Louisa H. Schminke, MD; Victor Jeger, MD; Dimitrios S. Evangelopoulos, MD, PhD; Heinz Zimmerman, MD; Aristomenis K. Exadaktylos, MD

Disclosures

Western J Emerg Med. 2013;14(2):141-145. 

In This Article

Abstract and Introduction

Abstract

Introduction About 10,000 escalator-related injuries per year result in emergency department treatment in the United States. Since the 1990s, a steady increase has been reported, but few statistics on escalator-related injuries have been published worldwide. We have therefore analyzed escalator accident statistics in admissions to our hospital in Switzerland since 2000.

Methods: Using retrospective electronic patient chart analysis, we included in our study patients >16 years treated over an 11-year period. We categorized patients in terms of gender, age and associated risk factors, and classified accidents according to day, time, location and cause. Resulting trauma was categorized according to type and location. We divided post-admission treatment into surgical and conservative, and into treatment as an outpatient, in a short-stay unit, or as a hospital admission. Women and men were compared using Fisher's exact test.

Results: We identified 173 patients with 285 discrete injuries. Of these, 87 patients (50%) were women. Fifty-three (61%) of the women and 38 (44%) of the men were >60 years old (P = 0.033). Fifty percent of the men (43/86) of the men, but only 7% (6/87) of the women showed signs of alcohol intoxication (P < 0.0001). Accidents in women occurred predominantly on Tuesdays (19/87; 22%) between 12pm and 6pm (35/87; 40%), and in men on Saturdays (16/86; 19%) between 6pm and 12am (29/86; 34%; P = 0.0097). Sixty-two percent (44/71) of the accidents were in public transport facilities and 30% (21/71) in shopping centers. The majority of injuries in women were to the lower extremities (49/87; 56%), while most accidents in men were to the head and neck (51/86; 59%; P = 0.0052). About half (90; 52%) of the patients were treated conservatively. Almost half of all patients (76, 44%) required hospital admission. Of those, 45% left the hospital within 24 hours of admission (short stay unit) and 55% stayed longer than 24 hours.

Conclusion: Escalator accidents can result in severe trauma. Significant gender differences in escalator accidents have been observed. Alcohol intoxication and age are significant risk factors in escalator-related accidents and might be possible targets for preventive measures.

Introduction

The first operational escalator was patented in 1892 and installed on Coney Island, New York, as an amusement ride. The device, however, was destined to serve as a serious means of transport.[1,2] Remarkably, wood was the key element in the construction of early escalator steps until metal took over in the 1920s, when the first escalator was installed in Germany.[2,3,4] About 30 years later, in 1958, a department store in Basle was home to the first escalator in Switzerland.[5]

Today the escalator is everyday common means of transport. With a total length of 800 meters and a 24-hour transport capacity of 210,600 passengers, the longest outdoor escalator system in the world is used by more than 55,000 passengers in Hong Kong each day.[6] The longest individual escalators can be found in St. Petersburg's underground stations, comprising a length of around 142 meters at a height of 71 meters each.[6]

Because escalators are ubiquitous, it is, however, not surprising that they have also attracted negative attention as an accident location. In the United States (U.S.), about 10,000 escalator-related injuries requiring emergency department (ED) treatment are reported annually.[7,8] The first reports of escalator-related injuries in Europe appeared in London in 1969.[4] Twenty years later, 10 patients per month sought medical attention due to escalator accidents.[9] In another study on escalator-related injuries, more than half happened in public transportation facilities and about 33% in shopping malls.[10] There has recently been an increase in escalator-related accidents.[11]

Despite this increase in accidents and the possible severity of the resulting injuries only few statistics on escalator-related injuries have been published worldwide, mostly studies on children and case reports. In contrast, our study is a retrospective analysis with a broad patient age range and a long observation period. To our knowledge, this is the first study to analyze escalator-related accident patients admitted to a European Level I trauma center over an extended period. Our aim was to understand the character of escalator-related accidents and to identify risk factors and groups, in order to contribute to the development of effective preventive measurements.

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