Research Journal · 2020. 1. 10. · 4: Em otio nal Distress or I cv enie 5: Additional Treatment...

2019 ― Volume 11.02 Research Journal

AbstractIn the U.S., the average rate of escalator incidents per year equals 0.221 accidents per escalator; 0.442 accidents per escalator pairing1. Campus wide, a large medical center in the southern United States has reported 19 separate escalator incidents between July 2018 to July 2019—with 9 of those incidents occurring within an on-campus outpatient care clinic. At almost 18 times the national rate, the incidence of escalator events within the clinic is a cause for concern for staff, patients and visitors.

This study sought to understand possible user behaviors that may contribute to the incidence of these events as well as propose possible design and operational strategies to reduce their occurrence. Site visits and observations helped provide insight into user behaviors on escalators, the potential risks associated with this type of vertical transportation in healthcare environments, as well as implementable mitigation strategies. A baseline feasibility analysis was conducted for each strategy proposed.

While removing the escalators was recommended as the only sure way to fully mitigate the occurrence of these incidents, a myriad of escalator safety upgrades and passive design techniques were proposed—with the caveat that once implemented, a follow-up impact study must occur to gauge the success of these strategies.

Keywords: escalator, safety, incidents, healthcare, elevators

1.0 Introduction1.1 Context

The clinic studied is an outpatient cancer care clinic within the southern United States. It is comprised of two sides: East Clinic and West Clinic. Each side contains a set of escalators and several elevators (West: 1 bank of 3; East: 2 banks of 2) which services the main clinic spaces on Level 2. East Clinic serves as the main entry for the clinic and was the predominate area of concern for this study.

1.2 Incident Log

Between July 2018 and July 2019, 9 separate safety incidents occurred within the outpatient clinic, some of which affected multiple visitors. Figures 1 and 2 map the incident log provided by the care clinic over the course of the year along with the “harm score” assigned to each incident by the recording staff member.

03

Escalator Safety within an Outpatient Clinic: A Review of Escalator

Incidents and Possible Mitigation Strategies

Kristen McDaniel, LEED AP® BD+C, [email protected]

Andrew Koska, AIA, LEED AP® BD+C, [email protected]

30


JUL JUNAUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUL

07.26Building:Location: EastHarm Score: 5Direction: Down

11.14Building: Location: EastHarm Score: 5Direction: Up*Multiple Injured

08.14Building: Location: N/AHarm Score: 3Direction: Up

03.27Building:Location: N/AHarm Score: 4Direction: Up

07.10Building:Location: N/AHarm Score: 4Direction: Down

04.03Building:Location: EastHarm Score: 5Direction: Up

06.03Building: Location: EastHarm Score: 4Direction: N/A

05.30Building:Location: EastHarm Score: 6Direction: Up*Multiple Injured


Harm Score

3: No Evidence of Physical Harm or Otherwise

4: Emotional Distress or Inconvenience

5: Additional Treatment

6: Temporary Harm

No Incidents

One Incident

Two Incidents

Incident Occurrences//Month

08.14.18Harm Score: 3


“The student donated blood.

When coming down escalator

she stated to her friend she did

not feel well. Sat down and

passed out.”

“(Users) were riding up the

with multiple wheeled bags.

Bag got stuck...resulting in

(user) falling backwards.”







“Found visitor sitting on the

escalator ...in shock mode

because the whole family was

injured. Aunt tripped ...made

the whole family off balance.”


“Patient fell on escalator.

Patient brought back to

pre-op area for assessment by

PA and RN. Three skin tears

noted, no other injuries.”


“Patient sustained fall on

upward escalator...slipped

with his right arm under his

body. Noted multiple bleeding

lacerations.”


“Domino effect of a family

member and patients at

upward escalator near

elevator S...sustained injury to

head and rib cage.”

“3 years old boy fell down

escalator with grandmother...

small cut over the left temporal

area. No active bleeding. No

other injury noted.”







“(Patient) reported that she

tripped on her shoes going

down the escalator and fell

hitting her left wrist and left


“(Patient) said she lost her

balance, her husband was just

behind her... Noticed small

bruising over left lower leg

with minimal bleeding.”




6: Temporary Harm

Harm Score

Figure 1: Incident log timeline.

Figure 2: Incident log recorded descriptions.

JUL JUNAUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUL


11.14Building: Location: EastHarm Score: 5Direction: Up*Multiple Injured

08.14Building: Location: N/AHarm Score: 3Direction: Up

03.27Building:Location: N/AHarm Score: 4Direction: Up

07.10Building:Location: N/AHarm Score: 4Direction: Down

04.03Building:Location: EastHarm Score: 5Direction: Up

06.03Building: Location: EastHarm Score: 4Direction: N/A

05.30Building:Location: EastHarm Score: 6Direction: Up*Multiple Injured


Harm Score




6: Temporary Harm

No Incidents

One Incident

Two Incidents

Incident Occurrences//Month



“The student donated blood.

When coming down escalator

she stated to her friend she did

not feel well. Sat down and

passed out.”











“Found visitor sitting on the

escalator ...in shock mode

because the whole family was

injured. Aunt tripped ...made

the whole family off balance.”


“Patient fell on escalator.

Patient brought back to

pre-op area for assessment by

PA and RN. Three skin tears

noted, no other injuries.”


“Patient sustained fall on

upward escalator...slipped

with his right arm under his

body. Noted multiple bleeding

lacerations.”


“Domino effect of a family

member and patients at

upward escalator near

elevator S...sustained injury to

head and rib cage.”

“3 years old boy fell down

escalator with grandmother...

small cut over the left temporal

area. No active bleeding. No

other injury noted.”







“(Patient) reported that she

tripped on her shoes going

down the escalator and fell

hitting her left wrist and left


“(Patient) said she lost her

balance, her husband was just

behind her... Noticed small

bruising over left lower leg

with minimal bleeding.”




6: Temporary Harm

Harm Score

Escalator Safety within an Outpatient Clinic

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1.3 Site Observations

During project meetings, staff members provided insight into user behaviors observed on escalators as well as information on current clinic operations (e.g. operating hours, peak use times, perceived elevator vs escalator usage, current escalator safety signage efforts, etc.). The design team utilized this preliminary information to inform both of their on-site visits.

During both site visits, the design team utilized the form in Figure 3 to count user traffic on both the escalators and elevators within East Clinic and West Clinic, as well as document observed user behaviors on escalators. Site observations occurred in the morning between 7 a.m.-11 a.m., and counts were conducted within 15-minute increments. Three members of the design team were present and stationed at the observation locations illustrated in Figure 4.

Figure 3: Traffic count example form.

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In addition to documenting traffic counts and user behaviors on escalators, the design team observed the circulation patterns within the clinic illustrated in Figure 5. Based on traffic counts during both site visits, it was determined that 89 percent of users utilized the East Clinic entry and vertical transportation options versus 11 percent utilizing West Clinic. In addition, 33 percent of

users were utilizing the elevators from the below-grade garage levels in East Clinic while 67 percent of users traveled on the elevators and escalators from levels 1 and 2 between East and West Clinic. These percentages were utilized in the design team’s recommendations and calculations for vertical handling capacity needed to accommodate visitor traffic to the clinic.

JA

SECURITY

VALET

VALETVALET

VALET

ELEVATORS R

ELEVATORS S

ELEVATORS P

SECURITY

EAST CLINIC

WEST CLINICKM

ELEVATORS R

ELEVATORS S

RECEPTION

WAITINGELEVATORS P

WAITING

MT

JAKM

WAITING

WAITING

EAST CLINICWEST CLINIC

Figure 4: Observation locations, level 1 (below) and level 2 (above).

33


Tables 1 and 2 illustrate the compiled observations from the design team for incoming and outgoing traffic during site visits—including elevator and escalator usage totals, observed escalator risk behaviors, as well as total vertical transportation demand during each 15-minute observation period. Peak usage was observed on both visits between 7:58 a.m.-8:13 a.m. with an observed peak

of 180 users per 15-minute period. It is important to note that a large percentage of users demonstrated one or more of the risk behaviors observed by the design team while utilizing the clinic escalators. Table 3 illustrates the percentage of users that exhibited one of the three top risk behaviors observed. On average, 68 percent of users exhibited a risk behavior per 15-minute period.

EAST CLINIC

WEST CLINICVALET

VALET

VALET

VALETVALET

VALET

11%

89%

SCULPTURERECEPTION


Figure 5: Circulation patterns, level 1 (below) and level 2 (above).

Major Vertical Circulation

Secondary Vertical Circulation

Major HorizontalCirculation Paths

Secondary Horizontal Circulation Paths

Major VehicleTransit Paths

Secondary VehicleTransit Paths

Campus Car

VisitorPatientStaff

Escalator Elevator

34


Table 1: Site visit September 10th, 2019.

Table 2: Site visit September 18th, 2019..

7:05-7:20a

Elevator Total: 57

7:23-7:38a

Elevator Total: 68

7:43-7:58a

Elevator Total: 80

7:58-8:13a

Elevator Total: 85

8:18-8:33a

Elevator Total: 80

8:33-8:48a

Elevator Total: 48

8:53-9:08a

Elevator Total: 64

9:08-9:23a

Elevator Total: 62

10:40-10:55a

Elevator Total: 68

Escalator Total: 53 Escalator Total: 75 Escalator Total: 83 Escalator Total: 81 Escalator Total: 73 Escalator Total: 49 Escalator Total: 95 Escalator Total: 85 Escalator Total: 55

Total Usage: 110 Total Usage: 163 Total Usage: 166 Total Usage: 153 Total Usage: 97 Total Usage: 159 Total Usage: 147 Total Usage: 102Total Usage: 143

Peak Time

Total Elevator Usage

Total Escalator Usage

Phone Usage

Carrying an Item

Cane/Walker

Earphone Usage

No Handrail Use

7:05-7:20a

Elevator Total: 55

7:23-7:38a

Elevator Total: 68

7:43-7:58a

Elevator Total: 79

7:58-8:13a

Elevator Total: 80

8:18-8:33a

Elevator Total: 76

8:33-8:48a

Elevator Total: 46

8:53-9:08a

Elevator Total: 65

9:08-9:23a

Elevator Total: 63

10:40-10:55a

Elevator Total: 45

Escalator Total: 50 Escalator Total: 69 Escalator Total: 99 Escalator Total: 100 Escalator Total: 102 Escalator Total: 51 Escalator Total: 97 Escalator Total: 73 Escalator Total: 55

Total Usage: 105 Total Usage: 178 Total Usage: 180 Total Usage: 178 Total Usage: 97 Total Usage: 162 Total Usage: 136 Total Usage: 100Total Usage: 137

Peak Time

Total Elevator Usage

Total Escalator Usage

Phone Usage

Carrying an Item

Earphone Usage

No Handrail Use

Cane/Walker

35


Using the peak user demand gleaned from site observations, the design team calculated a minimum handling capacity for vertical transportation needed within the clinic as well as minimum performance criteria

for any elevators added to the clinic’s design. These calculations are illustrated in Figure 6 and were used to inform the design team’s recommendations.

Table 3: Site visit September 10th, 2019, observed escalator risk behaviors.

Figure 6: Minimum vertical transportation design criteria.

Observed Behaviors (People/15 min) 7:05-7:20a 7:23-7:38a 7:43-7:58a 7:58-8:13a 8:18-8:33a 8:33-8:48a 8:53-9:08a 9:08-9:23a 10:40-10:55a

Phone Usage 7 11 16 18 10 7 14 10 7Carrying an Item 27 28 27 22 28 29 27 24 16No Handrail Usage 5 3 16 16 13 8 20 13 13

Total Risk Behavior 39 42 59 56 51 44 61 47 36

Total Escalator Use 53 75 83 81 73 49 95 85 55

% / Total with Risk Behavior 74% 56% 71% 69% 70% 90% 64% 55% 65%

180 / 15 min. = 100% Observed Peak

180 / 15 min. x 1.25 = 225 / 15 min.

225 / 15 min. = 125% Observed Peak

Minimum Design Handling CapacityMimimum Design Performance Criteria

Average Departure Interval 45 seconds (or less)

Handling Capacity 100% of Expected Demand (or greater)

During peak 15 minutes of traffic, on average, an elevator from each group should depart from the main lobby (Level 2) every 45 seconds, or less.

During the peak 15 minutes of traffic, the vertical transportation groups must have available capacity to handle 100%, or greater, of the traffic demand.

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2.0 Recommendations2.1 Recommendations Matrix and Diagrams

Based on stakeholder feedback and the previously stated site observations, the design team compiled a list of possible recommended mitigation strategies illustrated in Table 4. The recommended strategies range from removing the escalators and adding elevators, upgrading existing escalators with safety improvements,

and passive design strategies to help direct traffic towards existing elevators in East Clinic.

Strategies in which escalators are not removed would require follow-up study to verify their success at mitigating the occurrence of safety incidents on escalators.

These options are illustrated within Figures 7-10 and Tables 5-7 below.

StrategiesIntervention

LevelEstimated

Design & Construction Timeline

EstimatedCost

Follow-Up StudyRequired Design Team Recommendation

OwnerDecision

$ Low:Mid:High MonthsDescription of proposed strategy. Yes:No + Explanation. Accept:Reject

Hire Greeters To Direct Users to Elevators.

$5,000Low < 3 monthsUpdate Signage TBD

$20,000Low < 3 months TBD

$20,000Low < 3 monthsElevator Lighting TBD

Maybe. Design team observed limited use of signage on site visits, however signage could be simplified with a singular “Stop” message for clarity. More permanent semi-transparent signage could also be ceiling hung at Level 1.

Maybe. While lighting may help increase the visibility of elevators, it should be combined with an additional design strategy for greater impact.

$15,000Low < 3 monthsInstall Cameras TBD

A

B

C

$304,065Mid 8 months TBD

East//Remove Escalator & Add Two Elevators $2,434,550High 18 months TBD

East//Reconfigure Entry Vestibule at Level 1*& Add Elevator Lighting

Yes. Removing the escalators entirely & adding two elevators to help manage the additional user load & average interval would eliminate the occurrence of escalator safety incidents.

Additional Strategies

Maybe. While this strategy would help direct users to elevators, it may not fully reduce the occurrence of escalator incidents.

Yes. Could help provide valuable insight into the occurrence of incidents as well as “near misses” prior to the implementation of more invasive design strategies

1

2

3

4

5

6

7

8

9

N/ALow < 3 monthsRestore Comb Lighting TBD

$8,000Low < 3 monthsColor Comb Segments TBD

N/ALow < 3 monthsRestore Step Demarcation Lighting TBD

$200,000Low < 3 monthsStep Demarcation Strips TBD

$52,000Low 4 monthsColumn Traffic Lights TBD

Pass

ive

Stra

teg

ies

Esca

lato

r Sa

fety

Imp

rove

men

ts

Yes. Existing comb lighting on escalators is currently non-functioning. While no longer a code requirement, restoring this feature would be beneficial.

Yes. Existing comb segments are an aluminum color. While it may not fully mitigate incidents, coloring comb segments to yellow would help improve their visibility.

Yes. Based on the ASME A17.1 code in effect at time of installation, step demarcation lights were likely required & included with these escalators. While no longer a code requirement, restoring this feature would be beneficial.

Yes. Adding column traffic lights at the entry & exit of each escalator would help provide greater visibility to users.

Yes. Currently, only some steps have demarcation on the sides. No steps have demarcation at the rear. Provide new escalator steps, with plastic (replaceable) demarcation strips at rear & sides of each step. Step nose may also be painted.

Cautionary Audio Message

Maybe. Audio messaging may become “white noise” to reoccurring clinic users & visitors. May not have as great of an affect as other proposed strategies.

10 N/ALow < 3 months TBD

Maybe. Design team observed security sometimes directing patients to elevators during on site visits, however a greeter advising users to utilize elevators & escalator handrails full-time may be more effective.

Yes:No + Timeframe

No

Yes at 12 months

Yes at 12 months

Yes at 12 months

Yes at 12 months

Yes at 12 months

Yes at 12 months

Yes at 12 months

No

Yes at 12 months

Yes at 12 months

Yes at 12 months

Table 4: Recommended strategies.

37


ADD ELEVATOR

ADD ELEVATOR

ELEVATORS R

ELEVATORS S

ELEVATORS P


REMOVE ESCALATOR

Figure 7: Strategy A, remove escalators and add two elevators, level 1 (below) and level 2 (above).

HOLCOMBE

ADD ELEVATOR

ADD ELEVATOR

EAST CLINIC

WEST CLINIC

REMOVE ESCALATOR

ELEVATORS R

ELEVATORS S

ELEVATORS P

38


Figure 8: Elevator design criteria breakdown for strategy A.

Table 5: Estimated cost breakdown for strategy A.

308 personsper 15 minute period

DesignedHandlingCapacity

East Lobby: two (2) groups of three (3) elevators//Elevator Banks R and S.

- Average Interval: 34.9 seconds- Handling Capacity: 154 persons


BaselineHandlingCapacity Remove Escalators / Install Two Elevator Banks 1,600 sf

General Requirements 1 ls 40,000$ 40,000$ Demo Escalators 4 ea 18,000$ 72,000$ Infill Escalator - Floor Structural Upgrades 1,600 sf 30.00$ 48,000$ Infill Escalator - Structural Slab 1,600 sf 15.00$ 24,000$ Haul/Dispose 1 ls 15,000.00$ 15,000$

Sawcut/Demo for New Elevator - 6 levels 6 floors 15,000$ 90,000$ Elevator Steel 2 shaft 150,000$ 300,000$ New Elevator 12 stop 45,000$ 540,000$ Electrical Revisions - New/Reno 1 ls 125,000$ 125,000$ HVAC Revisions 1 allow 25,000$ 25,000$ Fire Protection Revisions 1 allow 20,000$ 20,000$ Fire Alarm Revisions 1 allow 20,000$ 20,000$ Finishes 6 floors 60,000$ 360,000$

Subtotal 1,679,000$ Total w/ Markups 2,434,550$

DESCRIPTION QTY UNIT UNIT COST EXTENSION TOTAL

STRATEGY A

125% of observed peak


East Clinic


DesignedHandlingCapacity

East Lobby: two (2) groups of three (3) elevators//Elevator Banks R and S.

- Average Interval: 34.9 seconds- Handling Capacity: 154 persons


BaselineHandlingCapacity Remove Escalators / Install Two Elevator Banks 1,600 sf

General Requirements 1 ls 40,000$ 40,000$ Demo Escalators 4 ea 18,000$ 72,000$ Infill Escalator - Floor Structural Upgrades 1,600 sf 30.00$ 48,000$ Infill Escalator - Structural Slab 1,600 sf 15.00$ 24,000$ Haul/Dispose 1 ls 15,000.00$ 15,000$

Sawcut/Demo for New Elevator - 6 levels 6 floors 15,000$ 90,000$ Elevator Steel 2 shaft 150,000$ 300,000$ New Elevator 12 stop 45,000$ 540,000$ Electrical Revisions - New/Reno 1 ls 125,000$ 125,000$ HVAC Revisions 1 allow 25,000$ 25,000$ Fire Protection Revisions 1 allow 20,000$ 20,000$ Fire Alarm Revisions 1 allow 20,000$ 20,000$ Finishes 6 floors 60,000$ 360,000$

Subtotal 1,679,000$ Total w/ Markups 2,434,550$


STRATEGY A



East Clinic

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Figure 9: Strategy B, reconfigure entry vestibule at Level 1 (below) and add elevator lighting.

ACCENT LIGHTING

ELEVATORS R

ELEVATORS S

ELEVATORS P


ACCENT LIGHTING

Clearance10’

ELEVATORS R

ELEVATORS S

ELEVATORS P

WEST CLINIC

EAST CLINIC

VESTIBULE UPDATE

SECURITY DESK

ACCENT LIGHTING

ACCENT LIGHTING

22’12’

40


Table 6: Estimated cost breakdown, strategy B.

Figure 10: Strategy C, escalator safety improvements.

Reconfigure Vestibule 900 sf

General Requirements 1 ls 25,000$ 25,000$ Select Demo Existing Vestibule Walls/Doors 1 ls 10,000$ 10,000$ Haul/Dispose 1 ls 5,000$ 5,000$

New Vestibule Curtainwall 35 lf 1,120$ 39,200$ New Doors - Automatic Slider 2 ea 15,000$ 30,000$ Miscellaneous Steel Support 1 ls 20,000$ 20,000$ Concrete Patch/Repair 900 sf 10.00$ 9,000$ Electrical Revisions 1 ls 20,000$ 20,000$ Mechanical/Plumbing/Fire Protection 1 allow 20,000$ 20,000$ Finishes 900 sf 35$ 31,500$

Subtotal 209,700$ Total w/ Markups 304,065$


STRATEGY B

Strategy #3

Strategy #4Strategy #1

Strategy #2 Strategy #5Strategy #3




Strategy #2 Strategy #5

Strategy #3




Strategy #2 Strategy #5

41


Table 7: Estimated cost breakdown, strategy C.

Table 8: Estimated cost breakdown, strategy C.

STRATEGY C

1 Restore Comb Lighting* -$ *No fee, feature already included.

2 Color Comb Segments 8,000$

3 Restore Step Demarcation Lighting* -$ *No fee, feature already included.

4 Step Demarcation Strips 200,000$

5 Column Traffic Lights 52,000$

DESCRIPTION TOTAL

StrategiesIntervention

LevelEstimated

Design & Construction Timeline

EstimatedCost

Follow-Up StudyRequired Design Team Recommendation

OwnerDecision

$Low:Mid:High MonthsDescription of proposed strategy. No + Explanation. Accept:Reject

$ $ $ $ $Mid 6-8 monthsEast//Add Reception Desk In Front of Escalators

D

E

F

$ $ $ $ $High 15 monthsEast & West//Remove EscalatorsEast//Add One Elevator & Reroute Traffic TBD

$ $ $ $ $ High 18 months

East & West//Remove Escalators & Reroute Traffic

TBD

$ $ $ $ $High 14 months TBD

TBD

East//Remove Escalators & Add Elevators in Place $ $ $ $ $High 24 months

East & West//Add Narrower Escalators $ $ $ $ $High 8 months

G

H

I

K

11

TBD

TBD

$ $ $ $ $Low < 3 monthsRemove Sculpture TBD

J TBD

$ $ $ $ $Low < 3 monthsEscalators for Staff Usage Only TBD

12

13

$ $ $ $ $Low < 3 monthsEscalators for Departure Only TBD

14

$ $ $ $ $Low < 3 monthsAdd Traffic Light: Newel or Floor Plate TBD

L

$ $ $ $ $Low < 3 months TBDSlow Escalator Speed

No. While this may help mitigate the occurrence of some escalator incidents, the log also includes some incidents in the upward direction of travel.

No. These options may not be available for retrofit on the current escalator models.

No. Design team recommends the addition of twoelevators to accommodate user loads, unless appropriate operational protocols are followed to reroute some traffic to West Clinic. Owner does not want reroute traffic at this time.

No. Design team recommends this strategy due to ease of implementation, but it comes with considerable traffic rerouting to West Clinic. Owner does not want reroute traffic at this time.

No. Design team recommends this strategy due to ease of implementation, but it comes with considerable traffic rerouting to West Clinic. Owner does not want reroute traffic at this time.

No. While this may help mitigate the occurrence of some escalator incidents, the log also includes staff incidents.

No. Design team analyzed this option & concluded it is not feasible without great cost & site intervention/interruption.

No. After analyzing lobby & escalator clearances in East Clinic, design team concluded this option is infeasible without considerable investigation into the current lobby & vestibule configuration

No. While this strategy seems to have success in other campus locations based on staff perceptions, owner does not want to explore this option at this time.

No. Owner does not want to explore this option at this time.

No. This is not a code compliant strategy & is only used to conserve energy when the escalator is not in use.

Yes:No + Timeframe

No

No

Yes at 12 months

Yes at 12 months

Yes at 12 months

Yes at 12 months

Yes at 12 months

Yes at 12 months

N/A

Yes at 12 months

No

East//Remove Escalators & Fill-In Floors with Additional Program $ $ $ $ $High 18 months

No. Owner to consider options presented but currently, this strategy is outside the parameters of this study.No

East & West//Remove Escalators & Add Grand Stairs $ $ $ $ $High 14 months

No. Design team does not recommend adding staircases in place of escalators due to research pointing to a potential increase in safety incidents.No TBD

East & West//Remove EscalatorsWest//Add Two Elevators & Reroute Traffic

2.2 Not Recommended Strategies Matrix

During this study, several design strategies were considered and recommended by the owner, design or

consultant teams. Table 8 illustrates the strategies that were not recommended at this time for various reasons.

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2019 ― Volume 11.02Research Journal

3.0 Relevant Research and Clinic Application3.1 Escalator Risk Factors

According to an analysis of outpatient falls conducted by Nagoya University Hospital in Nagoya, Japan, researchers found that escalators were the second greatest risk location for fall incidents within the hospital—comprising 10 percent of all outpatient falls in the year 20182. Older adults bear the greatest risk: according to another study on escalator safety, researchers found that the number of escalator-related injuries suffered by older adults more than doubled, resulting in nearly 40,000 elders being injured on escalators between 1991 and 20063. Balance issues, vision issues with moving floors, lack of edge contrast on escalator stairs, and difficulty stepping on and off escalators were all factors associated with the increase of escalator incidents in older populations4. While the studied outpatient clinic serves a variety of patient populations, the design team observed that many visitors seemed to be adults between 40-75 years of age.

As previously stated, an average of 68 percent of users exhibited one or more risk behaviors while utilizing the studied outpatient clinic escalators, possibly contributing to the increased incidence of escalator events within the clinic. One way to minimize the risk of falling (either the likelihood of falling, or the severity of outcome in case of a fall) is to hold onto escalator

handrails. Previous research study found that handrails are often not used on escalators4. The study observed 83 people at a set of commercial mall escalators, and found that over 25 percent of users did not hold either handrail while ascending, and over 40 percent did not hold either handrail while descending escalators. Additionally, less than 20 percent held both handrails while ascending, and less than 80 percent held both while descending. The study concluded that it is generally difficult to change consumer behavior through safety information such as signs, although explicit or implied enforcement may be enough to increase compliance for handrail usage4. While the design team recommended some operational strategies to help enforce safer escalator usage amongst clinic visitors (e.g. hiring a greeter or marshal), these strategies would need a follow-up assessment to test their impact on decreasing safety incidents.

3.2 Escalators vs Stairs Safety Statistics

If escalators were removed, the design team recommends adding elevators and infilling the residual space instead of adding stairs. Figure 11 illustrates a compilation of safety statistics for both escalators and stairs—highlighting the heightened risk stairs could bring to the outpatient clinic. While these statistics are not specific to healthcare environments, they provide insight into how stairs could potentially increase the occurrence of safety incidents.

Figure 11: Stairs vs. Escalator safety statistics.

1,077,558 patients treated in emergency departments for stair-related injuries annually⁵

Annually, there are 12,000 deaths from stair-related accidents⁶

- 93.8% are treated and released⁵- 5.7% of patients are further hospitalized⁵- 61.2% of incidents occur in the home⁵- 7.9% of incidents happen outside the home⁵- 30.9% of incidents – location is not specified⁵- The rate of injuries is 37.8 injuries per 10,000 persons⁵

Stair Statistics Escalator StatisticsThere are an estimated 35,000 escalators in operation in the U.S.

- Annually, there are 7,000 – 11,000 escalator-related injuries in the U.S. resulting in a trip to the emergency department.¹,⁷- 8% of escalator related injuries result in further hospitalization after evaluation in an emergency department⁸- The average rate of incidents is 0.221 accidents per escalator, annually¹- The rate of injuries is 0.362 injuries per 10,000 persons¹,⁷

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4.0 ConclusionWhile escalators may be an efficient mode of vertical transportation within buildings, their application in healthcare environments should be carefully considered. There are approximately 10,000 escalator injuries that take place on the 35,000 escalators in the United States each year—compared with the 900,000 elevators in the United States with a total number of 7,000 injuries9,1. While over-capacity elevators and mechanical failings can present a danger, the lack of human error on elevators solidifies them as the safest vertical transportation option—especially in healthcare environments. Since humans come into direct contact with an escalator's moving parts, it is much easier to become accidentally injured as a result; coupled with improper use as well as heightened risk factors associated with older populations and users with diminished physical capabilities, escalators will continue to pose a risk to users.

AcknowledgmentsThe authors would like to acknowledge individuals and organizations who contributed knowledge and expertise in the different areas explored in this article: Lerch Bates, Jeff Ainsley, Mike Thompson, Project Cost Resources, and Robert Hansen.

References[1] McCann, M., (2013). “Deaths and Injuries Involving Elevators and Escalators”, The Center for Construction Research and Training, Retrieved on 10/2019 from https://www.cpwr.com/sites/default/files/publications/elevator_escalator_BLSapproved_2.pdf.

[2] Kobayashi, K., Ando, K., Suzuki, Y., Inagaki, Y., Nagao, Y., Ishiguro, N., and Imagama, S., (2018). “Characteristics of Outpatient Falls that Occurred in Hospital”, Nagoya Journal of Medical Science, Vol. 80, No. 3, pp. 417-422.

[3] O’Neil, J., Gregory K., Steele, C., and Smith, G., (2008). “Escalator-Related Injuries among Older Adults in the United States, 1991-2005”, Accident Analysis & Prevention, Vol. 40, No. 2, pp. 527-533.

[4] Ayres, T., and Schmidt, R., (2008). “Age-Related Risk Patterns for Escalators”, Report, Retrieved on 10/2019 from http://hp-research.com/sites/default/files/publications/Ayres & Schmidt (2008, CybErg).pdf.

[5] Blazewick, D., Chounthirath, T., Hodges N., Collins C., and Smith, G., (2018). “Stair-Related Injuries Treated in United States Emergency Departments”, American Journal of Emergency Medicine, Vol. 36, No. 4, pp. 608-614.

[6] Myers, A., (2019). “Stairway Injuries: Safety Statistics & Causes”, Retrieved on 10/19 from https://attorney-myers.com/2016/02/stairway-injuries/.

[7] Unites States Consumer Product Safety Commission, (2019). “Know the Steps to Safety When Using Escalators”, Retrieved on 10/19 from https://www.cpsc.gov/Newsroom/News-Releases/2008/Know-the-Steps-to-Safety-When-Using-EscalatorsSome-shoes-more-likely-than-others-to-pose-risk.

[8] Indiana University, (2008). “Rate of Escalator Injuries to Older Adults Has Doubled”, Retrieved on 10/19 from https://www.sciencedaily.com/releases/2008/03/080313110337.htm

[9] Schminke, L., Jeger, V., Evangelopoulos, D., Zimmerman, H., and Exadaktylos, A., (2013). “Riding the Escalator: How Dangerous is it Really?”, Western Journal of Emergency Medicine, Vol. 14, No. 2, pp. 141-145.

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