SAFETY SATURDAY: TRIPS, SLIPS, AND FALLS

Take boots, for example. He earned thirty-eight dollars a month plus allowances. A really good pair of leather boots cost fifty dollars. But an affordable pair of boots, which were sort of OK for a season or two and then leaked like hell when the cardboard gave out, cost about ten dollars. Those were the kind of boots Vimes always bought, and wore until the soles were so thin that he could tell where he was in Ankh-Morpork on a foggy night by the feel of the cobbles.

 - Terry Pratchett, Men at Arms

Workspaces and work areas are diverse because work is diverse. For every job done, that job must be done in a place, like balancing account books in an office, building the frame of a house outdoors on a slab, pressing records in a workshop, or cooking in a kitchen. The places and spaces in which work is done are diverse as well - they can be as intimate as a bedroom turned into a home office, or as open and distributed as a shared office, warehouse, or port. Regardless of where work is done, what work is done, and how work is done, there are some empirical and practical realities that are the same for all modes and manner of work. One of these common elements is that work is always done on a surface of some kind. Workers stand on, sit on chairs placed upon, walk over, and navigate on the ground when doing their work. That ground can be unsealed dirt in the case of a farm or polished concrete or vinyl if it’s inside a building. Gravity is an inescapable reality, and regardless of what work is being done, a worker and their work are always at the mercy of gravity. The interaction between workers’ bodies, their work, and their environment is diverse in many ways, but a worker is always under the effect of gravity unless they are an Astronaut.

When considering flooring hazards, the most common risks are those of slips, trips, and falls (Safe Work Australia [SWA], 2012). Each of these arises from different causes. Slips happen when a worker’s foot loses traction with the ground surface - an example of this is if anyone’s ever felt their leg slide from underneath them when they’re standing on wet tiles. The example of tiling illustrates how slips happen very handily, especially as 90% of slips happen on flooring that is wet (Health and Safety Executive [HSE], n.d.); it is estimated that slipperiness and slipping may contribute to between 40 and 50% of all fall-related injuries (Courtney et. al., 2001). Objects including workers and material are acted upon by gravity, and so remain on the ground as a result of this force. Where something meets the ground, the ground also exerts a force back onto that object. Where the ground is at an angle, gravity and the opposing force act in different directions relative to the floor and the object, and so the object may slide. The speed at which the object slides is determined by many factors including the surface contact area, the angle of the floor, and if the objects are being moved or acted on. Practically, a person standing upright on solid ground is unlikely to slip from standing. However, if that person is moving, wearing inappropriate footwear, carrying a load, or if the floor is tiled, wet, or otherwise smoothened, the likelihood that they may slip increases. A person may be less likely to slip on wet flooring if they move slowly, or wear appropriate shoes, especially where the water is soapy (SWA, 2012). Again, anyone who’s stepped out of a bathtub after a soapy shower and felt their leg slip slightly underneath them understands what can happen. Slips can happen on any surface; tile, polished concrete, vinyl and sealed wood are more slippery surfaces when compared to carpet, fabric, dirt, or rough wood, but even mud can cause slipping if it is wet enough, and workers can lose their footing in dry, loose gravel. The important thing to remember is that slips can happen on any surface - all that matters is the relationship between load, force, and friction, and when that relationship is unbalanced, a person can slip and fall. 

Trips happen when a person catches their foot or part of their leg on an object. Most often, this object is low to the ground like a cable that kinks upward, the head of a nail sticking out of a piece of flooring, or a sudden crack in a pavement if walking outdoors. The world is full of hazards that exist below the human field of vision - anyone who owns a cat or who has a small child knows this intimately. Trips can cause problems because they disrupt human movement. Movement, such as walking, shuffling, and running, is cyclical: movement relies on one foot being placed in front of the other. Movement is also largely automatic - human balance is unconsciously controlled by the cerebellum (Paulin, 1993), the action of the muscles is fine-tuned by the sensation of sense and load through the joints (Richie, 2021), and the reciprocal movement of the legs is affected by unconscious spinal reflexes (Zehr & Stein, 1999). People generally do not need to concentrate on how they walk unless they are deliberately being mindful, if they are walking awkwardly, or if they have brain damage. Trips arise from a mechanical disruption to the repetitive action of walking that happens mid-cycle (Chang et. al., 2016). Once someone trips, the movement of their limbs has been interrupted, and they must respond. If they do not respond appropriately, they may fall down. Trips can cause physical trauma if a limb or foot strikes an object with force (Grönqvist, 2007), can cause muscular strains where a person flails about, and can cause injury if a person falls. The severity of the injury resulting from a trip depends on the speed at which the person was moving, the load they were carrying, the distance they fall, the force with which they may hit the ground, and the properties of the ground including softness, upholstering, and the angle of the collision (Nasarwanji & Sun, 2019). 

Falls happen when any part of the body inadvertently comes into contact with the ground or another object. Falls can happen as a result of trips and slips, but can also happen from falls from height, from a loss of balance, and from other factors that may not be related to flooring safety (Safe Work Australia, 2018), and so will not be discussed here. Falls can be significant medical events for older people and older workers. While older individuals are at increased risk of experiencing a severe medical event following a fall (Agnew & Suruda, 1993), older workers are at increased risk owing to the additional hazards that arise from diverse occupational profiles as well as those that arise as a consequence of going about life generally as an aged individual (Dong et. al., 2012). The management of fall risk in older workers is generally poorly managed because the management of risks in an occupational setting is generally done on an ad-hoc basis (Boyle, 2015). Falls at workplaces that do and do not cause injury are the end result of a failure of risk management of ergonomic, spatial, and structural risks . They are adverse outcomes that arise from a failure of risk awareness and control. Everyone has to navigate spaces upholstered in different flooring, from the carpet squares of an office, to the concrete floor of a warehouse, or the vinyl of a kitchen cool-room. All work is done on work surfaces and so all workers are at some risk of slips, trips, and falls (Safe Work Australia, 2022a). In the 2021-2022 reporting period, slips, trips, and falls resulted in the second highest percentage of reportable injury claims (23%) (SWA, 2022b), and while a breakdown for that working period is unavailable, the incidence of injuries due to falls on the level is three times the rate of injuries owing to falls from height (SWA, 2019). This may be due to the fact that workers spend more time working at their level than working at height, where working at height may be defined as “working where falling would mean someone or something would fall from one level to another” (WorkSafe ACT, n.d.). Not all slips or trips result in falls, but where a slip or a trip occurs without a fall, it is still necessary to note and control the hazard so as to minimise risk. 

Trips, slips, and falls resulting from poorly controlled flooring and environmental hazards have the potential to cause diverse injuries where people experience them. Body injuries including sprains and strains are the most common outcomes of falls (Bell et. al., 2008), and back pain is a common intermediate and longterm outcome (Bell et. al., 2013). When considering the 2021-2022 reporting period, of the 30,000 or so injuries experienced as a consequence of falls, trips, and slips, the knee, ankle, and back were the most commonly injured body locations (SWA, 2022b). This is understandable as someone who is slipping or tripping is likely to hurt or irritate their foot, especially if it rolls (Chang et. al., 2016). The knee may be struck upon the ground if someone falls onto it, or against something nearby. Ten percent of the serious claims arising from trips, slips and falls related to injuries of the back. That same dataset indicates that over the reporting periods from 2000-2001 to current day, the incidence of falls, trips and slips in the workplace resulting in serious injury claims has increased year on year. Specifically, while the number of falls from height has decreased, the number of falls on the same level has increased in sufficient proportion to offset the gains made in minimising the incidence of falls from height (SWA, 2022b). There may be some explanations for this; the first being the change in relative proportions of workers in professions that may predispose workers to falls from height, given the current shortages in the trades (Jobs and Skills, n.d.) even where within construction and the trades the most common contributing factors to falls were walking and working surfaces, terrain, and weather (Lipscomb et. al., 2006), the second may be the effectiveness of interventions protecting workers who work at height in those at-risk populations, and the last is the increasing age of the Australian workforce, reflecting increased vulnerability to hazards arising from the work environment. Within the 2000-2001 to 2020-2021 reporting periods, the number of injuries from environmental agencies has increased as well, and the number of serious claims for injury in the 2020-2021 period appear to reflect this, where environmental causes account for 55% of the mechanism of falls. Within the breakdown, environmental agencies including surface features and building features account for 17% of serious claims overall. Work environment design, arrangement, and hazard management is essential in managing risks of trips, slips and falls from flooring. Historically, there has been limited research conducted with an ergonomics systems approach in mind when considering workplace falls and flooring hazards (Bentley, 2009). This stands in contrast to the breadth of information available regarding the minimisation of and protection from falls in the elderly (Chang et. al., 2016).

Workers of all kinds are required to complete their duties of work in environments which, depending on the work tasks and job designs, may be more or less well-controlled. Falls, trips, and slips are the second-most common cause of injuries resulting in work-related musculoskeletal disorders (Bezzina et. al., 2023; SWA 2024a), and have been found to occur in those job roles which are exposed to high places at least once weekly, or which spend more than half the working time walking and running (SWA, 2023). The same occupational dataset shows that those occupations most exposed to walking and running were waiters, nurses, cleaners, electricians, and chefs, who were found to spend more time walking and running than other professions as a consequence of their job design characteristics. There are some occupations where the design of work cannot be changed due to the essential characteristics of that job role. In those circumstances where the work cannot be changed, workers should be provided with support in the form of resources and education to best protect them against ergonomic and physical hazards in their environment which pose risk to their wellbeing when interacting with their duties of work. This is assuming that risks have already been controlled as comprehensively as possible - that cables are tied down, that nails have been made flush, that gaps in pavers have been covered and that edges have been ramped or signed. In workspaces where there is not much walking or running, such as in technical roles or in professional services, flooring safety and environmental management to minimise trip risk should still be considered, as flooring and worker shoe choice may be considered as points of intervention in the management of lower limb, lower back, and trunk musculoskeletal discomfort (Anderson et. al., 2021). Trip, slip, and fall risks arising from environmental design can be controlled at the environmental design phase, where changes in floor level, arrangement of workspaces, the transition of floor surface textures and appropriate lighting can all be implemented to minimise residual hazards at the source (Safe Work Australia, 2024b). Additionally housekeeping of work areas to avoid the buildup of clutter, rubbish, or spillages can proactively minimise the risk of slips and consequent falls (Agwu & Ajayi, 2014). Environmental control and design is also effective in maintaining the visual and spatial cleanliness of working areas, supporting the health, wellbeing, and sustainable participation of workers in their places of work (Comcare, 2010). 

Every occupation in the labour market requires workers to navigate physical environments to greater or lesser extent. A worker may need to spend extended time on their feet, as in the case of waiters, couriers, post office personnel, or carers. Other workers may be more sedentary, but they must still travel within office buildings, navigate external environments, and go about their business in a world which is physical, ongoing, and dynamic. Trips, slips and falls are preventable incidences in workplaces and in daily life, where the hazards may change throughout the day, and a person’s vulnerability to harm may change with their work, with their age, and with time. However, proactive protective design of spaces, workplaces, and work, and the choice of appropriate attire and posture when interacting with work and daily environments can effectively minimise these hazards, and support the sustainable, successful, and smooth movement of people through their workplaces, their communities, and their lives. 

None of this information constitutes medical, legal, occupational health and safety, best guidance, standard, or other guidance, instruction, or prescription. 

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