Globally, work is the most dangerous activity we can statistically undertake. As recently stated by the International Labour Organization (ILO), every day, 6,300 people die as a result of occupational accidents or work related diseases, which equals more than 2.3 million deaths per year.

Further, 317 million accidents occur on the job annually, many of these resulting in extended absences from work (–en/index.htm).

It is not only the human cost of this daily adversity that is vast, but the economic burden of poor occupational safety and health practises is estimated at four percent of global Gross Domestic Product each year.

Much of this loss is due to the lack of application – whether by ignorance or by intention – of basic health and safety risk management techniques and the incorporation, and implementation, of basic standards, such as those promulgated by the ILO as part of their SafeWork programme (

Falling from height, while a clear and well understood mechanism of death and injury, remains one of the most common causes of loss that occurs – particularly within the construction industry – and this is where we shall focus in this article.

High place phenomenon

“You know that feeling you get when you’re standing in a high place… Sudden urge to jump… I don’t have it.” Captain Jack Sparrow, Pirates of the Caribbean: On stranger Tides, 2011.

I have heard some in the past look at workers at height and say “Do they have a death wish?” Well, according to research completed by Hames, J, Riberio, J, Smith, and Joiner, T, carried out in 2011 regarding the high place phenomenon, or that feeling of being compelled to jump when in high places, this is not psychologically true.

Their research indicated that when humans are put into a high placed location, our fear circuitry might react to the potential danger by sending a rapid signal such as ‘Back up, you might fall’. They term this the ‘safety signal’ and it is intended to keep us alive and out of danger, and due to its nature it is so fast that we may back away from the edge without realising why we did so.

It is not until moments pass that we try to understand this behaviour, and our much slower perception system kicks in and potentially misinterprets the initial signal to retreat from danger to a potential death wish concerning heights.

In fact, all that we are doing when we have these feelings is reacting to something so primal and quick that our brains interpret it as something else later – but what it has done has saved our life.

If you place a person in this position it is highly likely that this primal instinct will be what concentrates their mind, and not the work in hand. Even if they are able to focus on work they will work as quickly as possible to remove themselves from the situation – this is obviously not going to encourage diligent or quality work. Placing workers in such a situation therefore not only places them at risk of physical harm or even death, but is also counterproductive to any argument that the work achieved without proper precautions is quicker, better or easier.

The science of it

Gravity is a weak force – scientifically – and we can easily defeat it. We can pick up objects, build structures and walk the earth without fear of being sucked into the ground. When our engineering calculations fail, however, or our safety controls are not up to the job, then gravity can be unrelenting and have very dramatic consequences as we and our structures tumble to the ground.

The effect on the human body of an unimpeded fall from a known point to a known impaction point (fall from height) striking solid ground from a significant fall (five stories or more) is dramatic and rarely survivable. Obviously the major differentiator in any unimpeded fall is the distance of the fall itself, as well as the material with which you make impact.

There have been recorded cases, for example, of military and suicidal people surviving falls of more than 79m and beyond, but in all cases they did not land on concrete. The higher the fall, however, the higher the velocity of the falling person.

At impact, kinetic energy is quadrupled if the velocity is doubled. In this context it must also be taken into account that people in free fall from significant heights seem to strike the ground head first.

The conclusion of this study was summarised that “We have shown that in our homogenous study sample survival after a free fall with impaction on concrete is highly unlikely if the distance fallen is more than five stories (19.2m).” (Risser, D, Bonsch, A, Schneider, B, Bauer, G, 1995).

A rationale?

The research conducted by (Hames et al, 2012) alluded to the fact that our fear receptors are in tune with this hazard, so how does this match up with the fact that hundreds of people a year worldwide still meet their death from falling from height?

Perception is often argued as the differentiator and it should be noted that while the research carried out by Hames et al is interesting, it was not wide ranging, with all the participants in the study being college students – something that the authors acknowledge in their paper.

Our fear levels – importantly, not the risk levels – are reduced with exposure. If you look at an average motorist and a Formula 1 driver and swap their roles for one lap, then this fact becomes painfully obvious. Conditioning to that fear, knowledge of procedures, routines and being involved in the process from stage one, as well as the understanding that all has been done to protect them also has to have a massive effect.

Keeping with this analogy, should we not therefore seek similar recourse to the protection of those at work? The risk is well understood – much like the possibility of crashing a Formula 1 car into a wall at 200 KmPH – perhaps innately within our psyche. With systems of training, protective engineering systems, worker cooperation and obviously avoidance where possible, the results should speak for themselves.

Prevention to cure

As we look into the traditional methods and hierarchy of prevention it should be strongly noted that training, and more importantly, knowledge retention andrefresher courses, are essential when you introduce a new process or method of risk control into the workplace.

As we sit in the Middle East I think that we can easily discount elimination as an easy option to consider, especially in the construction industry. In other industrial facilities, however, it is very much something to consider. Further, work should be increased on the interaction of HSE professionals and the designers of structures to eliminate risks, where possible, at the design stage rather than during complicated and time pressure driven construction.

The most effective and probably the most overlooked option is the engineering solutions that are available to the employer. Often the need for fixed or removable barrier systems, covers and other physical means of restricting access to falling hazards are either temporary or overlooked altogether. Prior to construction, methods can be designed into how floors (for example) are constructed so that when a reinforcement bar is placed it forms a natural barrier when shuttering is removed, or walls are cast along with the floor as one. Another option is to allow casting of pipe sleeves into the slab that allow quick and solid recesses for handrail stanchions to be placed immediately after shuttering is removed.

It can be understood that some contractors and companies have yet to allocate sufficient business focus to health and safety impacts throughout the region and thus the sites and facilities are often left to make their own solutions with whatever is at hand. While this cannot be condoned from a macro viewpoint, it does show that the awareness level of falling from height is understood and although the solutions are far from ideal, the fact that there is something in place, rather than the stark alternative, has to be commended and encouraged.

A last resort

Personal protective equipment (PPE) is, as we know, the last resort, but is nevertheless the most often deployed control measure for falling at height. It is, in my experience, rarely maintained correctly, rarely stored correctly and often mistakenly deployed in situations where it would be of little use, or worse still, create a new hazard.

Fall protection systems have advanced greatly over the last ten years and are now very sophisticated technologically. They remain relatively simple and easy to use, however – when you know how. It is essential that when purchasing any type of PPE you do so from a reputed manufacturer and I would recommend that you ask them for any training packages they have on the equipment they supply. Fall protection equipment that is not maintained, stored or used correctly is firstly a waste of resources and secondly likely to instill a feeling of protection where none exists.

Harnesses and lifeline systems are designed and manufactured to specific requirements, and are tested to ensure that they will be effective, i.e. will save your life should a fall occur. It therefore only makes sense to ensure that they remain in a good condition, and are replaced when faulty and personnel are trained to use them correctly.

A systematic approach

The design of systems should be properly executed and should use secure anchor points – whether for an entire lifeline system or for individual harness placement. There is no point wearing the most expensive harness available and then attaching to a weak anchor point – one that cannot take both the weight of the person but has also not been calculated for the shock weight of the fall. If the system is thought of as a chain then you do not wish to have a self-imposed weak link in that system. All harness points (strong points) should have been identified and marked in an appropriate way – green paint for example – so that people know where to attach themselves.

Fall containment systems, or net based systems, are also often utilised, sometimes with great effect. As with everything, however, the product quality, installation quality and maintenance when not in use are essential to ensure that they are effective.

Again, many manufacturers of these systems will provide not only training but design consultancy services to allow their customers to get the best benefit possible from their systems, and this should be encouraged.

Further to all of this is the need to ensure that the organisation has addressed the need for rescue from a fallen position. A person who is suspended motionless in a harness is a medical emergency, and the primary goal during rescue/resuscitation should be the prevention of medical complications. Workers using a harness should never act alone, and the activity must be conducted in such a way as to allow for a prompt rescue or a quick release from suspension in an emergency situation. (Pasquier, Yersin, Vallotton, Carron, 2011)

While the other harness styles – whether that’s a sit harness, whole body harness, or body belt – have not been shown to influence the pattern and severity of injuries from a fall, the whole body harness is the only system that guarantees upright suspension, especially in an unconscious victim.

Since motionless suspension is a chief risk factor for syncope (fainting), a victim of suspension should:

• Move his legs in an attempt to increase venous return to prevent or at least delay the onset of syncope

• Elevate the legs to a semi-recumbent position if at all possible

Two experimental studies support this notion, as it has been shown to double the tolerable and symptom-free suspension time. Since it is difficult to achieve these tasks during a real-life suspension situation, people participating in activities that require a harness should be prepared for such emergency situations and should have specially designed foot slings – which alleviate stress on the body – within easy reach at all times. Such devices have recently been developed mainly for professional use, including ‘leg up suspension trauma straps’ and ‘suspension trauma relief straps’ (Pasquier et al, 2011).

If a victim has symptoms of syncope or is unconscious, he should be released from suspension as soon as is safely possible. This can be achieved using various rescue techniques such as helicopter winching, human cargo sling evacuation, or rappelling the victim to a flat area.

The best choice of evacuation strategy will depend on the expertise of the rescue team and the materials available, as well as meteorological conditions and the topography of the rescue site. If the victim is conscious and shows no symptoms of syncope, the evacuation strategy should take into account potential traumatic injuries, suspension trauma, and other medical or environmental insults (Pasquier et al, 2011).

Until recently, there was no consensus on the initial management of suspension trauma casualties. Most recommendations advised against laying a casualty down after being rescued from suspension because of the perceived risk of death from moving a victim to a horizontal position too rapidly.

These recommendations were based on expert opinions and case reports presented at the 1972 Innsbruck conference on mountain medicine. The hypothetical cause of death was thought to be due to an acute volume overload of the right heart from blood returning from the legs upon horizontal positioning, or due to recirculation of blood resulting in reperfusion (restoration of blood flow) injuries.

A recent critical review of the potential cases of rescue death presented at this same conference examined the circumstances and timing of the deaths associated with suspension. The data review found nothing to suggest that placing a victim in a horizontal position following suspension trauma increases the risk of rescue death (Pasquier et al, 2011).


The risk of falling from height has been with us for nearly all of our history as a working people and before this. Our understanding of the risk is clear and even our natural instincts are engaged and aware of the risks without the need for policy or training.

So, how do we justify the massive loss of life, loss of functionality due to injury or the trauma to families and colleagues, as well as the inevitable fines and payments to authorities that continue despite this realisation of risk?

I would like to challenge all industry leaders in the region to examine their practises and ensure that they have a comprehensive understanding of all risks, but particularly those of such great potential to be realised. Further, the reliance on PPE, as well as the quality versus expense argument, needs to be better examined. It is far too easy for entities to mandate PPE without fully understanding the standards that guide its production, the need for due diligence regarding suppliers and manufacturers, its suitability and the storage and maintenance requirements.

It is clear that we must do more, and what we do must be effective. Both senior management and health and safety professionals must work together to address this major shortcoming in risk management and effective control, and of course prevent the needless death and injury of hundreds of people every year.

Made famous for his controlled experiments on G force, Colonel John Paul Stapp coined an expression which became known as Stapp’s Ironical Paradox. Likened to ‘Murphy’s Law’ – namely that if something can go wrong, it will go wrong – Stapp said “The universal aptitude for ineptitude makes any human accomplishment an incredible miracle.” A proactive approach to height safety would remove both the ineptitude and the miraculous from the equation, and ensure safe work at height is the norm.

Published: 17th Dec 2013 in Health and Safety Middle East