Injury patterns at construction sites reveal need for safety devices to prevent falls

Understanding injury patterns after falls at construction sites can help prevent injury through safe practices, targeted training, and use of safety equipment, suggests a Singapore study.

“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,” the researchers said.

A retrospective review was conducted involving all persons falling from heights in the construction industry from 2006 to 2012 and attending a major hospital. The researchers collected data on injury and casualty characteristics, safety measures, pre-existing medical conditions, and clinical outcomes. They then analysed injury patterns and related them to mechanisms and contributory factors.

Of the 1,085 patients (mean age 39.8 years, mean height 165.9 cm, mean weight 69.7 kg), 951 were male. Most of the falls leading to death occurred between 08:00 and 20:00 hours. Among severe injuries, 2.4 percent were head, 54.9 percent chest, and 39.2 percent abdominal and pelvic injuries. The mortality rate for these victims was 60.8 percent. [Singapore Med J 2022;doi:10.11622/smedj.2022017]

Among those with less than major trauma, the most common injury was in the lower limbs (41.8 percent), followed by the upper limbs (40.8 percent) and spine (22.2 percent). All these casualties survived. In addition, the most common cause of severe injuries was falls from scaffolding, formwork, and platforms (41.1 percent).

Of note, safety helmets and harnesses were reported to be used in 1.8 percent and 4.1 percent of instances of falls, respectively. Among those injured at constructions sties, 94.1 percent 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.”

The scaffolding at construction sites could break the fall and alter the mechanism of landing, leading to a range of injuries depending on the body parts that bore the brunt of the multiple impacts that might occur, according to the researchers.

In an autopsy study of 52 cases of falls from 2005 to 2007 in Bangalore, India, 69.2 percent had head injuries and 61.5 percent thoracic. These results supported those of the present study and reflected the tendency for these body parts to be severely affected during falls from heights. [Murthy CRV. Study of pattern of injuries in fatal cases of fall from height (dissertation). Bangalore: Rajiv Gandhi University of Health Sciences, 2008]

Workplace safety

In the current Singapore Workplace Safety and Health Act, regulations stated that there should be one first-aider for every 100 persons employed if there are more than 25 employees in a 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.

In Singapore, 34 percent of fatal accidents were cases of falls from heights. More than half (51 percent) of these occur in the construction industry.