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Falling (accident)
Falling (accident)
Falling (accident)
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Falling
Falling is a normal experience for young children, but falling from a significant height or onto a hard surface can be dangerous.
SpecialtyEmergency medicine
ComplicationsHead injury, concussion, bone fracture,[1] abrasion, bruise
Risk factorsConvulsion, vision impairment, difficulty walking, home hazards[1]
Frequency226 million (2015)[2]
Deaths527,000 (2015)[3]

Falling is the action of a person or animal losing stability and ending up in a lower position, often on the ground. It is the second-leading cause of accidental death worldwide and a major cause of personal injury, especially for the elderly.[4] Falls in older adults are a major class of preventable injuries. Construction workers, electricians, miners, and painters are occupations with high rates of fall injuries.

Long-term exercise appears to decrease the rate of falls in older people.[5] About 226 million cases of significant[clarification needed] accidental falls occurred in 2015.[2] These resulted in 527,000 deaths.[3]

Causes and risk factors

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Accidents

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The most common cause of falls in healthy adults is accidents. It may be by slipping or tripping from stable surfaces or stairs, improper footwear, dark surroundings, uneven ground, or lack of exercise.[6][7] Studies suggest that women are more prone to falling than men in all age groups.[8]

Age

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Main article: Falls in older adults
Accidental deaths in the United States
2020
2004
  Poisoning
  Motor-vehicle
  Falls
  Choking
  Drowning
  Fires, flames, smoke
  Suffocation

Older people and particularly older people with dementia are at greater risk than young people to injuries due to falling.[9][10] Older people are at risk due to accidents, gait disturbances, balance disorders, changed reflexes due to visual, sensory, motor and cognitive impairment, medications and alcohol consumption, infections, and dehydration.[11][12][13][14]

Illness

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People who have experienced stroke are at risk for falls due to gait disturbances, reduced muscle tone and weakness, side effects of drugs, low blood sugar, low blood pressure, and loss of vision.[15][16]

People with Parkinson's disease are at risk of falling due to gait disturbances, loss of motion control including freezing and jerking, autonomic system disorders such as orthostatic hypotension, fainting, and postural orthostatic tachycardia syndrome; neurological and sensory disturbances including muscle weakness of lower limbs, deep sensibility impairment, epileptic seizure, cognitive impairment, visual impairment, balance impairment, and side effects of drugs to treat PD.[17][18]

People with multiple sclerosis are at risk of falling due to gait disturbances, drop foot, ataxia, reduced proprioception, improper or reduced use of assistive devices, reduced vision, cognitive changes, and medications to treat MS.[19][20][21][22]

Workplace

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At-risk workers without appropriate safety equipment

In the occupational setting, falling incidents are commonly referred to as slips, trips, and falls (STFs).[23] Falls are an important topic for occupational safety and health services. Any walking/working surface could be a potential fall hazard. An unprotected side or edge which is 6 feet (1.8 m) or more above a lower level should be protected from falling by the use of a guard rail system, safety net system, or personal fall arrest system.[24]

The National Institute for Occupational Safety and Health has compiled certain known risk factors that have been found responsible for STFs in the workplace setting.[23] While falling can occur at any time and by any means in the workplace, these factors have been known to cause same-level falls, which are less likely to occur than falls to a lower level.[23]

Workplace factors: spills on walking surfaces, ice, precipitation (snow/sleet/rain), loose mats or rugs, boxes/containers, poor lighting, uneven walking surfaces

Work organization factors: fast work pace, work tasks involving liquids or greases

Individual factors: age; employee fatigue; failing eyesight / use of bifocals; inappropriate, loose, or poor-fitting footwear

Preventive measures: warning signs

For certain professions such as stunt performers and skateboarders, falling and learning to fall is part of the job.[25]

Spectators look on as Starlin Polanco gets up from an attempt during the best trick contest at Coleman Skatepark.

Intentionally caused falls

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Main articles: Jumper (suicide) and Defenestration

Injurious falls can be caused intentionally, as in cases of defenestration or deliberate jumping.

Height and severity

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The severity of injury increases with the height of the fall but also depends on body and surface features and the manner of the body's impacts against the surface.[26] The chance of surviving increases if landing on a highly deformable surface (a surface that is easily bent, compressed, or displaced) such as snow or water.[26]

Injuries caused by falls from buildings vary depending on the building's height and the age of the person. Falls from a building's second floor/story (American English) or first floor/storey (British English and equivalent idioms in continental European languages) usually cause injuries but are not fatal. The height at which 50% of children die is between five and six storey heights above the ground.[27]

Prevention

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Main article: Fall prevention
Workplace safety campaigns attempt to reduce injuries from falling.

Long-term exercise appears to decrease the rate of falls in older people.[5] Rates of falls in hospital can be reduced with a number of interventions together by 0.72 from baseline in the elderly.[28] In nursing homes, fall prevention programs that involve a number of interventions prevent recurrent falls.[29] Falls can also be prevented by installing flooring with appropriate amounts of slip resistance for the intended use of the flooring. For instance, a pool deck and an outdoor ramp would need a floor with more wet slip resistance than a floor in a section of a store selling only canned food items. Reliable floor slip resistance testing methods can be very useful in preventing slips and falls in areas expected to get wet or otherwise contaminated in use.

Surviving falls

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A falling person at low altitude typically reaches terminal velocity of 190 km/h (120 mph) after about 12 seconds, falling some 450 m (1,500 ft) in that time. Without alterations to their aerodynamic profile, the person maintains this speed without falling any faster.[30] Terminal velocity at higher altitudes is greater due to the thinner atmosphere and consequent lower air resistance.

JAT flight attendant Vesna Vulović survived a fall of 10,000 metres (33,000 ft)[31] on 26 January 1972, pinned within the broken fuselage of the DC-9 of JAT Flight 367. The plane was brought down by explosives planted by Croatian Ustaše over Srbská Kamenice in the former Czechoslovakia (now the Czech Republic). The Serbian flight attendant suffered a broken skull, three broken vertebrae (one crushed completely), and was in a coma for 27 days. In an interview, she commented that, according to the man who found her, "…I was in the middle part of the plane. I was found with my head down and my colleague on top of me. One part of my body with my leg was in the plane and my head was out of the plane. A catering trolley was pinned against my spine and kept me in the plane. The man who found me, says I was very lucky. He was in the German Army as a medic during World War Two. He knew how to treat me at the site of the accident."[32]

In World War II there were several reports of military aircrew surviving long falls from severely damaged aircraft: Flight Sergeant Nicholas Alkemade jumped at 5,500 metres (18,000 ft) without a parachute and survived as he hit pine trees and soft snow. He suffered a sprained leg. Staff Sergeant Alan Magee exited his aircraft at 6,700 metres (22,000 ft) without a parachute and survived as he crashed through the glass roof of Saint-Nazaire train station. Lieutenant Ivan Chisov bailed out at 7,000 metres (23,000 ft). While he had a parachute, his plan was to delay opening it as he had been in the midst of an air-battle and was concerned about getting shot while hanging below the parachute. He lost consciousness due to lack of oxygen and hit a snow-covered slope while still unconscious. While he suffered severe injuries, he was able to fly again in three months.

It was reported that two of the victims of the Lockerbie bombing survived for a brief period after hitting the ground (with the forward nose section fuselage in freefall mode), but died from their injuries before help arrived.[33]

Juliane Koepcke survived a long free fall resulting from the 24 December 1971, crash of LANSA Flight 508 (a LANSA Lockheed Electra OB-R-941 commercial airliner) in the Peruvian rainforest. The airplane was struck by lightning during a severe thunderstorm and exploded in mid air, disintegrating 3.2 km (2 mi) up. Köpcke, who was 17 years old at the time, fell to earth still strapped into her seat. The German Peruvian teenager survived the fall with only a broken collarbone, a gash to her right arm, and her right eye swollen shut.[34]

As an example of "freefall survival" that was not as extreme as sometimes reported in the press, a skydiver from Staffordshire was said to have plunged 1,800 m (6,000 ft) without a parachute in Russia and survived. James Boole said that he was supposed to have been given a signal by another skydiver to open his parachute, but it came two seconds too late. Boole, who was filming the other skydiver for a television documentary, landed on snow-covered rocks and suffered a broken back and rib.[35] While he was lucky to survive, this was not a case of true freefall survival, because he was flying a wingsuit, greatly decreasing his vertical speed. This was over descending terrain with deep snow cover, and he impacted while his parachute was beginning to deploy. Over the years, other skydivers have survived accidents where the press has reported that no parachute was open, yet they were actually being slowed by a small area of tangled parachute. They might still be very lucky to survive, but an impact at 130 km/h (80 mph) is much less severe than the 190 km/h (120 mph) that might occur in normal freefall.[original research?]

Parachute jumper and stuntman Luke Aikins successfully jumped without a parachute from about 7,600 metres (25,000 ft) into a 930-square-metre (10,000 sq ft) net in California, US, on 30 July 2016.[36]

Epidemiology

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In 2013, unintentional falls resulted in an estimated 556,000 deaths globally, up from 341,000 deaths in 1990.[37] They are the second most common cause of death from unintentional injuries after motor vehicle collisions.[38]

  • Deaths due to falls per million persons in 2012   0–15   16–21   22–33   34–44   45–55   56–69   70–88   89–106   107–129   130–314
    Deaths due to falls per million persons in 2012
      0–15
      16–21
      22–33
      34–44
      45–55
      56–69
      70–88
      89–106
      107–129
      130–314
  • Disability-adjusted life year for falls per 100,000 inhabitants in 2004.[39]   no data   less than 40   40–110   110–180   180–250   250–320   320–390   390–460   460–530   530–600   600–670   670–1000   more than 1000
    Disability-adjusted life year for falls per 100,000 inhabitants in 2004.[39]
      no data
      less than 40
      40–110
      110–180
      180–250
      250–320
      320–390
      390–460
      460–530
      530–600
      600–670
      670–1000
      more than 1000

United States

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They were the most common cause of injury seen in emergency departments in the United States. One study found that there were nearly 7.9 million emergency department visits involving falls, nearly 35.7% of all encounters.[40] Among children 19 and below, about 8,000 visits to the emergency rooms are registered every day.[41]

In 2000, in the USA 717 workers died of injuries caused by falls from ladders, scaffolds, buildings, or other elevations.[42] More recent data in 2011, found that STFs contributed to 14% of all workplace fatalities in the United States that year.[43]

References

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Falling (accident)

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from Grokipedia
A fall, in the context of accidents, is an unintentional event that results in a coming to rest on the ground, floor, or another lower level, often leading to physical or . These incidents represent a significant concern, ranking as the second leading cause of unintentional deaths globally after road traffic collisions. Falls affect people across all age groups, but they disproportionately impact older adults over 60 and young children under 5, with contributing factors including environmental hazards, health conditions, and behavioral risks. Epidemiologically, falls cause an estimated 684,000 deaths annually worldwide as of 2021, with over 80% occurring in low- and middle-income countries, and result in 37.3 million cases severe enough to require medical treatment each year. In the United States, falls lead to more than 3 million visits and approximately 1 million hospitalizations annually among older adults, accounting for 83% of deaths in this population. The economic burden is substantial, with direct medical costs for nonfatal falls among older adults estimated at $80 billion in 2020 in the US, alongside indirect costs from and lost . Falls also contribute to 38 million disability-adjusted life years (DALYs) lost globally as of 2021, underscoring their role in long-term health impairments like fractures, traumatic brain injuries, and reduced mobility. Common causes of accidental falls include a combination of intrinsic risk factors—such as , balance disorders, , vision impairments, and medication side effects—and extrinsic factors like slippery surfaces, poor lighting, cluttered environments, and unsafe . Alcohol consumption exacerbates risks by impairing coordination, while occupational hazards, such as working at heights in or , elevate incidence among working-age adults. In older populations, chronic conditions like or neurological disorders further increase vulnerability, with multiple risk factors compounding the likelihood of a fall. Prevention efforts focus on multifactorial interventions tailored to at-risk groups, including exercise programs to improve strength and balance—such as for older adults—home modifications like installing grab bars and removing hazards, and clinical assessments to manage medications and vision issues. Public health strategies emphasize on fall risks, policy measures for safer built environments, and workplace safety regulations, which have demonstrated effectiveness in reducing fall-related injuries in targeted programs. Early screening tools, like the CDC's Stopping Elderly Accidents, Deaths & Injuries (STEADI) initiative, enable healthcare providers to identify and mitigate risks proactively.

Causes and Risk Factors

Environmental Hazards

Environmental hazards play a significant role in precipitating accidental falls by creating physical obstacles or conditions that compromise stability and visibility. These external factors, distinct from individual behaviors or health issues, include surfaces that reduce traction, structural irregularities, and adverse atmospheric conditions. According to the , unsafe environments contribute to the global burden of falls, with over 37 million falls requiring medical attention annually, many linked to modifiable home and community settings. Slippery surfaces represent one of the most common environmental triggers for falls, often resulting from wet floors, ice accumulation, or contaminants like oil and grease that diminish underfoot. The Centers for Disease Control and Prevention (CDC) identifies slippery or uneven surfaces as key extrinsic risk factors, contributing to slips that account for a substantial portion of fall incidents in both indoor and outdoor settings. For instance, in healthcare environments, liquid spills or weather-related moisture on floors heighten the likelihood of loss of traction, with epidemiological data indicating that slips cause 40-50% of fall-related injuries. Uneven terrain, cluttered walkways, and architectural features without proper support further exacerbate fall risks by promoting trips or missteps. Broken or uneven steps, along with throw rugs and in pathways, are frequently cited as tripping hazards by the CDC, where clutter obstructs clear navigation and increases stumble probability. lacking railings or handrails amplify this danger, as the absence of graspable supports during descent or ascent can lead to loss of balance on irregular surfaces. The CDC's STEADI initiative highlights poor stair and obstacles as preventable environmental contributors, emphasizing their role in community-based falls. Poor lighting conditions impair and obstacle detection, making environmental navigation hazardous, particularly in low-visibility areas like stairwells or hallways. Dim lighting or glare is listed by the CDC as a critical , where inadequate illumination leads to misjudgment of steps or hidden hazards, thereby elevating fall incidence. Outdoor weather conditions, including , , , introduce dynamic environmental perils that affect surface stability and balance. The CDC reports seasonal variations in fall-related emergency visits, with winter conditions contributing to about one-third of outdoor incidents through slips on , , or rain-slicked surfaces. Architectural defects such as loose rugs, missing handrails, or inadequate flooring materials directly facilitate falls by failing to provide secure footing or support. The CDC notes that throw rugs and the lack of handrails or grab bars in high-risk areas like bathrooms and are common modifiable hazards, where loose or unsecured elements can shift unexpectedly under weight. Inadequate , including worn or slippery materials, further promotes traction loss in built environments.

Human Factors

Human factors in falls refer to modifiable behavioral, physiological, and lifestyle elements that compromise an individual's stability, coordination, and , independent of external environments or underlying pathologies. These factors often stem from daily habits and acute states that can be addressed through and intervention, significantly influencing fall incidence across age groups. Sedentary lifestyles contribute to , especially in the lower body, which directly impairs balance and stability, increasing the likelihood of falls. indicates that prolonged inactivity leads to reduced proprioceptive and diminished in maintaining equilibrium, exacerbating this risk among older adults. For instance, epidemiological studies have established sedentary behavior as a strong predictor of recurrent falls, with physical playing a central role in altered mobility patterns. Distracted walking, particularly when involving mobile devices or multitasking, disrupts and attentional focus, heightening the chance of trips or missteps. Using smartphones for texting or reading while ambulating reduces walking speed and stride length, impairing overall stability and reaction to obstacles. Systematic reviews highlight that such cognitive-motor interference poses a notable for pedestrians, with young adults showing measurable declines in postural control during these activities. Alcohol and drug impairment severely affect coordination, balance, and reaction time, making falls more probable during intoxicated states. Even moderate alcohol consumption disrupts and judgment, leading to unsteady locomotion and delayed responses to perturbations. Similarly, substances like marijuana, when combined with alcohol, amplify injury risks from impaired equilibrium, as evidenced in data on substance-related incidents. Fatigue and diminish and cognitive processing, indirectly elevating fall risk by slowing reflexes and impairing environmental scanning. Chronic poor patterns result in heightened daytime , which correlates with reduced vigilance and increased , including falls. Prospective studies confirm that sleep-disrupted individuals, particularly older women, face a substantially higher incidence of falls due to these deficits. Inappropriate footwear, such as high heels or loose-fitting shoes, alters biomechanical alignment and traction, compromising stability during movement. High-heeled shoes shift the body's center of gravity forward, increasing forward sway and fall propensity, with greater heel heights directly linked to elevated risk in longitudinal analyses. Loose shoes, lacking secure fixation, cause foot slippage and instability, further contributing to imbalance on varied surfaces.

Medical Conditions

Neurological disorders significantly elevate the risk of falls by impairing , balance, and coordination. , characterized by bradykinesia, rigidity, and postural instability, is associated with an annual fall risk of 45% to 68% among affected individuals, often due to freezing of and . survivors experience falls at rates ranging from 7% in the acute phase to 73% within the first year post-event, primarily from hemiparesis, sensory deficits, and altered that disrupt stability. Orthopedic conditions compromise mobility and joint function, thereby increasing fall susceptibility. Arthritis, particularly rheumatoid arthritis, leads to joint pain, stiffness, and deformities that hinder and balance, with studies showing a heightened fall incidence linked to disease severity and functional limitations. Foot deformities, such as hallux valgus or hammertoes common in arthritic conditions, alter mechanics and reduce foot clearance, contributing to a dose-dependent increase in fall risk among older adults with these impairments. Cardiovascular conditions predispose individuals to falls through episodes of , , or syncope that cause transient loss of or postural instability. Syncope of cardiac origin, often stemming from arrhythmias or structural heart disease, carries a one-year of up to 30% and frequently results in falls due to abrupt cerebral hypoperfusion. Broader cardiovascular diseases may contribute to and imbalance through mechanisms like reduced cerebral blood flow during positional changes, though evidence on their direct role in predicting falls is mixed. Visual and hearing impairments diminish environmental awareness and spatial orientation, heightening the likelihood of stumbling or misjudging obstacles. , whether central or peripheral, correlates with a dose-response increase in falls, as reduced acuity impairs and detection. independently raises fall odds by 51% in cross-sectional analyses, potentially through decreased auditory cues for balance and increased during navigation. Certain medications induce physiological changes that precipitate falls, particularly by causing drowsiness, , or impaired alertness. Sedatives and hypnotics, including benzodiazepines and variants, elevate fall risk via and psychomotor slowing, with pharmacovigilance data confirming their association with injurious falls in older patients. Antihypertensive agents, such as alpha-blockers and centrally acting drugs, contribute through and fatigue, leading to a measurable increase in serious fall injuries among community-dwelling adults.

Occupational Settings

Falls in occupational settings represent a significant concern, particularly in industries involving elevated work, uneven surfaces, or physically demanding tasks. In , falls are the leading cause of fatalities, accounting for 421 deaths in 2023 out of 1,075 total construction fatalities, or approximately 39% of the sector's lethal incidents. This high incidence underscores the risks associated with job-specific hazards that are prevalent in professional environments. Elevated work environments, such as ladders, scaffolds, and roofs, pose acute dangers in due to the potential for rapid, unprotected descents. From 1992 to 2005, about one-third of fatal construction falls occurred from roofs, 18% from scaffolds or staging, and 16% from ladders, highlighting these as persistent vulnerabilities despite available . Annually, 300 to 400 construction workers succumb to falls from such heights, often on roofs, ladders, or scaffolds, where structural instability or improper setup exacerbates the risk. In and , same-level falls from slippery or cluttered floors contribute substantially to nonfatal injuries, driven by spills, wet surfaces, or obstructed walkways. Loss of traction on wet or contaminated floors is the primary cause of slips leading to falls across these sectors, with clutter from materials or equipment increasing trip hazards in high-traffic areas like warehouses or retail floors. These incidents account for a notable portion of occupational injuries, with reporting elevated rates of same-level falls due to repetitive floor-based tasks. Agriculture and mining amplify fall risks through fatigue induced by operating heavy machinery or engaging in repetitive motions over extended shifts. In agriculture, machinery operation is a leading injury factor, where fatigue from prolonged exposure to vibrating equipment or awkward postures contributes to slips and falls during mounting/dismounting or field navigation. Similarly, in mining, long hours and repetitive tasks foster fatigue, heightening the likelihood of falls on uneven terrain or around equipment, with the sector's fatality rate around 13-23 deaths per 100,000 workers as of the early 2020s. The absence of essential safety equipment, including harnesses for elevated tasks and non-slip mats for floor hazards, directly correlates with higher fall rates across industries. OSHA frequently cites violations for lacking fall protection on scaffolds, such as harnesses and lanyards, which are critical for arresting descents in and similar fields. In ground-level settings, the failure to deploy non-slip mats on wet surfaces in or service areas leaves workers vulnerable to traction loss, compounding environmental risks. While targeted training can mitigate these hazards by promoting proper equipment use, comprehensive interventions remain essential.

Intentional Falls

Intentional falls refer to incidents where a fall is deliberately induced by another person or self-inflicted, often as part of , , or attempts, contrasting with unintentional causes such as slips or environmental hazards. These events are associated with significant morbidity and mortality, with survival outcomes varying based on height, landing surface, and prompt medical intervention. In forensic contexts, distinguishing intentional from accidental falls relies on patterns, statements, and scene analysis to determine intent. In assault scenarios, intentional falls frequently occur through pushes or trips during domestic or intimate partner violence (IPV) and street confrontations. IPV accounts for approximately 12% of assault-related visits in the United States, predominantly affecting women over age 25, with physical mechanisms including being pushed down or thrown, leading to falls from heights up to several meters. Men are more commonly victims in street assaults, predominantly involving males, often resulting from pushes in spaces like or highways. These falls produce distinct injury patterns, such as upper extremity fractures or spinal injuries, differing from those in collisions or unintentional falls. Self-inflicted falls, typically involving jumping from heights, are a common method in attempts linked to mental health crises like depression or substance use disorders. Females select jumping from high places more frequently than males (59% versus 20%), while overall, deliberate falls result in death in a substantial portion of cases, influenced by fall height and comorbidities. In older adults, rates are notably high, with jumping as one method often from balconies or windows during acute psychiatric episodes; rates have shown increases post-2020. Child abuse involving intentional falls manifests as deliberate drops from heights, such as caregivers throwing or pushing infants from beds, stairs, or arms, leading to severe head and skeletal injuries. These acts are part of non-accidental trauma, where parents or guardians are common perpetrators, and forensic evaluation often reveals inconsistencies between claimed low-height falls and injury severity, like bilateral fractures incompatible with accidental drops under 1 meter. Such incidents represent a subset of pediatric emergency visits due to intentional injuries. Elderly mistreatment through induced falls commonly involves , such as withholding or sabotaging mobility aids like canes or walkers, increasing fall risk in vulnerable individuals. Physical , including pushes, has a of 0.2–2.1% among community-dwelling older adults, with neglect contributing to higher rates of bruising and maxillofacial injuries compared to unintentional falls (78% versus 54%). Caregivers, often family members, perpetrate most cases, exacerbating frailty-related risks. Forensic investigations emphasize differentiating intentional falls via trauma patterns: intentional cases show higher severity in spinal and lower limb injuries from feet-first landings in suicides, versus distributed impacts in accidents. Biomechanical analysis, including distribution and scene reconstruction, aids in legal determinations, as seen in cases where injury incompatibility with explained heights supports abuse charges.

Fall Dynamics and Injury Severity

Impact of Height

The physics of falls from height is governed by , which on Earth is approximately g=9.8 m/s2g = 9.8 \, \text{m/s}^2. For an object in from rest, the upon impact vv after falling a hh is given by v=2ghv = \sqrt{2gh}
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