Friday, August 21, 2009

Step off the ladder, before you get hurt (Marin IJ)

When I visit a house that I’ve never been to before, I can’t help but notice its danger zones. I guess my morbid awareness of hazards is a byproduct of the years I’ve spent working in the Emergency Department (ED). Walking up a sloped driveway (such as my own), I envision an elderly woman falling as she attempts to roll the garbage bin to the curb. Climbing a stairway that lacks a handrail, I imagine how a small misstep could result in a ten-step somersault. Entering a foyer with a glass coffee table, I remember a patient who sat on such a table while sleepwalking – and ended up with a foot-long triangle of glass lodged in her bottom. In the kitchen, I look suspiciously at the cheese slicer, bagel knife and garbage disposal. Out back, I cringe at the power tools – a nail gun, skill saw, and metal grinder. It’s not that I am paranoid, it is just that I have seen too many home projects gone awry – hands nail-gunned to 2x4s, fingers precisely amputated by skill saws, and bits of metal wedged in eyeballs by projectile-inducing grinders. But, danger lurks everywhere and we can’t live our lives afraid of everything. As Johann von Goethe once wrote, "the dangers of life are infinite, and among them is safety."

So while it is not instructive to excessively preach about prevention, there is one common backyard tool that really gives me the shivers, and this I must share with you. The ladder. Ladders are simple and useful objects in most situations, but they are also disasters waiting to happen. Nationwide, based on data from the United States Consumer Product Safety Commission (CPSC), there are approximately 170,000 ladder-related visits to EDs each year, including over 150 deaths. Based on a statistical analysis of the CPSC data published in the American Journal of Preventive Medicine, the rate of ladder injuries has increased by fifty percent since 1990. Here are a few things about ladder-related injuries that may not surprise you; they usually occur at home (a non-occupational setting), they are frequently related to improper positioning or support and/or over-extension of the ladder, they most frequently involve men, and their severity increases dramatically with the increasing age of the victim and the height of the fall. With this in mind, there are some folks who just shouldn’t be using ladders – elderly folks taking the medication Coumadin (warfarin), drunk or otherwise intoxicated people, and anyone with balance or equilibrium problems. For the rest of us, I have some simple advice.

These are common sense tidbits from the CPSC:

*Straight and extension ladders should be set up at about a 75-degree angle and should extend at least 3 feet over the roofline/working surface.

*Make sure the weight supported by your ladder does not exceed its maximum load rating (this includes you and your materials).

*Metal ladders conduct electricity so you should use a wooden or fiberglass ladder when working in the vicinity of power lines or electrical equipment.

*Be sure all locks on extension ladders are fully engaged.

*Keep your body centered between the rails of the ladder at all times and avoid leaning over to one side or the other.

*Do not use a ladder for any purpose other than that for which it was intended (i.e., ladders should not be used as a play structure for little Jimmy).

And, from my own clinical experience, I’d like to add the following helpful hints:

*If you are going to climb a ladder, leave the chainsaw behind. Unless you are a professional, chainsaws and ladders just don’t mix. I treated one 80-year-old gentleman who was on a ladder, trimming some branches, when he lost his balance and fell. Either on the way down or on impact, I’m not sure which, his chainsaw collided with his neck, dissecting it like an anatomy lesson. Remarkably, he survived (albeit with significant disfigurement) but if the chainsaw had cut another centimeter or so deeper his major blood vessels would have been severed…I do hope that he subsequently retired both his chainsaw and his ladder.

*Placing a mattress 15 feet below your ladder is not adequate protection from a fall – especially if you are 85-years-old. A colleague of mine has a neighbor who liked to clean the gutters on his two-story house and felt entirely safe doing so because of the mattress he placed on the ground beneath him. Apparently, this gentleman carefully considered the direction in which he was most likely to fall and placed the mattress accordingly. Luckily, he retired the ladder before he had a serious fall; that mattress would not have prevented a broken hip or cracked skull.

So, next time you pull out the ladder for a weekend project, take a moment to consider if you will be using it safely and, perhaps more importantly, whether you should be using it at all.