Falling while walking: A hidden contributor to pedestrian injury.

Walking is a sustainable mode of transportation which is beneficial to both individuals and to the broader community, however, there are risks and it is essential that road design and operation provides safe conditions for walking. In Victoria, pedestrians represent one of the most vulnerable road user groups, accounting for approximately 12% of all road fatalities and serious injuries. These figures largely represent injuries where the pedestrian has been struck by a vehicle with the extent of pedestrian-only injuries largely un-reported. Falling while walking may be a significant contributor to pedestrian only injuries. Indeed, the World Health Organisation has identified falls generally as the second leading cause of unintentional injury death in older populations. Despite the prevalence of fall-related injuries, there has been relatively little research undertaken to address the issues surrounding falls that occur while walking for transport and in public spaces. This study, therefore, aimed to address this gap in our knowledge. Analyses of various data sources were undertaken to enhance our understanding of fall-related injuries while walking in Victoria. Two sources of data were accessed: Only 85 fall-related incidents were reported in the crash-based data, however, pedestrian falls while walking in the road environment accounted for an average of 1680 hospital admissions and 3545 emergency department presentations each year, and this number is rising. The findings in this study show clearly that Police data is of little use when attempting to understand issues of safe travel for pedestrians other than vehicle-pedestrian incidents. However, analysis of hospital data provides a more realistic indication of the extent of pedestrian fall-related injuries and highlights the significant number of pedestrian fall-related injuries that occur each year. Moreover, the findings identified that older pedestrians are significantly over-represented amongst fall-related injuries that require hospital admission, while also having the highest rate of emergency department presentations when adjusting for age and exposure based on estimates of aggregate walking distances. The study also highlighted that the most common injury sustained from a fall were fractures. The implications of these findings and identification of 'best-practice' within a Safe System context are discussed in terms of enhancements to the physical environment (particularly footpath, kerb and ramp construction and maintenance), implementation of fall hazard assessment and management strategies, and educational programs to highlight the risks for falls and recommend preventative strategies, and overall enhancements of general fall interventions to include falls while walking outside (including exercise interventions). In addition, a number of research and data needs, particularly collection of in-depth data to identify contributory factors and injury outcomes related to falls while walking incidents.