality?

To investigate whether changes in death certificate coding and reporting practices explain part or all of the recent increase in the rate of fatal falls in adults aged 65 and older in the United States. Trends in coding and reporting practices of fatal falls were evaluated under mortality coding schemes for International Classification of Diseases (ICD), Ninth Revision (1992-1998) and Tenth Revision (1999-2005). United States, 1992 to 2005. Individuals aged 65 and older with falls listed as the underlying cause of death (UCD) on their death certificates. The primary outcome was annual fatal falls rates per 100,000 U.S. residents aged 65 and older. Coding practice was assessed through analysis of trends in rates of specific UCD fall ICD e-codes over time. Reporting quality was assessed by examining changes in the location on the death certificate where fall e-codes were reported, in particular, the percentage of fall e-codes recorded in the proper location on the death certificate. Fatal falls rates increased over both time periods: 1992 to 1998 and 1999 to 2005. A single falls e-code was responsible for the increasing trend of fatal falls overall from 1992 to 1998 (E888, other and unspecified fall) and from 1999 to 2005 (W18, other falls on the same level), whereas trends for other falls e-codes remained stable. Reporting quality improved steadily throughout the study period. Better reporting quality, not coding practices, contributed to the increasing rate of fatal falls in older adults in the United States from 1992 to 2005.

Strategies to reduce safety violations for working from heights in construction companies: study protocol for a randomized controlled trial.

BackgroundSafety measures should be applied to reduce work-related fatal and non-fatal fall injuries. However, according to the labor inspectorate, more than 80% of Dutch construction sites violate safety regulations for working from heights. To increase compliance with safety regulations, employers and workers have to select, implement and monitor safety measures. To facilitate this behavioral change, stimulating knowledge awareness and personalized feedback are frequently advocated behavior change techniques. For this study, two behavior change strategies have been developed in addition to the announcement of safety inspections by the labor inspectorate. These strategies consist of 1) face-to-face contacts with safety consultants and 2) direct mail with access to internet facilities. The objective of this study is to evaluate the effectiveness of these two strategies on the safety violations for working from heights, the process and the cost measures.Methods/DesignThis study is a block randomized intervention trial in 27 cities to establish the effects of the face-to-face guidance strategy (N = 9), a direct mailing strategy (N = 9) and a control condition of no guidance (N = 9) on safety violations to record by labor inspectors after three months. A process evaluation for both strategies will be performed to determine program implementation (reach, dose delivered and dose received), satisfaction, knowledge and perceived safety behavior. A cost analysis will be performed to establish the financial costs for both strategies. The present study is in accordance with the CONSORT statement.DiscussionThis study increases insight into performing practice-based randomized controlled trials. The outcome will help to evaluate the effect of two guidance strategies on safety violations. If these strategies are effective, implementation of these strategies through the national institute of safety and health or labor inspectorate can take place to guide construction companies in complying with safety regulations.Trial registrationNTR 4298 on 29-nov-2013.

Investigation of Factors Contributing to Fatal and Nonfatal Roofer Fall Accidents

Roofers continue to suffer frequent fall-related injuries and fatalities. The objectives of this research were (a) identifying the factors affecting roofer fall accidents; (b) investigating the frequency distributions of these factors; (c) examining the relationships between the factors; and (d) developing a statistical model for fatal and nonfatal fall outcomes. Occupational Safety & Health Administration (OSHA) accident data was analyzed using categorical variables. After establishing data demographics, cross-tabulation analysis was performed to determine factor relationships, and logistic regression modeling was done to predict accident outcomes using degree of injury as a dependent variable and the significant factors from cross-tabulation as independent variables. It was found that roofers most frequently experienced falls while working in smaller alteration/rehabilitation projects and at heights below 20 feet. Unguarded/improperly secured platforms, walkways, openings, edges and ladders, misjudgment of hazardous situation, and improper choice of equipment/process came out to be significant contributing factors. It was observed that the odds of fatality decreased when roofers were provided OSHA-compliant fall protection systems; used these systems; and received fall protection training per OSHA requirements. The model developed and validated in this study successfully predicted the fall accident outcomes in terms of fatality and nonfatal injury.

Nightingale’s Nest by Nikki Loftin (review)

Reviewed by: Nightingale’s Nest by Nikki Loftin Amy Atkinson Loftin, Nikki Nightingale’s Nest. Razorbill, 2014. [256p]. ISBN 978-1-59514-546-8 $16.99 Reviewed from galleys R* Gr. 4–7. At twelve-years old, “Little John” Fischer isn’t so little anymore. A recent growth spurt allows him to help his father earn money chopping and hauling trees—work that’s physically demanding and emotionally devastating, given his younger sister’s recent fatal fall from a dead branch. Drowning in the guilt of not having caught her, Little John plays along when his mother talks as if his sister’s still alive; he also ignores his father’s drinking and hides his family’s dwindling solvency from his best friend by avoiding him completely. Lonely and unbearably sad, he meets Gayle, an abused foster child with a magical voice that enchants the birds and heals the wounded. She trusts Little John immediately, leaping into his arms from her “nest,” the branch of a tree where she claims her parents will find her one day, and even following him into the home of Mr. King, the wealthy and unnerving landowner from whom she usually flees. When Little John sells her voice—and her trust—to Mr. King for the money to cover his family’s rent, he knows he must make it right, no matter the cost. Magical realism meets coming of age in this sensitive and haunting novel, with the relentless, eroding effects of family tragedy in full relief. Sympathetic but not saccharine, Loftin’s portrayal of Little John, with his tremendous sense of responsibility and his unflagging feeling of guilt, as well as his [End Page 413] need for love and acceptance, will resonate with readers who carry life’s burdens. The otherworldly Gayle will captivate their imaginations as she flutters in and out of reach, singing the injured back to health and calling the birds to her with her voice, but it’s Little John who will capture their hearts. Read this aloud and have both boys and girls alike utterly enraptured. Copyright © 2014 The Board of Trustees of the University of Illinois

An unusual mechanism for patterned bruising in a fatal fall from a building

A 90-year-old man was found dead lying on the ground in front of a building. He had committed suicide by jumping from the 5th floor (approximately 15 m height) of the building where he had lived in his apartment. His medical records revealed that the man had suffered from dementia with a history of psychiatric disorders and suicidal tendencies. A suicide note was found in his apartment. External examination of the body revealed blunt force injuries on the skin (abrasions and hematomas) of the thorax and on the limbs. Of note, an unusual finding was that of patterned bruising of the right forearm with parallel linear stripes along the posterior surface of the arm overlying the right radius and ulna (Fig. 1). At autopsy, multiple fractures of the thoracic cage including the sternum, the ribs and the thoracic spine, were found. Complete transmural tears of the heart were also observed together with extensive contusions and tears of both lungs and the liver. In addition, there were comminuted fractures of the lower limbs. Toxicological examination was negative. Death was attributed to multiple trauma. The manner of death was ruled as a suicide. Discussion

A Fatal Fall Associated With Undiagnosed Parenchymatous Neurosyphilis

A fall from a great height is often associated with altered mental status. Aside from the usual contributing factors, for example, alcohol consumption or mental illness, natural disease leading to a fatal fall is seldom identified by autopsy. The case described in this report is that of a 57-year-old man who had been clinically diagnosed with presenile Alzheimer disease and fell head first into a river from the bridge. These events were captured by a surveillance camera on the bridge; an acquaintance reported that he had previous suicidal ideation. At autopsy, the cervical spinal cord was determined to have been severely injured, and the sixth cervical vertebra was observed to have been fractured. Histological examination showed chronic meningoencephalitis including neuronal loss, perivascular cuffing, and the proliferation of microglia and astrocytes in the cerebral cortex. Serologic evaluation consisting of the nontreponemal antigen test (rapid plasma reagin [RPR]) and treponemal antibody test (Treponema pallidum latex agglutination) was positive in both cases (RPR: 18.2 RPR units, T. pallidum latex agglutination: 7718 U/mL). These findings suggested that the patient had been affected by a syphilis infection and that his suicidal behavior was associated with parenchymatous neurosyphilis.

Head and neck injury patterns in fatal falls: Epidemiologic and biomechanical considerations

Fatal falls often involve a head impact, which are in turn associated with a fracture of the skull or cervical spine. Prior authors have noted that the degree of inversion of the victim at the time of impact is an important predictor of the distribution of skull fractures, with skull base fractures more common than skull vault fractures in falls with a high degree of inversion. The majority of fatal fall publications have focused on skull fractures, and no research has described the association between fall circumstances and the distribution of fractures in the skull and neck. In the present study, we accessed data regarding head and neck fractures resulting from fatal falls from a Swedish autopsy database for the years 1992–2010, for the purposes of examining the relationships between skull and cervical spine fracture distribution and the circumstances of the fatal fall.Out of 102,310 medico-legal autopsies performed there were 1008 cases of falls associated with skull or cervical spine fractures. The circumstances of the falls were grouped in 3 statistically homogenous categories; falls occurring at ground level, falls from a height of <3 m or down stairs, and falls from ≥3 m. Only head and neck injuries and fractures that were associated with the fatal CNS injuries were included for study, and categorized as skull vault and skull base fractures, upper cervical injuries (C0–C1 dislocation, C1 and C2 fractures), and lower cervical fractures. Logistic regression modeling revealed increased odds of skull base and lower cervical fracture in the middle and upper fall severity groups, relative to ground level falls (lower cervical <3 m falls, OR = 2.55 [1.32, 4.92]; lower cervical ≥3 m falls, OR = 2.23 [0.98, 5.08]; skull base <3 m falls, OR = 1.82 [1.32, 2.50]; skull base ≥3 m falls, OR = 2.30 [1.55, 3.40]). C0–C1 dislocations were strongly related to fall height, with an OR of 8.3 for ≥3 m falls versus ground level. The findings of increased odds of skull base and lower cervical spine fracture in falls from a height are consistent with prior observations that the risk of such injuries is related to the degree of victim inversion at impact. The finding that C0–C1 dislocations are most common in falls from more than 3 m is unique, an indication that the injuries likely result from high energy shear forces rather than pure tension, as previously thought.

Geotechnical issues in the application of rock bolting technology for the development of underground coal mines in Indonesia

The application of a rock bolting system for Indonesian underground coal mines has been attempted for several years without any success. Recently, two new underground mining trials were conducted in East Kalimantan, Indonesia, in order to investigate the possibility of using rock bolting to address the technical challenges of underground coal mines under weak geological conditions. Unfortunately, one of the trials failed and was given up due to a fatal roof fall accident. However, in another trial, even though roof falls have occurred within the working area, the bolted roadways showed reasonable stability over time. Moreover, a comprehensive monitoring system has been installed in order to monitor the ground behaviour and its characteristics. This application of a comprehensive monitoring system has enhanced the ability to increase the level of support and to react to changing/deteriorating conditions. This paper describes the conditions and geotechnical issues for underground mines in Indonesia, and discusses the applicability of the rock bolting system to address problems associated with weak strata conditions in Indonesia.

Can health public expenditure reduce the tragic consequences of road traffic accidents? The EU-27 experience

This study uses data for the EU-27 countries in the period 1999-2009 to estimate determinants of road traffic fatality rates. Controlling for country attributes and road safety policy variables, we examine the influence of variables related with the national health systems; the number of hospital beds per square kilometer, and the percentage of health expenditures over gross domestic product. We find evidence that the density of hospital beds contributes to the fall in traffic-related fatalities. Furthermore, the quality of general medical facilities and technology associated with increases in health expenditure may be also a relevant factor in reducing road traffic fatalities.

Schwannoma vestibular y caída mortal en el anciano. Implicaciones médico-legales

Accidental falls among in the elderly are a significant cause of morbidity/mortality in developed countries because of their high prevalence. We report a case of fatal fall of an old man who lost his balance and fell sideways. The autopsy revealed multiple trauma. There was an infratentorial nodule that was diagnosed as cocleovestibular schwannoma (CVS).Although the death was deemed accidental, the presence of CVS and the associated vertigo could have contributed to the deadly imbalance. This influential factor is relevant from a legal point of view even if its onset remains uncertain. In this case, we believe that vertigo was the initial cause of the fall and there was a reasonable degree of diagnostic certainty since there was a coexistence of several reasonable possibilities (vertigo versus stumble). This standard has probative value in civil trials, particularly in the assessment of the indemnifications.

Fatal Falls in an Ethnically Diverse Urban Community

Fatal falls cause more than 15,000 deaths per year in the United States. Despite this, the circumstances surrounding fatal falls in elderly adults are poorly understood. It is unknown whether these circumstances differ across ethnicities, although Hispanic American individuals are at reduced risk for fatal falls. This study sought to describe fatal falls in an urban, predominantly Hispanic, and white non-Hispanic community and to determine the association of demographics with the circumstances surrounding these falls (proximate factors). The death certificates and medical examiners' reports for all 328 elderly individuals experiencing a fatal fall in Miami-Dade County, FL, from 2005 to 2007 were reviewed for demographic and proximate factors such as the preceding activity and fall location. Fatal falls in elderly adults were experienced mostly by individuals living in the community (80%) and affected all demographic subgroups, although 80% occurred in individuals older than 74 years. Most fatal falls occurred at home (74%), indoors (75%), and during nonvigorous activities such as walking (58%) and these tended to affect the oldest elderly. In addition, a significant number of fatal falls occurred in public locations, outdoors, and during vigorous activity, with these falls tending to affect younger individuals living without family. Hispanic ethnicity was not associated with proximate factors. Fatal fall prevention is needed for elderly individuals living in the community and should target the oldest elderly adults living at home while helping to ensure that individuals who are living without family have the appropriate support. These data suggest that Hispanic individuals may benefit from prevention strategies developed in other populations.

Applying Clustering Algorithms to Explore the Circumstances of Fatal Falls in Construction Industry

This research adopted constrained k-prototypes algorithm to analyze the database that contains 294 cases of fatal falls between the years 2003 and 2010 within the Taiwanese construction industry. The objective of this study is to explore the circumstances of the fatal falls. The results of the analysis indicate that the primary circumstances under which the accidents occurred include the professional category of other specialized construction businesses; hazardous mediums such as scaffolding, support frame, stairs, stairways, and the openings, etc.; the time period between 9:00 am and 11:00 am; the falling height between 0 and 10meters. Meanwhile, not adopting safe construction methods is a major indirect factor that contributes to the accidents. The fundamental factors contributing to the accidents include not clearly informing the subcontractors of the conditions of the work environment, risk factors, labor health and safety regulations as well as the necessary measures to ensure the health and safety prior to the project commences.

The Development of A Database Program for Fatal Electrocution and Fatal Fall Accidents in Construction Industry

The Development of A Database Program for Fatal Electrocution and Fatal Fall Accidents in Construction Industry

Organizational Accidents: A Systemic Model of Production versus Protection

abstractProduction pressure is often cited as an underlying contributory factor of organizational accidents. The relationship, however, between production and safety protection is complex and has not been adequately addressed by current theories regarding organizational accident. In addressing this gap, this paper uses the methodology of system dynamics to develop a causal model to address the dynamic interaction between management of production and protection, which can accumulate in an organizational accident. A case study of a fatal rock fall accident in Tasmania, Australia was conducted based on the developed model and is used to uncover the intricate dynamics linking production pressure, risk tolerability, perception of safety margin, and protection efforts. In particular, the study demonstrates how a strong production focus can trigger a vicious cycle of deteriorating risk perception and how increased protection effort can, ironically, lead to deterioration of protection.

멈춤 유형에 따른 노인 보행의 생체역학적 변화

The purpose of this study was to verify the difference in biomechanical variation and pattern of the lower limb between planned and unexpected termination, which is related to the prevention of fatal fall in the elderly. Therefore, selected twenty subjects for each group which composed of females(age: year, height: cm, body mass: kg) and women(age: year, height: cm, body mass: kg) in their twenties. As a result, lower limb`s extension moment and power were increased significantly in statistics(p

Fatal Falls Among Older Construction Workers

This study examines recent trends and patterns in fall fatalities in the U.S. construction industry to determine whether fatal falls among older workers are different from younger workers in this industry. Falls are the leading cause of fatalities in the U.S. construction industry. Given the increasingly aging workforce in construction, it is important to assess the risk of falls among older construction workers. Fatality data were obtained from the Census of Fatal Occupational Injuries for the years 1992 through 2008. Denominators for death rates were estimated from the Current Population Survey. Stratified and multivariate analyses were performed to examine whether there are differences in fatal falls between older workers (> or = 55 years) and younger workers (16-54 years). Fatal falls in nonconstruction industries were excluded from this study. Older workers had higher rates of fatal falls than younger workers; results were significant in 11 of 14 construction occupations. Regression analysis indicated that older decedents had a higher likelihood that work-related death was caused by a fall, after controlling for major demographic and employment factors (odds ratio = 1.50, confidence interval [1.30, 1.72]). Falls from roofs accounted for one third of construction fatal falls, but falls from ladders caused a larger proportion of deadly falls in older decedents than in younger decedents. Older workers have a higher likelihood of dying from a fall. Roofs and ladders are particularly risky for older construction workers. As the construction workforce ages, there is an urgent need to enhance fall prevention efforts, provide work accommodations, and match work capabilities to job duties.

Hispanic Ethnicity and Fatal Fall Risk: Do Age, Gender, and Community Modify the Relationship?

Hispanic ethnicity is associated with a reduced risk of fatal falls in the elderly despite lower socioeconomic standing. The factors responsible for this "Hispanic paradox" are unknown. We hypothesized that age and gender would modify this relationship and that the association would be accentuated in a community with prominent Hispanic culture. The number of fatal falls in a 3-year period in the United States (US) and in Miami-Dade County, Florida (MDC) were obtained through the CDC's WISQARS database and the Florida Office of Vital Statistics. US Census Bureau data were used to define the total at-risk populations by age group and gender. Age group- and gender-specific ratios of the risk of fatal fall in Hispanic to white non-Hispanic individuals were calculated. In the US and MDC, Hispanic ethnicity was associated with a reduced risk of fatal fall across all age and gender subgroups. In the US, the risk reduction associated with Hispanic ethnicity grew from 11% and 23% in 65- to 74-year-old men and women, respectively, to 43% for both men and women over 84-years-old. This relationship was stronger in MDC than nationally in five of the six age and gender subgroups examined. Older individuals, women, and residents of communities with prominent Hispanic culture have the greatest reduction in fatal fall risk associated with Hispanic ethnicity.

Injury pattern after a fatal feet-first fall from a building

A 49-year-old man was found dead in front of a building. A stairway window (freely accessible, 9th floor) directly above a porch (1st floor) was open. Witnesses close to the building heard a noise and found the man lying on the ground, but the fall itself had not been observed. Emergency personnel were called to the scene immediately, but on arrival—7 min after the incident—resuscitation procedures were not carried out, as the man was dead at the scene. On cursory inspection of the body at the scene— without undressing him—the body seemed to the emergency physician ‘‘too uninjured to have sustained a fall from the 9th floor’’ (approx. 27 m), although both legs were shortened and the lateral seams of the jeans were disrupted on the left side (Fig. 1). Despite the absence of indications of a struggle at the scene, investigators could not exclude involvement of a third party. Forensic pathological examination of the victim, which was performed at the site of the incident, showed that fragments of distal tibia and fibula shafts protruded through the soles of the man’s feet and shoes (Fig. 2). Pelvic and chest areas were unstable, which was consistent with severe internal injury due to a fall from height. In view of autopsy findings, death was attributed to extensive injuries involving severe craniocerebral, chest, vertebral column and pelvic trauma with severe visceral damage, e.g. rupture of the heart and the aortic root. In

Cardiac tamponade secondary to fulminant myocarditis - A case of custodial death

Cardiac tamponade following rupture of the heart occurs very rapidly, resulting in a fatal fall in the cardiac output and circulatory collapse. Spontaneous cardiac rupture is an uncommon occurrence and that too occurring secondary to myocarditis is a very rare event. Myocarditis is an inflammatory disease of the myocardium and its clinical presentation is highly variable. Due to its highly variable clinical presentation, the diagnosis is frequently made at autopsy. In this article, we report death of a prisoner due to cardiac tamponade following right ventricular rupture secondary to fulminant myocarditis.