Tools for Environmental Health.

Good Tools for Preventing Slips and Falls

About three years ago, we were conducting an environmental health and safety evaluation of a mental hospital. It was one of those rare occasions when the two of us were retained as expert witnesses on opposite sides-plaintiff and defendant. During the course of our inspections, we noticed several patients cautiously walking over a highly polished floor and gingerly bracing themselves along the walls to keep from slipping. Although the floor was immaculately clean, it was as slick as black ice on a country road. Since most of these patients were on psychotropic medications, it took no leap of faith to see a fall injury waiting to happen. Fortunately, our recommendations for correcting this hazardous condition were acted upon immediately. We were prompted to ask ourselves, however: At what point is a floor too slippery? With a bit of research and help from the Internet, we found ourselves immersed in the science of slips and falls. We have since purchased a slip meter to measure the coefficient of friction in f looring material as well as two manuals that help us interpret our findings, guide us through incident investigations, and direct us in preparation of reports.

Because of our work in forensic environmental health and safety we can state emphatically that, of all the instruments we have purchased over the years, the slip meter has yielded the greatest return on our investment. Not only do we regularly use the slip meter in our institutional practice, but we also have used it, on five separate occasions in the past year, to help adjudicate negligence suits. We think it is now time that we share the wealth.

Let's first put this issue into perspective. According to the 1999 edition of Injury [Facts.sup.TM], published by the National Safety Council, unintentional injuries from slips and falls are the second most common cause of personal injury. In fact, in 1998,16,600 deaths were attributed to falls, excluding those from moving vehicles. That is about the number of deaths from poisoning, drowning, and fires combined, and more than 18 times the number of deaths from unintentional firearm injuries. Epidemiologically, the mortality rate represents only a fraction of disabling injuries-not to mention the slip and fall injuries in which trauma is less severe but no less painful. The economic and personal impacts of these injuries must be quite staggering. Given these compelling statistics, we sincerely believe that slip and fall surveillance should be included in every environmental health and safety program.

A Valuable Handbook Resource

In our effort to learn more about the various factors involved in slips, trips, and falls, we came across an excellent resource: a softcover, 409page tome by Stephen I. Rosen, J.D., Ph.D., titled The Slip and Fall Handbook (1996 Edition). [*] It is available from the publisher and through major book retailers for $125. Do not let the price scare you away This handbook is simply crammed with good information in 34 chapters and three appendices. We find particularly useful the sections that detail what to look for in an inspection; how to measure and interpret the antislip coefficient of friction; and, most importantly, how to identify the means of prevention. The handbook also provides an excellent overview of the problems endemic to most common surfaces-stairways, ramps, handrails, guardrails, mats, and matting, as well as the biomechanics of walking and personal injury and the human factors in fall accidents. Each chapter reviews all pertinent codes and consensus standards, including the Americans with Disab ilities Act (ADA).

Of particular note is Chapter 10. For all sanitarians who inspect grocery and other retail food stores, this chapter is essential reading because it provides details on a "sweep standard," including frequency of sweeping under various conditions such as those found in produce and meat departments. Other sections list the types of flooring materials that should be used both inside and outside at sites such as schools, nursing homes, hospitals, malls, and grocery stores. The information on the slip resistance inherent in flooring materials under various environmental conditions is well presented and quite comprehensive.

We recommend this book for the resource library of every health department. In addition, Dr. Rosen has compiled a companion book titled Slip and Fall Pleadings and Practice Forms as an advanced reference. [**] Although prepared for the legal profession, this book is also an essential resource for any sanitarian in forensic practice. It provides detailed client questionnaires that cover most slip and fall scenarios, as well as requests for admissions and special interrogatories for attorneys to complement findings. Accompanying the book is a computer disk, from which users can download the incident questionnaires.

The Slip Meter

The accepted industry standard for a safe walkway surface is a static antislip coefficient-of-friction reading of 0.50 or above on a dry walkway surface, as tested with leather pads (ADA recommends 0.60 or above and 0.80 for ramps). To find the coefficient of friction on a surface, we need a slip-testing device. The one most commonly used is a horizontal pull meter. This is a drag-type device consisting of a weight with shoe material or "sensors" evenly distributed on its bottom. The sensors are pulled across the floor surface, and the force needed to commence movement of the weight yields the static antislip coefficient of friction.

After looking at meters from several manufacturers, we selected a compact and portable static-coefficient-of-friction measuring kit from American Slip Meter (ASM)(R). [+] The complete kit contains

* an ASM 725 Slip Meter,

* an easy-to-follow safety record log for recording findings,

* 24 leather and Neolite(R) test sensors with two sets of sensor retainers,

* a control line,

* a calibration chain, and

* a well-designed padded carrying case with a shoulder strap.

Unlike much of the equipment we evaluate, this kit comes with an instruction manual that is well written, contains a wealth of pertinent information, and provides citations to applicable standards and a reference bibliography The force gauge of the ASM 725 Slip Meter is accurate to within plus or minus one percent, as measured against a reference tile from the American Society for Testing and Materials (ASTM). The reference tile, used to validate the accuracy of the unit, can be purchased separately from the Tile Council of America; an order form comes with the kit. If the leather and Neoprene sensors ever need replacing, American Slip Meter provides them free of charge.

In spite of its diminutive size (a mere 4 by 5 by 8 inches), the complete kit weighs in at a hefty 5.75 pounds and costs $789. Even at $137.22 per pound, however, it is quite the bargain because so many benefits derive from its use.

(*.) Rosen, S.I. (1996), The Slip and Fall Handbook It, Del Mar, Calif.: Hanrow Press. Telephone: [phone].

(**.) Rosen, S.I. (1998), Slip and Fall Pleadings and Practice Farms, Del Mar, Calif.: Hanrow Press.

(+.) American Slip Meter, Inc., 644 N. Indiana Ave., Englewood, FL 34223. Telephone: [phone].