ArticlePDF Available

Escalator-related Injuries in Children

Authors:

Abstract and Figures

Escalator-related trauma is uncommon but can cause significant injury. This study reviewed escalator-related injuries in children to determine risk factors, types of injuries, medical interventions, and long-term outcomes. Retrospective clinical patient series, Municipal Hospital Pediatric Emergency Service. Participants. All children less than 18 years of age who presented to the Pediatric Emergency Service with an escalator-related injury from August 1990 through February 1995. We reviewed the chart and interviewed the parent of each child by telephone. We collected the following information: age, gender, child's supervision and activity while on the escalator, escalator location, direction of motion, presence of escalator defects, nature and extent of injury, medical interventions, and outcome. Twenty-six children had escalator-related injuries. The average age was 6 years (range, 2-16). Thirteen children (50%) were 2 to 4 years old. There were 15 (57%) boys. Eighteen children (69%) were accompanied by an adult. All children 7 years and younger were accompanied by an adult; however, 50% were not holding the hand of their guardian. Eight children (31%) were injured while riding improperly, ie, walking, running, playing, or sitting on the escalator, and among these, all who were standing fell down before the injury. Six (23%) children were injured while stepping off the escalator. Of 9 children less than 4 years old, 7 (78%) were riding the escalator properly. Of 9 children 4 years or older, only 3 (33%) were riding properly. Circumstances of injury included falling down with subsequent blunt trauma, falling down with subsequent entrapment of an extremity, and entrapment of an extremity not related to falling down. Locations of entrapment were between two steps, between a step and the side-rail, and between the last step and the comb plate. Twenty-one (81%) injuries occurred in rail or subway stations. Eight escalators were reported to have functional or structural problems. Seventeen (65%) children sustained lower extremity injuries and 8 (31%) sustained upper extremity injuries. Injuries included lacerations, avulsions and degloving injuries of the extremities, tendon and nerve lacerations, and digit fractures and amputations. Thirteen (50%) children were admitted to the hospital for operative management; the average length of hospitalization was 13 days (range 1-29). Four children (15%) suffered significant functional loss, and 12 (46%) sustained permanent cosmetic deformities. Children are at risk for sustaining severe injuries on escalators. Young age, inadequate adult supervision, improper activity while riding on the escalator, and escalator-related mechanical problems all increase the risk of injury. Public and parent education directed toward escalator safety issues may help to reduce escalator-related injuries in children.
Content may be subject to copyright.
DOI: 10.1542/peds.100.2.e2
1997;100;e2 Pediatrics
Shari L. Platt, Jeffrey S. Fine and George L. Foltin
Escalator-related Injuries in Children
http://www.pediatrics.org/cgi/content/full/100/2/e2
located on the World Wide Web at:
The online version of this article, along with updated information and services, is
reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
Village, Illinois, 60007. Copyright © 1997 by the American Academy of Pediatrics. All rights
trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove
andpublication, it has been published continuously since 1948. PEDIATRICS is owned, published,
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
by on September 21, 2010 www.pediatrics.orgDownloaded from
Escalator-related Injuries in Children
Shari L. Platt, MD, FAAP; Jeffrey S. Fine, MD, FAAP, ABMT; and George L. Foltin, MD, FAAP, FACEP
ABSTRACT. Objective. Escalator-related trauma is
uncommon but can cause significant injury. This study
reviewed escalator-related injuries in children to deter-
mine risk factors, types of injuries, medical interven-
tions, and long-term outcomes.
Design and Setting. Retrospective clinical patient se-
ries, Municipal Hospital Pediatric Emergency Service.
Participants. All children less than 18 years of age
who presented to the Pediatric Emergency Service with
an escalator-related injury from August 1990 through
February 1995.
Methods. We reviewed the chart and interviewed the
parent of each child by telephone. We collected the fol-
lowing information: age, gender, child’s supervision and
activity while on the escalator, escalator location, direc-
tion of motion, presence of escalator defects, nature and
extent of injury, medical interventions, and outcome.
Results. Twenty-six children had escalator-related in-
juries. The average age was 6 years (range, 2–16). Thirteen
children (50%) were 2 to 4 years old. There were 15 (57%)
boys. Eighteen children (69%) were accompanied by an
adult. All children 7 years and younger were accompa-
nied by an adult; however, 50% were not holding the
hand of their guardian. Eight children (31%) were injured
while riding improperly, ie, walking, running, playing,
or sitting on the escalator, and among these, all who were
standing fell down before the injury. Six (23%) children
were injured while stepping off the escalator. Of 9 chil-
dren less than 4 years old, 7 (78%) were riding the esca-
lator properly. Of 9 children 4 years or older, only 3 (33%)
were riding properly. Circumstances of injury included
falling down with subsequent blunt trauma, falling
down with subsequent entrapment of an extremity, and
entrapment of an extremity not related to falling down.
Locations of entrapment were between two steps, be-
tween a step and the side-rail, and between the last step
and the comb plate. Twenty-one (81%) injuries occurred
in rail or subway stations. Eight escalators were reported
to have functional or structural problems.
Seventeen (65%) children sustained lower extremity
injuries and 8 (31%) sustained upper extremity injuries.
Injuries included lacerations, avulsions and degloving
injuries of the extremities, tendon and nerve lacerations,
and digit fractures and amputations. Thirteen (50%) chil-
dren were admitted to the hospital for operative manage-
ment; the average length of hospitalization was 13 days
(range 1–29). Four children (15%) suffered significant
functional loss, and 12 (46%) sustained permanent cos-
metic deformities.
Conclusion. Children are at risk for sustaining severe
injuries on escalators. Young age, inadequate adult su-
pervision, improper activity while riding on the escala-
tor, and escalator-related mechanical problems all in-
crease the risk of injury. Public and parent education
directed toward escalator safety issues may help to re-
duce escalator-related injuries in children. Pediatrics
1997;100(2). URL: http://www.pediatrics.org/cgi/content/
full/100/2/e2; escalator, injury, child.
ABBREVIATIONS. PES, Pediatric Emergency Service; CPSC, Con-
sumer Product Safety Commission.
E
scalator-related trauma is uncommon but can
cause significant injury. After evaluating sev-
eral children with escalator-related injuries in
our pediatric emergency service, we became inter-
ested in investigating this unusual mechanism of
injury.
There are a number of case reports of escalator
injuries in children,
1–7
and one large series that in-
cludes three children.
8
In addition, a small number of
cases have been reported to the National Pediatric
Trauma Registry.
9
These reports suggest that
younger children are more frequently injured than
older children, that injuries occur when the child is
riding the escalator improperly, and that injuries
generally involve the hand, foot, or head.
We studied escalator-related injuries in children
with respect to mechanisms and extent of injury,
medical interventions required, and long-term out-
come. Our goal is to use this information to inform
and educate both health care personnel and parents
about escalator-related trauma to prevent further
injuries.
STUDY DESIGN
Bellevue Hospital is a municipal hospital serving a predomi-
nantly inner-city population in New York City and is a Level I
Trauma Center. The Pediatric Emergency Service (PES) sees 25 000
children annually. We reviewed the logs of visits to the PES from
August 1990 through February 1995. Children under the age of 18
years who sustained an escalator-related injury were included in
this study. We reviewed the medical chart for each patient and
abstracted the following historical information: age, gender,
child’s supervision and activity while on the escalator, escalator
location, direction of escalator motion, presence of escalator de-
fects, nature and extent of injury, medical interventions, and out-
come. In addition, we interviewed each child’s parent by tele-
phone to review the events surrounding the injury and to collect
additional information. Although all parents were contacted,
some information was unavailable either because the parent could
From the Department of Pediatrics, New York University School of Medi-
cine and the Pediatric Emergency Service, Bellevue Hospital Center, New
York, New York.
Poster presentation at the 35th Annual Meeting of the Ambulatory Pediatric
Association, San Diego, California, May 11, 1995.
Abstract published in Archives of Pediatric Adolescent Medicine (1995;149:92).
Received for publication Sep 16, 1996; accepted Feb 13, 1997.
Reprint requests to (S.L.P.) Bellevue Hospital Center, Department of Pedi-
atrics, New Bellevue, Room 1-South-6, First Ave and 27th St, New York, NY
10016.
PEDIATRICS (ISSN 0031 4005). Copyright © 1997 by the American Acad-
emy of Pediatrics.
http://www.pediatrics.org/cgi/content/full/100/2/e2 PEDIATRICS Vol. 100 No. 2 August 1997 1of5
by on September 21, 2010 www.pediatrics.orgDownloaded from
not remember certain details of the event or because the parent
was not actually with the child at the time of the event.
RESULTS
Epidemiology
Twenty-six children with escalator-related injuries
were identified. The average age was 6 years (range,
2–16; median 4.0 years). Thirteen children (50%)
were 2 to 4 years old, 4 (15%) were 4 to 7 years old,
4 (15%) were 7 to 11 years old, and 5 (20%) were 11
to 16 years old. There were 15 (57%) boys. There was
no difference in age between boys and girls.
Eighteen children (69%) were accompanied by
adults, 3 teenagers (11%) were accompanied by
friends, 1 5-year-old (4%) was accompanied by his
13-year-old sibling and 1 13-year-old (4%) was alone.
Information regarding accompaniment of three chil-
dren (12%) was unavailable. Of 12 children 7 years
old or younger for whom information is available, 6
(50%) were not holding the hand of their guardian
while on the escalator. Four of these children (67%)
fell before their injury.
Ten (38%) children were injured while riding
properly (standing and facing forward) on the es-
calator. Six of these children (60%) fell before their
injury. Eight children (31%) were injured while
riding the escalator improperly, ie, walking, run-
ning, playing, sitting, kneeling to tie a shoelace or
facing backwards, and all fell down before the
injury except for the 2 children already sitting or
kneeling. Six children (23%) were injured while
stepping off the escalator. The activity of 2 children
(8%) is unknown. Of the 18 children who were
injured while riding on the escalator, ie, not step-
ping off, and whose activity was known, 9 were
younger than 4 years and 9 were 4 years of age or
older. Among the younger age group, 7 (78%) were
riding properly, while among the children 4 years
and older, only 3 (33%) were riding properly. The
age varied for the 6 children injured while step-
ping off the escalator.
There were three types of injury events: 1) falling
down with subsequent blunt trauma, seen in 5 chil-
dren (19%), 2) falling down with subsequent entrap-
ment of an extremity, seen in 2 children (8%) and 3)
entrapment of an extremity not related to falling
down, seen in 11 children (42%). For 8 children (31%)
this information is incomplete. Of the 13 children
who suffered injury due to entrapment of an extrem-
ity, locations of entrapment were between two steps
in 2 children (15%), between a step and the side-rail
in 3 children (23%), and between the last step and the
comb plate (the metal plate at the end where the last
step slides in) in 8 children (62%).
Twenty-one injuries (80%) occurred in rail, bus, or
subway stations, 3 (12%) occurred in department
stores, 1 (4%) occurred in an office building, and 1
(4%) occurred at school. The escalator was going up
in 11 (42%) cases.
Structural escalator defects or malfunctions were
reported in 8 cases (31%) including step malfunction,
missing parts, or sudden stops. These 8 children had
a mean age of 9.1 years and 6 (75%) were riding
properly or stepping off.
Medical Data
The mechanism of injury was generally cutting,
tearing, or crushing. Seventeen children (65%) sus-
tained lower extremity injuries and 8 (31%) sustained
upper extremity injuries. Thirteen (50%) children
were admitted to the hospital for operative manage-
ment. The average length of hospitalization was 13
days (range, 1–29). Twelve hospitalized children
(92%) sustained severe lacerations, avulsions or de-
gloving injuries of the extremities, 3 (23%) sustained
tendon lacerations, and 2 (15%) sustained nerve lac-
erations. Five hospitalized children (38%) sustained
digit dislocations or fractures, and 2 (15%) had mul-
tiple digit amputations. Children who were dis-
charged from the emergency department sustained
minor lacerations, contusions or abrasions. One child
fell and fractured a tooth and 1 had a fingertip avul-
sion and fracture.
At the time of follow-up, 4 children (15%) had
significant functional loss, such as persistent abnor-
mal hand function or limp. Twelve (46%) sustained
permanent cosmetic deformities.
CASE REPORTS
Case A
A2
1
2
year old boy, was accompanied by his par-
ents and 1-year-old sibling. After stepping onto a
down-escalator located in a municipal office build-
ing, his father released the child’s hand and the child
fell. His leg was caught between the escalator step
and the side-rail.
The child sustained a 15-cm degloving injury to
the left calf (Fig 1). There were no fractures and
vascular function remained intact. Operative man-
agement included irrigation and debridement, su-
perficial peroneal nerve repair, and wound closure.
Although he was discharged after 2 days in the hos-
pital, he was readmitted for wound infection and
necrosis. A skin graft was performed and he was
discharged after 14 days. At follow-up the child had
a viable skin graft and was ambulating normally.
Case B
A 9-year-old boy, accompanied by his father, was
riding an up-escalator located in a subway station.
The escalator was reported to be missing a piece of
the comb plate creating a large gap. The patient’s
foot became entrapped in the escalator just before
stepping off. The escalator was stopped and required
disassembly to extricate the foot.
The child sustained an extensive plantar avulsion
of the left foot with open fractures of the first and
second metatarsal shafts, dislocation of the fifth
metatarsal-phalangeal joint, and crush injury of the
third metatarsal head. Open reduction and internal
fixation and skin grafting were performed (Fig 2 and
Fig 3). The child was hospitalized for 26 days, and
convalesced at home for more than 1 month after
discharge. At follow-up, the foot remained deformed
with abnormal function.
DISCUSSION
There is little information in the medical literature
about escalator-related injuries in children. Over the
2of5 ESCALATOR-RELATED INJURIES IN CHILDREN
by on September 21, 2010 www.pediatrics.orgDownloaded from
26 years covered by the on-line Index Medicus, there
are 25 case reports of children injured on escala-
tors.
1–8
Of 32 754 injuries recorded by the National
Pediatric Trauma Registry between 1988 and 1992,
only 18 were escalator-related.
9
The Consumer Prod-
uct Safety Commission (CPSC) reported that 7300
escalator-related injuries were treated in emergency
departments in 1994.
10
It is apparent that, although uncommon, signifi-
cant injuries can occur to children while riding on
escalators. The most serious escalator-related injuries
we observed were degloving injuries of an extremity
with extensive soft tissue damage. There were also
many neurovascular, tendon, and digit injuries.
These injuries frequently required operative man-
agement and many resulted in functional or cosmetic
deformity. Head and facial trauma may also occur
after falling while riding an escalator.
Murphy and Moore
8
reviewed 50 patients who
sustained escalator-related trauma. Their conclu-
sions about a primarily adult population were that
escalator-related injuries were associated with alco-
hol consumption, age over 70 years, and walking on
a moving escalator.
In our review we tried to gain further insight into
the epidemiology of escalator-related injuries in chil-
dren and the behavioral factors that may play a role.
There was no apparent relationship of gender to
injury. Younger children were more likely to be in-
jured while riding escalators properly, usually after
falling down. Lack of supervision and hand-holding
may have been causative factors for the initial fall.
Older children were more frequently injured when
riding the escalator improperly, ie, while playing,
running, or walking, because these activities led to
falls. According to the CPSC, 75% of reported esca-
lator-related injuries are attributable to falls.
10
Stairs
are a common site for fall-related injuries in tod-
dlers.
11,12
It is not surprising, then, that young chil-
dren should have difficulty with moving stairs.
Fig 1. Case A. Degloving injury to the
calf in a 2
1
2
-year-old boy, due to entrap-
ment between the escalator step and the
side-rail.
Fig 2. Case B. Plantar avulsion of the
foot with metatarsal fracture and dislo-
cation in a 9-year-old boy, due to en-
trapment between the escalator step
and the comb plate while stepping off
the escalator. Intraoperative view.
http://www.pediatrics.org/cgi/content/full/100/2/e2 3of5
by on September 21, 2010 www.pediatrics.orgDownloaded from
In our series, the action of stepping off the escala-
tor was also associated with an increased risk of
injury. Young children may remain standing on the
escalator and allow their feet to slide off at the end,
instead of actually stepping off. The small size of a
child’s foot might increase the risk of it slipping into
the gap where the last step slides into the comb plate.
While stepping off an escalator may seem like a
simple and natural task to an adult, the developmen-
tal level of young children limits their ability to both
anticipate and coordinate this action. In addition to
feet becoming entrapped during the process of step-
ping off, children’s small extremities may become
lodged between two steps or between a step and the
side-rail. According to the CPSC, 20% of recorded
injuries occur when hands, feet, or shoes become
entrapped.
10
Structural or mechanical escalator defects may also
contribute to injuries, especially in older children
who are riding properly. Escalator direction was not
related to the injury. Escalators in rail and subway
stations were most frequently associated with injury
in our sample. Contributing factors may be high
volume, poor lighting, or an insufficient number of
caution signs located on subway station escalators.
Seven of eight escalators that were reported to have
structural defects were located in rail and subway
stations.
There are several limitations to this retrospective
review. Some cases may have been missed. Parents
were interviewed to obtain additional details and
their recall may have been inaccurate or biased.
Some parents did not actually witness the exact
mechanism of injury, since it “all happened so fast.”
There may have been some ascertainment bias in this
series because Bellevue Hospital is a regional Micro-
vascular Surgery and Limb Reimplantation referral
center and it is possible that we had an inordinate
number of serious injuries triaged here from the
field. Minor injuries may have been triaged to other
institutions or may not have led to any medical eval-
uation whatsoever. Nonetheless, most of the patients
were transported by prehospital providers from
within our usual geographic catchment area. An-
other limitation is that the true injury risk cannot be
calculated because the total number of children
riding escalators (the denominator) is unknown. Ad-
ditionally, we do not know the frequency with which
children ride particular escalators. Although rail and
subway stations were identified as the most common
site for injury, it may be that escalators in these
locations were more frequently utilized by children.
Finally, the small sample size may limit our ability to
generalize our conclusions; however, this is the larg-
est single series of pediatric escalator injuries re-
ported to date.
In conclusion, children are at risk for sustaining
severe injuries while riding on escalators. Until
health care personnel and parents become aware of
these injuries, we cannot hope to prevent them. Pre-
vention of escalator-related injuries should be a pri-
mary goal and efforts should be focused in two di-
rections. Anticipatory guidance regarding injury
prevention should include information about riding
on escalators. Primary care providers can encourage
increased parental supervision, such as hand-hold-
ing or even carrying of young children while riding
on and especially while stepping off escalators. Chil-
dren should be taught not to run, play, or sit while
riding on an escalator. Children should face forward
and hold the handrails. In addition, education can
take place in other venues. The New York City Tran-
sit Authority promotes escalator safety through an
educational campaign that includes elementary
school programs, improved escalator safety caution
signs and posters, and distribution of safety litera-
ture. One organization, The Elevator Escalator Safety
Foundation, has developed a school-based education
program to promote escalator and elevator safety.
13
The CPSC has issued a “Safety Alert” regarding es-
calators (Fig 4).
10
Passive preventive efforts may have greater bene-
Fig 3. Case B. The same foot as in
Fig 2, after repair and skin graft pro-
cedure.
4of5 ESCALATOR-RELATED INJURIES IN CHILDREN
by on September 21, 2010 www.pediatrics.orgDownloaded from
fit than behavioral recommendations. Improved de-
sign and maintenance may reduce escalator-related
injuries. Regulations must ensure frequent inspec-
tion and appropriate escalator function. Improved
lighting and warning signs, painted borders on steps
and easily accessible emergency shut-off buttons
may also aid in injury prevention. The American
Society of Mechanical Engineers/American National
Standards Institute Escalator Committee have issued
voluntary standards for safe escalator function and
maintenance.
14
Central reporting of escalator injuries
may serve to better delineate risk factors for injury
and identify problem escalators.
REFERENCES
1. Kates A. A tragic moving-staircase mishap. Lancet. 1968;1:365. Letter
2. Reid DA. Escalator injuries. Lancet. 1968;1:473. Letter
3. Reid DA. Escalator injuries of the hand. Injury. 1973;5:47–50
4. Choovoravech N, Choovoravech P. Escalator injuries in Thai children.
J Med Assoc Thailand. 1975;58:442– 444
5. Kabelka M. Injuries of children sustained on moving escalators. Rozhl
Chir. 1982;4:212–214
6. Wells JJ, et al. Correspondence. Am J Dis Child. 1986;140:507–508
7. Bleyer WA. Escalator injuries in foreign countries. Am J Dis Child.
1987;141:14–15
8. Murphy JP, Moore FP. Escalator injuries. Injury. 1992;23:336–338
9. National Pediatric Trauma Registry, Boston, MA: 1988–1992
10. US Consumer Product Safety Commission. Escalator Safety Alert. Wash-
ington, DC: US Consumer Product Safety Commission; CPSC Docu-
ment No. 5111
11. Chiaviello CT, Christoph RA, Bond GR. Stairway-related injuries in
children. Pediatrics. 1994;94:679681
12. Joffe M, Ludwig S. Stairway injuries in children. Pediatrics. 1988;82:
457–461
13. Elevator/Escalator Safety Foundation, Mobile, AL
14. Safety Code for Elevators and Escalators. Standard A17.1–1996. New York,
NY: American Society of Mechanical Engineers; 1996
Fig 4. Recommendations adapted from CPSC Escalator Safety
Alert.
10
http://www.pediatrics.org/cgi/content/full/100/2/e2 5of5
by on September 21, 2010 www.pediatrics.orgDownloaded from
DOI: 10.1542/peds.100.2.e2
1997;100;e2 Pediatrics
Shari L. Platt, Jeffrey S. Fine and George L. Foltin
Escalator-related Injuries in Children
& Services
Updated Information
http://www.pediatrics.org/cgi/content/full/100/2/e2
including high-resolution figures, can be found at:
References
http://www.pediatrics.org/cgi/content/full/100/2/e2#BIBL
This article cites 6 articles, 2 of which you can access for free at:
Citations
http://www.pediatrics.org/cgi/content/full/100/2/e2#otherarticles
This article has been cited by 3 HighWire-hosted articles:
Subspecialty Collections
http://www.pediatrics.org/cgi/collection/office_practice
Office Practice
following collection(s):
This article, along with others on similar topics, appears in the
Permissions & Licensing
http://www.pediatrics.org/misc/Permissions.shtml
tables) or in its entirety can be found online at:
Information about reproducing this article in parts (figures,
Reprints
http://www.pediatrics.org/misc/reprints.shtml
Information about ordering reprints can be found online:
by on September 21, 2010 www.pediatrics.orgDownloaded from
... Such studies are often based on MRT escalator accidents. The second group focuses on describing the epidemiology of escalator-related injuries [9][10][11][12][13][14] by using data from hospitals. The characteristics of passengers, such as gender, age, and health status, are of interest to these researchers. ...
... Alcohol intoxication and age are significant risk factors in escalator accidents. Other studies have focused on children [9,11]. However, an epidemiological database alone cannot guide the safety manager in solving the safety problems it uncovers. ...
Full-text available
Article
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.
... In several studies, children have been reported to be a particularly vulnerable population. [5][6][7] Children may remain standing on the escalator and try to 'slip off', instead of stepping off. This can result in entrapment of the feet within the gap where the last plate slides into the comb plate. ...
... 5 Platt et al reported that escalator injuries were most common in children aged 2-4 years. 6 In contrast, in a recent study conducted in China, elderly passengers accounted for the highest proportion of all ERIs (49.1%). 1 In Taiwan, Chi et al reported that 50.5% were sustained by people over 65 years of age. 8 In our study, the majority of the injured individuals were over 50 years old. ...
Full-text available
Article
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.None.
... In several studies, children have been reported to be a particularly vulnerable population. [5][6][7] Children may remain standing on the escalator and try to 'slip off', instead of stepping off. This can result in entrapment of the feet within the gap where the last plate slides into the comb plate. ...
... 5 Platt et al reported that escalator injuries were most common in children aged 2-4 years. 6 In contrast, in a recent study conducted in China, elderly passengers accounted for the highest proportion of all ERIs (49.1%). 1 In Taiwan, Chi et al reported that 50.5% were sustained by people over 65 years of age. 8 In our study, the majority of the injured individuals were over 50 years old. ...
Full-text available
Article
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.
... Escalator-related injuries have been studied by many scholars, most of the studies [21,22,30,[32][33][34] have analyzed the characteristics of injuries and the statistical laws of age, gender and other aspects of the injured group from the perspectives of statistics and human-induced engineering. Platt et al. [26] is one of the scholars who first paid attention to escalator-related injuries. They emphatically reviewed the escalator-related injuries of the children and found that without guardian care, improper use of escalator and mechanical failure of escalators would significantly increase the probability of children being injured on escalators. ...
Full-text available
Article
Escalator-related injuries threaten public health with the widespread use of escalators. The existing studies tend to focus on after-the-fact statistics, reflecting on the original design and use of defects to reduce the impact of escalator-related injuries, but few attention has been paid to ongoing and impending injuries. In this study, a multi-module escalator safety monitoring system based on computer vision is designed and proposed to simultaneously monitor and deal with three major injury triggers, including losing balance, not holding on to handrails and carrying large items. The escalator identification module is utilized to determine the escalator region, namely the region of interest. The passenger monitoring module is leveraged to estimate the passengers’ pose to recognize unsafe behaviors on the escalator. The dangerous object detection module detects large items that may enter the escalator and raises alarms. The processing results of the above three modules are summarized in the safety assessment module as the basis for the intelligent decision of the system. The experimental results demonstrate that the proposed system has good performance and great application potential.
... Los niños mayores se lesionan con más frecuencia por subir de forma incorrecta a la escalera mecánica, mientras juegan, corren o caminan. 7 Los niños no deben ser transportados en vehículos de bebés en las escaleras mecánicas, debido a la posibilidad de caída por trabado del rodamiento. 8,9 Dado que, en las publicaciones, 3,4,6 se reporta la edad como un factor de riesgo, se considera que es necesario realizar mayor difusión de las medidas preventivas para concientizar a los padres. ...
Full-text available
Article
Escalator-related injuries are rare but can be a medical emergency with potentially dangerous complications. The severe upper limb involvement related to injury occurred on an escalator is described. A two year-old patient suffered a fall going down an escalator; her left arm was caught between one of the steps and the comb of the last step. She was admitted to the Emergency Room for the initial stabilization. The foreign body was removed in the operating room. No vascular or nervous compromise was found, but there was severe loss of subcutaneous cellular tissue. The metal comb was removed, and repair surgery was performed on the affected limb. She required four more surgical interventions for plastic and reconstructive surgery. The patient had a good clinical evolution and was discharged without functional sequelae.
... Escalator-related injuries have been studied by many scholars, most of the studies Xing et al., 2020;Mays, 2020;Xing et al., 2019;Liu et al., 2019;Wang et al., 2020) have analyzed the characteristics of injuries and the statistical laws of age, gender and other aspects of the injured group from the perspectives of statistics and human-induced engineering. Platt et al. (1997) is one of the scholars who first paid attention to escalator-related injuries. They emphatically reviewed the escalator-related injuries of the children and found that without guardian care, improper use of escalator and mechanical failure of escalators would significantly increase the probability of children being injured on escalators. ...
Full-text available
Preprint
Escalator-related injuries threaten public health with the widespread use of escalators. The existing studies tend to focus on after-the-fact statistics, reflecting on the original design and use of defects to reduce the impact of escalator-related injuries, but few attention has been paid to ongoing and impending injuries. In this study, a multi-module escalator safety monitoring system based on computer vision is designed and proposed to simultaneously monitor and deal with three major injury triggers, including losing balance, not holding on to handrails and carrying large items. The escalator identification module is utilized to determine the escalator region, namely the region of interest. The passenger monitoring module is leveraged to estimate the passengers' pose to recognize unsafe behaviors on the escalator. The dangerous object detection module detects large items that may enter the escalator and raises alarms. The processing results of the above three modules are summarized in the safety assessment module as the basis for the intelligent decision of the system. The experimental results demonstrate that the proposed system has good performance and great application potential.
... In this accident, 12 people were slightly injured, and one person was seriously injured [5]. To reduce the probabilities of escalator-related injuries, several studies has been conducted to investigate the epidemiology and cause of escalator-related injuries [6][7][8][9][10][11][12][13][14][15][16]. However, most of them focused on commercial escalators and only a few studies analyzed the accidents of metro escalator or heavy-duty escalator [2,3,17,18], which is designed specifically for transit system usage and substantially different from commercial escalators in terms of structure, configuration and performance [19]. ...
Full-text available
Article
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.
... The most common methods that are used to analyze escalator-related injuries, such as statistical methods, rely on observed data, covariates, and responses, rather than attempting to simulate the causal process that leads to the adverse outcome [10,13,[17][18][19]. The Bayesian network is a good cause-effect analysis tool for representing uncertain knowledge in probabilistic systems and has proven to be effective for capturing and integrating qualitative and quantitative information from various sources [20][21][22]. ...
Full-text available
Article
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.
Full-text available
Article
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%.
Article
Three almost identical hand injuries in children riding on escalators are described. The mechanism by which these injuries were sustained is studied and the means for preventing such potentially disastrous occurrences discussed.
Article
A series of 50 patients suffering injuries from falls on escalators attended our accident and emergency department. Of these, 8 (16 per cent) required admission. Alcohol was a factor in 11/15 (74 per cent) of men but in only 2/34 (6 per cent) of women. Of the injuries, 32 (64 per cent) were associated with the practice of walking on the escalator, while only 12 (24 per cent) were associated with stepping onto or off the escalator. Discouraging the practice of walking on one side of the escalator might help to minimize injuries.
Article
Sir.—Wells and colleagues1 advised pediatricians to stress to patients the importance of accompanying children on escalators and the importance of wearing hard-soled shoes. My son's experience emphasizes the importance of these recommendations, particularly in foreign countries, where riding on escalators is even more risky. While he was riding a down escalator in East Berlin, the toe of his tennis shoe slipped into the gap between the moving stairs and the stationary sidewall. The gap was larger than in most escalators in the United States, and the toe easily entered this space. Because of the configuration and pliability of the shoe, he was unable to extricate his foot before it got caught in the metal comb plate at the bottom. Eventually, he lost his right toe and function of his forefoot. All of the escalators in the United States we have subsequently examined did not have a gap of
Article
Children frequently injure themselves falling down stairways, but the characteristics of these injuries are not well described. A total of 363 consecutive patients seen in a pediatric emergency department were studied. The majority of patients had minor superficial injuries. Bony injuries occurred in 7% of patients. Head and neck injuries occurred in 73% of patients, extremity injuries, which were predominantly distal, in 28%, and truncal injuries in 2%. Children younger than 4 years of age were more likely to sustain head trauma than children older than 4 years of age (P less than .005). Injury to more than one body part occurred in only 2.7% of patients. Children who fell down more than four steps had no greater number or severity of injury than those who fell down less than four steps (P = .67). Patients were admitted to hospitals in 3% of cases. No patient had life-threatening injuries and no patients required intensive care. When multiple, severe, truncal, or proximal extremity injuries are noted in a patient who reportedly fell down stairs, a different mechanism of injury should be suspected.
Article
To identify the pattern and severity of injury associated with stairway-related falls in children. During a 2-year period, all children less than 5 years of age presenting to the University of Virginia Pediatric Emergency Department with a stairway-related injury were prospectively studied. At the time of the emergency department visit, demographic and epidemiologic information was obtained. Injuries were assigned E codes and N codes. A Modified Injury Severity Scale (MISS) score was calculated for each child. Excluded from the study were children with suspected intentional trauma and children with walker-related stairway injuries. Sixty-nine children were enrolled in the study. The median age was 2 years. Head and neck injuries occurred in 90% of the patients, extremity injuries in 6%, and truncal injuries in 4%. Injury to more than one body region did not occur. The majority of injuries were minor. Ninety-six percent had a total MISS score < or = 2. Fifteen patients (22%) suffered significant injuries, including concussion in 11 (16%), skull fracture in 5 (7%), cerebral contusion in 2 (3%), subdural hematoma in 1 (1%), and a C-2 fracture in 1 (1%). The majority of stairway-related injuries are minor. Injuries to the head and neck region predominate. Injuries to multiple body regions are rare. However, significant stairway-related injuries may be more common than previously reported.
Escalator Safety Foundation, Mobile, AL 14. Safety Code for Elevators and Escalators. Standard A17
  • Elevator
Elevator/Escalator Safety Foundation, Mobile, AL 14. Safety Code for Elevators and Escalators. Standard A17.1–1996.
  • Jj Wells
Wells JJ, et al. Correspondence. Am J Dis Child. 1986;140:507–508