Escalator-related injuries in children

Intelligent escalator passenger safety management

This article addresses an approach to intelligent safety control of passengers on escalators. The aim is to improve the accuracy of detecting threatening situations on escalators in the subway to make decisions to prevent threats and eliminate the consequences. The novelty of the approach lies in the complex processing of information from three types of sources (video, audio, sensors) using machine learning methods and recurrent neural networks with controlled elements. The conditions and indicators of safety assurance efficiency are clarified. New methods and algorithms for managing the safety of passengers on escalators are proposed. The architecture of a promising safety software system is developed, and implementation of its components for cloud and fog computing environments is provided. Modeling results confirm the capabilities and advantages of the proposed technological solutions for enhancing the safety of escalator passengers, efficiency of control decision making, and system usability. Due to the proposed solutions, it has become possible to increase the speed of identifying situations 3.5 times and increase the accuracy of their determination by 26%. The efficiency of decision making has increased by almost 30%.

Contributing Factors Affecting the Severity of Metro Escalator Injuries in the Guangzhou Metro, China

Urban rail transit has become one of the indispensable modes of public transportation in large cities. Escalators are ubiquitous in metro stations, as passengers typically use escalators when entering or leaving a metro station. Thus, escalators have become an accident-prone location. To develop suitable prevention strategies, it is necessary to understand the risk factors that affect the severity of escalator accidents. This study analyzed 967 escalator passenger accidents that occurred in the Guangzhou Metro from 2013 to 2015. The Haddon matrix was used to evaluate the interaction of humans, escalators, and environmental factors before, during, and after accidents. Then, the contributing factors associated with the severity levels were determined based on chi-square tests. Passengers aged 66 years and older are more vulnerable to serious injuries (p < 0.001), and previous health conditions are significantly related to the severity of the passenger’s injuries (p = 0.002). The weather conditions (rainy days) are also significantly related to the severity of escalator accident injuries (p = 0.039), and injured people with head injuries are at greater risk of being severely injured (p < 0.001). The analysis results of these risk factors can provide theoretical support for the metro operators to develop reasonable and effective preventive measures to reduce the escalator risk.

Critical Hazards Identification and Prevention of Cascading Escalator Accidents at Metro Rail Transit Stations

Escalator accidents not only happen frequently but also have cascading effects. The purpose of this study is to block the formation of cascading accident networks by identifying and preventing critical hazards. A modified five-step task-driven method (FTDM) is proposed to break down passenger-related cascading escalator accidents. Three complex network parameters in complex network theory are utilized to identify critical and non-critical Risk Passenger Behavior (RPB) hazards and Other Hazards related with Risk Passenger Behavior (OH-RPB) in accident chains. A total of 327 accidents that occurred in the Beijing metro rail transit (MRT) stations were used for case studies. The results are consistent in critical and non-critical RPB and OH-RPB and prove that through combination of FTDM accident investigation model and complex network analysis method, critical and non-critical RPB and OH-RPB in a complicated cascading hazards network can be identified. Prevention of critical RPB can block the formation of cascading accident networks. The method not only can be used by safety manager to make the corresponding preventive measures according to the results in daily management but also the findings can guide the allocation of limited preventive resources to critical hazards rather than non-critical hazards. Moreover, the defects of management plan and product design can be re-examined according to the research results.

Analysis Factors That Influence Escalator-Related Injuries in Metro Stations Based on Bayesian Networks: A Case Study in China

Escalator-related injuries have become an important issue in daily metro operation. To reduce the probability and severity of escalator-related injuries, this study conducted a probability and severity analysis of escalator-related injuries by using a Bayesian network to identify the risk factors that affect the escalator safety in metro stations. The Bayesian network structure was constructed based on expert knowledge and Dempster–Shafer evidence theory, and further modified based on conditional-independence test. Then, 950 escalator-related injuries were used to estimate the posterior probabilities of the Bayesian network with expectation–maximization (EM) algorithm. The results of probability analysis indicate that the most influential factor in four passenger behaviors is failing to stand firm (p = 0.48), followed by carrying out other tasks (p = 0.32), not holding the handrail (p = 0.23), and another passenger’s movement (p = 0.20). Women (p = 0.64) and elderly people (aged 66 years and above, p = 0.48) are more likely to be involved in escalator-related injuries. Riding an escalator with company (p = 0.63) has a relatively high likelihood of resulting in escalator-related injuries. The results from the severity analysis show that head and neck injuries seem to be more serious and are more likely to require an ambulance for treatment. Passengers who suffer from entrapment injury tend to claim for compensation. Severe injuries, as expected, significantly increase the probability of a claim for compensation. These findings could provide valuable references for metro operation corporations to understand the characteristics of escalator-related injuries and develop effective injury prevention measures.

Escalator-related injuries in one of the deepest subway stations in Europe

BACKGROUND

Escalator-related injuries (ERI) have emerged as a new injury type due to the frequent use of escalators in Metro stations.

OBJECTIVES

Investigate ERI in the stations on the Marmaray metro line.

DESIGN

Retrospective, observational study.

SETTING

Patients admitted to the emergency department of a training and research hospital.

PATIENTS AND METHODS

All patients with ERI were included in the study. We analyzed demographic characteristics, injury type and anatomical location of injury, Glasgow coma score, and body mass index (BMI). Patients were grouped by BMI: underweight (BMI less than 18.5 kg/m2), normal weight (BMI=18.5-24.9 kg/m2), overweight (BMI=25-29.9 kg/ m2) and obese (BMI greater than or equal 30kg/m2).

MAIN OUTCOME MEASURES

Injury characteristics and BMI values of patients with ERI.

SAMPLE SIZE

82 patients.

RESULTS

The mean age was 45.1 (15.5) years (range:14-77 years). Forty-two were women (52.5%). The mean BMI was 26.7 (2.2) kg/m2 (range: 22.1-33.3 kg/m2)]. Most of the patients who were injured due to escalators were older than 50 years (n=39, 47.6%) and 77.5% (n=62) of all patients were overweight. There was a significant relationship between increased BMI and serious ERI (P=.010, OR: 1.85, 95% C.I: 1.132.65). The most frequent mechanism of injuries was a fall (97.6%). The majority of injuries were the head (42%) and extremity injuries (33%). The major type of ERI was soft tissue injuries (41.3%), followed by lacerations (20.7%), closed head injuries (18.5%), fractures (15.2%) and serious injuries (4.4%). Serious injuries were more prevalent in patients aged older than 50 years (P less than .05), and in overweight and obese individuals (P less than .001) CONCLUSION: Novel protective measures against ERI should be developed for crowded subway stations.

LIMITATIONS

The small sample size and retrospective nature.

CONFLICT OF INTEREST

None.

An analysis of escalator-related injuries in metro stations in China, 2013-2015

In order to reduce the probability and severity of escalator-related injuries and enhance the safety of passengers, this study analyzed 950 escalator-related injuries in Guangzhou metro stations to identify the characteristics and the risk factors associated with escalator-related injuries in China. The data extracted from Management Information System of Guangzhou Metro covers the site and time of the accident, age and gender of the victims, escalator condition and injury information. The results from the statistical analysis indicated that the majority of the escalator-related injuries was caused by failing to stand firm (287 cases, 30.2%), passengers carrying out other tasks (214 cases, 22.5%), not holding the handrail (168 cases, 17.7%) and unhealthy passengers (18 cases, 9.3%). Age was associated with all factors except for need for an ambulance and the distribution law of these factors differed with age groups. Elderly passengers (aged 66 years and above) accounted for the highest proportion of all injuries (49.1%), and failing to stand firm (18.63%) was the main cause of escalator-related injuries of elderly passengers. The most common mechanism of injury for all age groups was a fall, accounting for (51.0%) injuries. Proportion of injuries caused by a fall increased with age, whereas injuries attributed to entrapment decreased. Female passengers (65.9%) were more likely to be involved escalator-related injuries than male passengers (34.1%), while male passengers were more likely to have accidents caused by unhealthy physical condition than female passengers. These results based on the analysis of current accident data can be used to help metro operation corporation develop effective injury prevention measures and document the need for continued improvement of escalator safety in metro stations.

An Analysis of Escalator-Related Injuries in an Emergency Department

Background

Escalator-related injuries have been considered uncommon and most likely to occur in children. In this study, we described the epidemiology of these injuries with focus on the aged population in order to determine whether escalators are safe for the aged, and to obtain information to help in preventing escalator-related injuries.

Methods

A prospective survey was taken to identify the number and nature of these injuries from May 2004 to December 2008. We enrolled patients who had sustained escalator-related injuries. A standard list of questions and answers were recorded by the emergency physician. A total of 104 questionnaires were completed during the study period.

Results

The average patient age was 59.2±24.0 years (range 1-94). There were 64 (61.5%) females. Only 11 (10.6%) were younger than 15 years old, and 59 (56.7%) were aged 65 or above; 35 (59.3%) of the aged people were injured while standing on the escalator. However, out of the 45 patients younger than age 65, 22 (48.9%) were injured from walking on a moving escalator. Head injury was the commonest site of injury overall and all were due to fall or slipping down.

Conclusions

Escalator-related injuries are not as rare as previously believed and the aged population 65 years old or above is the highest risk group. In particular, walking on a moving escalator was the main cause of injury in people under age 65. Therefore, primary prevention strategies are needed to prevent users from walking on escalators, especially young people, and educate aged people the safe utilization of escalators to prevent slip and fall injuries.

Escalator-related injuries in 30 dogs (2007-2014)

OBJECTIVE

To describe a population of dogs affected by escalator-related injuries, and to characterize the types of injuries sustained and describe treatment administered.

DESIGN

Retrospective study from March 2007 to November 2014.

SETTING

Large urban referral and emergency facility.

ANIMALS

Thirty client-owned dogs presenting with injuries acquired while riding an escalator.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

All injuries in this study occurred secondary to entrapment of 1 or more paws in the moving parts of an escalator; 39 paws were injured in total. The median body weight of the patients in this study was 4.25 kg, with 73.3% of the patients weighing less than 10 kg. Fifteen patients (50.0%) were treated surgically, the remainder were managed conservatively. Eight patients (26.7%) underwent digit or partial-digit amputation. Of the conservatively managed patients, 10 were treated with bandaging of the wounds. Antimicrobials, opiate analgesics, and nonsteroidal anti-inflammatory drugs were administered in both surgically and conservatively managed patients.

CONCLUSIONS

While uncommon, escalator accidents can result in significant injury to dogs. Measures can be taken to prevent these injuries from occurring, whether through client education, dog training, structural modifications in the escalators themselves, or avoidance of escalators. In the present study, the survival rate of dogs injured on escalators was 100%.

Anticipatory changes in control of swing foot and lower limb joints when walking onto a moving surface traveling at constant speed

Adapting to a predictable moving surface such as an escalator is a crucial part of daily locomotor tasks in modern cities. However, the associated biomechanics have remained unexplored. In a gait laboratory, fifteen young adults walked from the ground onto a moving or a static surface while their kinematic and kinetic data were obtained for calculating foot and pelvis motions, as well as the angles and moments of the lower limb joints. Between-surface-condition comparisons were performed using a paired t-test (α = 0.05). The results showed that anticipatory locomotor adjustments occurred at least a stride before successfully walking onto the moving surface, including increasing step length and speed in the trailing step (p < 0.05), but the opposite in the leading step (p < 0.05). These modifications reduced the plantarflexor moment of the trailing ankle needed for stabilizing the body, while placing increased demand on the knee extensors of the trailing stance limb. For a smooth landing and to reduce the risk of instability, the subjects adopted a flat foot contact pattern with reduced leading toe-clearance (p < 0.05) at an instantaneous speed matching that of the moving surface (p > 0.05), mainly through reduced extension of the trailing hip but increased pelvic anterior tilt and leading swing ankle plantarflexion (p < 0.05). The current results provide baseline data for future studies on other populations, which will contribute to the design and development of strategies to address falls while transferring onto moving surfaces such as escalators.

Escalators, rubber clogs, and severe foot injuries in children

BACKGROUND

Reports in the media suggest that escalator-related foot injuries are on the rise. Trendy, bright-colored rubber clogs have been implicated in a significant number of these incidents involving children. We review the children who sustained severe foot injuries on escalators, were wearing rubber clogs at the time of injury, and who were admitted to hospital for emergency surgery.

METHODS

A list of children who sustained foot injuries on escalators was generated from the hospital database and included for study. From clinical chart review, demographic data, footwear type, and injuries sustained were recorded. Inpatient or outpatient treatment rendered was also recorded for each patient.

RESULTS

Between September 2006 and September 2008, we treated 17 children for escalator-related foot injuries. There were 10 boys and 7 girls who were between 2 and 9 years of age (mean: 5.5). Thirteen children (76.5%) from this group were wearing rubber clogs at the time of injury. Nine of these 13 (69.2%) children sustained severe foot injuries that required admission to hospital for emergency surgery and are the focus of this study. One child had an unsalvageable traumatic amputation of the great toe at the level of the interphalangeal joint. Two children sustained crush injuries to the great toe: 1 with severe degloving and the other with an open fracture of the proximal phalanx. One child had an open fracture-dislocation of the second metatarsophalangeal joint with a comminuted fracture of the second metatarsal. Five children sustained multiple deep lacerations in the foot and 2 of them had associated cut tendons that required repair. In the group not wearing rubber clogs, 3 of 4 children had severe foot injuries. In this series, 4 children with rubber clogs and another child with a different footwear sustained minor injuries; they were treated as outpatients.

CONCLUSIONS

Escalator-related foot injuries involving rubber clogs can result in severe crushing of the foot and even traumatic amputation. The broad toe-box design may give a false perception of the distance between the foot and the side of the escalator, whereas the 'softness' of these rubber clogs makes them vulnerable to crush by moving escalator steps. This is the first report in the literature describing escalator-related severe foot injuries in children who were wearing rubber clogs. Injuries sustained can be significant and permanent. The potential dangers of escalators and rubber clogs must not be underestimated.

LEVEL OF EVIDENCE

Level IV, Case Series.

Child Injury: The Role of Supervision in Prevention

As the leading cause of death and major contributor to hospitalization for children, unintentional injury is a significant health problem in the United States. How supervision influences children’s risk of injury has been of interest for some time, and much progress has been made recently to address definitional and measurement issues pertaining to supervision. Increasing evidence supports the notion of a general relationship between increased supervision and decreased injury risk, but also reveals that child behavioral attributes and environmental characteristics can interact with level of supervision to affect injury risk, making it challenging to develop guidelines regarding what constitutes “adequate” supervision. Further research is needed to explore if and how children’s risk of injury varies with different supervisors (eg, mothers vs fathers vs older siblings) and how these relations change as a function of children’s developmental level. Recent research has identified messaging approaches that are effective to invoke a commitment to more closely supervising young children at home. Examining how these messages affect actual supervisory practices is an essential next step in this research and can support the development of evidence-based programs to improve supervision and reduce children’s risk of injuries.

Escalator-related injuries among children in the United States, 1990-2002

OBJECTIVE

We describe the epidemiology of escalator-related injuries among children 0 to 19 years of age in the United States, with a focus on the pediatric population that is younger than 5 years.

METHODS

We conducted a retrospective analysis of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission. Reported cases were used to project national estimates and rates of escalator-related injuries in the United States. The analysis included all patients who were 0 to 19 years of age in the National Electronic Injury Surveillance System database and were seen in an emergency department for an escalator-related injury during the 13-year period 1990-2002.

RESULTS

There were an estimated 26000 escalator-related injuries among children who were 0 to 19 years of age in the United States during 1990-2002, yielding an average of 2000 of these injuries annually (rate = 2.6 per 100,000 population per year). The mean age was 6.5 years at the time of injury, and 53.4% of the patients were male. When comparing cases by 5-year age groups, children who were younger than 5 years had the highest estimated number of injuries (12000), as well as the highest annual escalator-related injury rate (4.8 per 100000). The most common mechanism of injury for all age groups was a fall, accounting for 13000 (51.0%) injuries. Entrapment accounted for 29.3% of all injuries and 36.5% of injuries among children who were younger than 5 years. Six percent (723) of injuries to children who were younger than 5 years involved a stroller, with most injuries occurring when a child fell out of the stroller while on the escalator. The most common body part injured for all ages was the leg, accounting for 27.7% of all injuries. Among children who were younger than 5 years, the hand was the most common injury site (40.6%), with hand injuries frequently occurring as a result of entrapment (72.4%). A laceration was the most common type of injury, accounting for 47.4% of escalator-related injuries. Amputations and avulsions were uncommon; however, 71.4% (595 of 833) occurred among children who were younger than 5 years.

CONCLUSIONS

There was a disproportionate number of escalator-related injuries among children who were younger than 5 years. Entrapment occurred more frequently among children who were younger than 5 years than in any other age group, which may explain the increased number of hand injuries in this age group. Escalator designs that reduce the gap between the steps and sidewall or shield against access to the gap may decrease entrapment risk. Young children should be supervised properly and should not be transported in a stroller while riding on an escalator. All passengers should use caution and remain alert when riding an escalator to avoid injuries related to falls or entrapment. Additional research is needed to determine the relationship among passenger behavior, escalator design, and escalator-related injury.

Caregiver Supervision and Child-Injury Risk: I. Issues in Defining and Measuring Supervision; II. Findings and Directions for Future Research

OBJECTIVE

To discuss the role of caregiver supervision in child-injury risk, with attention given to definitional and methodological issues and outlining important questions to be addressed in future research.

METHODS

Analysis, synthesis, and critique of existing literature.

RESULTS

Comparisons across studies are difficult because of insufficient specificity regarding what constitutes supervision. Hence, a multi-dimensional definition of supervision is developed based on the literature. Numerous issues arise when attempting to measure supervision and these are extensively discussed, along with reporting on the recent development of two questionnaire measures of supervision (Beliefs About Supervision Questionnaire and Parent Supervision Attributes Profile Questionnaire) that have shown good validity and hold promise for addressing the problem of measuring caregiver supervision in reliable and valid ways. A review of the findings on relations between supervision and child-injury risk reveals that many substantive questions remain unanswered. A number of recommendations for future research are given and a conceptual model is presented that focuses attention on the need for research that examines how factors interact to influence child-injury risk. This model has relevance not only for research but also for prevention and serves to emphasize the complementary nature of environment-oriented and person-oriented approaches to child-injury prevention.

CONCLUSION

Direct evidence linking supervision to child-injury risk is scarce and many important questions remain unanswered. Based on the conceptual model presented, in future research it is important to examine how supervision interacts with other key factors to influence children's risk of injury.