Injuries associated with fall accidents pose a considerable threat to the United States in terms of both human suffering and economic losses. According to the Bureau of Labor Statistics, the three most frequent fatal injuries are highway incidents, falls, and homicide (Bureau of Labor Statistics 2010a). Approximately, nine out of ten nonfatal occupational injuries result from three events: bodily reaction and exertion, contact with objects and equipment, and “fall on same level” (Bureau of Labor Statistics 2008). For the first time in the history of the industrialized world, the combined cost of all fall related occupational injuries surpassed overexertion injuries caused by excessive lifting, pushing, pulling, holding or throwing an object with a significant burden on our economic system (National Safety Council 2006) and are responsible for a significant proportion of worker absenteeism (Courtney et al. 2001, Courtney and Webster 2001). The annual direct cost of occupational injuries due to falls in the U.S. is expected to exceed $43.8 billion by the year 2020 (Englander et al. 1996).

Although the elements behind occupational fall accidents are not yet fully understood, a number of demographic, lifestyle, and workplace factors have been linked with risk of injury in an occupational accident (Swaen et al. 2004, Laflamme et al. 1996, Chipman 1995, Frone 1998, Wells and Macdonald 1999, Leistikow et al. 2000, Frank 2000, Nag and Patel 1998). Successful interventions for reducing falls require a comprehensive knowledge of the mechanisms involved. The present study describes the characteristics of occupational fall accidents, the initiating events, and the final outcome leading to injury and disability. Moreover, because of the growth trends in occupational “fall on same level” incidents, the nonfatal occupational injury category related to this event is of particular interest. Hence, the objective is to describe occupational “fall on same level” injuries in U.S. private industries, categorized by the following factors: major U.S. industry, nature of injury, source of injury, types of exposures or events, part of body injured, occupation, age of injured, gender of injured, the number of days away from work due to fall related injuries, time of fall occurred, and finally, the cost of these injuries.

Information and costs accompanying non-fatal incidents were compiled from two sources: the U.S. Bureau of Labor Statistics (BLS) and the Liberty Mutual Research Institute, Workplace Safety Index (WSI). The data we accessed are available at the Bureau of Labor Statistics (Bureau of Labor Statistics, 2012) and Liberty Mutual Research Institute website (Liberty Mutual, 2010).

Table 1 specifies the 5-year period from 2006 to 2010, where approximately 5.32 million work-related nonfatal injuries involving DAFW occurred in the United States; more than 21.6% (1.14 million) of these accompanied falls. Subsequently, “slip, trip, loss of balance without fall” induced 170,270 injuries, contributing to around 3.2% of overall annual private industry injuries. The percentage of fall-related injuries classified by four main events involving DAFW from 2006 to 2010 is illustrated in Figure 1. Table 2 encompasses occupational injuries, overall fall injuries and fall-related injuries involving DAFW in the private industry. Among the fall events, “fall on same level” cases correlated with the most fall-related injuries, including an average of 66.2% of total occupational falls. “Fall to lower level” cases were a distant second, with an average of 29.8%. Workers during this period were two times more at risk of “fall on same level” injuries than “fall to lower level” injuries, with an average incident rate of 16.5 to 7.4 over the 5 years period.

Table 3, section A shows that female workers experienced a greater distribution of “fall on same level” injuries involving DAFW compared to their male counterparts (55.7% female; 44.3% male). In particular, female employees were two times more at risk than male employees over the five year period, with incidence rates of 22.0 and 12.5 respectively. In table 3, section B, workers between 45–54 years of age had the most fall-related injuries involving DAFW, with an average of 27.2%. The 55–64 and 35–44 age groups were the second and third largest fall populations with an average of 21% and 20.3%, respectively. The combination of these groups, ages 45–64 years, gave a total of 48.2% injuries associated with “fall on same level” accidents and indicates that the incidence rate of falls increases with advancing age. The incidence rate for falls was highest among persons 65 years and older with 34 falls per 10,000 workers, compared to the younger 25–34 year-old age group consisting of 11 falls per 10,000 full-time workers. The percentage of fall-related injuries among selected occupational specialties is shown in Table 3, section C. Overall, workers in the transportation and material-moving occupation had the highest amount of injuries associated with “fall on same level” events that involved DAFW, with an average of 15.1% of total falls. In addition, workers in food preparation and serving, along with the office and administration support occupation, amassed the second and third highest percentage of injuries, with 10.5% of “fall on same level” injuries. The office and administration support occupation comprises the following major groups: Switchboard Operators; Bill and Account Collectors; Clerks; Cargo and Freight Agents; Police, Fire, and Ambulance Dispatchers; Postal Service Mail Carriers; Computer Operators. In regards to incidence rates, healthcare support workers represented the highest rate of same level occupational fall-related injuries; equaling 41.7 falls in every 10,000 workers. The building and grounds cleaning and maintenance occupation was a close second with 40 falls, followed by the transportation and material-moving occupation with 30.5 falls.

Table 3, section D lists types of industries frequently involved in “fall on same level” injuries involving DAFW. The accommodation and food services industry has the highest number of falls with an average of 21.6% over the past five years, followed closely by the health care and social assistance industry with 20.1%; the retail trade industry with 15.4%. Figure 2 illustrates the incidence rate of the affected industries in “fall on same level” related injuries. The workers in transportation and warehousing sector are at high risk of falls with an average of 28.1 falls in every 10,000 workers. Healthcare and social assistance workers are the second highest with an incidence rate of 27.9 falls per 10,000 workers. The industries such as accommodation and food services (Incidence rate per 10,000 workers: 21.9); retail trade (19.1) and agriculture, forestry, fishing and hunting (18.9) experienced higher fall rates than the construction industry (15.3). Table 3, section E shows the length of service with the employer when the fall accident transpired. Workers exceeding a year of employment experienced more than 70% of fall accidents, while workers with under a year of employment endured considerably less (about 28.8%).

Table 4 summarizes the consequences of occupational “fall on same level” injuries involving DAFW. The lower extremities, which include the knees, feet, and toes, were the most affected areas with an average of 30.7% of total fall-related injury categories. Likewise, the trunk, which encompasses both the shoulder and back, was the second most injured body part, with an average of 25.6%. The BLS uses the classification “multiple body parts” for any injury in which body parts from two or more divisions of the body are injured. Workers injured multiple body parts ranked third with approximately 21.8% of overall injuries (Table 4, section A). The BLS defines source of injury as “the objects, substances, equipment, and other factors responsible for the injury or illness incurred by the worker or that precipitated the event or exposure” (U.S. Department of Labor Bureau of Labor Statistics 2012). The sources of injuries associated with “fall on same level” incidents are detailed in Table 4, section B. Amongst these sources, the majority, i.e., 87.9%, resulted from floors, walkways or ground surfaces, while the sum of the remaining causal factors only culminated in 12.1% of injuries. Work absences as a direct result of injuries incurred on the job are presented in Table 4, section C. The data shows that nearly 30% of “fall on same level” injuries resulted in a loss of 31 or more workdays.

Table 5 summarizes the compensated cost for the top ten most serious workplace injuries and “fall on same level” related injuries. The top 10 causes of workplace injuries includes overexertion, falls on same level, bodily reaction, falls to lower level, struck by object, repetitive motion, highway incident and others. The results show that over the 4-year period from 2006 to 2009, compensation costs grew 25% ($6.4 billion in 2006 to $7.9 billion in 2009) for the falls on the same level injuries.

The National Safety Council reported that falls are the leading cause of death in the workplace and source of more than 20% of all disabling injuries (National Safety Council 2002). Although the overall frequency of non-fatal “fall on same level” events decreased, the proportion of occupational “falls on the same level” injuries increased from 12.8% in 2006 to 15.0% in 2009 (2.2% during these 5-years period). Moreover, same level falls have consistently ranked second among the top 10 causes of serious workplace injuries in the United States (Liberty Mutual Workplace Safety Index, 2000–2010). Additionally, the costs of fall-related accidents are high since debilitating fall injuries such as back injuries increase the number of days away from work (National Occupational Research Agenda 1996). In addition, several studies claimed that using worker compensation claims to estimate the cost of injury underreports the actual burden of the injury; injured workers may choose not to file a claim for a variety of reasons: unfamiliarity about the system, legal status, fear of losing job or mistrust from filing with supervisors or even fellow employees (Azaroff et al. 2002, Boden and Ozonoff 2008, Boden et al. 2001, Eisenberg and McDonald 1988). Boden et al. (2001) suggested that the true economic burden of an injury to an employer includes the indirect costs of hiring and training replacements, the impact on the productivity of new workers and coworkers and the administrative and supervisory time devoted to an injury. Other indirect costs include loss of teamwork and communication, and reduced motivation for training (Koopmanschap et al. 1995, Van Beek et al. 1997, Berger et al. 2001).

Several limitations are noted. One of the main limitations is that the BLS data was subject to the employee’s recollection of the incident and identifying the environmental risk factors. The narrative analysis method is limited by the completeness and consistency of the available text data (Lincoln et al. 2004). For instance, Lombardi et al. (2005) reported that it is not known whether words were truncated, forgotten, omitted or even lost in conversation by those reporting or recording the claim. There is growing evidence that the annual BLS Survey of Occupational Injuries and Illnesses underestimates the true injury burden due to the underreporting of injuries (Azaroff et al. 2002, Boden and Ozonoff 2008). A study by Leigh et al. (2004) elaborated further, reporting that the Annual Survey missed from 33% to 69% of nonfatal injuries in 1999.

Another limitation is that the compensation costs taken from the Liberty Mutual (WSI) only reports the worker compensation cost for employees who missed six or more days away from work. Thus, we believe the actual number of falls and costs may be higher than what is reported in this study. Although the extrinsic factors, such as floor surfaces, are reported by the BLS, the intrinsic factors such as past history of falls, medication usage, physical and mental conditions (tiredness, diseases, fatigue), which often increase the risk of falls, were not noted. Lack of information on confounding factors such as body mass index is another limitation of this study, as obese adults fell almost twice as frequently (27%) as their lean counter parts (15%) per year (Fjeldstad et al. 2008), and are at higher risk of fall (Matter et al. 2007, Wu et al. 2012 ). Moreover, this study was unable to determine the impact the organization’s safety culture may have had on fall injuries. Despite the limitations, the findings allow us to form a useful picture around the risk and cost of “fall on same level” injuries and have helped to determine where more information is required.

This paper describes the nonfatal “fall on same level” injuries in a large population of private industry workers in the United States. Overall, workers in the health care and social assistance industry, the transportation and warehousing industry, and the accommodation and food services industry had the highest risk for nonfatal workplace “fall on same level” injuries. Apropos to gender and age groups, female workers had the highest risk of falls, while advancing age was congruent with a rise in incidence rates. Over 30% of “fall on same level” injuries resulted in 31 or more workdays being lost. This study also indicated that more than 70% of injured workers had more than one year experience with the company when the accident occurred. The most affected body parts were the lower extremities and the trunk. Floor and ground surfaces were the major determinant in fall injuries, and “fall on same level” accidents have been ranked second as a leading cause of injuries during the 4 year period being studied.”

This information can be used to prioritize designing and implementing preventive measures in U.S. private industry and to provide workers with the understanding of risk factors associated with falls in the workplace. Leamon and Murphy (1995) concluded that “based on the frequency and costs to industry and workers, prevention of falls should be given a high priority.” Preventive actions by the employer should be multidimensional, including a review of organizational practices and policies, work environment, health management programming, and options for employees to update professional competencies. As the workforce ages, we recommend that educating older workers to be more aware of their physical and cognitive limitations may be the first step towards alleviating the impact of age on the risk of “fall on same level” injury. Additionally, employers can play a critical role by monitoring working arrangements and facilitating appropriate adjustments in the physical work environment. Further investigations of gender, age, and occupation-specific prevention measures may be beneficial for workers.