What Happens After the Fall?

In the absence of automated fall detection, a buddy system, along with a mindful approach where workers remain aware of each other, is called for because an undiscovered victim is a tragedy in the making.

• By Peter Burnham
• Jul 01, 2016

This year's National Safety Stand-Down to Prevent Falls in Construction took place the first week of May. Safety managers and construction workers at risk of falls took the time to focus on fall awareness, safety equipment use, and requirements. Federal groups responsible for worker safety such as CDC, OSHA, NIOSH, CPWR, DOL, ANSI, and numerous state agencies all participated.

We promoted and discussed Plan, Provide, Train—the OSHA and CPWR position for preventing falls. We all get renewed focus, and I suspect more workers take the time to erect proper guardrails, check safety nets, and wear a harness. Prevention is acknowledged as the best way to lower the fatality and injury rate. We all take a victory lap . . . and bad things still happen.

• Three hundred people are going to die from construction related falls in 2016.¹
• One of every 125 construction workers will die of a fatal fall in their career.²
• Falls cost the construction industry $300 million per year.³

Despite our best efforts, accidents happen, and it's time for more focus on recovery. In the event of a serious fall without a harness in a situation where it could be required, you, your employer, and your family are all going to suffer. If you do wear a harness and an arrested fall takes place—what happens next? In any moment, if we take a chance and don’t take fall precautions, we are probably going to get away with it. But over the course of a career, some of us are going to get seriously injured or killed doing so. If we have a protected fall and the equipment works correctly, 100 percent of us will need a self or assisted rescue!

Here is where I'd like to embrace Plan, Provide, Train (a prevention strategy) with a mindful extension. In addition to regulations and paperwork, let’s be aware of what we are doing and do so safely. The regulations are a minimum and the paperwork is only paper. It's our actions, which are guided by regulation, that most affect safety. OSHA 1926.501 is specific about fall protection and is a minimum. Awareness is your best defense. When using a nail gun or a table saw, I'm always thinking, “Where is each of my hands?" Should the work slip or a hold-down fail, which way is the tool or projectile going to go? The same awareness needs to go with your entire body when working at height.

If I'm working near an edge and trip over trash on the deck, what will happen? If I go over the edge, what is below me that may interfere with a successful arrest?  Is there a sharp edge or sharp secondary edge that will hurt me or cut my line? Have I climbed above my tie point? Is my rope grab set at the proper height? While awareness is probably the best approach to safety, awareness cannot be regulated.

There is an entire industry dedicated to fall safety, and we can't cover all of the possibilities here. I'm simply suggesting the best bit of fall safety prevention equipment is between your ears.

Extending Plan, Provide, Train to Include Recovery
We go to great lengths to prevent fire. Prevention of fire is the best way to contain damage to persons and property. Obviously, with no fire, there is no fire damage. Yet we still have fire hydrants, fire extinguishers, and fire drills.

I'm suggesting the same should apply to fall recovery. We try our best to follow the regulations, use the equipment, and be aware of fall hazards, yet construction still has unpredictable fall elements and bad accidents still happen. The time to be mindful about recovery is before a fall happens. In addition to regulations and paperwork, let's identify what everyone needs to do, where the recovery gear is, how to do a recovery, and where to take an injured person in a non-life-threatening situation. There is a sequence of events from discovery through recovery that need to be known for the work site in its current state. The fall hazards of installing decking, raising peaks, and demolishing outside walls are all different. Every time a new piece of deck goes down, it's an invisible fall hazard until fastened.

The point is awareness. Are you aware of every person on the job site? If you are, that makes you a wizard, because most people can't be mindful of their own job and hazards while also being aware of other workers.

All Alone: Discovery is the First Step in Fall Recovery
Working at height, lone workers who fall and are unable to self-recover have a poor chance of a good outcome if they are undetected. An otherwise survivable arrested fall can become an undetected disaster. While teamwork is best, there are jobs where teams are neither reasonable nor a common practice. Roof inspectors, window and gutter cleaners, and pressure washers are all at risk if at height and alone. And teamwork is no guarantee of fall detection.

The first step in fall recovery is discovery. Someone needs to discover the victim if that person can't help himself. The noise from compressors, nail guns, saws, and music in combination with your hearing protection makes an out-of-eyesight fall nearly impossible to detect. A suspended victim on a far wall, beneath the deck, who can’t be heard and can't be seen, is in serious trouble. A victim in a harness has less than 30 minutes to be discovered and recovered.⁴ In the absence of automated fall detection, a buddy system, along with a mindful approach where workers remain aware of each other, is called for because an undiscovered victim is a tragedy in the making.

We Need a Plan and to Practice That Plan
Recovery plans and recovery equipment required are well understood by the safety equipment and training vendors. Staying with the OSHA code 1926.501 and enhancing our awareness past rules, the recovery is where we need a 100 percent performance every time.

Unlike preventative strategy, where you may or may not be hurt for non-compliance, an active recovery is a time for everyone's "A" game. The plan, the recovery equipment, the medical kit location need to be known to everyone. While not everyone may be trained in its use, everyone does need to know who the trained recovery persons are.

We can have a dozen discussions of how to recover victims from a dozen scenarios. The suggestion here is that as a building project progresses, the fall hazards change and the recovery method changes. So be equipped for the hazard and have some trained persons who can make a recovery. Ideally, we have a low-level recovery using a ladder. Other times, we may be dealing with a high-altitude, upward recovery with a winch and transfer of human load from one suspension system to another. If the need arises, the equipment and the training need to be at the ready, not in a supervisor's truck that is 30 minutes away.

Smart boaters and all ocean racers and cruisers practice a man overboard drill. Everyone knows where the life rings are, where the safety sling is, how to rig a winch from a boom or davit for recovery. This process is practiced, and I suggest you practice, too. Use a live person (safely) or use a bag of concrete, but someone should understand the winch, the rigger's pole, and every way to deploy it to suit the conditions of that day. If conditions dictate that a descending rescue is not possible, your rescue kit, practice, and planning should include a davit.

OSHA 1926.502 is written such that it's up to you to determine what rescue gear is suitable to the anticipated risk. Rescue gear and people need to be prompt and suited for the anticipated rescue operation. Remember that it makes great sense to have a plan and practice it. We can't recover around a sharp edge without chafing gear at a minimum, and a davit is a much better alternative. The friction that comes to the line lifting a 250-pound victim around an edge is extreme. It is nearly impossible to recover back to the same level and around an edge without a higher-level attach point. As the rescue person, think every day about how you will rescue from potential risks.

After the Rescue
First aid kits are good for bumps and bruises.

Here is my experience: Have you ever had a deep cut at home or on the job? Have you noticed how the little band aids, tapes, and gauze pads don’t really help much? And what do you do—grab the nearest rag and get a buddy with some duct tape to wrap it for the trip to the urgent care for stitches.

With a focus on what may actually happen, let's go beyond the rules and paperwork and think about what is really needed. I have had better results with clean towels ripped in strips and good tape. I recently discovered cloth-backed gaffing tape. What great stuff! It conforms to any shape and is not overly sticky to skin, but when put into contact with itself it is very secure. The ability to maintain good pressure on a bleeding limb or finger cannot be accomplished with a typical medical kit. A red backpack with the medical kit and trauma supplies is priceless in a blood loss emergency. Use simple items like strips of clean towel, clothesline cut in lengths, a couple of short shafts from broken sticks that stabilize a victim for a trip to the urgent care or the wait for emergency services.

For non-life-threatening but still serious injuries, it's good to know where the nearest walk-in clinic, urgent care, or doctor is located. Driving your truck with one hand while looking at a cell phone for directions is a poor way to take a co-worker to assistance. Make sure your plan includes where you go for the next level of medical help.

Summary
Not falling is the best choice and should be the main focus. Using fall protection is next. Being ready to detect a fall and recover from it is required, even if the specifics are left to you. Practice your plan and have whatever written documentation is required.

Realize that having a plan that has been practiced will be the best move after a fall.

References
1. Based on historic average. DOL, Bureau of Labor Statistics Census of Fatal Occupational Injuries, BLS fatal slips, trips, and falls in construction. Fatal count by year: 2010 – 264, 2011 – 262, 2012 – 290, 2013 – 302, 2014 – 359. http://www.bls.gov/iif/oshcfoi1.htm#2013
2. Work-Related Fatal and Nonfatal Injuries Among U.S. Construction Workers, 1992-2008, Dr. Xiuwen Sue Dong, et al., Construction fatal injury rate 9.6 per 100,000 FTE (≅ 1 in 10,000 per year). BLS 2003-2008 average fatal occupational injury attributed to construction falls, ≅ 1 in 125 over a 40-year career. http://www.bls.gov/iif/oshcfoi1.htm#2013
3. NIOSH Fatal Occupational Fact Sheet: Construction, $3,085,000,000 cost of construction falls for 10 years, 1992-2002, in 2003 dollars. http://www.cdc.gov/niosh/docs/2006-153/
4. OSHA Safety and Health Information Bulletin, Suspension Trauma/Orthostatic Intolerance. https://www.osha.gov/dts/shib/shib032404.html

This article originally appeared in the July 2016 issue of Occupational Health & Safety.