Nonuse of safety devices leads to most injuries at construction sites

Identifying and understanding the patterns of injuries from falls at construction sites can help prevent further injury, suggests a Singapore study, noting the importance of using safety equipment, targeted training, and other safe practices.

“This study of 1,085 patients who fell from a height in the construction industry has, by careful documentation of the patterns of injury, highlighted the need for greater use of safety devices in the prevention of falls,” said the researchers, who collected data on injury and casualty characteristics, safety measures, pre-existing medical conditions, and clinical outcomes.

Most patients were male (n=951, mean age 39.8 years, mean height 165.9 cm, mean weight 69.7 kg), while the majority of casualties fell between 0800 and 2000 hours. The mortality rate stood at 60.8 percent. [Singapore Med J 2023;64:237-243]

Among the severe injuries recorded, the most common involved the chest (54.9 percent), followed by abdominal and pelvic (39.2 percent). In addition, 2.4 percent injured their heads.

Among patients with less than major trauma, the most common parts affected were the lower limbs (41.8 percent), upper limbs (40.8 percent), and spine (22.2 percent). All injured workers survived. Furthermore, the most frequent cause of severe injuries was fall from scaffolding, formwork, and platforms (41.1 percent).

Safety helmets and harnesses were used in 1.8 percent and 4.1 percent of instances of falls, respectively. Overall, 94.1 percent of injured workers at construction sites did not use safety devices.

“The use of safety harnesses needs to be effectively implemented for protection against falls,” the researchers said. “Safety enforcement is an area that needs to be given greater emphasis if we wish to decrease instances of falls in these locations.”

Notably, nearly half of the falls at construction sites happened on ladders, stairs, and steps. These activity areas where workers climb up or down provided opportunities to slip or miss a foothold and fall.

“Falls at construction sites are unlike free falls from heights,” the researchers said. “The scaffolding at construction sites usually breaks the falls and can modify the mechanism of landing.” Such incidents could lead to various injuries, depending on the body parts that bore the brunt of the impact.

An autopsy study of 52 cases of falls from height in Bangalore, India, from 2005 to 2007 reported 69.2 percent of head injuries and 61.5 percent thoracic. These findings were similar to those of the current study, reflecting the tendency for these body parts to be severely impacted during falls at construction sites. [https://bit.ly/443DQlR]

First aid

“It was generally noted that most casualties arriving from construction work sites were usually not provided any on-site first aid soon after the incident and would generally await the arrival of the prehospital ambulances; in cases of severe falls, the first care is received when they either visit a doctor’s clinic or the ED of a hospital,” the researchers said.

In Singapore, chapter 354A, section 65 of the Workplace Safety and Health Act requires one first aider for every 100 persons employed if there are more than 25 workers in a certain workplace. [https://sso.agc.gov.sg/SL/WSHA2006-RG4]

“In a construction industry environment, where the workers are usually fairly dispersed rather than all working in very close proximity to each other, such a first aider may not be activated often or early enough to render appropriate assistance,” the researchers said.

“Immediate availability of first aid may be a positive intervention measure rather than waiting for an ambulance or paramedic to arrive from afar,” they added.

Nearly one in three (34 percent) of fatal accidents in Singapore were falls from heights, and half (51 percent) of these accidents occurred in the construction industry. [Singapore Med J 2023;64:237-243]