21. Falling associated with stairs and steps

Most vulnerable: The elderly and men over 40

This category covers any fall associated with a stairs, steps, and ramps where the change in level is greater than 300mm.

It includes falls associated with:

• internal stairs or ramps within the dwelling
• external steps or ramps within the curtilage of the dwelling
• internal common stairs or ramps within the building containing the dwelling and giving access to the dwelling, and those to shared facilities or means of escape in case of fire associated with the dwelling
• external steps or ramps within the curtilage of the building containing the dwelling and giving access to the dwelling, and those to shared facilities or means of escape in case of fire associated with the dwelling
• falls over guarding (balustrading) associated with the stairs, steps or ramps
• It does not include falls over guarding to balconies or landings, nor does it include falls associated with trip steps, thresholds, or ramps where the change in level is less than 300mm.

Effects

Falls on stairs account for around 25% of all home falls (fatal and non-fatal). Although fewer falls occur on stairs than on the level, stair falls are much more likely to lead to a Class I outcome.

After the age of 40, men are much more likely to die of a fall on stairs or steps in the home than women. In the age bands 40 to 64, and 75+, a man is almost twice as likely to die from a fall on stairs/steps at home than a woman in the same age band when the rate per million population of each gender is considered. In the age bands 65 to 74, a man is more likely to die from a fall than a woman, although the difference between the sexes is less marked.

Any fall can result in physical injury, such as bruising, fractures, head, brain, and spinal injuries and may even be fatal. The nature of injury is dependent on the distance of a fall, and nature of the surfaces collided with, as well as on the age and fragility of the person. Although typically the harm suffered from a fall is a physical impact type of injury, the health of an elderly person can deteriorate generally following a fall. Their cause of death within weeks or months of the initial fall injury can be cardio-respiratory illness, including heart attack, stroke and pneumonia.

22. Falling between levels

Most vulnerable: Adults between 20 and 29, and young children

This category covers falls from one level to another, inside or outside a dwelling, where the difference in levels is more than 300mm. For example:

• Falls out of windows
• Falls from balconies or landings
• Falls from an accessible roof
• Falls into basement wells
• Falls over garden retaining walls

Effects

Falls result in physical injury, including bruising; puncture injuries; fractures; and head, brain and spinal injuries. The nature of injury is in part dependent on the distance of a fall and the nature of the surface collided with.

Children under the age of five are most likely to fall between levels, and boys are more likely to fall than girls. Falls from windows, landings and balconies is an important cause of death within the under-five age group, because the underlying rate of death for children is low. In other words, this is one of the more common causes of death for children and young adults – the low average hazard scores reflecting the fact that at this age people are less likely to die from other causes.

Within the adult age group of 16 to 59 years, young adults between 20 and 29 years old are the most likely to fall between levels. Adults 60+ years old are the least likely to fall between levels but suffer much more severe health outcomes when they do.

There are around 50 fatal falls from windows in domestic buildings each year, and around 2,300 non-fatal cases treated in hospitals. There are around 8 fatal domestic balcony falls each year. The trend is that the number of non-fatal falls between levels are increasing while the number of fatal falls is decreasing year-on-year.

23. Electrical hazards

Most vulnerable: Children under 14

This category covers hazards from shock and burns resulting from exposure to electricity, including from lightning strikes.

Effects

When electricity passes through the human body, it causes shock to the nervous system. The shock effect ranges from mild tingling sensations to disruption of the normal regular contractions of the heart or respiratory muscles, causing death.

As human tissue acts as a resistance to electricity, heat is generated which may result in burns. Such burns usually occur at the point of contact with the source of electricity. Injuries are primarily burns (53%) to the finger or thumb (58%). The mouth is the second most frequent injury site. About half of electrical accidents in the home result in burns as well as shock.

The majority of injuries are not severe. Of those attending hospital accident and emergency, 38% of victims are sent home, and 47% are referred to out-patients or a GP. Of those admitted to hospital, 71% stayed for less than 3 days. Those under 40 have 80% of all accidents, and males have 59% of accidents. The most vulnerable group are young children, who are less likely to be aware of the risks posed by electricity. Boys between 5 and 14 are three times more likely to have accidents than girls of the same age.

24. Fire

Most vulnerable: The elderly and young children

This category covers threats from exposure to uncontrolled fire and associated smoke at a dwelling.

It includes injuries from clothing catching alight on exposure to an uncontrolled fire, which appears to be common when people attempt to extinguish such a fire. However, it does not include injuries caused by clothing catching alight from a controlled fire or flame, which may be caused by reaching across a gas flame or an open fire used for space heating.

Effects

There are around 70,000 dwelling fires reported to Fire Brigades in the UK each year, of which the majority (around four fifths – 56,000) are accidental. As only one fifth of fires are reported to Fire Brigades, this represents an under-estimation of the total number of uncontrolled fires, which occur at approximately 3% of dwellings each year. It is estimated that nearly 90% of domestic fires do not result in any injury.

The most common cause of death from a fire (around 38%) is being overcome by gas or smoke. Around 26% of deaths are attributed jointly to both burns and being overcome by gas or smoke, and 25% of deaths are the result of burns alone. (The remaining 11% of deaths are either unspecified or from other causes.)

The elderly and the very young (aged four and under) are most at risk. Impairment of mobility will increase vulnerability as it affects the ability to, and speed of, escape. More children die from carbon monoxide poisoning (mainly as a result of fires) than from any other poisoning. A household with children is twice as likely to experience a fire as one without children. This increased likelihood is probably because adults are distracted by children whilst cooking.

Although children are more likely to be exposed to fire, the elderly are more than three times as likely to die from a fire, and therefore are more at risk. People over 80 years of age have the highest rate of deaths per million population, and 36% of fire deaths are to people over 65 years of age.

25. Flames and hot surfaces

Most vulnerable: Children under 3

This category covers threats of:

• burns – injuries caused by contact with a hot flame or fire, and contact with hot objects or hot non water-based liquids
• scalds – injuries caused by contact with hot liquids and vapours

It includes burns caused by clothing catching alight from a controlled fire or flame, for example, when reaching across a gas flame or open fire used for heating.

Effects

Around 112,000 people visit hospital accident and emergency units each year suffering from burns or scalds incurred in the home or from leisure activities. At least a further 250,000 people visit doctor’s surgeries for burns and scalds injuries. Burn or scald injuries result in the death of over 200 people each year.

Burns or scalds in this hazard category account for the majority of non-fatal burn accidents (burns caused by uncontrolled dwelling fires result in the most deaths).

The severity of the burn or scald is dependent on its depth and the area covered. The depth of burn is dependent on the temperature of the hot object or liquid, the length of time exposed to the source of heat, the time taken before corrective action is taken, and the length of time that cold water is applied. How long a hot material can be touched without damage to human tissue also depends on the material and the temperature.

Where the burn or scald is severe, it can result in permanent scarring. Apart from the obvious physical pain, many victims, and also parents of children that are burnt or scalded, suffer acute psychological distress for many years.

Around half the injuries are to children under 5 years of age. Their risk level is 6 to 7 times greater than the average level for the population as a whole, with boys at slightly higher risk than girls.

The relatively small body area (especially when hot liquids are involved), the more sensitive nature of young children’s skin, and their low position in relation to hot objects, means that young children are particularly at risk of suffering severe injuries. Many of these victims suffer extensive full thickness burns and require plastic surgery, often for many years following the accident.

The incidence of burns and scalds is greater for those over 65 years of age than for other adults, but less than for children. The health outcome for the elderly is usually more serious than for all other age groups.

26. Collision and entrapment

Most vulnerable: The elderly, adults under 30 and young children

This category includes risks of physical injury from:

• trapping body parts in architectural features, such as trapping limbs or fingers in doors or windows
• striking (colliding with) objects such as architectural glazing, windows, doors, low ceilings, and walls

Effects

There are more than 200,000 injuries a year through collisions and entrapments involving doors in dwellings, and nearly 40,000 from collision and entrapment involving windows. Injuries sustained from window injuries tend to be worse, particularly when the accidents result from cutting and piercing from architectural glass. Nearly 1,000 injuries each year are caused by entrapment and collision involving lifts in domestic accommodation.

The most common type of door accident involves a door shutting on, or trapping, part of a body (39% of door accidents). Collisions with doors is the next most common (37% of accidents). Most door accidents, particularly a door shutting on part of the body, involve children aged 9 years and under. Accidents involving door glazing (15% of door accidents) are most likely to occur to young adults (20 to 29 years).

Children and young adults (15 to 24 years) are most vulnerable to glazing and window accidents. Children and the frail elderly are vulnerable to accidents involving lifts.

27. Explosions

Most vulnerable: All age groups

This category covers the threat from the blast of an explosion, from debris generated by the blast, and from the partial or total collapse of a building as the result of an explosion.

Effects

While the average likelihood of an explosion is very small, explosions can result in extreme harm. There are around 10 deaths per year in dwellings as a result of explosions, and over 500 non-fatal accidents where the victim was struck by debris from an explosion.

Typical injuries include crushing, bruising, puncture injuries, fractures, and head, brain and spinal injuries. If the explosion involves a hot water appliance, there may also be scalding.

28. Position and operability of amenities

Most vulnerable: All age groups

This category covers threats of physical strain associated with functional space and other features at dwellings.

Effects

Strain and sprain injuries are the obvious injuries resulting from poor ergonomics. However, this hazard can lead to other injuries where a person is forced to stretch or lean awkwardly to reach a handle, catch, or switch. This may include fall injuries.

29. Structural collapse and falling elements

Most vulnerable: All age groups

This category covers the threat of a whole dwelling collapsing, or of an element or a part of the fabric being displaced or falling because of inadequate fixing, disrepair, or as a result of adverse weather conditions.

Structural failure may occur internally, or externally within the curtilage threatening occupants, or externally outside the curtilage putting at risk members of the public.

Effects

Objects falling from the fabric of a building and as a result causing injury are extremely rare. Potential injuries range from minor bruising to death.