Pedestrian injuries from falls versus motor vehicle collisions: are we lacking critical policy and interventions?

Using Emergency Medical Services (EMS) data, researchers compared the national burden of pedestrian injuries from motor vehicles to that of pedestrian falls occurring on streets and sidewalks and found that the probability of a pedestrian suffering a severe injury is higher for motor vehicle collisions as compared to falls.   Yet, the public health burden of the number of pedestrians injured from a fall – severe or otherwise - is significantly higher compared to the number of pedestrians injured by a motor vehicle collision. This is particularly true for individuals 50 years of age or older. The results of this work are published in the Journal of Urban Health.

What the researchers say: “There has been substantial and appropriate policy attention given to preventing pedestrian injuries from motor vehicles.  But the population burden of injurious pedestrian falls is greater than that from pedestrians injured by motor vehicles and justifies an increased focus on outdoor falls prevention,” said the study’s lead author. “With the vast majority of injury occurring in urban spaces, this suggests that urban design, policy, and built environment interventions are important tools for reducing pedestrian fall related morbidity and are much needed compared to what currently exists in the U.S.”

Thirty-two percent of pedestrians struck by motor vehicles were classified as having an Emergent or Critical condition by the EMS clinician, while 19 percent of pedestrians injured by falls were similarly recorded. However, the number of pedestrian fall-patients who were classified as having an Emergent or Critical condition was twice as high as the number of pedestrians injured by motor vehicles who had an Emergent of Critical injuries.  Among pedestrians aged 50 years or older, the number of pedestrians whose condition was coded as Emergent or Critical was 3.9 times as high for injurious falls as compared with pedestrians-motor vehicle collisions.

“The overall number of older pedestrians who fell and required EMS responses is alarming, especially the proportion determined to have critical and life-threatening injuries on scene by EMS,” the researchers noted.

Until now pedestrian injuries from falls were an understudied cause of morbidity with little focus on interventions to prevent injurious pedestrian falls that occur on streets and sidewalks. Classical falls prevention guidelines from organizations such as the American Geriatric Society and the Society of Orthopedic Surgeons among other agencies, have focused on in home falls and person-level factors and omitted the environment beyond the individual’s home.

The researchers analyzed data from Emergency Medical Services response records with pedestrian and incident characteristics, identified in the 2019 National Emergency Medical Services Information System database, the most recent NEMSIS dataset available prior to the COVID-19 pandemic. The largest repository of EMS records in the U.S., it contains data for more than 34 million events from over 10,000 EMS agencies, including data on injurious falls, and includes information on the severity of the injuries, the medical disposition of these patients, and sociodemographic characteristics of the patients.

“Our objective was to use a single national data collection system, NEMSIS, to compare the burden of pedestrian injuries from motor vehicles to that of pedestrian falls occurring on streets and sidewalks that resulted in an EMS encounter,” the lead researcher told us. Among the EMS encounters, 118,520 pedestrian falls and 33,915 pedestrian-motor vehicle collisions were identified within the dataset.  

Whether falls are associated with a previous disease or injury, they are nonetheless associated with significant numbers of ED visits and hospitalizations and subsequent decline in functional status -all strong predictors for future falls and consequently, future hospitalizations, both of which hasten the decline in mobility or function.

“There has been much less policy attention given to the public health issue of pedestrian falls than to preventing pedestrian injuries from motor vehicles,” the researchers observed. “We argue that this likely arises from differences in who is responsible for, and who pays for, sidewalk (property owners) and road (local government) maintenance. We also note a lack of robust surveillance systems for monitoring pedestrian falls occurring on sidewalks. And without such systems, it is difficult to understand the burden of falls and motivate the development of prevention programs or prioritize interventions programs to high-risk areas.”

“Creating urban environments that support the health and engagement of older persons is becoming increasingly important as populations age,” the researchers concluded. They suggest that new approaches are required that span all aspects of age-friendly design. “Future studies should examine the health outcomes of these patients, including the extent of their injuries, rate of hospital admissions from the ED, and the expected healthcare needs. Without this information, we are at a loss to clarify the public health, clinical, and social impacts of pedestrian falls in these environments.”

So, what? Almost nothing in our society, our home or the way we work was devised according to human design-specs. One of the reasons for this is that we weren’t really aware of what they were until recently, and even those aspects of them that were obvious - e.g. people over 50 fall more frequently than those that are under that age - were ignored for the sake of convince, the cost of allowing for the problem, or the loss of profit that a refit might entail.

We were designed to live in an environment where falls were much less consequential. Falling on savannah grass or soil is much less of a problem than falling on concrete. Also, that environment had many more natural things to hold on to.

Cities are not natural to us, tall buildings, hard surfaces and cars are not what we were designed for - no matter what age we are. As the present researchers - and many others - have noted we need to allow for more green and blue spaces, reduce the size of our buildings, increase the number of things - like railings, or posts - that people can hold on to and separate cars from people.