NOMMA Technical Affairs Division - 10/24/05NOMMA POSITION STATEMENT IN SUPPORT OF THE INTERNATIONAL CODE COUNCIL (ICC)BUILDING AND RESIDENTIAL CODES

October 2005

The National Ornamental & Miscellaneous Metals Association (NOMMA) embraces sensible guidelines for improving the safety and quality of our products. NOMMA supports codes and standards with proven safety benefits for all building occupancies. Specifically:

• NOMMA endorses compliance with the 2001–2005 International Residential Codes (IRC) and International Building Codes (IBC), specifically with regards to railing design and installation requirements.

• NOMMA advocates adoption of the current IRC and IBC codes in the remaining jurisdictions that have not adopted such codes.

• NOMMA supports the retrofitting of all existing buildings to comply with the current IRC and IBC codes—specifically with regards to railing design and installation requirements—as a condition for continuing and maintaining their Occupancy Permit.

Since 1958 NOMMA members have provided fall protection in the form of guards, and guidance and support in the form of hand railings, within the built environment. NOMMA will continue to be the industry leader in safety advocacy for the products our members produce.

NOMMA ICC/IRC Code Position Statement 10-24-05

Studies on Falls

Compiled by Doug Bracken

Wiemann Ironworks

The Children’s Hospital of Philadelphia

Falls

Falls are the leading cause of unintentional injury for children. Falls are so common among children that they are the number one reason for trips to the emergency room. One in three emergency room visits among children ages 14 and under could have been prevented by parental supervision and the use of safety products.

Most falls occur from furniture, stairs, windows, baby walkers, shopping carts and playground equipment. The injuries caused by a fall depend on the distance of the fall and the type of landing surface.

Falls from windows are the most likely to cause death or serious injuries. The majority of the deaths and severe injuries from falls are head injuries.

Prevention Stay by your child’s side when she is on a changing table or any other type of furniture that raises her above the floor.

Use safety gates at the top and bottom of stairs if there are infants in the home.

Strap your child into highchairs and strollers. Use baby walkers that have a label saying “Meets New Safety Standard.” These walkers are too wide to fit through a doorway or have features that stop the walker at the edge of a step. Stationary activity centers that do not have wheels are an alternative to baby walkers. Move chairs, cribs, beds and other furniture away from windows.

Stay with your child when on high porches and balconies.

Keep steps and stairs well lit and clear of clutter .Use window guards to prevent falls. Remember, window screens are only designed to keep insects out—they will not prevent a child from falling .NEVER: Use old baby walkers with wheels .Leave your child unattended in a room with windows.

Learn More For more information, please contact Gina P. Duchossois, MS, CHES, Chair of the SAFE KIDS Coalition of Southeastern Pennsylvania at 215-590-KIDS.

The Children’s Hospital of Philadelphia is part of the National SAFE KIDS Campaign, a long-term effort to prevent unintentional childhood injury — the number one killer of children ages 14 and under.

Resources BooksChild safe: A practical guide for preventing childhood injuries. Mark A. Brandenburg, MD. Three Rivers Press, 2000. Complete Idiot’s Guide to Child Safety. Susan Crites Price, Miriam B. Settle, Heather Paul. MacMillan Distribution. Brochures Stair Steps and Baby Walkers Don’t Mix

Web sites U.S. Consumer Product Safety Commission New standards for window guards to help protect children from falls. Safety Alert: Old accordion style baby gates are dangerous CPSC gets newer, safer baby walkers on the market Protect your child Did You Know Your Home Can Be Hazardous to Your Child’s Health? Childproofing your home: 12 safety devices to protect your children Home playground safety tips Public Playground Safety Checklist Never Put Children’s Climbing Gyms On Hard Surfaces, Indoors Or Outdoors Preventing window falls Falls from shopping carts cause head injuries to children Shopping cart injuries

Gina P. Duchossois, MS, CHESTrauma Prevention CoordinatorMarch 2002

Subcommittee on Injury Prevention and ControlInjuries Due to Falls from Heights Carol R. Schermer MD, FACSFalls remain a significant cause of morbidity and mortality. At most trauma centers, falls are the primary mechanism of injury resulting in admission for children. Factors determining the probability of serious injury in a fall are the distance of the fall, the landing surface, orientation on falling, and whether the fall was broken. Factors contributing to falls from heights include faulty equipment, such as ladders and scaffold structures, and human factors, such as intoxication and inattention. In occupational settings, the most common type of accident is a fall from a height.1 The brain, spinal cord, and extremities are the most commonly injured systems. Falls from more than 20 feet have historically been triaged to trauma centers, but even low-level falls can cause serious head injuries.2,3

Demographics of Falls in ChildrenFalls among children and adolescents account for more than three million emergency department visits each year, and more than 40% occur among infants, toddlers, and preschoolers. In contrast to ground-level falls in the elderly, males and children are more susceptible to falls from heights.4 Black males under age 5 are at particularly high risk.5 Accounting for 5.9% of childhood deaths due to trauma, falls represent the third leading cause of death in children.6 Death due to falls is generally from a head injury.7 Falls in children tend to be from balconies, windows, and trees, and most frequently tend to occur in homes, followed by schoolyards and playgrounds.8 Nearly three-quarters of falls from a height in children are unintentional. In children under age 5, falls of less than 2 meters rarely result in death, and the proposed mechanism of injury should be investigated for inflicted trauma.9 Demographics of Falls in AdultsNon occupational falls from ladders and scaffolds have increasing incidence with increasing age. One-fifth result in hospitalization.10 In occupational injuries, greater heights and impact on concrete predict injury severity in nonfatal construction falls.

oNonunion status and poor safety climate scores predict increased risk.11 More than one-half of no occupational falls in adults and 17% of occupational falls are associated with alcohol use.12,13 Demographics of Falls in the ElderlyFalls in the elderly tend to occur with activities of daily living.14 Falls account for 29% of injury deaths among adults aged 65 and older.6 Older adults are five times more likely to be hospitalized due to falls than to injuries from other causes.15 Host factors such as poor muscle tone, vision problems, medication use, and sedentary lifestyle are the biggest contributors to ground-level and stair falls, but environmental components such as poor lighting and no handrails may increase the frequency.6 Fall Prevention and SafetyThe "Children Can't Fly" program in New York City required window guards to be installed in all multiple-family dwellings with children under age 10 and decreased accidental falls by 50% at two years and by 96% at four years.5,16 Height and surfacing requirements on playground equipment effectively prevent injuries. On playgrounds, the most important risk factor for injury is the height of the tallest piece of climbing equipment.17 Injuries are 2.56 times more likely to occur if a child falls from playground equipment higher than 2 meters.18,19 The acceptable surface absorption level for a playground should be set at less than 150-200 g.18

oCompliance with safety standards for soft surfaces on playgrounds has improved, whereas there has been less compliance with maximum height of equipment.19 oIn children and older adults, supervision is generally considered the strongest (yet least understood) of the protective factors against falls.

Most ladder injuries are due to safety precautions and regulations not being observed, and in the majority of preventable cases, precautions were ignored, resulting in patient fall.20,21 Recommendations1.Bars should be placed on windows in locations where children are at risk for falling. 2.Alcohol and drug use should not occur prior to working in high places or on ladders. 3.Stair gates effectively prevent falls in infants and toddlers except those in baby walkers. 4.The maximum height of playground equipment should be 1.5-2 meters. 5.The acceptable surface absorption level for a playground should be set at less than 150-200 g (such as sand or shredded rubber). 6.In older adults, handrails in bathrooms and on stairs decrease fall frequency.

This page and all contents are Copyright © 1996-2002by the American College of Surgeons, Chicago, IL 60611-3211

 

American College of Surgeons Document on Falls

References1. Jeong BY: Occupational deaths and injuries in the construction industry. Appl Ergon 39(5):355-360, 19982. Murray JA, Chen D, Velmahos GC, et al: Pediatric falls: Is height a predictor of injury and outcome? Am Surg 66(9):863-865, 20003. Kennedy RL, Grant PT, Blackwell D: Low-impact falls: Demands on a system of trauma management, prediction of outcome, and influence of comorbidities. J Trauma 51(4):717-724, 20014. Hoyert DL, Kochanek KD, Murphy SL: Deaths: Final Data for 1997. National Vital Statistics Reports. Vol 47 No 19. Hyattsville, MD, National Center for Health Statistics, 19995. Barlow B, Niemirska M, Gandhi RP, et al: Ten years of experience with falls from a height in children. J Pediatr Surg 18(4):509-511, 19836. Centers for Disease Control and Prevention, Injury Research Agenda: Preventing Injuries at Home and in the Community. National Center for Injury Prevention and Control, 2002 [www.cdc.gov/ncipc/pub_res/research_agenda/04]7. Hall JR, Reyes HM, Horvat M, et al: The mortality of childhood falls. J Trauma 29(9):1273-1275, 19898. Lallier M, Bouchard S, St-Vil D, et al: Falls from heights among children: A retrospective review. J Pediatr Surg 34(7):1060-1063, 19999. Reiber GD: Fatal falls in childhood: How far must children fall to sustain fatal head injury? Report of cases and review of the literature. Am J Forensic 14(3):201-207, 199310. Faergemann C, Larsen LB: Non-occupational ladder and scaffold fall injuries. Accid Anal Prev 32(6):745-750, 200011. Gillen M, Faucett JA, Beaumont JJ, et al: Injury severity associated with nonfatal construction falls. Am J Ind Med 32(6):647-655, 199712. Mosenthal AC, Livingston DH, Elcavage J, et al: Epidemiology and strategies for prevention. J Trauma 38(5):753-756, 199513. Alleyne B, Stuart P, Copes R: Occupational and other drug use in occupational fatalities. J Occup Med 33:496, 199114. Tinetti ME, Speechley M, Ginter SF: Risk factors for falls among elderly persons living in the community. N Engl J Med 319:1701, 198815. Alexander BH, Rivara FP, Wolf ME: The cost and frequency of hospitalization for fall-related injuries in older adults. Am J Public Health 82(7):1020-1023, 199216. Spiegel CN, Lindaman FC: Children can't fly: A program to prevent childhood morbidity and mortality from window falls. Am J Public Health 67(12):1143-1147, 197717. Briss PA, Sacks JJ, Addiss DG, et al: Injuries from falls on playgrounds: Effects of day care center regulation and enforcement. Arch Pediatr Adolesc Med 149(8):906-911, 199518. Laforest S, Robitaille Y, Lesage D, et al: Surface characteristics, equipment height, and the occurrence and severity of playground injuries. Inj Prev 7(1):35-40, 200119. Chalmers DJ, Parry ML, Crawford AI, et al: Compliance of Dunedin school playground equipment with the New Zealand playground standard. Aust NZ J Public Health 25(3):253-255, 200120. Muir L, Kanwar S: Ladder injuries. Injury 24(7):485-487, 199321. Eriksson A, Bjornstig U, Kullenberg K: Snowy roofs-A potential hazard. Scand J Soc Med 16:179, 1988

Online October 17, 2002 

American College of Surgeons Cont.

Jerusalem Post Article on Children Falls

• No window bars major factor in child falls•

Jerusalem Post

07-23-2001 Byline: JUDY SIEGEL Edition; Daily Section: News Page: 05

Monday, July 23, 2001 -- Although over a third of all children's visits to hospital emergency rooms are due to falls - most involving falls from heights - about 40 percent of all homes lack bars on windows, according to Beterem, the voluntary organization that aims to reduce accidental injuries to children.

In a statement yesterday, the organization - based at Sheba Hospital at Tel Hashomer - said that in the past month there have been five reported cases of children injured or killed after falling from windows, stairs, pillars, trees, playground installations, and other high places.

Beterem was reporting on a survey it conducted of emergency rooms around the country. The findings showed that children under the age of 10 are at highest risk for injury from such falls because of their insatiable curiosity and their inadequate motor coordination. Half of incidents involving falling involve children up to the age of five, and the most common age for such accidents to occur is one to two.

Infants most often fall from furniture, steps, and baby walkers, while toddlers most often fall from windows. Older children are injured by playground equipment and climbing in places not suited to such activity, said Beterem.

Another recent Beterem survey found that only 60 percent of homes with children have bars installed on windows and balconies to prevent falls, and these are not always on the high floors.

Beterem recommends that additional railings be installed on every balcony. They should be vertical and not horizontal to prevent climbing, and the gap between the bars should be smaller than 10 centimeters, to prevent heads from getting stuck. The bars themselves should be 90 centimeters high.

Keywords: Safety. Structure. Children. Beterem.

Dr. Culvenor article on Childproof Barriers, Austrailia 2002

QUEENSLAND: Article on Children Fall Injuries

• Fed: Highset Queenslanders a hazard for children...•

07-17-2001 By Rada Rouse, National Medical Correspondent

BRISBANE, July 17 AAP - Queensland's highset homes are proving hazardous for children, with balcony falls causing serious head injuries among the under-fives.

A survey of 14 hospital emergency departments across the state also shows that infants aged under one continue to be seriously hurt by baby walkers tumbling down stairs.

Dr Rob Pitt, director of the Queensland Injury Surveillance Unit (QISU), said falls from balconies and verandas caused a surprisingly high number of hospital admissions.

There was no downward trend in the childhood injury rate, although the death rate was falling due to road safety and pool fencing laws, he said.

Queensland had Australia's worst injury rate, with the death rate for children still 25 per cent above the national average, he said.

Dr Pitt said balcony falls caused about 150 injuries a year, more than half of which were to children aged under five years.

"Half of these falls cause head injuries, and most them are only little kids so it has a big impact," he said.

Dr Pitt, who is also director of paediatric emergency medicine at Brisbane's Mater Children's Hospital, called for building regulations to be tightened to outlaw horizontal balustrades on verandas regardless of height.

The latest QISU injury bulletin also cited baby walkers as a hazard for infants, saying the devices "have no benefit, pose an unacceptable risk and should not be used under any circumstances".

Baby-walkers were the third most common factor in injuries to infants aged under one year, the survey found.

Steps and stairs were involved in 60 per cent of baby walker accidents, according to QISU research.

"We have a lot of these injuries in highset homes," Dr Pitt said.

A survey of injuries to children treated across Queensland from 1998 to the end of 2000 found that 57 per cent had occurred in the home, amounting to more than 30,000 injuries.

Falls were the main source of injury from babyhood through to age 14, followed by poisoning and burns.

Play equipment caused more injuries as children became older, with the QISU singling out trampolines as a major cause of injury - 318 cases in three years - in the under fives.

The survey found boys were injured much more than girls, starting at 10 per cent more males as babies, and rising to 80 per cent more by the age of 14 years.

Queensland Balconies Typical

Queensland Balconies Typical

Queensland Balconies Typical

Queensland Balconies Typical

Queensland Balconies Typical

CPSC In the NEWS In Hawaii

Since 1997, the following fatalities occurred on the island of Oahu alone:• A 4 year-old child fell seventy feet through an opened window while jumping on anadjacent bed.• A 10-month-old female wandered to a balcony and fell seven floors when she slipped through the gaps of the railing there.• A 16-month-old male drowned when he fell through a screen in an opened window to amarina below. The victim gained access to the window by climbing onto adjacent couch in his home.• A 4 year-old male child fell over a balcony railing when he pushed a child’s picnic tableagainst the railing and stood on it. He subsequently lost his balance and fell 110 feet to hisdeath.CPSC estimates that nationally, about 12 children 10 years old and younger die each year, and more than 4,000 are treated in hospital emergency rooms for window fall-related injuries. CPSC knows of 120 window-fall related deaths to children since 1990 and most deaths are to children under the age of 5. The four incidents above accounted for nearly twice the national average of window-fall related deaths to children and in each case, the victims were under the age of 5.As a result of these incidents, new safety standards for window guards have been developed by industry at the urging of CPSC. These standards will help parents protect their children from window falls by ensuring that guards are strong enough to prevent falls, yet easily opened in the event of a fire.CPSC guidelines for preventing window and balcony falls are:• Install window guards to prevent children from falling out of windows (windows with guards located on the 6 th floor and below should be able to be easily opened by adults and older children in case of fire).• Guards should be installed in children’s bedrooms, parent’s bedrooms, and other rooms where young children spend time.• Or, install window stops that permit windows to open no more than 4 inches.• Never depend on screens to keep children from falling out of windows.• Whenever possible, open windows from the top – not the bottom.• Keep furniture and toys away from windows or balconies to discourage children from climbing or playing there .• Safety barriers should be installed on balcony railings with gaps greater than 4 inches to prevent children from falling through openings.

• Never leave children unsupervised around balconies and opened windows.

AAP Article on Childhood InjuriesReaffirmed in October 2004

Additional Sources for Data