VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 24 page 1

Hazard(Edition No. 24)September 1995

Victorian InjurySurveillance SystemMonash UniversityAccident Research Centre

SummaryTractors are responsible for more farminjuries and deaths than any otherpiece of agricultural machinery. Nineout of ten farm workplace fatalities inVictoria involve tractors andapproximately one quarter of theseinvolve children. In Victoria from1989/90-1991/92, there were 25 casesof tractor related injury deaths. Halfof these were the result of a rolloverincident, the majority of which arepreventable with the use of rolloverframes and seatbelts. There were fivechildren killed, three of whom werepassengers on tractors.

In addition, to the average of 8 deathseach year, approximately 54 peopleare admitted to a public hospital in

Victoria as a result of tractor relatedinjury. The most common causes ofhospitalisation are being run over bya tractor and falling from a tractor.

Emergency department surveillancedata show that falling from a tractor,being caught in a tractor moving part,hitting against a tractor, and being runover by a tractor are the most frequentcauses of emergency departmentpresentations. Over half of the childvictims presenting to emergencydepartments with a tractor relatedinjury were undertaking activitiesinvolving an operational tractor, mostoften as passengers, but in some cases,as the operator.

The most common injuries sustainedamong emergency department

presentations were fractures andlacerations, and the single mostcommon body part injured was thefingers. Injuries to the head were morecommon in child victims than adults.The admission rate was considerablyhigher for children.

Investigations of injuries related tothe public use of escalators by theHealth and Safety Organisation(H&SO) (Victoria), and supported byVISS data, identified the mostcommon causes of injury to be childrenriding on the escalators unsupervisedby an adult, prams and trolleys beingtaken onto the steps of a movingescalator, persons not holding ontothe handrail of the escalator, personsnot standing between the yellow linesand persons walking on the escalators.

Product Related Injuries:Tractors, EscalatorsIn recognition of the involvement of consumer products in approximately 60% of all injuries, this edition of Hazardcontinues its focus on severe, frequent and/or preventable product related injuries.

V.I.S.S.

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 24 page 2

TractorInjuriesKaren AshbyLesley Day1

IntroductionStatistics show that farmers are morelikely to be injured or killed on theirfarm in an incident relating to a tractorthan with any other piece ofagricultural machinery. In fact, inVictoria nine out of ten farm workplacefatalities involve tractors and onequarter of these involve children(Occupational Health and SafetyAuthority - Victoria, 1993). Duringthe last 10 years over 100 Victorianfarmers (or their children) have beenkilled in tractor related incidents(Coronial Services Centre, 1995).

Tractor incidents also result in seriousinjury requiring medical treatment andhospitalisation. Here we examineavailable databases for tractor injuryand discuss major safety and preven-tion issues. Since data from coronialand hospital admissions are limited,the major focus is on emergencydepartment injury surveillance data.

Mortality Data (25 cases)Approximately half of tractor-relateddeaths occur as the result of tractorrollovers (Clarke, 1993). Other majorcauses of tractor related death involvesequipment attached to tractors,passengers (especially children),falling off tractors, being run over bya tractor, ascending and descendingfrom moving tractors and stationarytractors left in gear with the motorrunning. (Victorian FarmersFederation, 1993). This is consistent

with analysis of the VictorianCoroner’s Facilitation System, detailsof which are shown below.

Of the 100 Victorian deaths in thepast 10 years, computerised data isavailable for only three years. In theperiod July 1989-June 1992 there were25 cases of unnatural death relating totractors recorded on the VictorianCoroner’s Database. Twenty cases(80%) were adults aged 15 and over.The remaining 5 cases were children,4 of whom were aged under 5 years.

Nearly half of the 25 cases occurredon farms, the remainder at the victim’sown home (6) and on public roads (5).

Of the 5 child deaths, 2 victims fellfrom the tractor, either under thewheels of the tractor or an attachedslasher. Two victims were run overby a tractor and the final victim was apassenger on a tractor which wasinvolved in a rollover on a slope.

Eleven of the 20 adult victims wereinvolved in tractor rollovers. Fouroccurred on sloping ground, 3 whenthe victim was using a chain to pull anobject and 3 cases involved the tractorhitting an obstacle. Only one of the20 cases of adult death recordedrollover protection being fitted to atractor, however this case did notinvolve a rollover. Other adult deathsoccurred when: the victim fell fromthe tractor (2 cases) or was run over(2), the tractor was involved in amotor vehicle collision (2), a bridgecollapsed (1), an attached slasher threwup a foreign object (1), and the lastwhen a victim was crushed againstthe rollover cage by the arms of a skidsteer loader.

Similar patterns are evident in thetractor deaths for the first 6 months of

1995. There seems to be a greaterproportion of tractor run over deaths(five out of the eight deaths). Two ofthese occurred when farmers were runover by a tractor after having started itby bridging the contacts while thetractor was in reverse gear.

RegulationsThe Occupational Health and SafetyAct 1985 regulates to ensure the safeoperation of tractors for workers inVictoria in conjunction with therecently released Occupational Healthand Safety (Plant) Regulations 1995(Statutory Rule No. 81/1995). Underthe new plant regulations, employersare required to conduct a process ofhazard identification, risk assessmentand risk control in regard to plant,including tractors which areconsidered to be powered mobileplant. Self-employed persons aregenerally required to comply in thesame manner as employers. There arespecific sections of the regulationswhich deal with rollovers (discussedbelow), and passengers. Passengerson tractors must be provided with thesame protection as an operator ie., aseat with seat belt, which is protectedby a rollover protective structure.Since tractors are not currentlydesigned for this purpose, passengersare not allowed on tractors underVictorian plant regulations.

Recommendations

• consistent advice and assistancein understanding obligationsunder the new plant regulationsshould continue to be providedto all farmers by appropriateorganisations.

• enforcement, with forewarningand concurrent publicity, wouldenhance the impact of currentregulations.1 Lesley Day is a Public Health Research and Development Committee

Research Fellow at Monash University Accident Research Centre.

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 24 page 3

Roll Over ProtectiveStructures (ROPS)Tractor rollover occurs when thetractor tips sideways or backward andoverturns, crushing the operator andis the single most commonly recordedcause of tractor related death inAustralia and overseas (Etherton etal, 1991, Karlson et al, 1979, Goodmanet al, 1985, Purschwitz et al, 1990,Kelsey et al, 1991, Erlich et al, 1993,Clarke, 1993). Rollovers typically areconsidered to occur on sloping terrain,often during a sharp turn at high speed.However, our data and that reportedelsewhere, show that approximatelyhalf occur on relatively flat land, oftenthe result of hitting obstacles orthrough the inappropriate use andhitching of implements, chains orropes.

The most effective form of rolloverdeath prevention is the use of rolloverprotective structures (ROPS). Theseare structural components (rollbardevices or crushproof cabs) whichattach to vehicles and provide anumbrella of safety for the operator inthe event of a rollover (See figure 1).The introduction of compulsory ROPSon tractors, ultimately as fullyenclosed cabins, played a significantrole in the 92% reduction in tractor

rollover fatalities which has beenobserved in Sweden (Springfeldt andThorsen in Etherton, 1991). In theevent of a rollover, a driver in anunprotected tractor is at least six timesmore likely to be killed than a driverin a ROPS fitted tractor (Day, 1995 ).

The use of seat belts greatly increasesthe effectiveness of ROPS bypreventing the operator falling ontothe cabin, and by preventing inten-tional and unintentional ejectionduring a rollover. The belief that anoperator can jump clear of a tractorduring a rollover is misplaced, sincetractors are estimated to backflip in 1/2 a second in fourth gear, comparedwith a person’s average reaction timeof 3/4 of a second (OH&S, 1992).

In Victoria, ROPS conforming withAS1636 are mandatory on all tractorsboth imported into and manufacturedin Victoria after July 1981, the onlyexceptions being tractors weighingless than 560kg or those used in anorchard or near a building. (VFF,1993). Under the new plant regula-tions tractors must be assessed forrisk identification and control. In anysuch assessment, rollover would beidentified as a risk, and given the stateof knowledge, the fitting of ROPScould be considered a necessary means

of controlling this risk. Consequently,the new regulations could be inter-preted to mean that all operationaltractors on farms should be fitted witha ROPS (Young, personal com-munication, 1995). Recently theVictorian Farmers Federation votedin favour of amending the Plant SafetyRegulations to require that all tractorsnot fitted with cabins be fitted with aROPS frame on change of ownership.This would be at the expense of thevendor prior to conclusion of the sale(FarmSafe, 1995).

Rollover injuryprevention

• use only tractors fitted with aROPS, preferably a full cab.

• continue rebate schemes.

• obtain a summary of tractorsfor which ROPS are available(contact AgHealth for detailson 067 59 9222 ).

• retrospective fitting of seat beltswhere mechanically feasible.

Hospital Admission DataIn Victoria there are an annual averageof 102 incidents of injury relating tofarm machinery that require admissionto a public hospital (Watt, 1995). It isestimated that 53% of these incidentsinvolve tractors (based on theproportion of agricultural machineryinjury admissions that related totractors in emergency departmentsurveillance data). Most of thesevictims were males (89%), there wasno distinct age pattern for these cases.Hospital admission data is furtherexamined using the more detailedanalyses possible using injurysurveillance data for emergency

Performance of ROPS during a rollover Figure 1

Source: Workcover Authority

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 24 page 4

department presentations which resultin admissions.

Emergency DepartmentPresentationsVictorian Injury SurveillanceSystem (125 cases)The Victorian Injury SurveillanceSystem (VISS) has collected data fromseven campuses of five hospitals, 4metropolitan and one rural hospital(Latrobe Regional Hospital -Traralgon and Moe campuses). Todate VISS has collected approximately162,000 cases of which 125 involvedtractors and power take-off (PTO)2

related injury, accounting for 56% ofall injuries relating to agriculturalequipment on the database3. Themajority of adult tractor related injury(76%) was recorded at the LatrobeRegional Hospital. In contrast 62%of children’s cases presented to theRoyal Children’s Hospital despiteoccurring predominantly in rural areas.This is partly due to the often seriousnature of children’s tractor relatedinjuries which require transferal to amajor hospital.

Age and sex distributionChildren under 15 years accountedfor 42 of the 125 cases. Male victimspredominated among adults andchildren (89% of adult and 81% ofchild cases). One quarter of adultvictims were aged 20-29 years, withthe next most common age groupsbeing 50-59 (12 cases) and 40-49(11).

Child victims were most commonlyin the 10-14 age group (16 cases) andthe 0-4 age group (15).

Seasonal variationNo distinct injury pattern exists,however injuries were most commonin April (20 cases), December (17)and November (16), all of which arepeak periods for farming activity.

Over one half of child cases occurredon the weekend.

LocationThe most frequently reported locationfor tractor related injuries was, notsurprisingly, farms which accountedfor just over one third of all sites.Fields or paddocks (24 cases), publicroads (13) and the victim’s own homeyard (12) were other common injurysites. It is worth noting that fields andpaddocks and the home yard couldalso be farm locations.

A greater proportion of child injuriesoccurred in the victim’s own homeyard, (14% of child cases vs 7% ofadult cases).

ActivityChildren (42 cases)Over half of child victims wereundertaking activities that involvedan operational tractor, most oftenthey were passengers on the tractor orattached trailer (17 cases), werethemselves involved in the operationof the tractor (3), or moved too closeto a tractor while it was in operation(3).

Other victims were playing in thevicinity of a tractor (7 cases), climbing

onto a tractor (5) or using a tractor tyre(which has been removed from thetractor) as a toy (3).

Adults (83 cases)Over half of these victims wereworking when the injury occurred,the majority of whom (64%) recordedtheir occupation as farmer or farmhand.

Only 10 victims clearly specified thatthey were actually driving the tractorwhen the injury occurred, however anexamination of the narratives showthat another 16 victims could possiblyhave been driving the tractors. Afurther nine victims were injured whileattaching an implement to the tractor,8 while the victim was mounting ordismounting the tractor, 6 whilerepairing a tractor and 6 while involvedin a collision between a tractor and amotor vehicle.

Injury severityThe admission rate was considerablyhigher for child victims (45% child vs18% adult), at least in part a reflectionof the major children’s hospital inVISS. Three child victims attendingemergency departments sustainedfatal injuries, 2 of whom were dead onarrival or died in the emergencydepartment, the other victim died afteradmission to hospital.

Nature of injuryVISS records up to 3 separate injuriesper victim and there were 157 injuriessustained as a result of the 125 casesdiscussed. These injuries were mostcommonly fractures (26%), particu-larly to the skull (4% of total injuriessustained) and the tibia/fibula (4%),and lacerations (17%), particularly tothe fingers (6%). Crush injuries to thefingers were also common (4%).

Fingers were the single most commonbody part injured (18% of total

2 Power take-offs are the rapidly rotating shafts which transfer power from the tractor toattached farm machinery implements. For the purposes of this article tractor injury refersto both tractor and power take-off injuries.

3 The collection period for each participating VISS hospital is as follows: Royal Children’sHospital (1988-93), Western Hospital - Footscray and Sunshine campuses (1989-93),Preston and Northcote Community Hospital (1989-93), Royal Melbourne Hospital (1992-93) and Latrobe Regional Hospital - Traralgon and Moe campuses (1991/92 - 1994/95).

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 24 page 5

injuries) and were only slightly morecommon in adult (19%) than in childvictims (16%). Injuries to the headwere far more common in childvictims (40% of child injuries)compared to adults (16% of adultinjuries). Figures 2 and 3 show themost common body parts injured foradult and child victims.

Causes of injuryAn examination of the case narrativesindicates common injury scenariosand those occurring most often areshown in Table 1 and discussed inmore detail below.

Fall from tractor (driver or passenger)(23 cases)Drivers and passengers who fell fromthe tractor into the path of the tractoror an attached implement and wererun over by it are included in thiscategory. Children and adults werealmost evenly represented in thiscategory (table 1) with 7 of thesevictims aged 5 years and under. Only2 victims were noted as being thedriver of the tractor, while nearly halfwere passengers on the tractor (allchildren, one aged two years). Theremainder were unspecified. Whilein most of these cases the passenger’sposition was unspecified, it was notedthat 3 victims were riding on a trailerattached to the back of the tractor, onewas sitting on the mudguard of the

tractor and one was standing on thetractor.

Serious injuries were sustained by the6 child victims, all under 6 years,who fell under the wheels of themoving tractor (4 cases) or under thewheels of an attached trailer (1) orimplement (1). eg “Sitting on mudguard of tractor, fell forward betweenwheels, run over by tractor”. Allrequired admission to hospital, 4 ofthe 6 sustaining severe head injuries,two of which were fatal.

Seven victims fell while dismountingfrom the tractor, most often rolling ortwisting their ankles, one of thesevictims fell onto an attached slasher.

Run over by tractor (18 cases)Only 3 of the victims in this categorywere not involved in the operation ofthe tractor when they were injured.Two were children playing in the areaof the tractor, eg. “Near tractor beingreversed by father, run over leg,caught under back wheel”. The othervictim was asleep in a field when hewas run over.

Of the remaining cases, 5 victimswere working alongside a tractor whenthe tractor moved, hitting or runningover the victim; 3 were run over onattempting to alight or board themoving tractor eg. “Trying to steponto moving tractor, tractor ran over

Children’s Tractor RelatedInjuries by Body Part

Figure 2

Source, VISS: RCH, WH, PANCH, LRH. (NB upto 3 injuries per case).

Severity of tractor injury by cause of injury Table 1

AdultsN = 83

ChildrenN = 42

AdmissionsN

Non-admissions

N

AdmissionsN

Non-admissions

N

TotalN

Fall from 2 10 6 (+ 3 deaths) 2 23Run over by 5 7 4 2 18Body part caught 2 9 3 3 17Hit against 1 8 2 4 15Other 5 34 3 10 52Total 15 68 21 21 125

Source, VISS: RCH,WH,PANCH,RMH,LRH

Adult Tractor RelatedInjuries by Body Part

Figure 3

Source, VISS: RMH, WH, PANCH, LRH.(NB up to 3 injuries per case).

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 24 page 6

victim” . Another victim had movedbehind a bogged tractor when thedriver reversed striking the victim.Half of the injuries sustained in thiscategory were to the lower limbs.

Body part caught in a moving part ofa tractor (17 cases)Victims in this category were injuredwhen they became caught in a movingor operational part of the tractor.Adults accounted for two thirds ofcases in this category. Six victimswere caught in the hydraulics of thetractor, 3 in the PTO shaft, 3 in thelinkages and 2 in the fan belt. Theseinjuries were mainly to the extremities:toes, feet, fingers, hands and arms.

Hit against tractor (15 cases)Almost half of these cases werecollisions between tractors andvehicles. Six victims were involvedin 4 separate collisions involving atractor and a motor vehicle. Five ofthe victims were motor vehicleoccupants (3 were the driver) and onevictim was a tractor driver. All butone occurred on a public road. Twofurther cases involved collisionsbetween other vehicles and tractors,one a motor cycle and one a bicycle,each of which rode into a tractor. Afurther 5 victims were playing in thearea of a tractor and fell, hitting againstthe tractor, “Running, chased by adog, landing on tractor bucket”, andthe remaining two victims wereoperating a tractor when they hit abump and knocked against the tractor.

Other common injuriesOf the remaining cases, 7 victimssustained a foreign body in the eyewhilst operating a tractor, 6 were hiton the hand/forearm by a spinningsteering wheel after the tractor hit abump, 6 caught/jammed their fingerson an unspecified part of the tractor, 4were lacerated by a metal part on the

tractor, 4 were jammed between thetractor and another solid object suchas a pole or a car, 4 victims caughttheir fingers in a closing tractor cabindoor, 3 were hit by an implementduring the process of attaching it tothe back of the tractor, 3 were injuredin tractor rollover/tipping incidentsand 2 others were injured when aprojectile was thrown from the tractor.

Safety DevicesThe use of safety devices was reportedin 16 cases, with work boots (7 cases)being the single most common safetydevice reported. One case eachreported the use of gloves, ear muffsand a protective vest. Of the 6 victimsin motor vehicle associated incidents,4 of the motor vehicle occupantsreported the use of seat belts. There

was no indication of the use of seatbelts on tractors and the use of rollover protective structures was reportedin only one case.

National Injury SurveillanceUnit(number of cases = 417 cases)The National Injury Surveillance Unit(NISU) data is an accumulation of thedata collected by the state injurysurveillance systems in Victoria,NSW, Queensland, Tasmania andSouth Australia. Note that the farminjury data collected by NISU is notnecessarily representative of thenational picture of farm related injury.

There were 417 cases of tractor relatedinjury on the NISU database up toAugust 1995, representing 47% of all

Tractor Design Recommendations

Tractor design has improved over recent years. However, there remain anumber of additional features, which if incorporated, would greatly reducereliance on operator behaviour for safe tractor use. Some of these featuresmay be retro-fitted to existing models. These include:

• the provision of passenger facilities including seat, seat belt and protectionby ROPS.

• a dead man seat brake which operates when seat is vacated, as in otherindustrial equipment such as forklifts.

• an ignition switch which starts only when tractor is in neutral.

• improved seat design.

• safe access platforms with hand holds to prevent falling under the rearwheels while mounting and dismounting.

• PTO guards with hinges to give easier access when attaching implementswithout requiring removal of the shield.

• PTO guards which are inter-changeable with any implement to beattached.

• reversing “beepers” to alert bystanders to a reversing tractor.

• rear marking plates and flashing yellow lights to improve conspicuityespecially when travelling on public roads.

• a reduction of engine noise.

Critical evaluation of the adequacy of current designs may reveal additionalrecommendations.

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 24 page 7

Child tractor injuryprevention

• children should not ride ontractors.

• farming activities in whichchildren are involved should beappropriate to their age and haveconstant adult supervision.

• designated, preferably fenced,children’s play areas should beprovided around the home andin key locations on the farm.

• children should not be permittedto play in farm work areas.

Management of safety on thefarmIn a recent review of tractor relateddeaths, the Victorian State Coronerobserved the importance of theincorporation of safe workingpractices into daily farm management,these findings were consistent withCoroner’s reports from 1990/91.Farmsafe Australia is currentlyaddressing this need by the develop-ment and promotion of the “ManagingFarm Safety” kit, designed to be asafety management tool for farmers.Kits are available in Victoria atManaging Farm Safety presentations,organised by the Victorian FarmersFederation.

Uptake of the kit, and other farmsafety material, could be enhanced bythere being an increased priorityassigned to safety by farmers.Therefore, the Victorian State Coronerhas recommended that variousrelevant authorities such as Healthand Safety Organisation (Victoria),Agriculture Victoria, FarmsafeVictoria, the Victorian FarmersFederation, and the Country Women’sAssociation consider a joint project toregularly distribute details of farminjury and deaths to farmers.

Farmers could benefit from theproduction of a single document inwhich the wide range of informationand advice available on safe tractoroperations is integrated andsummarised. Issues which should becovered include: starting and stoppingthe tractor, mounting and dis-mounting, safe working loads, correctimplement attachment, operations inhilly country, and maintenance forsafety.

Educationalrecommendations

• integration of the range ofexisting materials on safe tractoroperations into one document,widely distributed.

• training in safe tractor operationand maintenance.

• demonstration of speed andmechanisms of rollovers toshow the importance of rolloverprotective structures.

• hobby farmers as well asprofessional farmers to beincluded in tractor safetycampaigns.

Generalrecommendations

• development of a licence systemfor tractor operation.

• tractor machinery dealers couldconsider a role in replacingtractor parts with newer, saferparts where possible eg,replacement of starter motorswith those featuring rust proofsolenoids, replacement of PTOguards with those made fromultra violet resistant material.

• personal protective equipmentincluding boots, ear plugs andmuffs, hat and 15+ sunscreen,should be worn by tractoroperators.

injury relating to agricultural equip-ment in that database. The VISS dataincorporated into the NISU dataaccounts for 29% of NISU casesdiscussed here.

As with the VISS data, male victimspredominated accounting for 89% ofadult injuries. Male children alsowere more commonly injured thanfemales but not to the same extent asin the VISS data (81% male VISS vs68% male NISU). A greater percent-age of cases were to adults (72%NISU vs 66% VISS) and the mostcommon age for injuries was the 20-29 age group (one third of all adultinjuries).

Other findings from the NISUdatabase, ie, location, activity, causeof injury, types of injuries sustainedand admission rate were notsubstantially different from those onthe VISS database.

Child related tractorinjuriesAs the farm is often the workplaceand home combined, an unfortunateresult is that children are ofteninvolved in tractor related injuriesand deaths, accounting for one thirdof emergency department presenta-tions, more than half of tractor relatedadmissions in the VISS database, andone fifth of deaths in the VictorianCoroner’s database.

Involvement in farming activities isintegral to growing up on a farm.However, current pressures in theagricultural industry may mean thatchildren are increasingly called uponto perform farming duties. Further,both the lack of child care in somerural areas and the time required todrive to it where it is available, coupledwith financial constraints, are possiblycontributing to the exposure ofchildren to the farm workplace.

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 24 page 8

For further information on safe tractoroperations contact the AustralianAgricultural Health Unit (067 529222); the Victorian FarmersFederation (03 9650 9261); Healthand Safety Organisation (Victoria)(03 9628 8111).

AcknowledgmentsThe authors would like to thank thefollowing people for their valuablecomment: Graham Corless, PrivateSafety Consultant; Eric Young andDon Gilmore, Health and SafetyOrganisation (Victoria); GraemeJohnstone, Victorian State Coroner;George Rechnitzer, MonashUniversity Accident Research Centre;Dr Lyn Clarke, Australian Agricult-ural Health Unit and Eric Jowett,Victorian farmer.

References• Agricultural Health Unit, Moree

District Hospital, Fact Sheets.

• Centers for Disease Control andPrevention, 1993, Public HealthFocus: Effectiveness of RolloverProtective Structures for PreventingInjuries associated withAgricultural Tractors, Morbidityand Mortality Weekly Report,42(3):57-59.

• Clarke, L., 1993, Profile of FarmHealth and Safety, A Report ofFarmsafe Australia.

• Code of Practice for Plant, 1995,Occupational Health and Safety Act1985, No. 19.

• Coronial Services Centre, 1995,Tractor Related Death Findings,Comments and Recommendations.

• Day, L., 1995, Rural InjuryPrevention, in Ozanne- Smith, J.and Williams, F., (Eds) InjuryResearch and Prevention: A Text,Monash University AccidentResearch Centre.

• Erlich, S.M., Driscoll, T.R.,Harrison, J.E., Frommer, M.S., andLeigh, J., 1993, Work-relatedagricultural fatalities in Australia,1982-1984, Scandanavian Journalof Work Environmental Health, 19,p162-7.

• Etherton, J.R., Myers, J.R,. Jensen,R.C., Russell, J.C., and Braddee,R.W., 1991, Agricultural Machine-Related Deaths, American Journalof Public Health, 81 (6): 766-768.

• Farmsafe Victoria, 1995, Agendapapers, Farmsafe VictoriaCommittee Meeting.

• Jellie, D., 1995, Farmers battletractor death toll, The Age, page 9.

• Karlson, T. and Noren, J., 1979,Farm Tractor Fatalities: The Failureof Voluntary Safety Standards,American Journal of Public Health,69(2):146-149.

• Kelsey, T.W., Dennis, J.W., andJenkins, P.L., 1994, Dairy Barnsand Roll-Over Protection on FarmTractors: Work EnvironmentImpacts on the Adoption of Roll-Over Protective Structures,American Journal of IndustrialMedicine, 25: 589-592.

• Kelsey, T.W., Jenkins, P.L., 1991,Farm Tractors and Mandatory Roll-Over Protection Retrofits: PotentialCosts of the Policy in New York,American Journal of Public Health,81(7):921-922.

• MacCollum, D.V., RolloverProtective Systems (ROPS), inPeters, G.A. and Peters B.J. (eds)Automotive Engineering andLitigation, Garland LawPublishing.

• Occupational Health and SafetyAuthority, Tractor Safety is DeadlySerious, What every family shouldknow about Tractor Safety.

• Occupational Health and SafetyAuthority, 1993, Danger Tractorsand Other Farm Machinery

• Rivara, F.P., 1985, Fatal and Non-fatal Farm Injuries to Children andAdolescents in the United States,Pediatrcs, 76(4):567-573.

• Simpson, S.G., 1984, FarmMachinery Injuries, The Journal ofTrauma, 24(2): 150-152.

• Springfeldt, B., 1991, Overturningof Tractors - InternationalExperiences,

• Swanson, J.A., Sachs, M.I.,Dahlgren, K.A., and Tinguely, S.J.,1987, Accidental Farm Injury inChildren, American Journal ofDiseases in Children,141(12):1276-1279.

• Thelin, A., 1990, Epilogue:Agricultural Occupational andEnvironmental Health PolicyStrategies for the Future, AmericanJournal of Industrial Medicine, 18:523-526.

• Victorian Farmers FederationIndustrial Association, 1993,Tractor Safety.

• Watt, G., Hospitalised InjuriesVictoria, July 1987-June 1993,1995, Monash University AccidentResearch Centre, Report no. 67.

• Wilk, V.A., 1993, Health Hazardsto Children in Agriculture,American Journal of IndustrialAgriculture, 24 (3):283-290.

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 24 page 9

EscalatorInjuriesKaren AshbyInvestigations of injuries related tothe public use of escalators by theHealth and Safety Organisation(H&SO) (Victoria) have identifiedthe most common causes of injury tobe children riding on the escalatorsunsupervised by an adult, prams andtrolleys being taken onto the steps ofa moving escalator, persons notholding the handrail of the escalator,persons not standing between theyellow lines and persons walking onthe escalators. These findings areconsistent with the practicesundertaken by the victims of 84 casesof escalator related injury found onthe Victorian Injury SurveillanceSystem database between 1988 and1995.3 These cases will be discussedin this article.

Almost half of escalator relatedinjuries occurred in the 0-4 age group.Boys under 5 years were more likelyto be injured than their femalecounterparts, (63% of cases). Forother age groups the sex ratio wasapproximately equal. Elderly victims(>=65 years) accounted for another11% of injury cases.

Almost half of incidents occurred ona Saturday, particularly between4:00pm and 5:00pm or Friday. Thepattern over months of the year showedpeaks in winter (August, June) andpre-Christmas (November, Dec-ember).

Table 1 shows the most common sitesfor these cases.

Escalator injuries usually occurredwhen the victim became caught in apart of the escalator (24% of cases),

fell on the same level (20%), slipped(17%), tripped (7%) or fell from alevel up to one metre (7%).

Fifteen per cent of cases warrantedadmission to hospital, a further 26%required General Practitioner referraland 24% required only minortreatment.

The 84 cases resulted in 109 separateinjuries (up to 3 injuries per case).

Fingers were the most commonlyinjured body part (17% of total injuriessustained), especially lacerations(12% of total injuries), bruising (2%)and fractures (2%). Other commoninjuries were lacerations of the faceand scalp (7%), strain/sprain of theankle (5%), lacerations to the hand(5%) and abrasions of the lower leg(4%).

Falls, Slips & Trips(n=43)Falls, including slips and trips werethe cause of just over one half (51%)of all injuries. While many of theseinjuries were the result of simple slips,trips or falls, others were the result ofa particular action or related to the useof a particular product. Walking orrunning on the escalator, taking apram on the escalator and inapprop-riate travelling all resulted in falls,slips or trips on escalators.

Falls often resulted in the victimcatching fingers, hands or feet in theescalator (18%), landing on the stepsor sharp edges of the escalators (14%of cases) and in the more severe casesfalling down almost a full flight andfalling on top of, or causing others tofall on top of, the victim.

Escalator Injuries by Location Table 1

Place of occurrencePresentations

N% of totalinjuries

Shopping centre or department store 48 57Train station 13 16Airport 6 7Racecourse 6 7Other public place 6 7Unknown 5 6TOTAL 84 100

Source: VISS: RCH, PANCH, WH, RMH, LRH n = 84

Escalator Injuries by BodyPart Figure 1

(NB up to 3 injuries per case). Source:VISS-RCH, WH, PANCH, RMH, LRH

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 24 page 10

Common injury scenariosAn examination of the narrativesshows some common factorsassociated with escalator injury, theseare discussed below.

Caught in escalator (n=27)Hands, fingers, feet and in 2 caseswhole bodies were the most commonbody parts caught, particularlybetween the side of the moving stepand stationary sidewall of theescalator. In these types of caseslimbs or clothing are pulled into themachinery and sliced by the sharpedges of the step. All but one of thesevictims was aged under 13 years.

Seven victims fell or tripped catchingfingers (n=2), hands (n=3) or theirbody (n=2) in the escalator, eg. “Onescalator, playing around, fell, caughtfinger in escalator”.

Of the remaining victims, 8 caughttheir foot or shoe in the escalator.Seven of these victims were aged 5 to9 years. By contrast the 13 additionalvictims who caught hands and fingersin the escalator were all aged under 5years. The pattern for child victimsthen appears to be that victims agedunder 5 are more likely to catch fingersand hands in the escalator, those over5 years tend more towards catchingfeet.

Investigations in the USA show thatafter falls, entrapments are the nextmost common cause of injury onescalators and often the most serious.(Murphy and Armstrong, 1994).

Walking/Running on anescalator (n=15)There were 11 victims walking and 4running on an escalator. “Walkingdown escalators, lost balance andslipped” and “Walking up escalator.Fell forward. Hit nose on step ofescalator” were typical examples.

A British study of escalator relatedinjuries (Murphy and Moore, 1992)reported that 64% of 50 emergencydepartment patients in the study werewalking on the escalator, a practiceencouraged for passengers of theLondon Underground. They claimthat “Discouraging the practice ofwalking on one side of the escalatormight help to minimise injuries”. TheVictorian Public TransportCorporation (PTC) estimates anannual carry of 7.8 million at the onesuburban and four city stations whereescalators are in use, and have recorded144 escalator incidents over the period1992-94. While the PTC has no firmpolicy on the issue of walking onescalators the practice is not openlyencouraged. (Public TransportCorporation, personal communic-ation, 1995).

Pram/stroller (n=7)Seven injuries occurred whilst thevictim was a passenger in a pram orbaby stroller. Five of the casesoccurred when a parent lost control ofthe stroller or pram on the escalatorcausing the child to fall, be thrownout, or fall against the escalator. eg.“Sitting in stroller. Stroller slippedout of mum’s hand. Landed onescalator. Strapped in stroller”.

Warnings appear upon boardingescalators stating that prams, alongwith trolleys and wheelchairs shouldnot be taken onto escalators. Locationsusing escalators as a mode oftransportation also have lifts availablefor disabled customers/patrons. Theseshould be utilised by people withchildren in prams or strollers, andthose wishing to transport heavyobjects. A spokesperson from theRisk Control department at a majordepartment store confirms that whilelifts are made available they must relyon customer discretion to use them

when appropriate. (Myer, personalcommunication, 1995).

Other Injuries (n=35)There were 4 injuries which occurredon alighting and boarding theescalator, 3 when the escalator beingridden on stopped suddenly. Twoadditional victims were injured whensitting on the escalator while it was inmotion and 2 victims were misusingthe hand rail at their time of injury.The potential for major injury, fromthe handrail, when falling over it thewrong way is extremely high,particularly in locations whereescalators are in use over a series offloors.

Only one recorded fatality from anescalator injury was found in aMedline literature search. InWashington DC a 3 year old felldown a downwards moving escalatorand choked to death when the nylonstrings of her parka were caught in thetreads at the bottom of the escalator.(Wells et al, 1986)

Hospital Admission DataAnalysis of admissions data toVictorian Public Hospitals for theperiod July 1987 - June 1994 shows atotal of 101 cases of injury relating tofalls on or from an escalator. Figure2 shows a steady increase in injuriesfrom 1991. This upward trend issignificant (p = 0.008). Other injuries,such as entrapments, cannot beidentified in the hospital admissionsdatabase.

Travelators (Moving InclinedWalks)A travelator is a device similar to anescalator but without the steps, nowoften found in shopping centres,sometimes in preference, often inaddition to escalators. At a localShopping Centre (Brandon Park) adecision was made to install travelators

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 24 page 11

instead of escalators believing themto be more suitable for the older peoplewho frequently shopped there.Travelators reduce the risk of fallingas they have no steps to trip over.There were no injuries found in thedata base arising from travelators, butthis may be a reflection of their limitedpresence in the catchment areas of theparticipating hospitals.

Safety Features & StandardsEscalators are covered by the recentlyreleased Occupational Health andSafety (Plant) Regulations 1995(Victoria). Under the Code of Practicein these regulations escalators arelinked to the Australian Standard1735, (5) 1986 - Lifts, Escalators andMoving Walks (known as SAA Liftcode), which sets out the requirementsfor electric escalators for carryingpersons. The Standard stipulates theoperating and safety devices whichmust be fitted to protect passengers incases of an electrical or mechanicalfailure. These include yellowdemarcation lines, safety stickers atboth top and bottom of escalators (seefigure 3), sensor activated safetyswitches at various sites on the

escalators, including the bottom ofthe handrail (where it goes back underthe front skirting panel), at thecombplate where it detects objectscaught under the combplate andbetween the skirting panel and stepsat the point it reaches the combplate.Emergency stop buttons, amechanically applied brake (whichcan hold the weight of a fully loadedescalator) and a broken step-chainand drive-chain device which shutsdown the escalator in case of the chainbreaking or excessive sag occurringare other safety features of allescalators. All of these safety devicesare activated by sensors and in theevent of an object being detected inhazardous parts of the escalator, theescalator will shut down auto-matically. It should be noted thatwhile the new plant regulations linkwith the Australian Standardcompliance is no longer compulsory.It should be noted that only 10% ofinjury cases seen in a major departmentstore are from mechanical faults, theremaining injuries are from inapprop-riate use of the escalator (MyerChadstone, personal communication1995).

Escalator injuries, all ages, rates and trends Figure 2Public Hospital Admissions, Victoria, July 1987-June 1994

Rat

e/10

0,00

0 po

pn

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

1988 1989 1990 1991 1992 1993 1994

Slope = 0.09 (95% CI 0.03, 0.14)

Source: Victorian Inpatient Minimum Dataset, July 1987-June 1994 (Public Hospitals)

Safety stickers on topand bottom of escalator

Figure 3

Source: Otis Elevator Company

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 24 page 12

In the early 1980’s entrapment injurieswere common in the LondonUnderground, 1-2 injuries per month.In an attempt to alleviate this problema UK company, in conjunction withthe London Underground and inconsultation with the UK Health andSafety Executive, developed a deviceknown as the escalator safety strip,which after trialing a prototype, wasfitted to all escalators in theUnderground. The safety strip (seefigure 4) is a brush device fixed byscrews to the skirts of the escalator,running its entire length, it is intendedto discourage users from standing tooclose to the moving edge of theescalator by brushing against theirfeet when they become too close,making them aware they need to stepaway to a safer position.

Escalator Safety StripFigure 4

Source: Corrtech Pty. Ltd.

The safety strip is used widely inHong Kong, the USA and Canada andaccording to the importer is becomingincreasingly popular in Australia,currently featuring in shopping centresin Victoria and Queensland.Discussions are currently underwaywith Standards Australia with a viewto incorporate the escalator safety strip

as part of AS 1735, thus eliminatingthe need for the yellow demarcationline.

An independent Australian manu-facturer (Northlink Pty. Ltd.) iscurrently looking at developing asimilar device in Australia.

Lifts/Elevators (N = 36)There were 36 cases of injury on theVISS database relating to lifts/elevators. The most common injury,accounting for 50% of injuries, wasthe victim’s hand being caught in thelift door, either when the doors wereopening or closing, eg, “Getting outof the lift. Lift closed on hand” and“Trying to stop lift, doors shut onhand”.

Thirty-nine per cent of victims wereaged under 5 years. The remainingvictims were aged between 5 and 87years.

Another 14% of victims tripped whenthe lift and floor level they wereentering onto or exiting from was notlevel, eg,”Getting into lift, lift didn’tstop flush with floor”.

Recommendations

• Parents need to ensure that children do not ride unaccompanied onescalators and even when accompanied by an adult they need to be underclose supervision, ie, remain inside the yellow lines clearly marked on theescalators and not ride on the hand rail.

• Lifts are provided in areas where escalators are in use. This service shouldbe utilised by people with children in prams or strollers, and those wishingto transport heavy objects.

• Training is needed in the correct techniques of using escalators, aimed atreducing injury and improving confidence eg. department store display.

• The level of risk associated with walking on escalators requires furtherstudy to determine whether discouraging this practice is warranted.

• Investigations of the relative safety and other costs and benefits ofescalators and travelators should be examined.

• Assessment of whether the Standard adequately covers prevention offinger entrapment and other frequent injuries identified in this article isrequired.

• An investigation of whether multilingual versions of the safety stickerswould reduce the number of injuries involving prams and strollers beingtaken onto escalators is required.

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 24 page 13

Recommendations

• Reviewing the design of liftclosures is necessary to ensurefirstly that there is a soft contactzone and secondly that thesettings for pressure to stop thedoor from shutting are not settoo high.

• Reviewing the settings thatensure the lift stops level withthe floor, making adjustmentsas regularly as required isnecessary to ensure that theyare always working to anoptimal level. In the cases ofthe lift not stopping flush withthe floor a light should activateto warn passengers of thepossibility of danger.

AcknowledgmentsRob Hopkins, Environmental, Health& Safety Co-ordinator Victoria/Tasmania, OTIS Elevator CompanyPty. Ltd.; Tony Jenkins, Secretary,Lift Industry Safety Committee; WalMatthews, Lift Industry SafetyCommittee; Ian McWaters,Transportation Design Consultants;Lew Martin, Insurance Officer, PublicTransport Corporation; MarianaVardi, Risk Control Department,Myer Chadstone and Brandon ParkShopping Centre, Centre Managementfor their greatly appreciated assistancein providing background informationfor this article.

George Rechnitzer, MUARC; DavidMoss, Office of Fair Trading andWarren Brown, Northlink Pty. Ltd.for additional comment. GiuliettaValuri, MUARC, for assistance withVIMD data.

INJURY EPIDEMIOLOGY AND PREVENTIONA SHORT COURSE

MELBOURNE, AUSTRALIAMONDAY TO FRIDAY, FEBRUARY 12 TO 16, 1996

Enquiries to: Sarah JowettMonash University Accident Research CentrePh: (61 3) 9905 1808, Fax: (61 3) 9905 1809 Area code 03 within AustraliaEmail: SarahJ@its-menz.cc.monash.edu.au

(See enclosed flyer for further details)

Copies of bound volumes 1 and 2 of Hazard are availableat a cost of $10 and $20 respectively.

Also available from MUARC are copies ofInjury Prevention and Research: A text at $27.50.

Please ring +61 3 9905-1805 or Fax +61 3 9905 1809 for details.

Safecomm5THE FIFTH INTERNATIONAL CONFERENCE

ON SAFE COMMUNITIES

MAINSTREAMING COMMUNITY SAFETY

22-26 February 1996Cities of Hume and La Trobe, Victoria, Australia

All correspondence to:Convention Network,224 Rouse street, Port Melbourne Victoria 3207 AUSTRALIATelephone; +61 3 9646 4122 Fax: +61 3 9646 7737

Conference manager: Helen Gordon-Clark

International Societyfor Child and Adolescent Injury Prevention

An International meeting ground for organisations and individuals engagedin injury prevention, training, research and policy development.

ISCAIPc/o Child Accident Prevention Trust Tel: +44 171 608 382818-20 Farringdon Lane Fax: +44 171 608 3674London ECIR 3AU e-mail: iscaip@capt.demon.co.ukUnited KingdomorIan Scott Kidsafe Australia (03)9670 1319

A quarterly publication, Injury Prevention, is the official journal of the Society, and asubscription will be provided with each ISCAIP membership. The first issue was publishedin March 1995. Published by the British Medical Journal Publishing Group, the journalfeatures scientific reports dealing with unintentional injury or violence, excluding childabuse, reports describing local or national control programmes or front-line organisations,and review articles, opinion pieces, bibliographic citations and news items.

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 24 page 14

- INDEX -Subject Edition PagesBabywalkers, update .................................................................................................................. 16,20........................... 1-4,12-13Bunkbeds ......................................................................................................................................... 11 ....................................... 12Bicycles

- Bicyle related injuries ......................................................................................................... 6 ...................................... 1-8- Cyclist head injury study ................................................................................................... 2, ......................................... 2- Cyclist head injury study updates ............................................................................... 7,8,10 ................................. 8,13,9

Burns- Scalds ................................................................................................................................... 3 ...................................... 1-4- Burns prevention ............................................................................................................... 12 .................................... 1-11

Child care settings ........................................................................................................................... 16 .................................... 5-11Data base use, interpretation & example of form ............................................................................ 2 ...................................... 2-5Deaths from injury (Victoria) ......................................................................................................... 11 .................................... 1-11Dishwasher machine detergents - Update ...................................................................................... 18 ....................................... 11Dogs

- Dog related injuries ............................................................................................................. 3 ...................................... 5-6- Dog bite injuries ................................................................................................................ 12 ....................................... 12

Domestic architectural glass ............................................................................................................. 7 .................................... 9-10Domestic Violence .......................................................................................................................... 21 ...................................... 1-9Drownings/near drownings .................................................................................................................

- Immersions .......................................................................................................................... 2 ......................................... 3- Pool fencing leglislation, update ..................................................................................... 2,7 ...................................... 3,7- Drownings & near-drownings at home ............................................................................... 5 ...................................... 1-4

Exercise bicycles, update ............................................................................................................... 5,9 ...............................6,13-14Home injuries .................................................................................................................................. 14 .................................... 1-16Horse related injuries ...................................................................................................................7,23............................. 1-6,1-13Infants - injuries in the first year of life ........................................................................................... 8 .................................... 7-12Intentional injuries .......................................................................................................................... 13 .................................... 6-11Latrobe Valley

- The first three months ......................................................................................................... 9 .................................... 9-13- Latrobe Valley injuries .................................................................................. * March 1992 ...................................... 1-8- Injury surveillance & prevention in the L. V. ..................................................... *Feb 1994 .................................... 1-14

Martial arts ...................................................................................................................................... 11 ....................................... 12Motor vehicle related injuries, non-traffic ..................................................................................... 20 ...................................... 1-9Needlestick injuries......................................................................................................................... 11 ....................................... 12Older people, injuries among.......................................................................................................... 19 .................................... 1-13Off-street parking areas .................................................................................................................. 20 .................................. 10-11Playground equipment ...................................................................................................................... 3 ...................................... 7-9Poisons.................................................................................................................................................

- Child resistant closures ....................................................................................................... 2 ......................................... 3- Drug safety and poisons control ......................................................................................... 4 ...................................... 1-9- Dishwasher detergent, update ........................................................................................10,6................................. 9-10,9

Roller Blades ................................................................................................................................... 15 .................................. 11-13School injuries................................................................................................................................. 10 ...................................... 1-8Skateboard injuries............................................................................................................................ 2 ...................................... 1-2Smoking Related injuries ................................................................................................................ 21 .................................. 10-12Sports

- Sports related injuries.......................................................................................................... 8 ...................................... 1-6- The 5 most common sports ................................................................................................. 9 ...................................... 1-8- Adult sports injury............................................................................................................. 15 .................................... 1-10

Trampolines..................................................................................................................................... 13 ...................................... 1-5VISS: early overview ........................................................................................................................ 1 ...................................... 1-5VISS: how it works ........................................................................................................................... 1 ...................................... 6-8Work Related Injuries ................................................................................................................ 17,18........................... 1-13,1-10

* Special edition

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 24 page 15

Editorial BoardProfessor Peter Vulcan, Monash University Accident Research Centre

Dr Joan Ozanne-Smith, Monash University Accident Research Centre

Assoc. Professor Terry Nolan, Department of Paediatrics, Melbourne University

Jerry Moller , National Injury Surveillance Unit

VISS StaffDirector: Dr Joan Ozanne-Smith

Co-ordinator: Virginia Routley

Research Assistant: Karen Ashby

Administrative Assistant: Christine Chesterman

Data Processor: Julia Palmer Latrobe Regional Hospital

Associate Director: Associate Professor Terry Nolan(Child Injuries)

GeneralAcknowledgementsParticipating HospitalsLatrobe Regional Hospital (Traralgon and Moe)

The contributions to the collection of VISS data by the director and staff of theEmergency Departments of these hospitals, other particpating clinicians, MedicalRecords Departments, and ward staff are all gratefully acknowledged. Thesurveillance system could not exist without their help and co-operation.

Coronial ServicesAccess to coronial data and links with the development of the Coronial Service’sstatistical database are valued by VISS.

National Injury Surveillance UnitThe advice and technical back-up provided by NISU is of fundamental importanceto VISS.

How toAccess VISSData:VISS collects and tabulates informa-tion on injury problems in order tolead to the development of preventionstrategies and their implementation.VISS analyses are publicly availablefor teaching, research and preventionpurposes. Requests for informationshould be directed to the VISS Co-ordinator or the Director by contactingthem at the VISS office.

VISS is located at:Building 70Accident Research CentreMonash UniversityWellington RoadClayton, Victoria, 3168

Postal address:

As above

Phone:

Reception (03) 9905 1808

Co-ordinator (03) 9905 1805

Director (03) 9905 1810

Fax (03) 9905 1809

VICTORIAN INJURY SURVEILLANCE SYSTEM HAZARD 24 page 16

VISS is a project of the Monash University Accident Research Centre.

Hazard was produced by the Victorian Injury Surveillance Systemwith the layout assistance of Glenda Cairns, Monash University Accident Research Centre.

Illustrations by Jocelyn Bell, Education Resource Centre, Royal Children’s Hospital.

ISSN-1320-0593

Printed by Sands and McDougall Printing Pty. Ltd., North Melbourne

Project Funded byVictorian Health Promotion Foundation