Ladder Fall Research Articles

Strategies to Reduce Fall Severity after a Perturbation during Ladder Climbing

OCCUPATIONAL APPLICATIONS Falls from ladders remain a significant cause of injuries in workplaces as well as residential settings. While recent research reveals factors related to fall severity from a ladder, strategies that workers can adopt to minimize fall severity are not well understood. Results from our current study indicated that increased upper limb strength, achieving a higher hand hold, and controlled reestablishment of the foot on the rung have summative benefits to reduce fall severity and increase recovery from a misstep perturbation. Ensuring adequate upper limb strength among workers, and training workers to climb ladders leading with hand placement during ascent and foot placement during descent, can facilitate these beneficial strategies to arrest a ladder fall.

Ladder Use Ability, Behavior and Exposure by Age and Gender.

This study aimed to quantify and compare ladder use ability and behavior in younger and older men and women from three ladder use behavior experiments. The experimental tasks comprised (1) changing a lightbulb on a household stepladder under two cognitive demands (single and dual task), (2) clearing a simulated roof gutter on a straight ladder and (3) querying ladder choice in different exigency scenarios. Ladder use ability and behavior data were captured from recorded time, performance, motion capture and user choice data. In addition, this study surveyed ladder use frequency and habitual behaviors. The experimental findings indicate that older adults require more time to complete ladder tasks; younger adults display riskier ladder use behaviors; men and women display similar ladder use ability; and men are more willing to climb riskier ladders. The survey found older adults to report more frequent ladder use than younger adults, and men use straight ladders more frequently than women. These results suggest that the reported higher ladder fall rates experienced by older adults and men are linked to increased ladder use exposure and riskier ladder choice. This knowledge can help guide population-specific interventions to reduce ladder falls in both young and older people.

Falls from ladders in New South Wales: A data-linkage study

IntroductionFall from ladders is increasingly identified as a significant cause of injury and mortality, yet large-scale research into ladder fall outcomes and trends is limited. ObjectivesTo explore the nature and severity of injuries resulting from ladder falls and to determine predictors of Injury Severity Score (ISS) and 6-month mortality. MethodsData were obtained from the New South Wales (NSW) Trauma Registry, Admitted Patient Data Collection and Registry of Births, Deaths, and Marriages on patients aged 15 and over who had major trauma from a ladder fall and were admitted to hospital between January 1st, 2012, and July 31st, 2019. Data linkage and descriptive statistics were carried out alongside bivariate and multivariable regression analysis. Results963 patients injured after ladder falls were identified. The mean age was 61.9 years (SD 14.2), 91.0% were male, and 489 (50.8%) were born in Australia. The height of fall was between one and five meters in 827 (86.2%) patients, and the place of fall was home and residential places in 27.5%. The most common body areas injured were the head (26.5%), spine (21.2%) and thorax (20.6%), and the median injury severity score was 17. The median length of stay of patients’ in-hospital and intensive care unit was six days and two days, respectively. Six months post-discharge mortality was 6.4%. The unadjusted association between the presence of comorbidities or socio-economic class and ISS or mortality was not statistically significant. Increasing ISS was found to be associated with increasing age (Estimate (Est), 15.2; 95% Confidence Interval (CI), 12.3–18.1) and a fall height greater than five metres (Est, 5.8; CI, 3.2–8.4). Mortality was found to be associated with increasing age (Odds ratio (OR), 1.06; CI, 1.03–1.08) and increasing ISS (OR, 1.19; CI, 1.15–1.24). ConclusionPeople presenting to the hospital after falling from a ladder were predominately male, aged over 60 and had fallen in a residential setting. Increasing age and fall height are associated with more severe injuries.

Ladder Use in Older People: Type, Frequency, Tasks and Predictors of Risk Behaviours.

Ladder fall and injury risk increases with age. People who present to a hospital after an injurious ladder fall have been surveyed, but little is known about ladder use in the community. The purpose of this study was to: (1) document salient factors related to ladder safety, and (2) determine physical, executive function, psychological and frequency-of-use factors associated with unsafe ladder use in older people. One hundred and two older people (aged 65+ years) were recruited. Participants completed questionnaires on demographics, health, and ladder use (type, frequency, task, behaviours) and underwent assessments of physical and executive function ability. Results showed both older men and women commonly use step ladders (61% monthly, 96% yearly), mostly inside the home for tasks such as changing a lightbulb (70%) and decorating (43%). Older men also commonly use straight ladders (27% monthly, 75% yearly), mostly outside the home for tasks such as clearing gutters (74%) and pruning trees (40%). Unsafe ladder use was more common in males and individuals with greater ladder use frequency, greater quadriceps strength, better upper limb dexterity, better balance, better stepping ability, greater self-reported everyday risk-taking, a lower fear of falling, and fewer health problems compared to their counterparts (all p < 0.05). These findings document ladder use by older people and provide insight into unsafe ladder behaviours that may be amenable to interventions to reduce ladder falls and associated injuries.

Individual factors that influence task performance on a stepladder in older people

Ladder falls are a common cause of injury in the domestic setting, particularly among older adults. There is a need, therefore, to understand contributing factors of safe and effective ladder use in this group. This study investigated associations between individual human factors (vision, lower and upper limb sensation, upper limb control, strength, balance, cognitive function and psychological status) with task performance on a ladder (time to climb a household stepladder and change a light bulb) under single and secondary cognitive task conditions in 104 older adults. Measures of upper limb control, strength, balance, cognitive processing speed and psychological domains were significantly associated with ladder task completion time in the single task condition; with the addition of executive function and global cognition significantly associated with ladder task completion time in the dual task condition. Knee extension strength, upper limb bimanual coordination, cognitive processing speed and fear of falling were found to be robust predictors of ladder task completion times. These findings help identify individuals with greater ladder use ability and presumably lower fall risk. This work can guide ladder fall interventions, such as strength and balance training, ladder design and targeted safety instructions.

Individual factors that influence task performance on a straight ladder in older people.

Older adults have the highest incidence of domestic ladder falls, but little investigation has been given to this important injury issue. There is therefore a need to understand the influence of individual factors like physical and cognitive ability and psychological status on safe and effective ladder use in this population. This study investigated associations between vision, lower and upper limb sensation, upper limb control, strength, balance, cognitive function and psychological status with task completion time and number of ladder moves taken in a simulated roof gutter clearing task on a straight ladder in 97 older adults. Several measures from upper limb control, strength, balance, processing speed, executive function and psychological domains were significantly associated with the two ladder task performance measures. Upper limb bimanual coordination, knee extension strength, coordinated leaning balance, and self-reported risk-taking were identified as independent and significant predictors of task completion time in a multiple regression model, predicting 56% of the variability in ladder task completion time. Upper limb bimanual coordination and proprioception, simple reaction time and coordinated leaning balance were independent and significant predictors of the number of ladder moves in a separate multiple regression model, predicting 38% of the variability in ladder moves taken. These findings help identify individuals at greater ladder fall risk and can guide ladder fall interventions, such as strength and balance training, ladder design and targeted safety instructions.

Non-occupational falls from ladders in men 50 years and over: Contributing factors and impact

BackgroundResearch into falls from ladders in older men in the non-occupational setting is limited, yet such falls are increasing. AimTo explore non-occupational falls from ladders in older men presenting to a major trauma centre; identify factors influencing ladder climbing behaviour and explore the post fall impacts. MethodsWe conducted a retrospective review of medical records of men aged 50 years and older admitted to a major trauma centre following a non-occupational ladder fall between February 2011 and December 2013. Interviews were conducted with a sample of men (and their partners where possible) after discharge from hospital. The Late Life Functional Disability Instrument-computer adaptive testing (LLFDI-CAT) was administered to determine pre-and post-fall function. Basic descriptive analysis was undertaken on medical record data. Thematic analysis was used with the socioecological (SE) model as an interpretive frame. ResultsOf 86 men included in the study (range 50–85 years, mean age 64.7 years), 27% sustained severe trauma. The median length of stay was 4 days. Fourteen interviews were conducted with 19 participants (12 men, 7 spouses). The most salient pre-fall factor was a lack of assessment of risk, reflecting individual and community factors. Post fall impacts were identified in all domains of the SE model. A statistically significant decrease in self-reported post-fall compared with pre-fall LLFDI-CAT scores for interviewed men was found, despite seven having minor trauma (Injury Severity Score [ISS]<12) on admission. ConclusionLadder fall injuries cause marked morbidity, often with life changing impacts, even with minor trauma. Contributing factors are multifactorial. Injury prevention strategies should address these factors.

Hand-rung forces after a ladder climbing perturbation

The hands are believed to be important for arresting falls from ladders. Yet, there is a paucity of kinetic data for the hand-handhold interface during recovery from a ladder climbing perturbation. This study quantified the hand-rung forces utilized after ladder climbing perturbations and the factors (upper body strength, fall severity, reestablished foot placement) contributing to hand-rung force. A ladder rung was released under the foot of the participants to simulate a climbing misstep perturbation. Hand-rung forces after the perturbation were quantified from load cells connected to two ladder rungs. Mean peak hand-rung force magnitudes were found to range between 46% and 84% of the climber’s body weight. These magnitudes approached and, in some cases, exceeded individuals’ grasping capacity. Individual upper body strength was not found to consistently contribute to hand-rung force, but increased hand-rung force was clearly linked with greater fall severity after an ascending perturbation. Individuals that reestablished foot placement after an ascending perturbation utilized lower hand-rung forces. Therefore, this study suggests hand-rung force to be dependent on circumstances of the falling event (fall severity, reestablished foot placement) as opposed to the climber’s capability of producing upper body force. This knowledge highlights the importance of handhold and ladder designs for arresting a falling event, and is critical to inform ladder fall interventions such as designing handholds that resist high forces and permitting steps that enable reestablished foot placement.

Characteristics of stepladder fall injuries: a retrospective study

Stepladders are used to work at heights in daily life, but their structure and usage differs from that of a ladder; stepladders can fold and stand without support, whereas ladders cannot fold and, thus, require support from other objects. We hypothesised that this difference made ladder and stepladder fall injuries to differ in characteristics. To clarify this hypothesis, we performed a retrospective cohort study on the stepladder fall injuries and compared their characteristics with that of ladder fall injuries. We conducted a retrospective cohort study of injuries sustained from either ladder or stepladder falls. In this study, data were retrieved from the computerised database of Teikyo University Chiba Medical Center. Patients admitted to the orthopaedic department because of injury from ladder or stepladder fall were included. The following data were retrieved from the patient records: sex, age, height, body weight, body mass index (BMI), injury severity score (ISS), season, number of injury sites, details of injury and treatment option. One hundred thirty-two patients were included in this study. 101 patients were injured from stepladder falls, and 31 patients were injured from ladder falls. The number of females sustaining injuries due to a stepladder fall was significantly higher than those due to a ladder fall. The most frequent type of injury after fall from stepladder was fracture (48.9%), whereas the most frequent type of injury after fall from ladder was contusion/sprain (56.4%). The most frequently injured body part from stepladder fall was lower extremity (32.6%). In contrast, the most frequently injured body part due to a ladder fall was spine (27.3%). The current study found that the number of females sustaining injuries due to a stepladder fall was significantly higher than those due to a ladder fall. Furthermore, the most frequent body parts that needed surgery following a ladder fall injury were spine and upper extremity, whereas the most frequent body parts that needed surgery following a stepladder fall injury was lower extremity. Our study indicated that stepladder falls cause severe injuries and physical disability and can be a huge financial burden.

Stats and ladders: Injury risk and outcomes following falls from ladders

Fatal lower level falls commonly result from ladder fall injuries (LFIs), an often-avoidable injury. We hypothesized that older patients’ injury severity differs from younger patients falling from the same mechanism with fall height determining overall morbidity. A retrospective review was completed of all traumatic LFIs during a 6-year period resulting in 178 patients. The mean LFI height was 10.9 ± 6.0 feet, the majority being male (87%), with a mean age of 50.7 ± 16.6 years. The mean ISS was 7.7 ± 7.0 (range, 1–38), 23.6% sustaining > 1 injury. Age inversely correlated with the mean LFI height with patients ≥66 years falling from significantly lower heights (12.3 ft For age group 18–45 y; 10.4 ft vs 9.0 ft (p = 0.003) and having longer LOS (7.3 vs 3.8 days, P = 0.011). No difference in ventilator requirement/days, blood product requirements, or mortality among age groups was observed. Geriatric patients sustain similar injury patterns at lower height levels compared to all ages. Injury prevention programs are necessary to reduce the incidence of a commonly preventable injury.

Effects of upper body strength, hand placement and foot placement on ladder fall severity

BackgroundA plurality of fatal falls to lower levels involve ladders. After a slip/misstep on a ladder, climbers use their upper and lower limbs to reestablish contact with the ladder. Research questionThis study investigates the impact of upper body strength, hand placement and foot placement on fall severity after a ladder climbing perturbation. MethodsParticipants performed upper body strength tests (breakaway and grip strength) and climbed a vertical, fixed ladder while a misstep perturbation was applied under the foot. After the perturbation, three hand placement and two foot placement responses were generally observed. Common hand placement responses included the hand moving two rungs, one rung, or did not move to a different rung. Foot placement responses included at least one foot or no feet reestablished contact with the ladder rung(s). Fall severity was quantified by the peak harness force observed after the perturbation. ResultsIncreased strength, reestablishing at least one foot on the ladder, and ascending (compared with descending) the ladder was associated with a reduction in fall severity. An interaction effect indicated that the impact of hand placement was altered by climbing direction. Moving the hand one rung during ascent and moving the hand two rungs during descent was associated with an increased fall severity. Cases where the hand decoupled from the ladder was associated with higher fall severity. Upper body strength assessed using a portable grip dynamometer was sufficient to predict fall severity. DiscussionThis study confirms the multifactor role of upper body strength, hand placement and foot placement in preventing falls from ladders. Furthermore, a portable dynamometer shows potential to screen for high-risk individuals. Results of this investigation may guide targeted interventions to prevent falls from ladders.

Effects of Ladder Climbing Patterns on Fall Severity

A fall from a ladder is the most common cause of a fatal fall injury to a lower level. Current guidelines recommend proper ladder climbing to avoid a ladder fall, but there is a lack of understanding on safe ladder climbing biomechanics. The purpose of this study was to investigate the effects of different temporal (2-beat, 4-beat) and coordination (lateral, diagonal) ladder climbing patterns on fall severity. In this study, fall severity is quantified as the peak weight supported by a safety harness (normalized to body weight) after a climbing perturbation. A greater harness force is associated with a greater probability of a falling event resulting into a fall. The airborne times of the hand and foot for each climbing pattern were investigated to better understanding differences between climbing patterns. This study did not find climbing patterns to affect fall severity. Thus, the events that occur after a ladder climbing perturbation may be more critical to consider when investigating ladder fall severity. Hand and foot airborne times varied by climbing pattern. Specifically, hand airborne times for the lateral coordination pattern were 19% longer than those of the diagonal coordination pattern. Foot airborne times of the 2-beat temporal pattern were 15% longer than those of the 4-beat temporal pattern. Increased airborne times may be indicative of overlapping regions and resources competition in the primary cortex.

Danger at every rung: Epidemiology and outcomes of ICU-admitted ladder-related trauma

IntroductionThe incidence of ladder-related falls is increasing, and this represents a disturbing trend, particularly in the context of increased life expectancy and the impending retirement of the populous ‘baby-boomer’ generation. To date, there have been no critical illness-focused studies reporting on the incidence, severity and outcomes of severe ladder-related injuries requiring ICU management. MethodsMajor trauma patients admitted to ICU over a 5year period to June 2011 after ladder falls >1m were identified from prospectively collected trauma data at a Level 1 trauma service. Demographic and ICU clinical management data were collected and non-parametric statistical analyses were used to explore the relationships between variables in hospital mortality/survival. ResultsThere were 584 ladder fall admissions, including 194 major trauma cases, of whom 29.9% (n=58) fell >1m and were admitted to ICU. Hospital mortality was 26%, and fatal cases were almost entirely older males in domestic falls of ≤3m who died as a result of traumatic brain injury. Non-survivors had lower GCS at the scene (p=0.02), higher AIS head code (p=0.01), higher heart rate and lower mean arterial pressure (p<0.01) in the initial 24h period in ICU, and were ≥55years of age (p=0.05). Only 46% of patients available for follow-up were living at home at 12months without requiring additional care. ConclusionsThe incidence of ladder falls requiring ICU management is increasing, and severe traumatic brain injury was responsible for the majority of deaths and for poor outcomes in survivors. In-hospital costs attributable to the care of these patients are high, and fewer than half were living independently at home at 12months post-fall. A concerted public health campaign is required to alert the community to the potential consequences of this mechanism of injury. The use of helmets for ladder users in domestic settings, where occupational health and safety regulations are less likely to be applied, is strongly recommended to mitigate the risk of severe brain injury. The benefits of this simple strategy far outweigh any mild inconvenience for the wearer, and may prevent catastrophic injury.

Characteristics and Costs of Ladder Fall Injuries: A Report from a Single Emergency Center in Okayama.

We sought to identify the incidence, injury patterns, and financial burden of ladder fall injuries to provide a reference for reinforcing guidelines on the prevention of such injuries. We enrolled the patients who were injured in a ladder-related fall and required intensive care between April 2012 and March 2014 at Okayama University Hospital, a tertiary care hospital in Okayama City:9 patients injured in 7 stepladder falls and 2 straight ladder falls. The median patient age was 69 years, and 8 were males. Six falls occurred in non-occupational settings. Head injuries predominated, and the injury severity score ranged from 2 to 35 (mean＝21±12). At the time of discharge from the intensive care unit, one patient had died and 5 patients had some neurological disabilities. The case fatality rate was 11%. The total cost of care during the review period was ￥16,705,794, with a mean cost of ￥1,856,199 per patient. Ladder fall injuries are associated with a high rate of neurological sequelae and pose a financial burden on the health insurance system. A prevention education campaign targeting at older-aged males in non-occupational settings may be a worthwhile health service investment in this community.

Research to improve extension ladder angular positioning

A leading cause for extension ladder fall incidents is a slide-out event usually related to suboptimal ladder inclination. An improved ladder positioning method or procedure could reduce the risk of ladder stability failure and the related fall injury. The objective of the study was to comparatively evaluate the effectiveness of a multimodal angle indicator with other existing methods for extension ladder angular positioning.Twenty experienced and 20 inexperienced ladder users participated in the study. Four ladder positioning methods were tested in a controlled laboratory environment with 4.88 m (16 ft) and 7.32 m (24 ft) ladders in extended and retracted positions. The positioning methods included a no-instruction method, the current standard anthropometric method, and two instrumental methods – a bubble level indicator, and a multimodal indicator providing direct feedback with visual and sound signals. Performance measures included positioning angle and time.The results indicated that the anthropometric method was effective in improving the extension ladder positioning angle (p < 0.001); however, it was associated with considerable variability and required 50% more time than no-instruction. The bubble level indicator was an accurate positioning method (with very low variability), but required more than double the time of the no-instruction method (p < 0.001). The multimodal indicator improved the ladder angle setting as compared to the no-instruction and anthropometry methods (p < 0.001) and required the least time for ladder positioning among the tested methods (p < 0.001).An indicator with direct multimodal feedback is a viable approach for quick and accurate ladder positioning. The main advantage of the new multimodal method is that it provides continuous feedback on the angle of the device and hence does not require repositioning of the ladder. Furthermore, this indicator can be a valuable tool for training ladder users to correctly apply the current ANSI A14 standard anthropometric method in ladder angular positioning.The multimodal indicator concept has been further developed to become a hand-held tool in the form of a smart phone application.

Factors Affecting Extension Ladder Angular Positioning

The study objectives were to identify factors affecting extension ladders' angular positioning and evaluate the effectiveness of two anthropometric positioning methods. A leading cause for extension ladder fall incidents is a slide-out event, usually related to suboptimal ladder inclination. An improved ladder positioning method or procedure could reduce the risk of ladder stability failure and the related fall injury. Participants in the study were 20 experienced and 20 inexperienced ladder users. A series of ladder positioning tests was performed in a laboratory environment with 4.88-m (16-ft) and 7.32-m (24-ft) ladders in extended and retracted positions. The setup methods included a no-instruction condition and two anthropometric approaches: the American National Standards Institute A14 and "fireman" methods. Performance measures included positioning angle and time. The results indicated that ladder setup method and ladder effective length, defined by size and extended state, affected ladder positioning angle. On average, both anthropometric methods were effective in improving extension ladder positioning; however, they required 50% more time than did the no-instruction condition and had a 9.5% probability of setting the ladder at a less-than-70 degrees angle. Shorter ladders were consistently positioned at shallower angles. Anthropometric methods may lead to safer ladder positioning than does no instruction when accurately and correctly performed. Workers tended to underperform as compared with their theoretical anthropometric estimates. Specific training or use of an assistive device may be needed to improve ladder users' performance. The results provide practical insights for employers and workers to correctly set up extension ladders.

Work-related falls from ladders – a follow-back study of US emergency department cases

Ladder falls comprise 16% of all US workplace fall-related fatalities, and ladder use may be particularly hazardous among older workers. This follow-back study of injured workers from a nationally representative sample of US emergency departments (ED) focused on factors related to ladder falls in three domains of the work environment: work equipment, work practices, and worker-related factors. Risk factors for fractures, the most frequent and severe outcome, were also evaluated. Workers injured from a ladder fall, treated in one of the 65 participating ED in the occupational National Electronic Injury Surveillance System (NEISS) were asked to participate. The questionnaire included worker demographics, injury, ladder and work equipment and environment characteristics, work tasks, and activities. Multivariate logistic regression models estimated odds ratios and 95% confidence intervals of a work-related fracture. Three-hundred and six workers experiencing an injury from an--on average--7.5-foot-fall from a step, extension, or straight ladder were interviewed primarily from construction, installation, maintenance, and repair professions. Injuries were most frequently to the arm, elbow or shoulder; head, neck, or face with diagnoses were primarily fracture, strain, sprain, contusion or abrasion. Workers were most frequently standing or sitting on the ladder while installing, hanging an item, or performing a repair when they fell. Ladder movement was the mechanism in 40% of falls. Environmental conditions played a role in <10% of cases. There was a significant association between fracture risk and fall height while working on the ladder that was also influenced by older work age. This study advances knowledge of falls from ladders to support those who specify means and methods, select equipment, and plan, supervise, or manage the performance of employees working at heights.

Work-related ladder fall fractures: Identification and diagnosis validation using narrative text

Objective To identify ladder-related fracture injuries and determine how ladder fall fractures differ from other ladder-related injuries. Methods Ladder-related fracture cases were identified using narrative text and coded data from workers’ compensation claims. Potential cases were identified by text searches and verified with claim records. Injury characteristics were compared using proportionate injury ratios. Results Of 9826 ladder-related injuries, 7% resulted in fracture cases. Falls caused 89% of fractures and resulted in more medical costs and disability days than other injuries. Frequent mechanisms were ladder instability (22%) and lost footing (22%). Narrative text searches identified 17% more fractures than injury codes alone. Males were more likely to sustain a fall fracture than other injuries; construction workers were most likely, and retail workers were the least likely to sustain fractures. Conclusions Fractures are an important injury from ladder falls, resulting more serious consequences than other ladder-related injuries. Text analysis can improve the quality and utility of workers compensation data by identifying and understanding injury causes. Proportionate injury ratios are also useful for making cross-group comparisons of injury experience when denominator data are not available. Greater attention to risk factors for ladder falls is needed for targeting interventions.

Ladder fall injuries: patterns and cost of morbidity

Ladder fall injuries are associated with a wide spectrum of injury patterns. However, the healthcare cost of these injuries is unknown. The aim of this study was to determine the healthcare cost and duration of the morbidity associated with ladder fall injuries. A retrospective observational study involving patients with ladder injuries who presented to a Level 1 Trauma Centre over a 3-year period was performed. Patients then underwent a structured telephone interview to provide information about the duration of their disability and unemployment. There were 72 patients in the study, of whom 89% were male. Thirteen patients (18%) required hospital admission. The median length and cost of hospital stay was 1 week and €3555 (US$ 3950), respectively. The median duration of disability and unemployment was 6 weeks. The longest duration of disability was associated with foot fractures. The majority of patients fell between 5 and 10 ft, and fell at work. The upper extremity was the most commonly injured anatomical region. There were no fatalities. Ladder injury falls are expensive to the health service and may warrant investment in their prevention.

The mechanism and severity of nonoccupational ladder fall injuries

Methods: A series of 131 patients aged 15 years or older with nonoccupational fall injuries from ladders admitted to Odense University Hospital, Denmark were studied. Results: The mean age was 53 years, and 107 were males. Males most frequently fell from straight tilting ladders outdoors when performing activities such as repairing, painting, or cleaning up gutters, whereas females most frequently fell from stepladders indoors performing activities such as repairing, painting, or getting objects from an attic. The majority of accidents occurred as the patient reached too far sideways causing the ladder to tip or slip. Males fell, as an average, from a higher mean height than females. About one-fifth of the patients were hospitalized with a median number of 5 days in the hospital. Half of the registered injuries were contusions or sprains, whereas about one-third were fractures or dislocations. The extremities were most commonly injured. The majority of the patients suffered from minor to moderate injuries [Maximum Abbreviated Injury Scale (MAIS) 2–3]. Impact on industry: In our study, the majority of the patients reported no or minor knowledge about safety regulations. It seems obvious to extend information and knowledge of safety regulations to the public concerning the nonoccupational use of ladders. The information should include all models of ladders with particular emphasis on the level of stability.