# Abstract

## Paper aims

To study fall-accident cases in order to analyze the commonly missing or not adequately applied risk management measures (RMM) and its consequences depending on falling height.

## Originality

First study to analyze failed RMM for preventing falls from height.

## Research method

The study reviewed court cases published by the journal “Safety & Health Practitioner”. NIOSH recommendations were used to define RMM to apply to this study.

## Main findings

Finally, in 98% of analyzed cases, the fall from height was a result of several non-adequate or missing RMM: in 81.6% procedures of work, 65.8% guardrails and edge protection, 60.5% risk assessment, and 60.5% platforms or scaffolds. It can be concluded that falls from height pose a significant risk for workers, which could be prevented by adequately apply RMM.

## Implications for theory and practice

The focus in the prevention of falls should be given on most common RMM.

Keywords
Injury; Fall accidents; Risk control; Workplace fatalities; Safety in construction

# 1. Introduction

Every day, people die as a result of occupational accidents or work-related diseases. In total, it reaches more than 2.78 million deaths and some 374 million non-fatal work-related injuries and illnesses each year (International Labour Organization, 2017International Labour Organization – ILO. (2017). Safety and health at work. Retrieved in 2017, November 30, from http://www.ilo.org/global/topics/safety-and-health-at-work/lang--en/index.htm
http://www.ilo.org/global/topics/safety-...
). The human cost of this daily adversity is vast, and the economic burden of poor occupational safety and health practices is estimated at 3.94% of global Gross Domestic Product each year (International Labour Organization, 2017International Labour Organization – ILO. (2017). Safety and health at work. Retrieved in 2017, November 30, from http://www.ilo.org/global/topics/safety-and-health-at-work/lang--en/index.htm
http://www.ilo.org/global/topics/safety-...
). Globally, among all, unintentional injuries represent a major public health problem and a leading cause of deaths (Centers for Disease Control and Prevention, 2017Centers for Disease Control and Prevention – CDC. (2017). Ten leading causes of death and injury. Retrieved in 2017, November 30, from https://www.cdc.gov/injury/wisqars/LeadingCauses.html
). After road traffic injuries, falls represent the second leading cause of unintentional injury deaths worldwide. An estimation is a number of 646 000 fatal falls and some 37.3 million non-fatal falls each year, severe enough to require medical attention (World Health Organization, 2017World Health Organization – WHO. (2017). Falls. Retrieved in 2017, November 30, from http://www.who.int/mediacentre/factsheets/fs344/en/
http://www.who.int/mediacentre/factsheet...
). The construction industry represents the most influential group in these numbers, with around 21.4% of USA’s workers fatalities, where the leading causes were falls (38.8%) (Occupational Safety and Health Administration, 2017Occupational Safety and Health Administration – OSHA. (2017). Construction’s “fatal four”. Retrieved in 2017, November 9, from https://www.osha.gov/oshstats/commonstats.html
https://www.osha.gov/oshstats/commonstat...
) and around 31% of UK’s workers fatalities, where the primary cause of falls from height (20%) (Bomel, 2003Bomel. (2003). Falls from height: prevention and risk control effectiveness (Research Report, 428). Sudbury: HSE Books.). The severity of fall-risk was investigated in many studies, analyzing the risk depending on occupation, age and location (Beavers et al., 2006Beavers, J. E., Moore, J. R., Rinehart, R., & Schriver, W. R. (2006). Crane-related fatalities in the construction industry. Journal of Construction Engineering and Management, 132, 901-910. http://dx.doi.org/10.1061/(ASCE)0733-9364(2006)132:9(901).
http://dx.doi.org/10.1061/(ASCE)0733-936...
; Dong et al., 2009Dong, X. S., Fujimoto, A., Ringen, K., & Men, Y. (2009). Fatal falls among Hispanic construction workers. Accident Analysis & Prevention, 41(5), 1047-1052. http://dx.doi.org/10.1016/j.aap.2009.06.012. PMid:19664444.
http://dx.doi.org/10.1016/j.aap.2009.06....
; Johnson et al., 1999Johnson, H. M., Singh, A., & Young, R. H. F. (1999). Fall protection analysis for workers on residential roofs. Journal of Construction Engineering and Management, 124(5), 418-428. http://dx.doi.org/10.1061/(ASCE)0733-9364(1998)124:5(418).
http://dx.doi.org/10.1061/(ASCE)0733-936...
). Some went further, analyzing heights from which people mostly fell, the type and value of projects where fall-accidents mostly occurred (Huang et al., 2003Huang, X., Hinze, J., & Asce, M. (2003). Analysis of construction worker fall accidents. Journal of Construction Engineering and Management, 129, 262-271. http://dx.doi.org/10.1061/(ASCE)0733-9364(2003)129:3(262).
http://dx.doi.org/10.1061/(ASCE)0733-936...
; Kang et al., 2017Kang, Y., Siddiqui, S., Suk, S. J., Chi, S., & Kim, C. (2017). Trends of fall accidents in the U. S. construction industry. Journal of Construction Engineering and Management, 143(8), 1-7. http://dx.doi.org/10.1061/(ASCE)CO.1943-7862.0001332.
http://dx.doi.org/10.1061/(ASCE)CO.1943-...
).

Despite all of these studies and the risk of falling from height is clearly identified as a challenge to be solved. Even after several studies have investigated the reasons why they continue to occur and solutions to minimize hazards or eliminate their risk, the number of accidents due to falls from height continues to grow.

The objective of this study was to analyze the consequences depending on falling height and to investigate the risk management measures that were commonly missing or not adequately applied in preventing and controlling at the time when falls from height occurred.

# 2. Methodology

The methodology of this review was based on the PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses (Liberati et al., 2009Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Annals Internal Medicine, 151(4), W65-94. http://dx.doi.org/10.7326/0003-4819-151-4-200908180-00136. PMid:19622512.
http://dx.doi.org/10.7326/0003-4819-151-...
). The searching process was conducted by using the Brazilian CAPES searching tool (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, 2017Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – CAPES. (2017). Portal Periódicos CAPES. Retrieved in 2017, August 11, from http://www.periodicos.capes.gov.br/
http://www.periodicos.capes.gov.br/...
), by using the institutional IP address of the University of Pernambuco federate credentials. The following two keywords were defined: “fall” AND “height”. The selection process included first applying the exclusion, and afterward inclusion criteria.

## 2.1. Exclusion and inclusion criteria

The review only included court cases, as studies, published in the English language by the journal “Safety & Health Practitioner” (Institution of Occupational Safety & Health, 2017Institution of Occupational Safety & Health. (2017). The safety & health practitioner. Retrieved in 2017, October 20, from http://www.shponline.co.uk/
http://www.shponline.co.uk/...
), as this journal made all the analyzed information open access. Afterward, the studies were excluded if repeated, then screened and excluded by title, considering only those related to falls from height, excluding if the fall height was unknown, if falls were from a standing height, if the person fell on material which absorbed the impact, or if suffered multiple falls. As inclusion criteria, only accidents were considered, while suicidal and homicidal events were excluded.

Additionally, this study included a previously conducted systematic review on falls from height (Zlatar & Barkokébas, 2018Zlatar, T., & Barkokébas, B. J. (2018). Building information modelling as a safety management tool for preventing falls from height (1st ed., pp. 15-21). Mauritius: LAP Lambert Academic Publishing.). This article serves as state of the art on the topic of falls from height, give indicators for the data analysis (fall accidents by height and by location) and develop the discussion part by comparing the results from this study with the results from previously conducted studies.

## 2.2. Data analysis

Statistical analysis was done by using excel statistical toolbox. The data were analyzed in accordance with rules specified in the following sections:

1. A

Fall height and place

In order to be able to compare data with previous studies (Huang et al., 2003Huang, X., Hinze, J., & Asce, M. (2003). Analysis of construction worker fall accidents. Journal of Construction Engineering and Management, 129, 262-271. http://dx.doi.org/10.1061/(ASCE)0733-9364(2003)129:3(262).
http://dx.doi.org/10.1061/(ASCE)0733-936...
; Kang et al., 2017Kang, Y., Siddiqui, S., Suk, S. J., Chi, S., & Kim, C. (2017). Trends of fall accidents in the U. S. construction industry. Journal of Construction Engineering and Management, 143(8), 1-7. http://dx.doi.org/10.1061/(ASCE)CO.1943-7862.0001332.
http://dx.doi.org/10.1061/(ASCE)CO.1943-...
), the cases were distributed in four height-groups as given by previous studies:

• Falls from a height between 0 to 3 m;

• Falls from a height between 3 to 6.1 m;

• Falls from a height between 6.1 to 9.0 m;

• Falls from a height of more than 9.1 m.

The analyzed results include activities which were conducted before falling, the fall height and where it occurred.

1. B

Consequence analysis

In order to better analyze the consequences of falls from height, the cases were divided into four groups according to the consequences:

• Nothing injured (bruising, minor burns, and blisters, minor cuts on the head);

• Temporary disability (fractured leg, ankle, ribs);

• Permanent disability (serious spinal injuries or paralyzed from the waist down);

• Death (including instant death and death which occurred after some time, but which was related to injuries suffered by the fall).

The consequences of the falls were then related and grouped according to the height of fall, determined by studies previously mentioned section in the “A) Determination of fall-height”.

1. C

Risk management analysis

For risk management analysis, five categories were selected in order to evaluate which measures were applied to prevent and control workplace hazards, and therefore minimize or eliminate safety hazards. For this study, the NIOSH recommendations (National Institute for Occupational Safety and Health, 2018National Institute for Occupational Safety and Health – NIOSH. (2018). Hierarchy of controls. Washington.) on the hierarchy of controls were reflected, considering the following categories and measures:

• Risk Assessment (including identification and evaluation of the risk);

• Elimination (to physically remove the hazard) or Substitution (to replace the hazard);

• Engineering Controls (to isolate people from the hazard, including the use of work platforms, scaffolds, ladders, stepladders, guardrails, handrails, barriers, edge protection, and nets);

• Administrative Controls (to change the way people work, including procedure, method, and plan of work, training certification, signs, lighting, warning labels, and supervision);

• Personal Protective Equipment – PPE (to protect the worker).

This recommendation is commonly accepted by Safety at work engineers and practitioners to always start with the most effective possible measure (elimination), and when not feasible to apply it, go to the next measure of the hierarchy.

# 3. Results

The identification process resulted in 386 studies. All were screened thoroughly in order to exclude those that were not in accordance with the exclusion and inclusion criteria. Finally, 114 cases were included in this analysis (illustrated in Table 1A of the Appendix A).

## 3.1. Fall height and place

In the included studies, falling height ranged between 1.2 to 42 meters, where the numbers were: 19 cases between 0 to 3 m; 52 cases between 3 to 6.1 m; 21 cases between 6.1 to 9.0 m; and 22 cases of more than 9.1 m. The distribution of cases per group is illustrated in Figure 1.

Figure 1
Distribution of encountered cases by fall height.

The location of all included cases was in the United Kingdom, ranging from the year 2003 to 2014. Nevertheless, this review did not analyze fall cases fluctuation during the years on one specific territory, but was primarily focused on consequences depending on fall height, among other analyzed questions. The building height and type was not specified by included articles. The type of working activity was mostly (in 65 cases, 57%) related to construction working activities (building, reforming or demolishing buildings), in three cases it was related to leisure time, while other (in 46 cases) were related to other working activities, such as sewage maintenance, vehicle repairing or boat building.

Figure 2 illustrates the most common places where falls from height occurred: on scaffolds/platforms (26-22.8%); roofs (30-26.3%); collapses, including collapses of floors, walls and staircases (4-3.5%); through opening, including falls through stairwells, trapdoors, lift wells or the glass panels in construction (15-13.2%); ladders and stepladders (10-8.8%); lifting, including lifting’s with forklifts (10-8.8%), and other (19-16.7%).

Figure 2
Most common places for falls from heights.

## 3.2. Consequence analysis

The consequences depending on fall height were illustrated in Table 1, showing the number of cases and percentages for each of the four analyzed consequences.

As it could be seen from the Table 1, the consequence of not having anything injured was present only in fall heights below 6.1 meters.

Table 1
Fall consequences per height groups.

## 3.3. Risk management analysis

Figure 3 illustrates missing or non-adequate safety procedures. In total, 5 main categories with 11 measures were illustrated: category 1 – identification, evaluation and risk control (measure 1); category 2 – risk elimination/prevention (measure 2); category 3 – engineering controls and measures (measures 3, 4, 5 and 6); category 4 – administrative controls and measures (measures 7, 8, 9 and 10); and category 5 – using of PPE. The data for each analyzed measure was divided into: missing (if the measure was not applied); not adequate (if the measure was not appropriate); additionally (if the measure should be revised if appropriate); and total (the total number the three mentioned situations).

Figure 3
Measures failed while working at heights. Measures: (1) Risk Assessment; (2) Risk Elimination (Prevention); (3) Work platform, Scaffold; (4) Ladder/Stepladder; (5) Guardrails, Handrails, Bariers, Edge Protection; (6) Nets; (7) Procedure of work (method, plan); (8) Training and Certification; (9) Signs, Lighting, Warning labels; (10) Supervision; (11) Personal Protective Equipment.

# 4. Discussion

## 4.1. Fall height and place

Table 2 illustrates groups depending on falling height and compares the results from this study with results from two other studies. It is important to notice that percentages were a product of the analyzed cases and that in reality, it is probable to expect a much higher number of falls from lower heights, where falls are probably passing not recorded.

Table 2
Fall accidents by height.

As it could be concluded from Table 2, this study found a lower number of cases with falling heights between 0 to 3.0 meters. The results from falling heights between 3.0 to 6.1 meters are in accordance with the findings from one study (Kang et al., 2017Kang, Y., Siddiqui, S., Suk, S. J., Chi, S., & Kim, C. (2017). Trends of fall accidents in the U. S. construction industry. Journal of Construction Engineering and Management, 143(8), 1-7. http://dx.doi.org/10.1061/(ASCE)CO.1943-7862.0001332.
http://dx.doi.org/10.1061/(ASCE)CO.1943-...
). The percentage of falls between 6.1 to 9.0 meters was higher, while the percentage of falls from heights ≥9.1 meters was in between both previously conducted studies.

In Table 3, the fall accidents by location were compared with findings from other studies.

Table 3
Fall accidents by location.

Data analyzed through this review show that falls from height occur mostly when working on roofs, scaffolds, and platforms, representing almost 50% of all analyzed cases. Therefore, workers working at these positions are most endangered, were all mentioned risk management measures and procedures should be applied and revised on a regular basis. In accordance with the Table 3, some studies concluded that scaffolders and roofers are among the most exposed working activities, which is understandable as they spent more time working on heights (Bobick, 2005Bobick, T. G. (2005). Falls through roof and floor openings and surfaces, including skylights: 1992-2000. Journal of Construction Engineering and Management, 130(6), 895-907. http://dx.doi.org/10.1061/(ASCE)0733-9364(2004)130:6(895).
http://dx.doi.org/10.1061/(ASCE)0733-936...
; Wong et al., 2016Wong, L., Wang, Y., Law, T., & Lo, C. T. (2016). Association of root causes in fatal fall-from-height construction accidents in Hong Kong. Journal of Construction Engineering and Management, 142(7), 1-12. http://dx.doi.org/10.1061/(ASCE)CO.1943-7862.0001098.
http://dx.doi.org/10.1061/(ASCE)CO.1943-...
), and as they typically carry heavy and bulky materials on slippery and inclined walking/working surfaces (Wiersma & Charles, 2006Wiersma, M., & Charles, M. (2006). Occupational injuries and fatalities in the roofing contracting industry. Journal of Construction Engineering and Management, 131(11), 1233-1240.). Further-on, innovative safety solutions should be considered, because as compared with one study (Cheung & Chan, 2012Cheung, E., & Chan, A. P. C. (2012). Rapid demountable platform (RDP): a device for preventing fall from height accidents. Accident Analysis & Prevention, 48, 235-245. http://dx.doi.org/10.1016/j.aap.2011.05.037. PMid:22664686.
http://dx.doi.org/10.1016/j.aap.2011.05....
) comparing scaffolds, it could benefit to the safety of workers, reduce the cost of the equipment in use, increase durability and speed of setting the equipment, among other advantages. Most of the challenges about falls from height might be solved through tools (Ezisi & Issa, 2018Ezisi, U., & Issa, M. H. (2018). Case study application of prevention through design to enhance workplace safety and health in Manitoba heavy construction projects. Canadian Journal of Civil Engineering, (204), 1-36.) for implementing the approach of Prevention through Design.

## 4.2. Consequence of falls from height

Other studies did not analyze the consequence of falls from height; therefore it was not possible to compare the results. By comparing consequences among analyzed studies, the number of cases which resulted in no injury was very low (5; ≈4% of all analyzed cases). With only 5 cases it could be assumed that this is probably the most biased category, as it is reasonable to assume that many low-altitude fall cases happen on a daily basis, but most of them end with no or light injuries, therefore ending up unreported.

The number of cases which resulted in a temporary disability was the highest (51; ≈45% of all analyzed cases). Although workers did not suffer the more severe consequence, it can be seen that falls from height temporarily disabled further working activities, where it is probable to expect rehabilitation costs and loss of production.

Serious consequences were represented in a high number of cases, the permanent disability was encountered in 17 (≈15%), while deaths in 41 (≈36% of all analyzed cases). The fatal falls from a height above 9.1 m were responsible for 33.9% of fatal falls, which is in accordance with the findings from another study where falls above 9.1 m (30 feet in the article) were accounted for more than one-third of fatal falls (Dong et al., 2017Dong, X. S., Largay, J. A., Choi, S. D., Wang, X., Cain, C. T., & Romano, N. (2017). Fatal falls and PFAS use in the construction industry: findings from the NIOSH FACE reports. Accident Analysis & Prevention, 102, 136-143. http://dx.doi.org/10.1016/j.aap.2017.02.028. PMid:28292698.
http://dx.doi.org/10.1016/j.aap.2017.02....
).

Figure 4 illustrates the severity of the consequence depending on fall height (distance) and the percentage of occurrence of each consequence. It also illustrates the logarithmic tendency lines (chosen because they minimize the overall R2 value) with their equations for each consequence. The severity of injuries varied according to the falling height. Although falling from any altitude may result in any of considered consequences, the results show that falls from heights above 20m should result in death consequence, while other consequences could happen only by chance, therefore set up to height until 20m. Some cases were removed for the construction of the interpolations as have been considered as cases by chance and therefore withdrawn from Figure 4 (For example, the percentage of death consequences gradually increased as falling height increased, reaching 75% of death cases on height of 10m, and then being 100% on heights from 12 to 42m. From analyzed data, on falling height of 16m, there was a death consequence of 50%, not following the logical trend, and therefore considered as cases by chance and withdrawn from the figure).

Figure 4
Consequences depending on falling height.

The Figure 4 illustrating the tendencies of consequences depending of falling height, show that as the fall height increase there was a tendency of:

• Decrease for consequence “nothing injured” $y=−3.112lnx+13.03$;

• Decrease for consequence “temporary disability” $y=−19.84lnx+83.599$;

• Increase for consequence “permanent disability” $y=15.437lnx+1.0332$;

• Increase for consequence “death” $y=40.243lnx–25.992$.

It is also important to notice that in some cases a consequence resulted in temporary disability, while it could as easily result with death. For example, in one case fall resulted in a person being on life support machines for 10 days (The Safety & Health Practitioner, 2006bThe Safety & Health Practitioner. (2006b). Fall from height: three firms fined over bus garage plunge. Retrieved in 2017, October 15, from http://link.galegroup.com/apps/doc/A141175247/AONE?u=capes&sid=AONE&xid=a3f90bf6
) or in another case, being unable to return to work for 2 years (The Safety & Health Practitioner, 2013bThe Safety & Health Practitioner. (2013b). Miscommunication led to worker’s stairwell plunge. Retrieved in 2017, October 15, from http://link.galegroup.com/apps/doc/A341129969/AONE?u=capes&sid=AONE&xid=e790bfb1
).

The lowest altitude from which the person died was 1.8 m. By analyzing death cases from low altitudes, it was noticed that all died due to falling headfirst, received severe head injuries, fractured skulls or hit their head on the kerb (The Safety & Health Practitioner, 2005The Safety & Health Practitioner. (2005). Fall from height: unsecured ladder implicated in worker’s fatal fall. Retrieved in 2017, October 15, from http://link.galegroup.com/apps/doc/A132848205/AONE?u=capes&sid=AONE&xid=21be3201
, 2006aThe Safety & Health Practitioner. (2006a). Fall from height: engineer fell from forklift truck while repairing door. Retrieved in 2017, October 15, from http://link.galegroup.com/apps/doc/A143775620/AONE?u=capes&sid=AONE&xid=711faf9d
, 2009The Safety & Health Practitioner. (2009). Company director “wholly culpable”. Retrieved in 2017, October 15, from http://link.galegroup.com/apps/doc/A204090998/AONE?u=capes&sid=AONE&xid=e226e1db
, 2010aThe Safety & Health Practitioner. (2010a). Construction firm fined over death at premier-league club. Retrieved in 2017, October 15, from http://link.galegroup.com/apps/doc/A243044576/AONE?u=capes&sid=AONE&xid=cb36c9a5
, bThe Safety & Health Practitioner. (2010b). Death of Polish worker a wake-up call to construction bosses. Retrieved in 2017, October 15, from http://link.galegroup.com/apps/doc/A218591885/AONE?u=capes&sid=AONE&xid=e744f410
, 2013aThe Safety & Health Practitioner. (2013a). Lack of work-at-height checks contributed to ladder death. Retrieved in 2017, October 15, from http://link.galegroup.com/apps/doc/A318915529/AONE?u=capes&sid=AONE&xid=1607eff8
). These findings are in accordance with a study (Türk & Tsokos, 2004Türk, E. E., & Tsokos, M. (2004). Pathologic features of fatal falls from height. The American Journal of Forensic Medicine and Pathology, 25(3), 194-199. http://dx.doi.org/10.1097/01.paf.0000136441.53868.a4. PMid:15322459.
http://dx.doi.org/10.1097/01.paf.0000136...
) which found that head trauma was the cause of death in 11 of the 19 cases that were from 9m or less (58%). Therefore, as head injuries were found to be responsible for deaths on lower heights, it can be concluded that helmets would be an effective life-protection equipment for lower heights. On the other hand, analyzed deaths from heights over 10m (Türk & Tsokos, 2004Türk, E. E., & Tsokos, M. (2004). Pathologic features of fatal falls from height. The American Journal of Forensic Medicine and Pathology, 25(3), 194-199. http://dx.doi.org/10.1097/01.paf.0000136441.53868.a4. PMid:15322459.
http://dx.doi.org/10.1097/01.paf.0000136...
) were caused mainly due to polytrauma (72%), and in only ≈24% cases (8/33) by head trauma.

In practice, falls from height typically occur when carrying heavy and bulky materials on slippery and inclined walking/working surfaces (Wiersma & Charles, 2006Wiersma, M., & Charles, M. (2006). Occupational injuries and fatalities in the roofing contracting industry. Journal of Construction Engineering and Management, 131(11), 1233-1240.). Therefore, for working activities when this is the case, wearing helmets could be considered for activities on the same level, while for activities on height, special attention should be taken in applying risk management measures.

## 4.3. Risk management analysis

Figure 3 illustrates a total percentage of 11 failed risk management measures for analyzed cases. The administrative measure - the procedure of work (method and plan) was found to be the most common safety measure noted as “not adequate” or as “should be revised”, within 81.6% of analyzed cases. The engineering measure - guardrails, handrails, barriers and edge protection were found to be the second most failed safety measure with 65.8% (where it was missing in 33.3% of cases). Further two most commonly failed measures were risk assessment (60.5%) and the engineering measure - work platform/scaffold (60.5%). Inadequate PPE or missing PPE was noticed in 56.1% of the cases. By comparison, one previously conducted study found that in 48% of the cases workers fell due to their loss in balance while not wearing adequate fall protection devices (Wong et al., 2016Wong, L., Wang, Y., Law, T., & Lo, C. T. (2016). Association of root causes in fatal fall-from-height construction accidents in Hong Kong. Journal of Construction Engineering and Management, 142(7), 1-12. http://dx.doi.org/10.1061/(ASCE)CO.1943-7862.0001098.
http://dx.doi.org/10.1061/(ASCE)CO.1943-...
).

It is also interesting to notice that training and certification were missing in 19.3% of the workers. This is important because training increases workers' perception and reaction to risk and, when conducted regularly, can improve safety performance and therefore the worker is more likely to identify, evaluate and control risks (Chan et al., 2008Chan, A. P. C., Wong, F. K. W., Chan, D. W. M., Yam, M. C. H., Kwok, A. W. K., Lam, E. W. M., & Cheung, E. (2008). Work at height fatalities in the repair, maintenance, alteration, and addition works. Journal of Construction Engineering and Management, 134, 527-535. http://dx.doi.org/10.1061/(ASCE)0733-9364(2008)134:7(527).
http://dx.doi.org/10.1061/(ASCE)0733-936...
; Hinze & Gambatese, 2003Hinze, J., & Gambatese, J. (2003). Factors that influence safety performance of specialty contractors. Journal of Construction Engineering and Management, 129, 159-164. http://dx.doi.org/10.1061/(ASCE)0733-9364(2003)129:2(159).
http://dx.doi.org/10.1061/(ASCE)0733-936...
; Rodríguez-Garz et al., 2015Rodríguez-Garz, I., Lucas-Ruiz, V., Martínez-Fiestas, M., & Delgado-Padial, A. (2015). Association between perceived risk and training in the construction industry. Journal of Construction Engineering and Management, 141(5), 1-9. http://dx.doi.org/10.1061/(ASCE)CO.1943-7862.0000960.
http://dx.doi.org/10.1061/(ASCE)CO.1943-...
). In addition, it is essential to consider that training should be conducted in accordance with the individual characteristics of workers as age, position, trade, number of years of work, past experience with accidents, and personality, which was all found to contribute on how effective would be the training (Kim et al., 2011Kim, E., Yu, I., Kim, K., & Kim, K. (2011). Optimal set of safety education considering individual characteristics of construction workers. Canadian Journal of Civil Engineering, 38(5), 506-518. http://dx.doi.org/10.1139/l11-024.
http://dx.doi.org/10.1139/l11-024...
). Kang found that workers were not equipped with fall protection in 70.7% of cases, and were equipped incorrectly in 17.9% of cases (Kang et al., 2017Kang, Y., Siddiqui, S., Suk, S. J., Chi, S., & Kim, C. (2017). Trends of fall accidents in the U. S. construction industry. Journal of Construction Engineering and Management, 143(8), 1-7. http://dx.doi.org/10.1061/(ASCE)CO.1943-7862.0001332.
http://dx.doi.org/10.1061/(ASCE)CO.1943-...
). Although this could not be directly compared with results from this study, the same conclusions could be adopted – there is an urgent need to improve working safety culture and adopt adequate occupational risk management measures.

Missing or not adequate supervision was found in 22.8% of the analyzed cases. One study found that supervision is important as scaffolders failed to anchor their harness, not due to poor safety attitude, but due to a subjective norm (perceived social pressure) (Goh & Binte Sa’adon, 2015Goh, Y. M., & Binte Sa’adon, N. F. (2015). Cognitive factors influencing safety behavior at height: a multimethod exploratory study. Journal of Construction Engineering and Management, 141(6), 1-8. http://dx.doi.org/10.1061/(ASCE)CO.1943-7862.0000972.
http://dx.doi.org/10.1061/(ASCE)CO.1943-...
).

The 11 risk management measures illustrated in Figure 3 were further analyzed by each case separately. It was noted that most of the cases had failed several risk management measures. In the following Figure 5 were illustrated all 114 cases (100%) by the number of failed risk management measures (both missing and not adequate risk management measures) by each case, where 1 failed measure was only present in 2% of analyzed cases, 2 failed measures in 15%, 3 in 19%, 4 in 20%, 5 in 15%, 6 in 19% and 7 in 10% of analyzed cases.

Figure 5
Number of failed risk management measure from the analyzed cases.

As it is shown in Figure 5, only 2% of the analyzed cases could be associated with one failed risk management measure, while in other 98%, the fall from height was a result of several non-adequate or missing risk management measures. Therefore, it is possible to conclude that in the majority of cases, falls from height were not a coincidence or an unlucky event due to only one fail, but that it could be promptly easily noted due to various failures, and prevented with daily safety screening of the working process.

## 4.4. Future studies

In order to be able to analyze fall consequences further and understand better how some factors benefit to the survival of falling from greater heights, there is a need to include more data on persons which fell and explain how it occurred. For example, fall (impact) energy could be calculated through data on fall height and human body mass: E=mgh (J).

Results on calculations regarding fall energy for four different persons (body mass of 60, 75, 90 and 105kg) were illustrated in Figure 6.

Figure 6
Human body mass an its relation to fall energy and fall height.

As it is illustrated in Figure 6, the fall energy of 10,500J correspond to fall of a human with a body mass of 105kg from a height of 10m, 90kg from 12m, 75kg from 14m and 60kg from 18m. Therefore, a fall impact from the same height would be much lower for those humans having lower body mass compared with those with higher, representing a heavy person less chance of surviving a fall.

Future studies should also consider exploring with more details the employment conditions of workers which suffered falls from height, including the type of employment contract, the age, and experience of the worker.

# 5. Limitations

The limitations of this study lay in analyzing cases which were reported and recorded by the reviewed source. A bias probably lays in the number of no reported cases of falls from height, especially when the fall resulted in minor or no injuries which could be expected in falls from lower heights. Therefore, the percentages on injuries and death occurrences might not correspond to actual values, especially for lower heights. Finally, the analyzed data do not contain information on workers body mass, which would be interesting to analyze as it might have influenced the energy of fall impact, explaining why some persons survived falls from greater heights. Analyzing more cases would help in more consistent results and therefore understanding better the consequences of falls from heights, and possibly result with more or different consequence-based groups.

# 6. Conclusions

The falls from height represent one of the leading risks, causing more than 2.78 million deaths and some 374 million non-fatal work injuries each year. Through the analysis of included studies, it was found that a typical accident of falls from height would be in 45.6% from heights between 3 to 6.1 meters and in 49.1% occurring from scaffolds or roofs. The consequences this fall would result in death if the person fell on head and suffered head trauma, while if not, the percentage representing survival would be ≈55%, depending on the persons mass and also material on which he would fall. As the data show, there would be a percentage of ≈98% that several risk assessment measures were not applied. Among those not applied (failed) measures the reason would be: in 81.6% the procedures of work (administrative measure); in 65.8% the guardrails, handrails, barriers and edge protection (engineering measure); in 60.5% risk assessment; and in 60.5% work platform/scaffold (engineering measure). Therefore, it can be concluded that falls from height pose a great risk for workers, which could be prevented by adequately apply management measures.

Future studies should include more cases with data on body mass of persons which fell from heights, and evaluate how falling height affect each body part.

# Appendix A   Falls from height: analysis of 114 cases.

This appendix file contains 4 tables, which illustrate all included and analysed cases within the article “Falls from Height: Analysis of 114 Cases”:

- Table 1A: Included articles, illustration of the article title, reference, year, type of industry and age of the injured worker;

- Table 2A: Included articles, illustration of the falling height by articles, consequence, injured body parts and recovery period;

- Table 3A: Included articles, illustration of the measures which were Not Appropriate (NA), were missing (0) or should be Additionally (A) considered among each one of included cases;

- Table 4A: Included articles, illustration of accidents which were related to most common falling places.

Table 1A
Included articles, illustration of the article title, reference, year, type of industry and age of the injured worker.
Table 2A
Included articles, illustration of the falling height by articles, consequence, injured body parts and recovery period.
Table 3A
Included articles, illustration of the measures which were Not Appropriate (NA), were missing (0) or should be Additionally (A) considered among each one of included cases.
Table 4A
Included articles, illustration of accidents which were related to most common falling places.

# Acknowledgements

This project was financially supported by the Brazilian Ministry of Education through the Program for Coordination and Improvement of Higher Level Personnel (PNPD/CAPES). Many thanks for all the support from the Faculty of Engineering, University of Porto (FEUP), Federal University of Pernambuco (UFPE) and to the University of Pernambuco (UPE).

• How to cite this article: Zlatar, T., Lago, E. M. G., Soares, W. A., Baptista, J. S., & Barkokébas Junior, B. (2019). Falls from height: analysis of 114 cases. Production, 29, e20180091. https://doi.org/10.1590/0103-6513.20180091.

# References

• Beavers, J. E., Moore, J. R., Rinehart, R., & Schriver, W. R. (2006). Crane-related fatalities in the construction industry. Journal of Construction Engineering and Management, 132, 901-910. http://dx.doi.org/10.1061/(ASCE)0733-9364(2006)132:9(901)
» http://dx.doi.org/10.1061/(ASCE)0733-9364(2006)132:9(901)
• Bobick, T. G. (2005). Falls through roof and floor openings and surfaces, including skylights: 1992-2000. Journal of Construction Engineering and Management, 130(6), 895-907. http://dx.doi.org/10.1061/(ASCE)0733-9364(2004)130:6(895)
» http://dx.doi.org/10.1061/(ASCE)0733-9364(2004)130:6(895)
• Bomel. (2003). Falls from height: prevention and risk control effectiveness (Research Report, 428). Sudbury: HSE Books.
• Centers for Disease Control and Prevention – CDC. (2017). Ten leading causes of death and injury Retrieved in 2017, November 30, from https://www.cdc.gov/injury/wisqars/LeadingCauses.html
• Chan, A. P. C., Wong, F. K. W., Chan, D. W. M., Yam, M. C. H., Kwok, A. W. K., Lam, E. W. M., & Cheung, E. (2008). Work at height fatalities in the repair, maintenance, alteration, and addition works. Journal of Construction Engineering and Management, 134, 527-535. http://dx.doi.org/10.1061/(ASCE)0733-9364(2008)134:7(527)
» http://dx.doi.org/10.1061/(ASCE)0733-9364(2008)134:7(527)
• Cheung, E., & Chan, A. P. C. (2012). Rapid demountable platform (RDP): a device for preventing fall from height accidents. Accident Analysis & Prevention, 48, 235-245. http://dx.doi.org/10.1016/j.aap.2011.05.037 PMid:22664686.
» http://dx.doi.org/10.1016/j.aap.2011.05.037
• Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – CAPES. (2017). Portal Periódicos CAPES Retrieved in 2017, August 11, from http://www.periodicos.capes.gov.br/
» http://www.periodicos.capes.gov.br/
• Dong, X. S., Fujimoto, A., Ringen, K., & Men, Y. (2009). Fatal falls among Hispanic construction workers. Accident Analysis & Prevention, 41(5), 1047-1052. http://dx.doi.org/10.1016/j.aap.2009.06.012 PMid:19664444.
» http://dx.doi.org/10.1016/j.aap.2009.06.012
• Dong, X. S., Largay, J. A., Choi, S. D., Wang, X., Cain, C. T., & Romano, N. (2017). Fatal falls and PFAS use in the construction industry: findings from the NIOSH FACE reports. Accident Analysis & Prevention, 102, 136-143. http://dx.doi.org/10.1016/j.aap.2017.02.028 PMid:28292698.
» http://dx.doi.org/10.1016/j.aap.2017.02.028
• Ezisi, U., & Issa, M. H. (2018). Case study application of prevention through design to enhance workplace safety and health in Manitoba heavy construction projects. Canadian Journal of Civil Engineering, (204), 1-36.
• Goh, Y. M., & Binte Sa’adon, N. F. (2015). Cognitive factors influencing safety behavior at height: a multimethod exploratory study. Journal of Construction Engineering and Management, 141(6), 1-8. http://dx.doi.org/10.1061/(ASCE)CO.1943-7862.0000972
» http://dx.doi.org/10.1061/(ASCE)CO.1943-7862.0000972
• Hinze, J., & Gambatese, J. (2003). Factors that influence safety performance of specialty contractors. Journal of Construction Engineering and Management, 129, 159-164. http://dx.doi.org/10.1061/(ASCE)0733-9364(2003)129:2(159)
» http://dx.doi.org/10.1061/(ASCE)0733-9364(2003)129:2(159)
• Huang, X., Hinze, J., & Asce, M. (2003). Analysis of construction worker fall accidents. Journal of Construction Engineering and Management, 129, 262-271. http://dx.doi.org/10.1061/(ASCE)0733-9364(2003)129:3(262)
» http://dx.doi.org/10.1061/(ASCE)0733-9364(2003)129:3(262)
• Institution of Occupational Safety & Health. (2017). The safety & health practitioner Retrieved in 2017, October 20, from http://www.shponline.co.uk/
» http://www.shponline.co.uk/
• International Labour Organization – ILO. (2017). Safety and health at work Retrieved in 2017, November 30, from http://www.ilo.org/global/topics/safety-and-health-at-work/lang--en/index.htm
» http://www.ilo.org/global/topics/safety-and-health-at-work/lang--en/index.htm
• Johnson, H. M., Singh, A., & Young, R. H. F. (1999). Fall protection analysis for workers on residential roofs. Journal of Construction Engineering and Management, 124(5), 418-428. http://dx.doi.org/10.1061/(ASCE)0733-9364(1998)124:5(418)
» http://dx.doi.org/10.1061/(ASCE)0733-9364(1998)124:5(418)
• Kang, Y., Siddiqui, S., Suk, S. J., Chi, S., & Kim, C. (2017). Trends of fall accidents in the U. S. construction industry. Journal of Construction Engineering and Management, 143(8), 1-7. http://dx.doi.org/10.1061/(ASCE)CO.1943-7862.0001332
» http://dx.doi.org/10.1061/(ASCE)CO.1943-7862.0001332
• Kim, E., Yu, I., Kim, K., & Kim, K. (2011). Optimal set of safety education considering individual characteristics of construction workers. Canadian Journal of Civil Engineering, 38(5), 506-518. http://dx.doi.org/10.1139/l11-024
» http://dx.doi.org/10.1139/l11-024
• Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Annals Internal Medicine, 151(4), W65-94. http://dx.doi.org/10.7326/0003-4819-151-4-200908180-00136 PMid:19622512.
» http://dx.doi.org/10.7326/0003-4819-151-4-200908180-00136
• National Institute for Occupational Safety and Health – NIOSH. (2018). Hierarchy of controls Washington.
• Occupational Safety and Health Administration – OSHA. (2017). Construction’s “fatal four” Retrieved in 2017, November 9, from https://www.osha.gov/oshstats/commonstats.html
» https://www.osha.gov/oshstats/commonstats.html
• Rodríguez-Garz, I., Lucas-Ruiz, V., Martínez-Fiestas, M., & Delgado-Padial, A. (2015). Association between perceived risk and training in the construction industry. Journal of Construction Engineering and Management, 141(5), 1-9. http://dx.doi.org/10.1061/(ASCE)CO.1943-7862.0000960
» http://dx.doi.org/10.1061/(ASCE)CO.1943-7862.0000960
• The Safety & Health Practitioner. (2005). Fall from height: unsecured ladder implicated in worker’s fatal fall Retrieved in 2017, October 15, from http://link.galegroup.com/apps/doc/A132848205/AONE?u=capes&sid=AONE&xid=21be3201
• The Safety & Health Practitioner. (2006a). Fall from height: engineer fell from forklift truck while repairing door Retrieved in 2017, October 15, from http://link.galegroup.com/apps/doc/A143775620/AONE?u=capes&sid=AONE&xid=711faf9d
• The Safety & Health Practitioner. (2006b). Fall from height: three firms fined over bus garage plunge Retrieved in 2017, October 15, from http://link.galegroup.com/apps/doc/A141175247/AONE?u=capes&sid=AONE&xid=a3f90bf6
• The Safety & Health Practitioner. (2009). Company director “wholly culpable” Retrieved in 2017, October 15, from http://link.galegroup.com/apps/doc/A204090998/AONE?u=capes&sid=AONE&xid=e226e1db
• The Safety & Health Practitioner. (2010a). Construction firm fined over death at premier-league club Retrieved in 2017, October 15, from http://link.galegroup.com/apps/doc/A243044576/AONE?u=capes&sid=AONE&xid=cb36c9a5
• The Safety & Health Practitioner. (2010b). Death of Polish worker a wake-up call to construction bosses Retrieved in 2017, October 15, from http://link.galegroup.com/apps/doc/A218591885/AONE?u=capes&sid=AONE&xid=e744f410
• The Safety & Health Practitioner. (2013a). Lack of work-at-height checks contributed to ladder death Retrieved in 2017, October 15, from http://link.galegroup.com/apps/doc/A318915529/AONE?u=capes&sid=AONE&xid=1607eff8
• The Safety & Health Practitioner. (2013b). Miscommunication led to worker’s stairwell plunge Retrieved in 2017, October 15, from http://link.galegroup.com/apps/doc/A341129969/AONE?u=capes&sid=AONE&xid=e790bfb1
• Türk, E. E., & Tsokos, M. (2004). Pathologic features of fatal falls from height. The American Journal of Forensic Medicine and Pathology, 25(3), 194-199. http://dx.doi.org/10.1097/01.paf.0000136441.53868.a4 PMid:15322459.
» http://dx.doi.org/10.1097/01.paf.0000136441.53868.a4
• Wiersma, M., & Charles, M. (2006). Occupational injuries and fatalities in the roofing contracting industry. Journal of Construction Engineering and Management, 131(11), 1233-1240.
• Wong, L., Wang, Y., Law, T., & Lo, C. T. (2016). Association of root causes in fatal fall-from-height construction accidents in Hong Kong. Journal of Construction Engineering and Management, 142(7), 1-12. http://dx.doi.org/10.1061/(ASCE)CO.1943-7862.0001098
» http://dx.doi.org/10.1061/(ASCE)CO.1943-7862.0001098
• World Health Organization – WHO. (2017). Falls Retrieved in 2017, November 30, from http://www.who.int/mediacentre/factsheets/fs344/en/
» http://www.who.int/mediacentre/factsheets/fs344/en/
• Zlatar, T., & Barkokébas, B. J. (2018). Building information modelling as a safety management tool for preventing falls from height (1st ed., pp. 15-21). Mauritius: LAP Lambert Academic Publishing.

# Publication Dates

• Publication in this collection
13 May 2019
• Date of issue
2019