Prevention of fall injuries among workers

Falls constitute a major injury among workers in all employment sectors that include manufacturing, agriculture, and services. Fall is a leading cause of injury to workers in other countries as well where plenty of research studies reported on the risk factors, burden, and preventive measures. While there has been a substantial amount of ongoing and completed research on controlling falls in industrialised countries, there is a paucity of epidemiological and prevention research in Bangladesh and other similar low and middle-income countries on workplace falls. Only the fatal cases of falls are reported in newspapers and other media here but the real number of such falls may be many times more. As examples, three construction workers died while working in Dhaka on September 25 last year and it came to the media; several workers were killed in Chattogram shipbreaking yards in August 2021 by falling from height. There may be hundreds or even thousands of cases where workers fall but somehow survive.

Injuries due to falls in the workplace are an important concern as the incident rate of falls is steadily increasing in many countries where data is available, along with the corresponding treatment, work loss, and rehabilitation costs. Injuries due to falls are a multifaceted issue with several contributing extrinsic and intrinsic factors identified previously.

One research study describes that environmental hazards such as obstacles, inadequate lighting, uneven/slippery surfaces, and clutter are major risk factors. According to another study, in the construction industry, falls were largely caused by surface conditions, terrain, and weather. Researchers have found that postal workers are prone to falls due to slippery surfaces, improper footwear, poor lighting, abrupt vertical transitions, steps, slopes, and climate. As community health and social workers work outside office buildings, they may share similar dangers of slipping/falling as postal workers.

Among healthcare personnel in Sweden, the following constitute the majority of fall risk factors: slipping on wet floors, falling from stairs, tripping on objects, rushing to emergency situations, trying to move a patient, assaults by patient or relatives, and slipping on icy outdoors. Likewise, a study on hospitals in the US showed that environmental risk factors for falls include obstacles, cords, uneven flooring, liquid contamination, stairs, and ice/snow. Furthermore, falls were principally resulting from liquid contamination.

Things should be worse for workers in Bangladesh because of its long and heavy rainy season and outdoor workers have to keep on working during rain when the work surfaces are wet and slippery.

To help develop an accurate and effective intervention programme for a particular sector, it may be useful to study the individual causes of slips and falls using a survey or focus group of injured workers. Evidence is needed to identify occupational groups who are experiencing a higher rate of falls than others in Bangladesh. Intervention among those groups should be a priority. Both quantitative and qualitative studies need to be conducted to understand the epidemiology of falls. Once the risk of falls is identified, a follow-up project may develop a risk assessment tool. The tool in the form of a checklist can be used by supervisors, workers and health and safety officials, and committees (if exists) to assess the risk factors for falls.

As mentioned before, fall injury rates vary substantially by sector, occupation, and location, and have assorted contributing factors. Finding that certain occupational groups are at high risk, indicates that policy and prevention strategies should be targeted towards improving the work environment for those specific occupations. Observational studies and interviews and focus group sessions with these workers may help develop and pilot prevention programmes and determine the most suitable and cost-effective interventions. It is imperative that injury incidents are tracked effectively to ensure suitable documentation of the occupation of the worker, time of injury, location of the injury, activities involved, and environmental factors contributing to an injury. An ongoing surveillance system will make it easier to effectively identify the modifiable risk factors.

Accessible evidence recommends that location, as well as factors such as the indoor/outdoor environment, layout, and design of the workplace and workplace organization, contribute to raising the risk of falls. A revision of the existing footwear policy for community social or health workers was repeatedly brought to attention in Canada. A follow-up project can then be planned to develop a tool in the form of a checklist that assesses and manages the risk of falls at the department or floor level. Findings from investigations must be distributed to all the managers or owners, worker groups, advocacy organizations, and other stakeholders with the intention that the findings be utilised to update their policy issues related to falls.

Research has shown that change in the working environment and the adoption of new technologies can alter the risk factors of fall injuries. Examining how, when, where, and why fall injuries take place and who are at higher risk -- the varying degrees of susceptibility by demographic and workplace characteristics -- is helpful in developing, implementing, and evaluating appropriate fall injury reduction programmes.

The monitoring of falls in the workplace is critical to understand the size of the problem, characterise trends, and estimate the associated economic burden, and thereby, improve the knowledge among health and safety professionals, managers and supervisors, and the workers so that appropriate preventative initiatives are designed and implemented. Falls in certain sectors have been reported as these were falls from elevation and the consequences were severe but fall on the same level must be quite prevalent as well. Bangladesh-specific research is necessary to examine how and why fall injuries take place to determine the varying degrees of susceptibility of workers to help develop suitable injury interventions.

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