STAIR SAFETY

A Review of the Literature and Data Concerning

Stair Geometry and Other Characteristics

Prepared for

U.S. Department of Housing and Urban Development

Office of Policy Development and Research
Washington, D.C. 20410

Instrument No. DU100K000005897

by

NAHB Research Center

Upper Marlboro, MD 20772

November 30, 1992

 Acknowledgements

This report was prepared by the NAHB Research Center under a cooperative agreement with the U.S. Department of
Housing and Urban Development (HUD). The Principal Investigator for this study was Phillip Davis. Internal technical
review was provided by David Dacquisto and Mark Nowak. Contributing analysts were Mark Gibson and Tom Levin.
We would like to gratefully acknowledge the care and diligence exercised by Dr. Carol Meeks who provided external
review on the major studies, and to William Freeborne, government technical representative of HUD.
 TABLE OF CONTENTS

1.0 INTRODUCTION.....................................................................................................................1

2.0 BACKGROUND ......................................................................................................................1

3.0 REVIEW OF SOURCES OF STATISTICAL DATA, LITERATURE AND

RESEARCH 6

3.1 SOURCES OF DATA ..................................................................................................6

3.2 REVIEW OF LITERATURE.......................................................................................8

3.2.1 Introduction ......................................................................................................8

3.2.2 Summary of Review Findings..........................................................................9

3.3 DETAILED REVIEW ................................................................................................10

3.3.1 Templer, J. A. Stair Shape and Human Movement, doctoral

dissertation. New York, NY: Columbia University (1975).........................10

3.3.2 Templer, J.A., G.M. Mullet, J. Archea, and S.T. Margulis. An

Analysis of the Behavior of Stair Users. NBSIR 78-1554.
Washington, D.C., National Bureau of Standards, U.S. Department
of Commerce (1978........................................................................................24

3.3.3 Carson, D.H., J.C. Archea, S. T. Margulis, and F. E. Carson. Safety

on Stairs. BSS 108. Washington, D.C., National Bureau of
Standards, U.S. Department of Commerce (1978). .......................................27

3.3.4 Alessi, D., M. Brill, and Associates. Home Safety Guidelines for
Architects and Builders. Washington, D.C., National Bureau of
Standards, U.S. Department of Commerce (1978). .......................................28

3.3.5 Archea, J., B.L. Collins, and F.I. Stahl. Guidelines for Stair Safety.
BSS 120. Washington, D.C., National Bureau of Standards, U.S.
Department of Commerce (1979). .................................................................30

3.3.6 Templer, J., J. Archea, and H.H. Cohen. "Study of Factors

Associated with Risk of Work-Related Stairway Falls," Journal of
Safety Research. Vol. 16 (1985): 183-196....................................................32

i
 3.3.7 Fruin, J.J., D.K. Guha, and R.F. Marshall. Pedestrian Falling
Accidents in Transit Terminals. Washington, D.C., Urban Mass
Transportation Administration, U.S. Department of Transportation
(1985)..............................................................................................................39

3.3.8 Templer, J. The Staircase--Studies of Hazards, Falls, and Safer

Design, Cambridge, MA, The MIT Press (1992).Error! Bookmark
not defined. .....................................................................................................39

4.0 CONCLUSIONS .....................................................................................................................40

5.0 RECOMMENDATIONS ........................................................................................................41

APPENDIX A ALTERNATIVE STAIRWAY SAFETY FEATURES ................................ A-1

APPENDIX B REVIEW OF OTHER LITERATURE ......................................................... B-1

APPENDIX C ISCRIMINANT ANALYSIS AND TESTING IN

STAIR SHAPE AND HUMAN MOVEMENT ................................................ C-1

APPENDIX D TAIR-RELATED SCENARIOS FROM HOME SAFETY

GUIDELINES FOR ARCHITECTS AND BUILDERS .................................. D-1

APPENDIX E BIBLIOGRAPHY FROM GUIDELINES FOR STAIR SAFETY .................. E-1

APPENDIX F ESULTS OF EXTERNAL REVIEW BY DR. CAROL MEEKS

INDEX

ii
 LIST OF FIGURES

FIGURE 2-1 .......................................................................................................................... 4

FIGURE 2-2 .......................................................................................................................... 5

iii
 LIST OF TABLES

TABLE 2-1 RESIDENTIAL STAIR RISER AND TREAD REQUIREMENTS

OF MAJOR CODES FOR INDIVIDUAL DWELLING UNITS ............... 2

TABLE 3-1 RESIDENTIAL STAIR-RELATED INJURY DATA

FROM NEISS DATABASE ....................................................................... 7

TABLE 3-2 RELATIONSHIP BETWEEN RISER HEIGHT AND SPEED OF

ASCENT BY PERFORMANCE GROUP FROM TOE-SWITCH* .......... 12

TABLE 3-3 RELATIONSHIP BETWEEN STAIR ANGLE, RISER HEIGHT,

AND SPEED OF ASCENT BY PERFORMANCE GROUPS
FROM HEEL-SWITCH* ............................................................................ 13

TABLE 3-4 CLASSIFICATION OF TREADS INTO PERFORMANCE

GROUPS FROM TOE AND HEEL SWITCHES IN ASCENT*............... 13

TABLE 3-5 RELATIONSHIP BETWEEN TREAD DEPTH AND SPEED

OF DESCENT BY PERFORMANCE GROUP FROM THE
TOE-SWITCH* .......................................................................................... 14

TABLE 3-6 RELATIONSHIP BETWEEN RISER HEIGHT AND SPEED OF

DESCENT BY PERFORMANCE GROUP FROM HEEL-SWITCH* ..... 15

TABLE 3-7 RELATIONSHIP BETWEEN STAIR ANGLE, TREAD SIZE,

AND SPEED OF DESCENT BY PERFORMANCE GROUP
FROM THE TOE AND HEEL SWITCH* ................................................. 15

TABLE 3-8 TABLE 2.0.1 RANGE OF STAIRS FOR COMFORT

AND SAFETY* .......................................................................................... 17

TABLE 3-9 STAIR CLASSIFICATION BY GEOMETRY........................................... 25

TABLE C-1 TOE-SWITCH...ASCENT CLASSIFICATION* ....................................... C-3

TABLE C-2 HEEL-SWITCH...ASCENT CLASSIFICATION* .................................... C-3

TABLE C-3 TOE- AND HEEL-SWITCH...ASCENT CLASSIFICATION* ................. C-4

TABLE C-4 TOE-SWITCH...DESCENT CLASSIFICATION* .................................... C-4

TABLE C-5 HEEL-SWITCH...DESCENT CLASSIFICATION* .................................. C-5

TABLE C-6 TOE- AND HEEL-SWITCH...DESCENT CLASSIFICATION* .............. C-5

*Indicates that table title used in this review is as it appears in the source document

iv
 STAIR SAFETY

A Review of the Literature and Data Concerning

Stair Geometry and Other Characteristics
1.0 INTRODUCTION

For the first time in any U.S. model building code, the 1992 edition of the BOCA National
Building Code requires residential stairs to have risers no greater than 7 inches and treads no less
than 11 inches. Before 1992, the BOCA code specified 8¼-inch maximum riser heights and 9-
inch minimum tread depths. This 7-11 geometry, as it is known, has the potential to influence
housing costs significantly, particularly the cost of entry-level affordable housing.

The primary objective of this report is to assess the state of knowledge with regard to the role of
riser and tread dimensions in accidental falls on residential stairways. A more specific purpose is
to examine existing sources of data and research and to determine what they indicate about the
safety performance of various stair geometries. The study, therefore, involved an examination of
statistical data and a literature review. A secondary objective of the report is to identify other
features or characteristics of stairs that potentially play a role in stair safety. Thus, the study also
included a review of literature to identify other stair features or characteristics possibly related to
stair safety.

Section 2 of this report discusses stair geometry in general. Section 3 discusses the major
sources of statistical information and reviews the research contained in the existing literature.
Sections 4 and 5 present conclusions and recommendations. A brief description of other
potential safety features of stairs is contained in Appendix A. For the readers convenience, two
indices have been provided at the end of this work. The first is an index of the titles of all
articles reviewed. The second is an index of authors' surnames, organizational names, acronyms,
periodical names, and other terms frequently used in citations to the literature.

The Research Center's evaluation of five key studies was subjected to an external review. The
reviewer's comments are included as the final appendix to this document. Some of the results of
that review have been integrated into this report, but the reviewer's comments should be
consulted directly for additional information.

2.0 BACKGROUND

Stairs are one of the more difficult items to fit into a home. Not only is the space they occupy
typically unavailable for living space or other uses but the location of stairs heavily influences the
remainder of the floor plan. Various approaches have been devised over the years to limit the
space required for stairs or to regain some of the lost space for other uses. Approaches have
included the use of spiral stairs, winders, alternating tread devices, and even elevators. However,
with the exception of the increasing use of winders, no other solution has seriously penetrated a
market dominated by conventional straight-run stairs.

1
The tread depth and riser height are the two most important variables in determining the space
required for stairs. In designing a stairway, the first task is to select a trial riser height and divide
it into the total floor-to-floor distance. This number is usually rounded up to the next whole
number and then divided into the total floor-to-floor distance to obtain the actual uniform riser
height. The number of treads is based on the number of risers. Any tread depth can be selected
as long as it meets the minimum code requirement.

Aside from space requirements, stairs present safety concerns that often appear in reports and
1
literature related to falls . As a result, building codes designed to protect the public health and
safety have traditionally required minimum safety features in stairs. For example, handrails and
guardrails are required to provide support and prevent falls over the side of an open stair.
Likewise, the geometry of the treads and risers is limited to certain minimum and maximum
distances, respectively. Table 2-1 shows the residential stair geometry requirements promulgated
by some of the major model code organizations.

TABLE 2-1

RESIDENTIAL STAIR RISER AND TREAD REQUIREMENTS OF MAJOR CODES

FOR INDIVIDUAL DWELLING UNITS
Tread Depth Maximum Section
Model Code Riser Height (w/o nosing) Slope Reference
2
BOCA 1990 ≤ 8¼" ≥ 9" 42.5° 817.6
3
SBCCI 1991 ≤ 7¾" ≥ 9" 40.7° 1108.3.1
4
ICBO 1991 ≤ 8" ≥ 9" 41.6° 3306(c)
5
CABO 1989 ≤ 8¼" ≥ 9" 42.5° Fig.R-213.1

≤ 7.87" ≥ 8.27"
6
NRCC 1990 (200 mm) (210 mm) 43.6° 9.8.3.1

1National Electronic Injury Surveillance System (NEISS) Database, U.S. Consumer Product

Safety Commission, Washington, D.C.

2Building Officials and Code Administrators International, Country Club Hills, Illinois,
publishers of the BOCA National Building Code.

3Southern Building Code Congress International, Birmingham, Alabama, publishers of the

SBCCI Standard Building Code.

4InternationalConference of Building Officials, Whittier, California, publishers of the ICBO

Uniform Building Code.

5Councilof American Building Officials, Falls Church, Virginia, publishers of the CABO One-
and Two-Family Dwelling Code.

6National Research Council Canada, Ottawa, publishers of the National Building Code Canada.

2
Origin of the 7-11 Geometry as a Code Issue

The major model code organizations have historically accepted a variety of stair geometries; 7-11
is a relatively recent code requirement. For example, BOCA and ICBO modified stair and riser
dimensions during the late 1970s and early 1980s, although they have always imposed less
stringent requirements for residential buildings as compared to other use groups. The
requirement for 7-11 stairs in nonresidential buildings first appeared in the 1981 BOCA code,
indicating that the code was modified sometime between publication of the 1978 and 1981
editions. Likewise, the ICBO code did not require 7-11 stairs for nonresidential uses until the
1985 edition and has never required 7-11 for one- and two-family dwellings. Conversely, SBCCI
has never required 7-11 for any use group.

Because published building codes do not reveal why or how requirements are set, it was
necessary to identify other sources to determine the origin of the 7-11 requirement. One such
source identified in this search is the Life Safety Code (LSC) published by the National Fire
Protection Association, Batterymarch Park, Massachusetts.

The 1991 edition of the LSC requires 7-11 geometry for all new stairs except those in one- and
two-family dwellings; in those cases, the LSC requires an 8-inch maximum riser and a 9-inch
minimum tread. The 1985 edition provides some insight into the origin of 7-11 stairs in the LSC.
Appendix Section A-5-2.2.2.1 states that "Recommendations on tread and riser dimensions can
be found in National Bureau of Standards (NBS) BSS 120 and Scientific American, October
1974." Both of these references were published in the 1970s and apparently reflect the earliest
technical literature specific to the 7-11 geometry referenced in the code literature. The work
discussed in these references is reviewed later in this report. BSS 120 is Guidelines for Stair
Safety, reviewed in Section 3.3.5. The Scientific American article is "The Dimensions of Stairs,"
reviewed in Appendix B of this report.

Recent Events

In 1991, the members of the BOCA National Building Code voted to revise its stair requirements
for individual dwelling units to include a maximum riser height of 7 inches and a minimum tread
width of 11 inches. This standard, which became known as the 7-11 geometry, has touched off
considerable controversy throughout the building industry and within the code community.
Figures 2-1 and 2-2 present examples of the differences between 8¼-9 and 7-11 stairs.

Critics of the 7-11 geometry claim that the new requirement will add considerable cost to some
homes, particularly to smaller affordable homes by necessitating an increase in the size of the
building shell. These same critics argue further that studies do not support the 7-11 geometry as
more (or less) safe than other geometries.

Proponents claim that the 7-11 geometry has been shown to be a safer stair. Some of these
proponents also suggest that the added costs are not significant and that stairs with a 7-11
geometry can fit into the existing building shell.

3
3.0 REVIEW OF SOURCES OF STATISTICAL DATA, LITERATURE AND
RESEARCH

The following sections provide a summary and analysis of stair safety data and literature
identified through bibliographic references in safety literature and other sources. Section 3.1
comprises a discussion of the National Electronic Injury Surveillance System (NEISS) database
as it relates to injuries involving stairs. Section 3.2 provides an overview of the research findings
in the existing literature. Section 3.3 contains detailed reviews of major works that either
represent statistical research examining the role of stair geometry or other types of literature that
are widely known and referenced. The remaining literature is presented in Appendix B.

3.1 SOURCES OF DATA

National Electronic Injury Surveillance System (NEISS) Database. Washington, D.C.,

Consumer Product Safety Commission.

The National Electronic Injury Surveillance System (NEISS) Database is the most well known
source of information on injuries and accidents; it contains information on accidents related to
stairs.

Contents

The NEISS database contains information on stair-related accidents based on the data gathered
from the emergency rooms of participating hospitals. It contains almost 16,000 records of stair-
related injuries reported in 1990 and includes information on age, sex, diagnosis, body part
injured, disposition, severity, treatment date, location, and up to three products to which the
accident is related. A "COMMENT" field can contain amplifying data pertaining to the accident.
With the exception of the "COMMENT" field, the data are available in the electronic media.
The entire database is available in printed form. The information in the "COMMENT" field is
free- form and does not appear to follow any observed rules for inclusion of data. Illustrative
excerpts from a printed copy of the 1990 stair-related injuries data are presented in Table 3-1,
along with a legend explaining abbreviations and codes.

The information on products, locations, and the "COMMENT" field provide the data most
relevant to the accident. One category under the product field is "stairs or steps." Inquiries so
identified are stair-related. The location field indicates the type of building, such as home,
apartment/condominium, mobile home, industrial place, etc., where the injury occurred.

Diagnosis is numerically coded to reflect such categories as laceration or amputation.

Disposition is numerically coded to reflect treated and released, fatality, and the like.

Comments

The database does not contain any information on the geometry of the stairs involved in the
reported accidents. In many cases, reports based on this database are erroneously interpreted as
indicating stairs as the cause of the accident. In fact, it is incorrect to attribute any causal role to
stairs. The Consumer Product Safety Commission (CPSC) offers the following disclaimer:

6
 TABLE 3-1

RESIDENTIAL STAIR-RELATED INJURY DATA FROM NEISS DATABASE

TR_DATE AGE SEX DIAG BDYPRT DIS LOC F/A OCC PRD2 3RD SV COMMENT

900306 017 M ST/SP ANKLE 1 1 0 2 0000 0 1 PT TWISTED ANKLE FALLING DOWN STAIRS AT HOME

900306 025 F CT/AB L/TRK 1 1 0 2 0000 0 2 PT FELL DOWN THE STAIRS INJ. LOWER BACK AT HOME

900310 038 M CT/AB U/TRK 1 1 0 2 0000 0 3 SON THREW HER AGAINST STAIRS & INJURED RIB AREA

900315 004 F CT/AB FACE 1 1 0 2 0000 0 3 FELL & HIT NOSE ON STEPS

900308 019 M CT/AB L/ARM 1 1 0 2 0000 0 2 PT FELL DOWN THE STAIRS INJ. ARM AT HOME

900309 079 F CT/AB U/TRK 1 1 0 2 0000 0 3 PT FELL DOWN THE STAIRS AT HOME

900208 054 F CT/AB U/TRK 1 1 0 2 0000 0 3 PT FELL DOWN THE STAIRS AT HOME INJ. CHEST

900208 218 F CT/AB FACE 1 1 0 2 0000 0 3 PT FELL DOWN THE STAIRS AT HOME

900311 003 M ST/SP ANKLE 1 1 0 2 0000 0 1 INJ. L FOOT--PT FELL OFF STEPS

900315 068 M LACR FACE 1 1 0 2 0000 0 4 RECEIVED FACIAL LACERATIONS/ SHOULDER CONTUSION
AFTER FALLING DOWN 12-14 STEPS

900309 057 F FRACT L/ARM 1 1 0 2 0000 0 3 FELL INJURED R ARM/WRIST ON CONCRETE STEPS

900309 020 M CT/AB HAND 1 1 0 2 1817 0 1 INJ. L HAND--FELL FROM PORCH, LANDED ON STEPS &
THEN THE GROUND

900306 055 M CT/AB HEAD 1 1 0 2 0000 0 3 CONTUSED HEAD--FELL ON OUTDOOR STEPS--PATIENT WAS
INTOXICATED

LEGEND:

TR_DATE (Treatment Date) = YYMMDD DIS (Disposition) = "1" for treated/examined & released
AGE (2 Years and Older) = age in years LOC (Location) ="1" for home
(Less than 2 Years) = "2" + age in months F/A (Fire or Auto Assoc.) ="0" for not
SEX = M - male OCC (Occupational)="0" for not
= F - female PRD2 (Second Related Product)
= ? - unknown 3RD (Third Related Product)
DIAG (Diagnosis) = 31 diagnoses SV (Severity)=ascending numerical scale with "1" for mildest
BDYPRT (Body Part) and 8 for most severe (death)
 NEISS data and estimates are based on injuries treated in hospital emergency
rooms that patients say are related to products. Therefore, it is incorrect, when
using NEISS data, to say the injuries were caused by the product (emphasis in
original).

The data, therefore, reflect "products" such as stairs that were related to the accident. The
database does not attempt, for example, to differentiate an emergency room visit prompted by an
injury sustained during a fall down a flight of stairs from a visit for the removal of a splinter from
a patient's foot when a stair tread was the source of the splinter. Both could be classified as
"stair-related" and used to estimate stair-related injuries that are frequently referenced in
literature.

The data have additional limitations. For example, the database identifies the location of the
stairs related to the injury in terms of home, industrial place, and the like, but the data fail to
differentiate explicitly between interior and exterior stairs. The "COMMENT" field for records
of injuries related to stairs, however, contains references such as icy steps. The role of stair
geometry in injuries resulting from icy conditions and other similar hazards on exterior stairs
would be highly questionable.

Other frequently reported cases include accidents in which children in walkers fall down stairs or
accidents in which the victims were involved in fighting or horseplay. Although stairs were
involved in these accidents, it is unlikely that the characteristics of the stairs caused the accidents.

Even if the "COMMENT" data were available in suitable electronic media, the results of
statistical analysis would be of limited use. As stated above, the format is free-form.
Inconsistencies in the type and amount of information in the field would preclude the accurate
identification of circumstances of accidents such as those discussed above.

Despite its shortcomings, the NEISS data are a frequently cited source in estimating stair-related
injuries. For 1990, the estimated total number of stair-related injuries requiring emergency room
treatment based on the NEISS data was 998,871. However, this number should be regarded as
highly suspect if it is either presented as an estimate of falls caused by stairs or used as a basis for
computation of the number of preventable accidents. The exact proportions of injuries that can
be causally attributed to stairs is unknown.

3.2 REVIEW OF LITERATURE

3.2.1 Introduction

Approximately 60 books, reports or other studies, were identified through bibliographic

references and other sources as part of an intensive investigation devoted to stair safety. A
review of that literature yielded only five research efforts aimed directly at identifying the role of
riser and tread geometry in stair safety through either the study of accidents or some proxy such
as "incidents." The five works describing those efforts are:

• Stair Shape and Human Movement

• An Analysis of the Behavior of Stair Users

8
 • Safety on Stairs
• Guidelines for Stair Safety
• Study of Factors Associated with Risk of Work-Related Stairway Falls

A detailed review of each of those works is presented in Section 3.3.

Section 3.3 also includes reviews of three additional works noted for their prominence or
relevance to the above five pieces. A review of Home Safety Guidelines for Architects and
Builders--the "BOSTI" report--is included because it has been used as the basis for estimating the
effects of 7-11 geometry on accidents. Pedestrian Falling Accidents in Transit Terminals is
another well-known work that presents recommendations for tread dimensions. Finally, a brief
discussion of conclusions offered in The Staircase, Studies of Hazards, Falls, and Safer Design
is included to aid in clarifying the findings of earlier work. Further, it represents the most recent
major work on stair safety.

Over 50 other works are listed and discussed in Appendix B. An examination of these works
indicated that they provide no additional insights into the role of stair geometry in stair safety.
Some address the 7-11 issue but recount no research other than that described in the major works
above. Others are devoted to subjects not directly related to stair geometry.

3.2.2 Summary of Review Findings

An in-depth review of the major works mentioned above found that the described research,
considered either separately or together, fails to establish a consistent, statistically valid link
between stair safety and stair geometry. A brief description of the research follows.

In attempting to relate "arrhythms of gait" to riser and tread dimensions, the gait analysis in Stair
Shape and Human Movement was flawed by the use of an inappropriate combination of
methodology and number of participants, inadequate statistical controls, the presentation of
conclusions based on statistically insignificant relationships, and other problems. Thus, it failed
to produce results that can be accepted for stairways in general. Further, although the work
includes recommendations for the use of treads with depths no less than 11 inches, the findings
of the gait analysis did not include any reference to 11-inch treads and thus did not support the
recommendations. Careful reading of the work and an examination of The Staircase, Studies of
Hazards, Falls, and Safer Design, a more recent work by the same author, indicate that the
recommendation for 11-inch treads originated in an examination of foot dimensions. Because
Stair Safety and Human Movement did not relate foot size to either accidents or any type of
"incident," the 11-inch tread recommendation is without any statistically confirmed basis.

Based on an analysis of data at the stairway level, the initial attempt of An Analysis of the
Behavior of Stair Users to establish a link between stair geometry and incidents on stairs failed.
A subsequent analysis at the per tread level was based on only six stairways. The range of riser
and tread dimensions in the second analysis was too narrow to allow for the generalization of any
results to residential stairs. Further, research findings contradict the recommendations of other
reports reviewed here in that they classify stairs with a tread of 12 inches or less as more likely to
be "high risk." The research efforts described in Safety on Stairs and Guidelines for Stair Safety

9
could not identify any statistically significant relationship between riser and tread dimensions and
accidents.

Even though it suggests 7-inch risers and 11-inch treads as guidelines, the BOSTI report did not
even attempt to establish a statistically valid relationship between riser and tread dimensions and
stair accidents or "incidents." The recommendations for riser and tread dimensions in Pedestrian
Falling Accidents in Transit Terminals were not based on any statistical or other analysis
described in the report.

In discussing etiological studies, the author of The Staircase, Studies of Hazards, Falls, and
Safer Design asserted, "Finally, the 1985 NIOSH study seems to provide the strongest evidence
that step dimensions affect incident rates" (p. 38). This refers to the research described in Study
of Factors Associated with Risk of Work-Related Stairway Falls. The results of this work are
inconsistent and contradictory and flawed by several statistical problems. Some of the attempts
to relate incidents and step dimensions failed completely. Another attempt produced one
regression equation that indicated a positive relationship between narrower tread depths and
incident rates, and another equation indicating a negative relationship. Still other statistics
presented in the work failed to adjust for the effects of other factors and thus provide no insight.

In summary, none of the works established a clear, statistically significant relationship between
riser and tread dimensions and either accidents or incidents. In addition, many of the major
works focused on incidents and missteps, which are not the same as accidents. No study was
found that established a quantifiable relationship between proxies such as missteps or incidents
and accidents.

3.3 DETAILED REVIEW

Detailed discussions of each of the above works follows.

3.3.1 Templer, J. A. Stair Shape and Human Movement, doctoral dissertation. New York,
NY: Columbia University (1975).

Contents

This doctoral dissertation is composed of five sections and four appendices:

• Stair Shape: A Comparative Historical Typology (Ch. 1 - 3)

• Stair Shape: Comfort and Safety (Ch. 4 - 6)
• Stair Shape: Human Space Needs and Stair Capacity (Ch. 7 - 8)
• Stair Shape: Behavioral and Movement Patterns (Ch. 9 -10)
• Conclusions (Ch. 11)
• Appendices (A - D)

This review focuses on Chapter 5 of Section 2 and Appendix B of the dissertation, which recount
the author's use of gait analysis to study stair geometry. Other chapters provide background
information or describe research not related to stair safety in residential applications. Chapter 4
entitled "The Etiology of Stairway Accidents," summarizes earlier studies of stair safety. Other

10
portions of Chapter 5 deal with such issues as posture, gait cycle, and foot size. Chapter 6
addresses energy expenditure on stairs. None of these relate any original research to the link
between stair geometry and safety and, as such, are discussed only as they relate to the gait
analysis.

The research described in Chapter 5 attempted to relate riser and tread dimensions to missteps
and arrhythmic distortions of gait. Based on statistics quantifying the distribution of foot sizes,
the author suggested that a stair tread of no less than about 11 to 11.5 inches is a reasonable
minimum. The author postulated that treads less than 11 inches deep will produce distortions in
the gait of users with large feet and that narrower treads would produce more "arrhythmic
incidents during descent" (p. 144).

To examine the impact of tread and riser dimensions along with speed of ascent and descent, the
author conducted an investigation by using a variable-speed mechanical stair treadmill that
allowed adjustment of tread and riser dimensions. The experiment was based on the hypothesis
that gait rhythm might be disturbed by certain combinations of stair angle, riser height, tread
depth, and speed of ambulation.

Although 16 subjects participated in the experiment (eight males and eight females), only three
were tested on all geometric set-ups. All participants were fitted with rubber overshoes over
their ordinary, low-heeled footwear. Two pressure-sensitive switches were embedded in the sole
of each overshoe. A toe-switch was located 2½ inches from the front of each overshoe, and a
heel-switch was located 5 inches behind that.

The experiment used three stair pitches: 25, 35, and 45 degrees. Three different sets of
riser/tread dimensions were used for each pitch. Walks on each of these combinations were
performed at three vertical speeds. The author successfully recorded 1,291 walks (652 ascents
and 639 descents). Each ascent or descent consisted of the participant traversing "about twenty-
two steps." The first five and the last three steps were ignored to allow for the acceleration and
deceleration of the treadmill (p. 150).

The foot switches were monitored through the use of a polygraph to identify successful and
unsuccessful switch contacts. The results were analyzed separately for ascent and descent by toe-
switch contact records, heel-switch contact records, and combined heel and toe-switch records.
For each run, the author classified the results into performance groups based on the number of
successful contacts. Toe-switch contact results were classified in a three-category system, with
category one the "best" category and three the "worst." Heel-switch and combined heel-switch
and toe-switch results were classified in a four-category system, with category one the best. The
author characterized the classification scheme as "...ranging from a perfect score in group one to
a few or no switch contacts in group three or four (depending on the number of groups)" (p. 152).

The author then applied discriminant analysis to the data to derive equations predicting the group
into which any riser/tread/speed/pitch combination would likely fall. The equations and a
description of the use of discriminant analysis and statistical testing are contained in Appendix C
of this review.

11
The resultant tables (derived by classifying each combination into the performance category of
the equation producing the highest measure of probability) are presented as Tables 3-2 through 3-
7 as given in this document, inclusive of possible typographical and other errors.

TABLE 3-2

RELATIONSHIP BETWEEN RISER HEIGHT AND SPEED OF ASCENT BY

PERFORMANCE GROUP FROM TOE-SWITCH
Speed, Vertical Feet Per Minute
Riser (x tread) Inches Performance Groups
1 (Best) 2 3 (Worst)

4.6 (x 10.0) 60 45 30

5.4 (x 11.5) 60 45,30

6.3 (x 9.0) 75,60 45

6.4 (x 14.2) 75,60 45

7.2 (x 10.3) 75 60 45

7.7 (x 7.7) 90,75 60

8.7 (x 12.3) 90,75 60

8.9 (x 8.9) 90,75 60

10.7 ( 10.7) 90 75,60

Tables 3-2, 3-3, and 3-4 address the performance of participants in ascent. The entries in
Table 3-2 represent the speed in vertical feet per minute. The author pointed out that, with one
exception (i.e., 7.2 inches), there was a wider range of optimal climbing speeds when risers fell
between 6.3 and 8.9 inches (p. 154).

In discussing Tables 3-3 and 3-4, the author noted that "...it would not be possible for heel
switches to be triggered during ascent when using treads that are less than about nine inches"
(p. 156). He later added that "Furthermore, it was observed that several of the subjects habitually
put the soles of their shoes, only, on the treads--never the heels, regardless of the tread size.
These heel-switch limitations may explain the poor showing of these small treads; even the
slightly larger treads may have been compromised in the tests when the sole of the shoe is put
down close to the nosing. For these reasons, the heel-switch, and the next performance
classification--the combined toe-switch and heel-switch record--are of limited value as indicators
of gait in ascent" (pp. 156-157).

12
 TABLE 3-3

RELATIONSHIP BETWEEN STAIR ANGLE, RISER HEIGHT, AND SPEED

OF ASCENT BY PERFORMANCE GROUPS FROM HEEL-SWITCH
Riser (x tread) in Inches x Speed in Vertical Ft./Min.
Stair Angle Performance Groups
1 (Best) 2 3 4 (Worst)

4.6(x 10.0) x 30 4.6(x 10.0) x 45 4.6(x 10.0) x 60

5.4(x 11.5) x 30 5.4(x 11.5) x 60
25° 5.4(x 11.5) x 45
6.4(x 14.2) x 45 6.4(x 14.2) x 60 6.4(x 14.2) x 90

6.3(x 9.0) x 45
6.3(x 9.0) x 60
6.3(x 9.0) x 75
35° 7.2(x 10.3) x 45 7.2(x 10.3) x 60 7.2(x 10.3) x 75
8.7(x 12.3) x 60 8.7(x 12.3) x 75
8.7(x 12.3) x 90

7.7(x 7.7) x 60
7.7(x 7.7) x 75
8.9(x 8.9) x 60
45° 8.9(x 8.9) x 75
8.9(x 8.9) x 90
10.7(x 10.7) x 60 10.7(x 10.7) x 75
10.7(x 10.7) x 90

TABLE 3-4

CLASSIFICATION OF TREADS INTO PERFORMANCE GROUPS

FROM TOE AND HEEL SWITCHES IN ASCENT
Tread (x riser) Inches
Performance Groups

1 (Best) 2 3 4 (Worst)

14.2 (x 6.4)
12.3 (x 8.7)
11.5 (x 5.4)
10.7 (x 10.7)
10.3 (x 7.2)
10.0 (x 4.6)
9.0 (x 6.3)
8.9 (x 8.9)
7.7 (x 7.7)

The following three tables in the report (Tables 3-5, 3-6, and 3-7 as presented in this review)
address the performance of participants in descent. The author noted of the data in Table 3-5 that
treads of "...12.3 inches or more had the fewest missteps at all speeds." These were followed, in
order, by 10.6 to 11.5 inches, 10.0 to 10.3 inches, and 9 inches or less. According to the author,

13
"In descent it was virtually impossible to avoid triggering the toe switches." He added, "This
would seem to indicate that distorted foot location positions occasioned by the narrower tread
produced arrhythms of gait" (pp. 157-158).

TABLE 3-5

RELATIONSHIP BETWEEN TREAD DEPTH AND SPEED OF DESCENT

BY PERFORMANCE GROUP FROM THE TOE-SWITCH
Speed, Vertical Feet per Minute
Tread (x riser) Inches Performance Groups
1 (Best) 2 3 (Worst)

7.7 (x 7.7) 60,75,90

8.9 (x 8.9) 60,75,90

9.0 (x 6.3) 45,60,75

10.0 (x 4.6) 30,45,60

10.3 (x 7.2) 45,60 75

10.6 (x 10.6) 75,90 60

11.5 (x 5.4) 60

12.3 (x 8.7) 60,75,90

14.2 (x 6.4) 45,60,75

In discussing the results of the heel-switch tests reflected in Table 3-6, the author noted that risers
between 4.6 and 7.2 inches had the fewest missteps and that "...there is evidence that treads less
than 9.0 inches are related to more missteps" (pp. 158-159).

14
 TABLE 3-6

RELATIONSHIP BETWEEN RISER HEIGHT AND SPEED OF DESCENT

BY PERFORMANCE GROUP FROM HEEL-SWITCH
Speed, Vertical Feet per Minute
Riser (x tread) Inches Performance Groups
1 (Best) 2 3 4 (Worst)

4.6 (x 10.0) 30,45 60

5.4 (x 11.5) 30,45 60

6.3 (x 9.0) 45 60 75

6.4 (x 14.2) 45 60,75

7.2 (x 10.3) 45 60 75

7.7 (x 7.7) 60,75,90

8.7 (x 12.3) 60,75,90

8.9 (x 8.9) 90 60,75

10.7 (x 10.7) 60 75,90

Referring to the results of the combined descent data in Table 3-7, the author pointed out that
stairs with large treads and low angles had the best performance and that steeper stairs,
particularly those with small treads, produce more missteps (p. 159).

TABLE 3-7

RELATIONSHIP BETWEEN STAIR ANGLE, TREAD SIZE, AND SPEED OF DESCENT

BY PERFORMANCE GROUP FROM THE TOE AND HEEL SWITCH
Stair Tread (x riser) Inches x Speed, Feet Per Minute
Angle Performance Groups
1 (Best) 2 3 4 (Worst)

10.0 (x 4.6) x 30,45 10.0 (x 4.6) x 60

25° 11.25 (x 5.4) x 30,45,60
14.2 (x 6.4) x 45,60,75

9.0 (x 6.3) x 45,60,75

35° 10.3 (x 7.2) x 45,60 10.3 (x 7.2) x 60
12.3 (x 8.7) x 75,60 12.3 (x 8.7) x 75,60

7.7 (x 7.7) x 60,75,90

45° 10.7 (x 10.7) x 60,75 10.7 (x 10.7) x 90 8.9 (x 8.9) x 60,75,90

15
The author's conclusions upon completion of the gait analysis include: (p. 160)

• Ascent

Within the tested speed ranges, stairs with risers 6.3 to 8.9 inches and treads 7.7 to
14.2 inches had the fewest missteps.

• Descent

» The larger the tread, the fewer were the missteps. Treads below about 9 inches
performed uniformly poorly.

» Risers measuring 4.6 to 7.2 inches had the fewest missteps.

» Missteps increased with steepness. Performance was poorest with small treads.

At the conclusion of Chapter 5, the author presented design implications "Stairs with risers from
4.6 to 7.2 inches and treads greater than 9 inches seem to have the safest potential in descent,
particularly if the angle was low, and the pedestrian was descending slowly." He later continued
"A reasonable compromise to suit ascent and descent movements, on the basis of the findings,
would be a stair with a riser that, to suit ascent, is not less than 6.3 inches; and to suit descent, is
not more than 7.2 inches, and a tread never less than 9 inches." He immediately followed by
saying, "But in public places, the tread should be wide enough for at least 95 percent of the
population -- 11 inches. However, these recommendations need to be considered in the light of
another important affective variable, the energy demands imposed by the stair on the body"
(p. 161).

Section 2 of the dissertation also examined and made general design recommendations for ramps
and stairs with regard to energy expenditure. It concluded with further "Implications for Design,"
wherein the author made the following statement:

From the foot location studies (of Ward and Beadling), and from the discussion of
foot dimensions, and also from the gait studies, treads that are narrow are at least
uncomfortable, and are likely to generate an awkward gait and cause missteps.
Except in exceptional circumstances, treads should not be less than about eleven
inches for stairs that are used in descent (p. 215).

He followed by saying, "In ascent, risers that perform best come from a middle range of
dimensions, 6.3 to 8.9 inches; but in descent the lower risers performed best." He further
suggested as a compromise the use of risers that perform well in both ascent and descent,
"...between 6.3 and 7.2 inches (with a tread of 11 inches or more)" (p. 216). He continued:

To limit stairs to these dimensions would be to read more into the gait analysis
findings than can be concluded legitimately. In ascent the findings are by no
means so clear cut that it can be concluded that all risers outside the best
performance range should be excluded; there were speeds at which all these
remaining risers were quite as satisfactory as the others. On the other hand, the

16
 descent findings were quite unequivocal: risers of greater than 7.2 inches,
regardless of tread size, were decidedly less satisfactory. A more cautious
recommendation, on the basis of gait analysis, would be to limit stairs to risers of
less than 7.2 inches, with treads that are at least 11 inches (p. 216).

In relating the energy expenditure approach, the author stated that "Ward and Beadling's
preference studies suggest that rate of energy expenditure affects people's judgment of stairs
more than the total expenditure. Stairs that demand high rates of expenditure were those that
were least preferred. As stair climbing at usual speed demands expenditure rates that are
comparable to heavy manual work, this is not surprising." He added that "Stair climbing is less
fatiguing in terms of rates of energy expenditure, when the steps are low. However, this must be
qualified, for the rate is also related to the proportion of riser to tread" (p. 217).

The section concludes with a table of combinations of riser and tread dimensions characterized
by the author as follows: "From all the investigations in Section 2, then, the range of stairs shown
in Table 2.0.1 fulfills the criteria of comfort and safety best (within the observed range)" (p. 218).
The referenced Table 2.0.1 is shown here as Table 3-8.

TABLE 3-8

TABLE 2.0.1 RANGE OF STAIRS FOR COMFORT AND SAFETY

Risers Treads
7" 11

6½" 11 11½ 12 12½

6" 11 11½ 12 12½ 13 13½ 14

5½" 11 11½ 12 12½ 13

5" 11 11½ 12

4½" 11

4 11

Comments

The gait analysis conducted as part of this dissertation was fatally flawed by an inappropriate
application of the chosen statistical technique and thus cannot be characterized as identifying any
statistically valid link between stair geometry and "arrhythms of gait," "missteps," "incidents," or
accidents. Before discussing the statistical aspects of the analysis resulting in this flaw, however,
some clarification of the study, its findings, and recommendations are called for.

First, the research recounted in this dissertation did not attempt a direct investigation of accidents
on stairs. Rather, the author attempted to correlate "missteps" and "arrhythmic distortions of
gait" to stair geometry and speed of transit. No quantitative link has been established between
accidents and either "missteps" or "arrhythmic distortions of gait."

17
Next, a concern regarding recommendations of specific stair geometry and their basis in the
findings of the gait analysis should be discussed. The author's recommendations for minimum
tread width varied in different sections of the report and, at times, did not seem to be based solely
on the gait analysis. Because such recommendations, taken in isolation, may be misinterpreted,
this review attempts to clarify the basis of those recommendations.

In the summary of findings following the author's well known treadmill study, the author made
no reference to 11-inch treads. For ascent, he reported that treads from 7.7 to 14.2 inches were
found to have the fewest missteps. For descent, the author stated that "...the larger the treads, the
fewer the number of missteps that occurred." and that "...treads below about 9 inches performed
uniformly poorly." He also stated that "...where the treads were small, the performance was
poorest" (p. 160).

In the design implications section immediately following these findings, the author recommended
treads not less than 9 inches. He also recommended 11-inch treads for public stairways, which,
he noted, are needed for 95 percent of the population (p. 161). This population percentage is a
reference to a discussion in Section 2 of the distribution of foot sizes (pp. 139-144). A study of
any correlation between foot size and missteps or arrhythms of gait was not part of the gait
experiment and hence is not supported by the research.

In the implications for design contained at the end of Section 2, the author stated, "A more
cautious recommendation, on the basis of the gait analysis, would be to limit stairs to risers of
less than 7.2 inches, with treads that are at least 11 inches" (p. 216). This statement could be
construed as linking just the limit on riser height to gait analysis, with the 11-inch limit on tread
dimension added because of other criteria. Alternatively, it might be taken that the author is
saying that the gait analysis suggests an 11-inch limit for treads. If the latter is true, the support
for this position is again not clear from the summary of findings discussed above. If the former
is true, additional criteria such as foot dimensions (pp. 139-144) or energy expenditure were not
analyzed in terms of accidents or missteps in the dissertation. In addition, subsequent research
(Ref. Kose, 1985) found that energy expenditure was not a factor in residential settings.

In citing geometries contained in Table 3-8, the author indicated that they "...fulfill the criteria of
comfort and safety best (within the observed range)" (p. 218). This statement also lends itself to
two different interpretations. The first is that treads less than 11 inches are inadequate for either
safety or comfort. The second is that treads less than 11 inches fail to provide for comfort and
thus do not meet the combined requirements of comfort and safety. If the latter is the correct
interpretation, it reveals nothing about the safety requirements. If the former is true, it again
finds no basis in the summary of findings at the end of the treadmill gait study.

The author's more recent work, The Staircase--Studies of Hazards, Falls, and Safer Design
(Cambridge, Massachusetts: The MIT Press, 1992), examined elsewhere in this review, more
clearly separates recommendations based on gait analysis from those based on foot dimensions or
energy expenditure. Examination of the conclusions at the end of Chapter 2 of that work
indicated that the author saw the gait analysis as suggesting only that treads should not be less
than 9 inches. He associated the need for an 11-inch tread with foot dimensions. Energy
expenditure recommendations were classified as comfort related.

18
Therefore, citations of the gait analysis described in this dissertation indicating a need for 11-inch
treads would seem incorrect. Any citation of recommendations elsewhere in the dissertation for
11-inch treads would seem to be based on foot dimensions. In assessing such citations, however,
it should be remembered that no research effort associating foot dimensions with "missteps,"
"arrhythmic distortions of gait," or other types of "incidents" or accidents was undertaken as part
of the dissertation.

With the discussion of those two points complete, the statistical problem referenced above can be
addressed. As stated earlier in this review, the experiment produced 1,291 successful walks
based on the observation of 16 participants, with three of those 16 being tested on all
combinations. Discriminant analysis was then applied to the resulting data to produce equations
used to classify stair geometries into performance categories.

This was an incorrect application of discriminant analysis. The 1,291 observations were treated
as if they were for 1,291 individuals. The application of discriminant analysis with multiple
observations of the small number of participants is inappropriate. To produce statistically valid
results through discriminant analysis, 1,291 participants would be required. Therefore, no
statistical validity can be attached to the results of the gait analysis. With such a small number of
participants the results could have been subjected to some descriptive analysis.

There were, however, additional problems encountered during the review of the dissertation.
Some of those problems were:

• The description of the experiment omits mention of standard controls that would have
reduced the likelihood of systematic errors.

• Omissions and other errors contained in the tables and other places complicate
reconstruction of the work and interpretation of the results.

• Ambiguities and potential subjectivity raise doubts concerning the measurement and
classification methodologies.

The Description of the Experiment Omits Mention of Standard Controls That Would Have
Reduced the Likelihood of Systematic Errors

A quantitative experiment, such as the gait analysis, must be carefully designed to measure the
desired phenomenon and to control for potential sources of error. A number of concerns arose
during the review of the work, including the following:

• The gait analysis produced results based on stairways of significantly different heights.

• There was no indication that the order of testing was randomized for different stair
geometries.

• No particular level of statistical validity seems to have been chosen before the
experiment's data collection phase.

19
 • Artificiality of the apparatus and testing environment may have distorted the results.

Regarding the first point, as mentioned earlier, each walk consisted of about 22 steps, with the
first five and last three discarded to allow for acceleration and deceleration. Subsequent analysis
was then performed on the number of "missteps" or "arrhythmic distortions of gait" during each
walk for the remaining steps. The results of the analysis were then presented in tables (Tables 3-
2 through 3-7 in this review) that classified each geometry into a discriminant analysis-based
category. By using the same approximate number of steps per walk, the gait analysis ignored the
fact that in a real-world situation, the number of risers and thus steps required for a stairway is
determined by the vertical distance between floors. For example, the vertical distance between
floors in a house with 8-foot ceilings and 8-inch floor joists is 104.5 inches. A stairway with 4.6-
inch risers would need to contain 23 risers (rounding up from 22.72) compared to 10 (rounded
from 9.77) for a stairway with 10.7-inch risers. To put the walks compared in the research in
perspective, a flight of 14 steps with 4.6-inch risers would be 64.4 inches high-- almost 5½ feet.
A flight of 14 steps with 10.7-inch risers would be 149 inches high--almost 12½ feet. The results
of the experiment, as performed, was a comparison of one set of stairs only partially ascending to
the next level with another set of stairs ascending to above the next level.

A second point is that the walks do not appear to have been conducted in random order. The
dissertation explained that 27 different geometry/speed combinations were tested in ascent and
27 tested in descent and that 652 ascent and 639 descent walks were successfully recorded
(p. 150), but it never mentioned any effort to randomize the testing of those combinations.
Failure to randomize leaves open the possibility that if walks on certain geometries were
conducted early in the experiment while walks on others were conducted later, participants might
have become more accustomed to the apparatus and thus performed better.

The third concern in the design of experiment was that no particular level of statistical validity
was presented as having been selected before the experiment. Even though the dissertation's
statistical appendix presents an example based on the use of a 5 percent significance level
(p. 403), the levels in the statistical tables contained in Appendix B of the dissertation are as high
as .1469 (excluding those which are obviously erroneous entries). According to Siegel (Sidney
Siegel, Non-Parametric Statistics for the Behavioral Sciences, New York: McGraw-Hill, 1956,
p. 9), "Since the value of α enters into whether Ho is or is not rejected, the requirement of
objectivity demands that α be set in advance of the collection of data," where α is the level of
significance and Ho is the null hypothesis.

The final concern over the design of the experiment is the overall artificiality of the experiment
and its environment. The author acknowledged the artificiality regarding the mechanical stair
treadmill, but the artificiality extends beyond the treadmill. The use of rubber overshoes with
embedded switches and wire leads is far removed from real-world practice. In addition, the
effects of artificiality would likely be greatest at the outset of the experiment when participants
were still adjusting to the mechanical stairway, the overshoes, and the wires. As the experiment
progressed, the participants could have become more accustomed to the paraphernalia, lessening
any confounding effect. This may indicate the potential for a relationship between the number of
missteps on a particular geometry set-up and the point in the overall experiment when it was
tested, as noted in the earlier discussion of the lack of any reference to randomizing the order of
the walks.

20
In another aspect of artificiality, the experiment also differed from actual use of stairs in that
participants were not allowed to determine individual speeds of ascent and descent. The author
stated, "For each stair set-up, three different speeds were used; firstly, a speed that forced the
subject into a rhythm that bordered on a run; secondly, a speed that was estimated to be
comfortable for the particular riser/tread ratio; and thirdly, a speed that was close to being 'slow
motion'" (p. 149). Even if this were so, it takes the choice away from the stair user, with an
unknown effect on the results.

Omissions and Errors

Most of the tables that classify each set-up's performance category were based on the author's use
of statistically insignificant formulas. A description of the statistical techniques and the resultant
formulas can be found in Appendix C of this review. For example, in examining the toe-switch
in ascent table (Table C-1) in that appendix, it can be seen that the testing of Equation 2 indicated
that the equation was statistically insignificant. Nonetheless, it seems clear that the author used
this equation in producing Table 3-2 (of this review) as there are entries for the mid-performance
category. In the other ascent category, two out of the four equations for heel-switches (Table C-2
in Appendix C of this review) and three out of four equations for combined toe- and heel-
switches (Table C-3) appear to be statistically insignificant. The statistical testing of the
functions developed for the descent statistics indicate that one of the four heel-switch equations
(Table C-5) was statistically insignificant. Entries for the level of significance for the combined
toe- and heel-switch data (Table C-6) in descent are clearly erroneous.

The use of statistically insignificant equations to classify riser/tread/speed of ambulation/angle of

incline combinations for developing entries for the tables (Tables 3-2 through 3-7 of this review)
would seem inappropriate. The fact that they were not found significant indicates that the
resulting classifications could have been produced by chance.

Some of the test tables indicate that the equations produced results significantly worse than
chance. The following table-by-table listing illustrates the poor ability of some of the functions
to classify the walks:

Table Number Number Correctly

(of this review) Test Number Classified Total

C-1 2 2 20
C-2 2 2 20
C-3 2 3 20
C-4 2 0 29
C-5 4 3 23

The statistical testing for the last example (Table C-5) was characterized by the author as, "In
particular, ability to identify poor performance is sharp" (p. 408). According to the entry to the
right of the Test 4 row (Table C-5 as reproduced in this review), the level of significance
associated with that test was .0001. This is clearly wrong since only 3 of 23 walks were
"correctly" classified.

21
The tables classifying the geometries (presented as Tables 3-2 through 3-7 of this review), which
were produced through the use of those equations, were also flawed by seeming errors and
omissions. An attempt was made to reproduce the author's tables by using the functions
produced by the discriminant analysis and the given tread, riser, incline, and speed for each set-
up. The following is a table-by-table recounting of apparent errors:

Author's Reconstruction
Geometry Classification Classification

• Toe-switches in ascent (Table 3-2) 4.6 x 10 at 45 FPM 2 1

7.2 x 10.3 at 60 FPM 2 1
7.7 x 7.7 at 60 FPM 2 3

• Toe-switches in descent (Table 3-5) 5.4 x 11.5 at 30 FPM None 2

5.4 x 11.5 at 45 FPM None 2

• Heel-switches in descent (Table 3-6) 6.3 x 9.0 at 60 FPM 2 4

6.3 x 9.0 at 75 FPM 3 4
6.4 x 14.2 at 60 FPM 4 3
6.4 x 14.2 at 75 FPM 4 3

• Combined toe- and heel-switches 7.2 x 10.3 at 60 FPM 2&3 2

in descent (Table 3-7) 7.2 x 10.3 at 75 FPM None 3
8.7 x 12.2 at 60 FPM 2&3 2
8.7 x 12.2 at 75 FPM 2&3 3
8.7 x 12.2 at 90 FPM None 3

The source of most of the discrepancies is not readily apparent. Discrepancies related to omitted
or redundant entries would seem self-explanatory if the reconstructed table entries replicated
those of the original work that were somehow omitted or entered twice. The sources of other
discrepancies in the tables are less clear. Potential sources include possible mistakes in the
classification equations as they were reproduced in the dissertation.

It should also be pointed out that, in his discussion of Table 3-6, the author inappropriately drew
conclusions on riser height (pp. 158-159). The functions generated by the discriminant analysis
of heel-switch in descent data (p. 402) that were used to generate this table contain no riser
height variable. This indicates that the statistical software found the riser height insufficiently
significant and omitted it from the function. Therefore, there is no basis for drawing conclusions
from Table 3-6 on riser height.

Further, it appears that the wrong formulation of the test statistic was presented (p. 403). The
formula as presented uses the estimated probabilities in lieu of the probabilities under the null
hypothesis in the denominator.

Finally, with respect to riser dimensions, although the author recommended a riser of not more
than 7.2 inches for descent, the test sample of risers did not contain any risers that were between

22
7.2 and 7.7 inches. Given the absence of data for risers of 7.3 to 7.6 inches in height,
recommendations against those heights are not supported by the experiment.

Ambiguities and Potential Subjectivity Raise Doubts Concerning the Measurement and
Classification Methodologies

Difficulties with the measurement and vagueness of the definition of missteps or arrhythmic
distortion of gait indicate that subjectivity possibly flawed the results. No precise definition of
what always constitutes a valid switch contact is apparent. A reference to "the number of perfect
contacts" (p. 153) (emphasis added) would seem to suggest some standard for judging the
"perfection" of a contact. If that were the case, no discussion of a precise criteria used to
discriminate between successful and unsuccessful switch closures was included with the
discussion of the experiment, leaving open the possibility that a component of the contact
assessment process was subjective.

Difficulty with the switches may have further clouded the results. The author noted that, in
ascent, it was impossible for the heel-switch to be triggered on treads that were less than 9 inches
deep without the foot turning laterally. He further stated that some of the participants were
observed placing their sole, but never their heel, on the tread in ascent (p. 156). Therefore, the
author concluded that the heel-switch and combined toe-switch and heel-switch records were of
"limited value." In discussing the toe-switch data for descent, the author commented that "it was
virtually impossible to avoid triggering the toe switches" (p. 158), suggesting that there were not
many missing contacts.

Additionally, the author provided no detailed and consistent description of the criteria used for
classifying the observations into the performance categories but did include some loose
descriptions of classification when he discussed categories "...ranging from a perfect score in
group one to a few or no switch contacts in group three or four (depending on the number of
groups)" (p. 152). In describing the performance group classifications used as input to the
discriminant analysis, the author stated, "Each classification group was designed to accept data
within a certain range; for example, group one might accept data that showed no missteps, group
two might accept data with one to three missteps, group three might accept three to six missteps,
and so on" (pp. 400-401). Although the dissertation's statistical appendix gives the number of
cases classified into each category, it does not provide the number of "missteps" corresponding to
each category. Important questions concerning the origins and consistency of application of any
precise classification rule or criteria are left unanswered.

A further question regarding measurement is related to the fact that toe-switch data were
classified into only three performance groups while the rest of the data were classified into four
groups. No reason is given for this disparity.

Summary

It appears that on the basis of gait analysis, the author saw only that treads "...about below
9 inches performed universally poorly" and "...the larger the treads, the fewer the number of
missteps that occurred." No specific mention of 11-inch treads is found in the discussion of the
findings of the gait analysis. This analysis, based on "arrhythmic distortions of gait" and not

23
accidents, was fatally flawed by an inappropriate application of the chosen statistical
methodology and thus did not identify any statistically valid link between stair geometry and
"arrhythmic distortions of gait," "missteps," "incidents," or accidents.

3.3.2 Templer, J.A., G.M. Mullet, J. Archea, and S.T. Margulis. An Analysis of the
Behavior of Stair Users. NBSIR 78-1554. Washington, D.C., National Bureau of
Standards, U.S. Department of Commerce (1978

Contents

The authors list three purposes for this study: to identify dangerous or potentially dangerous
reactions to different types of stairs; to identify probable causes; and to suggest helpful design
guidelines.

This study is based on an analysis of videotaped incidents on stairs. The videotapes were drawn
from NBS's approximately 50 hours of video recordings of people using stairs. From these, six
30-minute tapes of incidents in which people "fell, slipped, tripped or experienced an event that
might have resulted in a fall" were produced. The incidents selected for analysis met criteria for
the quality, duration, and extent of the video recording; camera angle; types of stair;
environment; and stair users and time.

To compare the characteristics of the stair users involved in the accident to the characteristics of
those not involved in the accident, the authors selected a matching sample. Therefore, a
corresponding nonincident was selected from the original videotape that contained the incident.
The nonincident user was randomly selected from the group that had used the stairs in the same
direction at least one minute before the incident victim.

From the quantity of videotape that met the initial requirements for quality and the like,
20 percent of the total sample was selected as the basis for computation of the frequency of stair
incidents for each flight. This sample, the authors felt, was representative of the conditions of
the original sample. The computed incident rate was then used as the dependent (criterion)
variable against which physical characteristics of the stairs were correlated.

The independent variables in this study fell into three categories. The first was stair user
characteristics, such as age and sex. The second was behavior characteristics and included such
factors as speed, gait, and handrail use. The third were environmental conditions, including riser
height and tread depth. The first two were used as independent variables to compare the
characteristics of nonincident and incident users through the analysis of the matched sample.
Tread width and riser height served as independent variables in an examination of the
representative sample.

The analysis of the environmental variables addressed the authors' hypothesis that certain stairs
are more dangerous than others. In this context, stairs with certain environmental characteristics
(such as higher risers or narrower treads) should have higher incident rates. To test this
hypothesis, the authors statistically tested the null hypothesis that incident rates are homogenous
across stairways. The authors used incident data from 14 stairs and a contingency table

24
approach. They were unable to reject the null hypothesis, indicating no statistically significant
difference between incidence rates on different stairs.

In reanalyzing the data on a "per step basis or an exposure risk basis," the study indicated that
three stairs had more incidents than chance would predict and three had fewer. The authors
conducted a statistical comparison of the characteristics of the "high-risk" and "low-risk" sets of
stairs. The differences between the actual incidents and the predicted incidents are presented in
Table 3-9 and reflect the information contained in Table 14 of the appendix to the report (p. 65).

TABLE 3-9

STAIR CLASSIFICATION BY GEOMETRY

Observed Values Expected Values
Riser Height High Risk Low Risk High Risk Low Risk

< 6.25" 14 30 9.06 34.94

≥ 6.25" 0 24 4.94 19.06

Tread Depth

≤ 12" 11 24 7.10 32.90

> 12" 0 32 3.90 18.20

The expected values in Table 3-9 reflect the null hypothesis of homogeneity. The riser height
values tested significant at the .01 level, and the tread depth values tested significant between the
.01 and .05 levels.

In the summary of findings, the authors characterized high risk stairs as those that tend to have
lower risers and treads less than 12 inches in depth (p. 15).

Comments

The results of the research described in this paper provided no insight into the role of stair
geometry in either incidents or accidents on residential stairs. The research developed no facility
to predict the effect of stair geometry on either an accident or incident rate. A second
formulation of the analysis of the data was needed to produce a categorization of stairs by "risk"
as expressed in Table 3-9. The risk categorization developed in the second approach is based on
stairways uncharacteristic of residential stairs, thus rendering the findings irrelevant.

It should be noted that this study addressed incidents, not accidents, and no quantitative link
between missteps or incidents and accidents has been identified in this report or elsewhere. The
study of "incidents" gives rise to the same potential pitfalls discussed elsewhere in this review.
The identification of an incident is a highly subjective process and does not produce results that
lend themselves to quantitative analysis. As such, any inferences drawn from incidents must be
regarded with extreme caution.

25
Within the context of analyzing "incidents," however, the authors attempted to relate riser height
and tread depth with incident rates at the stairway level by comparing the frequency of incidents
on 14 stairs using a contingency table approach. This attempt failed when the null hypothesis of
homogeneity between stairways could not be rejected (p. 11).

The authors next turned to a per step approach for the comparison of the expected and actual
incident rates based on riser and tread dimensions. Table 3-9 presents the results of that study.
The categorization reflected in the table is based on the characteristics of six sets of stairs
classified by the analysis as either high- or low-risk. The former category--"high-risk"--was
found to "...have more incidents than could be expected by chance alone" (p. 11). The "low-risk"
had fewer.

This comparison excluded the other eight stairways that were part of the failed stair-level
comparison. Any description or classification of the excluded stairways is absent from the
discussion of the analysis. These stairs represent most of the stairways subjected to the stairway-
level test. Further information might have proved useful in assessing the stair-level analysis.

In addition, the limited range of dimensions of the six stairways that formed the basis for the
"high-risk" or "low-risk" groups preclude the application of the results to stairways in general.
The stairways categorized as either "high-risk" or "low-risk" were referenced as stairways 1, 5,
11, 12, 20, and 22 (p. 11). Their dimensions are contained in Appendix 1 (pp. 41-48) of the
report and are produced below.

Stair Riser Tread

Number Height Width
1 6 11
5 5.9 11
11 5.9 10.9
12 5.9 11
20 5.2 12
22 6.9 12.5

As can be seen, riser heights for this set of stairs ranged between 5.2 and 6.9 inches. Tread
depths ranged between 10.9 and 12.5 inches. On its face, the study cannot be construed as
addressing any categorization by "risk" for geometries outside of these ranges. For example,
study results cannot be used to draw any inferences about stairs with 8¼-inch risers and 9-inch
treads.

Properly stated, the table merely presents stairs with treads between 10.9 and 12 inches as
carrying a "risk" that is higher than stairs with treads between 12 and 12.5 inches. For example,
if the table were applied to a specific geometry, it would classify 11-inch treads as riskier than a
stair with a tread between 12 and 12.5 inches. It would, however, be unable to classify a stair
with a 9-inch tread.

Further, the contingency tables do not carry any predictive power; they merely classify stairs as
"high-risk" or "low-risk." They offer no quantitative aspect of risk.

26
The other characteristics of the stairs were not representative of residential stairs and thus further
limited the applicability of the table. Four of the six stairs had treads covered with Terrazzo, one
tread was covered with granite and one with concrete. The granite stairway appeared to be a one-
tread step-up.

In addition, the lack of full explanations of certain practices during the analysis makes a thorough
assessment of the study more difficult. For example, the authors adopted "a per-step basis or an
exposure rate basis..." in the second analysis (p. 11). Given that a detailed definition of this
approach and a rationale for its use was omitted, the justification for its use and its implications
for the analysis and the results are unclear.

From the above reservations, it can be seen that the study described in this report offers no
insights into the role of riser and tread geometry in either incidents or accidents on residential
stairs.

3.3.3 Carson, D.H., J.C. Archea, S. T. Margulis, and F. E. Carson. Safety on Stairs. BSS
108. Washington, D.C., National Bureau of Standards, U.S. Department of
Commerce (1978).

Contents

This report recounts an analysis of stair-related accidents based on mail surveys, telephone
interviews, and personal site visits that produced information on 253 residences in Milwaukee
County, Wisconsin. Based on the analysis of the resultant information, the authors provide
guidelines for improving stair safety.

The research examined the relationship between accident events and three items: physical
characteristics of stairways, the surrounding environment, and the behavior of the stair user.

Information on most physical characteristics was solicited from all participants and included
number and structure of stairways located at the residence, stair configuration (presence of turns
or landings), length of the stairs, headroom and orientation edge, tread materials, riser
irregularities, handrail and lighting data, and hazards.

The behavior information solicited by the researchers pertained to personal habits on the
frequency of stair use, repairs required, and suggestions for improvement.

The researchers gathered data on 170 accident events, which were defined as serious accidents,
moderate accidents, and critical events. Serious accidents were comparable to those in the
NEISS database. They require either medical attention or first aid and result in at least a one-day
limitation on activity. Moderate accidents were those in which no medical attention is required.
Critical events include slips, missteps, catching oneself to prevent a fall, or falls that do not result
in an injury. The 170 events included repeated events involving the same person or repeated
events on the same stairs or within the same dwelling units.

Data on riser height and tread depth were gathered from only 54 personal interviews conducted
during site visits, which allowed the opportunity to measure the stairs.

27
In the statistical analysis phase of this project, the authors attempted to relate the data on riser-
tread dimensions to accident event rates. No statistically significant relationship was established.
The authors, however, did interpret the data as indicating a trend in the relationship.

In a related issue, the authors performed a multiple regression that related selected physical
variables and personal variables to the accident event rate. The authors concluded "...to lower the
probability of that event by eliminating as many factors as feasible, both physical and behavioral,
to break up the patterns or at least reduce their probability of occurrence" (p. 57).

In providing recommendations to improve stair safety, the authors presented 18 guidelines,

including the following two related to riser-tread geometry:

• Emphasize combinations of riser-tread dimensions that have shallower slopes.

• Study effects of riser-tread combinations on critical incidents in the field.

Comments

The study did not identify any statistically valid relationship between riser-tread dimensions and
accidents. Although the authors referred to a "trend," the failure of the data to pass tests of
statistical significance means that the relationship, given the size and other characteristics of the
sample, cannot be differentiated from a random variation. Therefore, the study established no
statistically significant relationship that supports the authors' recommendations for shallower
slopes through the use of deeper treads or lower risers (pp. 10 and 51).

The multiple regression relating physical and personal variables to accidents (pp. 10 and 56-57)
omitted riser height and tread depth. Therefore, any conclusion based on that regression should
not be interpreted as reflecting the effects of riser height and tread depth on accidents.

The authors acknowledged the shortcomings of the data in failing to substantiate the role of riser-
tread dimensions in stairway accidents. In the section devoted to analysis of accident and critical
incidents, the authors indicated that "there is a trend in the data (note accident rates) that a larger
sample and more refined measurement techniques might prove stable" (p. 51). This reference to
a "trend" should not be construed as referring to a statistically significant relationship. None was
established in the research. The reference to the insufficiency of the sample size or the use of
different techniques, moreover, would seem to reinforce this point.

3.3.4 Alessi, D., M. Brill, and Associates. Home Safety Guidelines for Architects and
Builders. Washington, D.C., National Bureau of Standards, U.S. Department of
Commerce (1978).

Content

This document, frequently referred to as the "BOSTI" (the Buffalo Organization of Social and
Technical Innovation) report, has the stated goal of "...the analysis, organization and presentation
of state-of-the-art information on home accidents and ways to reduce their frequency and/or
severity." The study is an effort to synthesize the results of existing research on the NEISS data

28
into guidelines related to major building elements. Its primary audience is architects, home
builders, product designers, and home owners.

This report contains five major sections, one for each of the following building elements: stairs,
doors, windows, bathtubs and showers, and floors.

For each major section, a "Design Consideration" is presented for each of a number of accident
scenarios related to that building section. The design considerations provide information
pertaining to the characteristics of the victims and the circumstances surrounding various types of
accident. Statistics pertaining to each type of accident scenario accompany each design
consideration. "Design ideas" representing potential solutions to the problem are presented.

The report provides 12 stair-related scenarios, along with the design ideas. It is within that
context that stair geometry is addressed. The stair-related accident scenarios and the statistical
data that accompany them in the report are contained in Appendix D of this review.

The use of stairs with a minimum tread depth of 11 inches and riser height of 7 inches is
presented as one of the design ideas for five of those scenarios. They are the first three, the fifth,
and the ninth scenarios as presented in Appendix D of this document.

The authors noted: "Design Ideas for residential safety in this report are intended to serve as
examples of solutions to the problems represented in the corresponding Design Consideration.
No attempt has been made to provide prescriptive solutions."

The authors' assessment of the impact on each suggested design idea on accident reduction, the
design process, first costs, and life costs are presented graphically following the presentation of
each design consideration and the related design ideas. These provide ratings on scales of 0 to
100 percent for accident reduction.

Comments

The statistics given with each scenario should not be taken as reflecting established accurate
estimates of each type of accident. The authors acknowledge that "...it is impossible to claim that
they are accurate representations of the problem. They have been included to provide an idea of
the possible magnitude of the problem" (emphasis added).

The basis of the BOSTI analysis were the data available through the NEISS. The authors,
however, referenced both the NEISS database of emergency room reports and the in-depth
investigations of selected cases reported through the NEISS system. The role that each may have
played in the investigation is not readily apparent. The database of injuries as reported by the
emergency rooms of the participating hospitals was not coded to reflect systematically as
complete a description of the accident circumstances as contained in the design considerations. It
would, therefore, seem likely that the statistics were based on the in-depth investigations
commissioned by the CPSC. Guidelines for Stair Safety, issued after the BOSTI report and
discussed elsewhere in this review, noted that "...the accidents which had been included in the
initial in-depth investigations were not selected systematically and, therefore, they could not be
analyzed statistically." Given that no other research beyond the NEISS data was cited, the

29
statistics should not be taken as accurate. Thus, the imputed potential impact of any design idea
cannot be assumed to be accurate, as affirmed by the authors.

3.3.5 Archea, J., B.L. Collins, and F.I. Stahl. Guidelines for Stair Safety. BSS 120.
Washington, D.C., National Bureau of Standards, U.S. Department of Commerce
(1979).

Content

As noted in the abstract, "This report summarizes information and research in the area of stair
use and provides design guidelines for improving stair safety." The earlier portion of the report
recounts the authors' research aimed at determining the behavior of stair users and the design
features of stairs that can be related to successful and unsuccessful (i.e., accident-producing) use
of stairs. Guidelines and recommendations related to stair safety follow this section. The report
then concludes with a summary section that includes a review, general recommendations, and a
discussion of future research.

The initial research consisted of a review of related literature, an analysis of NEISS stair accident
data, and a review of building codes. The study of the NEISS information involved the analysis
of 476 in-depth investigations of stair-related accidents compiled by the CPSC. These
investigations were detailed follow-ups to selected accidents reported from hospital emergency
rooms and contained in the NEISS database. Analysis of this data led the authors to conclude
that no statistically sound relationship between any design feature and stair-related accidents
could be identified.

The literature review addressed stair safety research and design. A list of works reviewed by the
authors can be found in Appendix E of this review. The authors concluded that the analysis of
the NEISS data and literature produced "little if any" data on stair designs that are associated
with stair accidents.

The building code review investigated the relevant recommendations of the Federal Housing
Administration minimum property standards and of the following model codes: Basic Building
Code of the Building Officials and Code Administrators International, Inc. (BOCA); the Life
Safety Code (LSC); the National Building Code (NBC); the Southern Standard Building Code
(SSBC); and the Uniform Building Code (UBC). This review failed to produce any revelations
into the causes of stair accidents.

Following the above analysis phase of the project, the authors formulated an "accident-behavior
model" that evolved from "...a combination of common sense, informal observations, reviews of
specialized literatures, logical deductions, and a close re-examination of the literature, standards,
and incidents" (p. 10). The authors believed that such a model was necessary given the
"fragmented understanding" (p. 10) of stair accidents from the analysis of the NEISS data,
literature, and codes. The purpose of the model was to provide a framework for testing behavior,
developing design criteria, and providing input to research. The authors deduced that the model
suggests four phases of successful stair use: expectation, perceptual test, negotiation, and
adjustment (p. 13). An accident results in an unsuccessful use. The authors indicated that

30
"further consideration of the model suggests" that other processes might include "Proportion of
the stairs to accommodate user needs" (p. 13).

The authors examined NBS-sponsored videotapes of public stairways to assess certain

implications of the model. The studied videotape included "...about a dozen accidents (without
serious injury)" and 120 noticeable missteps (p. 15). The discussion of the analysis indicated that
distractions and deceptions associated with the environment appeared to be a major factor.

A detailed analysis of videotapes of the upper-most flight of a shopping center stairway focused
on the behavior of stair users in terms of the position and placement of head and limbs. No
statistical inferences relative to riser/tread dimensions were presented for the analysis.

A discussion of other research (examined elsewhere in this report) precedes the presentation of
recommendations and guidelines. In addressing riser/tread dimensions, guideline 2.1.1 suggested
that if the riser is less than 4 inches or greater than 7 inches, or treads have depths less than 11
inches or greater than 14 inches, or the tread depth results in a missed or partial step, the stairs
should be either redesigned or provided with signing and lighting (p. 31).

The accompanying commentary cites other studies and sources of recommendations on riser
tread geometry, including McGuire (1979) and Templer (1974), which are discussed elsewhere in
this report. Additional references include the suggestions of Harper, Florio, and Stafford (1958)
that the sum of the riser height and tread depth should not fall out of the range of 17 to 18 inches.
Grandjean's (1973) recommendations, based on energy consumption, for dimensions of 6.7 and
11.4 inches for riser and tread dimensions are cited along with the formula that the sum of twice
the riser height plus the tread depth should equal 24.5 inches. The source of a recommendation
contained in the commentary for a riser height of 7 inches for interior stairs, 6 inches for stairs
used mostly by the elderly, and 5 or 6 inches for exterior stairs is unclear (p. 32).

The issue of stair geometry is again addressed in guidelines pertaining to excessively steep,
frequently used stairs. The guideline indicates that if the riser height exceeds the effective tread
depth, or the riser height is greater than 9 inches, or the effective tread depth is less than 9 inches,
then consideration should be given to rebuilding or replacing the stairway. The accompanying
commentary cites Carson (1978), who found no statistically significant relationship between
steepness and accident rates, and Templer (1974). The authors suggested that steepness may
provoke increased alertness. A further discussion of the Carson study centers on the various
combinations of riser and tread dimensions and notes that dimensions not conforming to those
given in guideline 2.1.1 "...are believed to constitute a serious stair hazard" (p. 90).

The report concludes with a summary section devoted to recommendations and future research.
Other than suggesting uniform riser/tread dimensions, the authors offered no suggestion on the
size of risers or treads.

In addressing future research, the authors recommended that efforts be devoted to "verifying the
theoretical premises which underlie the design guidelines" (p. 103) and "...the effectiveness of
the specific design solutions recommended in the guidelines." The authors suggested that future
research address the nature of the interaction of visual, tactile, and kinesthetic perceptions with
tread/riser dimensions and handrails in stair use (p. 104).

31
Comments

Although this study provides two guidelines for tread and riser dimensions, the research
conducted in the early phase of this work did not uncover any empirical support. Of the analysis
of NEISS data, the authors stated, "Thus, no statistically sound relationship could be determined
between specific design features and stair accidents" (p. 5). The lack of findings was further
emphasized in the authors' conclusions when they stated, "...studies providing empirical support
for the particular design solutions offered by the guidelines were neither found in the stair safety
literature, nor conducted during this project. Future research which tests hypotheses about the
effectiveness of specific design guidelines in preventing stair accidents is, therefore, required" (p.
104) (emphasis added).

Given its failure to identify any statistically significant relationship, this report cannot be
characterized as providing either insight into the role of tread and riser geometry in stair
accidents or support for any specific geometry.

3.3.6 Templer, J., J. Archea, and H.H. Cohen. "Study of Factors Associated with Risk of
Work-Related Stairway Falls," Journal of Safety Research. Vol. 16 (1985): 183-196.

Contents

This article recounts a research project funded by the National Institute of Occupational Safety
and Health (NIOSH). It presents the results of a statistical analysis of 98 videotaped incidents on
31 flights of stairs. The article discusses the approach and methodologies, outlines the statistical
findings, and presents a set of conclusions. This review discusses only those sections and
findings of the article that are relevant to stair tread and riser geometry.

Discriminant Analysis

The first section devoted to statistical analysis describes the application of discriminant analysis
to identify the difference between incident and nonincident treads in terms of the characteristics
of stairs and stair users. The authors indicated that the nonincident group tended to be those who
were very large or heavy while the incident group were "...those whose movement was impeded
by others and those who were older" (p. 189). The authors also reported that the characteristics
found to be significant in distinguishing incident from nonincident treads were the size of the
nosing projection, the presence of views ahead, and the number of orientation changes. They
made no mention of tread depth or riser height in the description of distinguishing characteristics.
Correlation Assessment and Regression Analysis

In the next section of the report, the authors recounted the use and results of both correlation
coefficients and stepwise multiple regression to examine factors possibly associated with stair
incidents. Correlation coefficients measure the strength and the direction (sign) of a linear
relationship between two variables. Stepwise regression is a type of regression analysis in which
independent variables are examined to determine if they meet criteria for inclusion in the
regression equation and for retention in subsequent iterations as more independent variables are
added to the equation. The criteria for entry and retention can be either the probability at which

32
the new combination must pass an F-test or the value against which the F-ratio must be
compared. Multiple regression means that there is more than one independent variable in the
equation.

The authors stated that the small number of incidents and flights precluded addressing all 72
environmental variables in a stepwise multiple regression. Therefore, the assessment of
correlations of those variables with the incidence rates allowed the elimination of variables that
were statistically insignificant at the .05 level and the retention of the remaining variables as
candidates for subsequent multiple regression analysis (p. 189).

Stairway Analysis

The authors first analyzed the data on an incidence rate per flight basis. The rate was computed
by dividing the number of incidents on each flight of stairs by the number of people who had
used the flight. The correlation assessment was applied to the combined data set of both ascent
and descent incidents and indicated a correlation of both the higher mean effective riser height
and the "less" mean effective tread depth with a higher incidence rate. For ascent incidents
alone, the authors found a correlation among riser height, tread depth, and incidence rate. For
descent, no correlation was found between either riser height or tread depth and the incidence
rate (pp. 189-190). When the authors applied the stepwise multiple regression to the data, they
found no statistically significant relationship (p. 190).

Incident Tread Analysis

The authors followed a similar procedure in performing an analysis of the incident tread
incidence rates, which were derived by dividing the number of incidents on each tread on which
there was an incident by the number of users crossing the tread for ascending, descending, and
combined (both ascending and descending) incidents. The correlation coefficients indicated a
relationship between the incidence rate and "less effective tread depth" for the incident tread for
the combined data and the ascending data but not for the descending data. They also indicated a
relationship with higher effective riser height for ascent, descent, and combined. The
relationship to the characteristics associated with the first, second, and third treads prior to the
incident tread was also examined as part of this process. Some relationships that were indicated
for the combined data set vanished when the data for ascents and descents were examined
separately.

The multiple regression for the combined category generated the following equation:

Equation 1 y = -.25(A7 1 ) + .32(A7 3 ) + .95(A24 C 0 ) - .64

No relationship was found between the depth of the incident tread and the incidence rate (y), but
the authors found a relationship between the incidence rate and the depth of the tread (A71)
immediately prior to the incident tread and that of the third prior tread (A73). The signs of the
coefficients, however, were different. The relationship between the depth of the first prior tread
and the incidence rate was negative, suggesting that increasing the depth of that tread would
diminish the incidence rate. The opposite sign for the third prior tread, however, suggested that

33
decreasing the depth would lower the incidence rate. No relationship between riser height and
the incidence rate was generated for the combined data set. A relationship between the presence
of stone or concrete materials (A24C0) on the incident tread and the incidence rate was also
generated.

A stepwise multiple regression analysis on the descent incidents generated the following
equation:

Equation 2 y = .16(A 41 ) - .83

A relationship between the incidence rate (y) and effective riser height of the tread immediately
prior to the incident tread (A41) was found. The equation generated by the process did not
indicate a relationship between tread depth and the incidence rate.

When the same process was performed on ascent incidents, the following equation was
generated:

Equation 3 y = -.16(A7 0 ) - .18(A30 C 0 ) + .19

Equation 3 reflects a negative relationship between the incidence rate (y) and the effective depth
of the incident tread (A70). The generated equation also contained a negative relationship
between "the absence of a rich open view" (A30C0) and the incidence rate. If we read this as the
absence of distraction, then the relationship seems counter-intuitive. No relationship between the
riser height and the incidence rate was generated in the equation.

A similar analysis was performed for behavioral factors. Equations 4 and 5 were generated for
the combined incidents and descent incidents, respectively.

Equation 4 y = -.31(C 91 ) + .24

Equation 5 y = -.78(C 91 ) + .52

As can be seen, the multiple regression equations for the combined data and the descent data
expressed a negative relationship between the proportion of the foot placed on the first tread prior
to the incident tread (C91) and the incidence rates. The treatment of the correlation coefficients
related to "having less of the foot on the (incident) tread" was the source of confusion. Although
the discussion in the text and the accompanying table indicated a positive value for the
correlation coefficient, the value given for the correlation coefficient was -.256 for the combined
data and was not given at all for the descent data. No correlation was expressed in either text or
tables for the ascending data.

The report concludes with discussion and conclusions sections. In those sections, the authors
draw the following conclusions:

34
 High risers and narrow treads were the design features most consistently found to
be associated with incidents on industrial stairs. For the combined ascent and
descent data, narrow treads on the first and third tread prior to the ones on which
incidents occurred were found to be significantly associated with those incidents.
For the ascent data alone, narrow treads at the point at which the incident occurred
were also found to be significantly associated with those incidents. For the
descent data alone, higher risers on the treads prior to the ones on which the
incidents occurred were found to be significantly associated with those incidents
(p. 194).

In the conclusion, the authors stated that, "In general it was found that several design features
were related to higher incidence rates on industrial and commercial stairs. These included risers
in excess of 6 to 7 in. (15 to 18 cm) in effective height, treads of less than 10 to 11 in. (25 to 27
cm) in effective depth..." (p. 196).

Comments

Review of this article revealed that the research produced inconsistent and contradictory results.
The results failed to provide reliable support for conclusions about the role of stair geometry in
either accidents or incidents.

The following concerns arose during the review:

• The inconsistent and contradictory results of the statistical analyses failed to provide
reliable support for conclusions expressed in the article.

• Analysis at the incident-tread level disregarded other available information.

• The subjectivity of the judgment criteria and potential for variation seriously hampered
accurate quantification and potential replicability.

• Omissions and lack of explanations inhibited assessment of the research.

The Results of the Research Do Not Support Conclusions in This Article

The authors suggested that "High risers and narrow treads were the design features most
consistently found to be associated with incidents on industrial stairs" (p. 194). In the
conclusions section of the article, the authors stated, "In general it was found that several design
factors were related to higher incidence rates on industrial and commercial stairs. These included
risers in excess of 6 to 7 in. (15 to 18 cm) in effective height, treads of less than 10 to 11 in. (25
to 27 cm) in effective depth..." (p. 196).

The use of discriminant analysis, correlation coefficients, and regression analysis failed to
support such statements.

• The description of the discriminant analysis contains no mention of tread width or riser
height; however, it seems reasonable to assume that these were candidate factors used in the

35
 analysis because they figure so prominently in the other analyses. If this is true, then
discriminant analysis failed to distinguish any difference between the tread and riser
dimensions of the incident and nonincident treads.

• The authors presented simple correlation coefficients relating tread depth, riser height, and
various other characteristics to the incidence rate at both the stair and the incident tread
level. These coefficients should not be interpreted as establishing causality between any of
those characteristics and the incidence rate. This statistic is insufficient to establish a
statistically significant relationship between the incidence rate and any single independent
variable such as tread depth because it does not adjust for the simultaneous role that other
independent variables could have played. For example, let us assume that an examination
of correlation coefficients indicated that narrower treads, loose tread covering, and lack of
illumination were positively associated with the incidence rate. An interpretation that the
narrower treads resulted in a higher incidence rate would ignore the fact that the narrower
treads could all be located on ill-illuminated stairs with loose covering. Simple correlation
coefficients cannot separate the simultaneous effects of those three factors, thus providing a
misleading view of a multivariate relationship. The proper application of a more
sophisticated technique such as regression analysis is needed to separate the effects of each
of the independent variables and to estimate the individual relationships between each of the
three independent variables and the incidence rate.

• When regression analysis was applied at the stair level, no statistically significant
relationship between tread depth or riser height and incidence rate was identified.

• When the authors attempted regression analysis at the incident tread level, they reported
contradictory results. For the descent data, the resultant equation (Equation 2) indicated that
the effective riser for the first prior tread height was positively correlated with the incidence
rate, but tread depth was not significant. For ascent data (Equation 3), the effective tread
depth was negatively correlated with the incidence rate, but riser height was not. For the
combined data (Equation 1), the first prior tread was negatively related to the incidence rate,
and the third prior tread was positively related. The combined effect of the two resultant
coefficients actually predicts that larger tread depths produce a higher, not lower, incidence
rate, thereby contradicting the indications of the ascent equation.

In light of this last result, the following quotation is troubling: "For the combined ascent and
descent data, narrow treads on the first and third treads prior to the ones on which incidents
occurred were found to be significantly associated with those incidents" (p. 194). The statement
failed to point out the opposite signs and thus the opposite effects of the depth of the treads on
the incidence rate. Further, it did not note that the regression suggests that the incidence rate
increased with tread depth.

Given that no statistically significant relationship was identified through regression analysis at
the stairway-level and that the results of the tread-level analysis were mixed and contradictory, it
is inappropriate to characterize the results as supporting the hypothesis that deeper treads and
lower risers produce fewer incidents. Objectivity demands consideration of all results, not just
selected results.

36
It should also be noted that even the correlation coefficients failed to indicate a relationship
between tread depth and the incidence rate in descent on either the per flight basis or the
incident-tread basis.

Analysis at the Incident-Tread Level Disregards Other Available Information

After the authors' application of regression analysis failed to identify any statistically significant
relationship between either riser height or tread depth and the incidence rate at the stairway level,
the researchers used the technique on data at the incident-tread level but limited the data set to
treads where incidents occurred. This approach ignored the characteristics of the vast majority of
treads on which no incidents occurred.

Subjectivity of the Judgment Criteria

In assessing the findings of this article, it must first be noted that "incidents" and not actual
accidents were the subject of the analysis. The convention of using incidents as some type of
proxy for accidents is frequently found in the stair safety literature; however, no quantified,
statistically valid relationship between incidents and accidents has been established.

In describing the process, the authors reported that:

A total of 516 potential incidents were identified. These were then reviewed a
second time to identify bona fide accidents and missteps. Only those incidents in
which there was a clear misstep, loss of balance, or apparent disruption of the
user's intended pattern of movement were selected. A total of 98 undisputed
critical incidents were selected for the final analysis (p. 187).

Later, in discussing the training of observers, the authors related:

From previous research it was clear that the degree of coding precision decreased
as the amount of observer judgment increased (Templer et al., 1978). Much of the
training period concentrated on improving the precision of the observers'
judgmental decisions (p. 188).

The necessity of using a process to differentiate between "potential incidents" and "bona fide
accidents and missteps" to identify "undisputed critical incidents" indicates that the identification
of "missteps" and "incidents" is not a straightforward process. Further, given that coding
precision has been a problem in the past and that training was needed to improve on "judgmental
decisions," it is clear that an element of judgment was introduced that seems to have been a
problem in the past. Further, the presence of multiple observers and coders and the failure of the
article to demonstrate consistency among them leaves open the potential for variation in
judgment. The results of applying quantitative techniques to data of such uncertain precision
must be regarded with extreme care.

37
Omissions and Lack of Explanations Inhibit Assessment of the Research

Additional problems identified during the review of the article include the apparent omission of
observations from the incident-tread level analysis and the lack of information about variables
and techniques used in the analysis. Regarding the first concern, the authors included in the
results of the correlation analysis the degrees of freedom for the correlation coefficients for
selected variables. Since degrees of freedom are computed by subtracting two from the number
of observations, it is possible to deduce the number of observations used to compute each
correlation.

An examination of the description of the correlation coefficient for combined data at the tread
level yields the following degrees of freedom: treads of concrete or stone, 57; rich views open to
one side, 57; tread depth, 48; and riser height, 52. These numbers mean that at least 59
observations (i.e., 59 treads) were available for analysis, yet only 50 were used for the tread
correlation coefficient and only 54 for the riser coefficient. The same condition was true of the
descent data: riser height, 25; concrete or stone treads, 30. This indicates the existence of at least
32 observations, with only 27 used for the riser correlation. In ascent, the following was found:
tread depth, 33; presence of rich views open to one side, 37. This suggests at least four omitted
observations. No mention of these omissions or explanation could be found in the text. Further,
if the same practice was followed in the regression analysis, the implications are even more
serious. No information is provided on the number of observations used in the tread-level
regression analysis.

The failure to provide both a full list of variables used as candidates in the analysis and an
explanation of statistical methods further hampers the assessment of the research. Although the
authors indicated that 123 variables were considered in the research, they provided no
comprehensive list. In addition, the authors did not explain the statistical problems encountered
during the analysis and the acceptable statistical techniques used to deal with such problems.

For example, in the case of the first, second, and even third tread prior to the incident tread, the
report made no mention of encountering any difficulties with multicollinearity among the
independent variables. Perhaps, though, some such difficulty may explain a portion of the
contradictory results. The lack of this information makes it extremely difficult to assess the
validity of the techniques and thus the results of the analysis.

Conclusion

The research described in this article did not identify a consistent statistically significant
relationship between tread depth or riser height and "incidents." First, simple correlation
coefficients are inadequate for establishing any causal relationships. Second, the discriminant
analysis and regression analysis failed to isolate any statistical relationship between stair
geometry and the incident rate at the stairway level. Finally, the results of regression analysis at
the incident-tread level were inconsistent and contradictory. Thus, the work cannot be
characterized as providing consistent statistical insight into the role of tread and riser dimensions
in "incidents" or accidents.

38
3.3.7 Fruin, J.J., D.K. Guha, and R.F. Marshall. Pedestrian Falling Accidents in Transit
Terminals. Washington, D.C., Urban Mass Transportation Administration, U.S.
Department of Transportation (1985).

Content

This report begins with a section devoted to the human factors of falling and design. It continues
with a recounting and analysis of a study conducted by the Port Authority of New York and New
Jersey into falling accidents in transit terminals. Following a brief section on risks and claims
management, the report presents design and operating strategies. Finally, the report concludes
with a summary of an industry workshop addressing falls.

Causality was characterized in terms of slipping, tripping, pushing, lost balance, alcohol
influence, foreign objects on the tread, and unknown. The authors indicated that few falling
accidents were caused by design or operating problems.

The authors' presentation of design strategies included a discussion of anthropometric

measurements of the human foot, which led to the recommendations for a tread dimension of
11 inches. The section on riser height asserts that "Studies of human energy expenditure, the
probability of missteps, and stair accidents show that the preferred range of riser heights is 5 to 7
inches (emphasis added). Recommended tread and riser dimensions that are based on "human
factors studies of stairs" and reflect risers of those heights and treads between 11 and 14 inches
are contained in an appendix to that report.

Comments

The report's recommendations for stair geometry were not based on any statistical or other
analysis of the research conducted by the Port Authority. The data presented in the analysis of
fall accidents did not address the specific role of either tread or riser dimensions.

3.3.8 Templer, J. The Staircase--Studies of Hazards, Falls, and Safer Design, Cambridge,
MA, The MIT Press (1992).Error! Bookmark not defined.

Contents

The second of a two-volume set, this work addresses the safety aspect of stairs. Although it
presents no new research into the role of riser and tread dimensions in either accidents or
"incidents," the recommendations contained in the conclusion of Chapter 2 aid in clarifying the
recommendations contained in the author's earlier work--Stair Shape and Human Movement.
Chapter 2 (p. 38) states:

After considering the studies of preference, energy expenditure, foot dimensions,

and etiology, we can set out recommendations for safety and comfort:

39
 Recommendations for Safety:

• In terms of gait, risers should be 6.3 to 7.2 inches (16-18.3 cm) and goings should not
be less than 9 inches (22.9 cm).
• The etiological studies suggest that risers should not exceed 7.5 inches (19.1 cm) and
goings should not be less than 9 inches (22.9 cm).
• To accommodate feet adequately, goings should not be less than 11 inches (27.9 cm).

Recommendations for Comfort:

• From the preference studies, we learn that people prefer lower risers.
• In terms of energy expenditure, higher risers are more fatiguing. However, higher
risers with smaller treads are no more fatiguing than much lower risers with larger
treads.

Comments

As can be seen above, the author interpreted the gait analysis (described in Stair Shape and
Human Movement) as indicating that treads should be no less than 9 inches. Further, it appears
that the recommendation for treads of no less than 11 inches found its source in an examination
of foot dimensions, not in the gait analysis. The etiological studies referenced above are reviewed
elsewhere in this report. Neither they nor the gait analysis produced any statistically significant
results that provide insight into the role of stair geometry in accidents or "incidents."

4.0 CONCLUSIONS

In this review of literature and other sources of statistical data, the following conclusions can be
drawn:

• Research has established no quantitative relationship between riser height and tread depth
and accident rates on stairs.

• Researchers have attempted to establish a link between riser and tread dimensions and
proxies for accidents such as "incidents," "missteps," and "arrhythmic distortions of gait."
These studies suffer from the following serious shortcomings:

» No quantitative link has been established between accidents and such proxies.

» The results of the studies are contradictory.

» The study of proxies suffers from subjectivity in defining valid observations, thus
making quantitative analysis potentially more difficult and questionable.

» The research fails to provide consistent findings within individual studies. The
failure of initial research efforts to identify a statistical relationship often resulted
in the reformulation and reanalysis of data, which produced different results.

40
These conclusions are based on a review of the literature listed in this document, which includes
in-depth reviews of the major documents frequently cited in support of various stair geometries.
In addition to presenting research aimed at identifying a valid quantitative relationship between
either accidents or incidents to riser and tread dimensions, the in-depth reviews also recount
other major studies that do not contain any original research but that are often referenced in
relation to the role of stair dimensions in accidents. None of these established a statistically
significant relationship between riser and tread geometry and either accidents or such proxies as
"incidents."

5.0 RECOMMENDATIONS

This review indicates that the data and research on stairs and stair geometry do not substantiate
any direct link between stair geometry and user safety (where "safety" is defined in terms of
accidents leading to personal injury). Related research has focused on the correlation of
"incidents," "missteps," and similar proxies that occur far more frequently than accidents and
lend themselves more readily to examination. These studies, however, suffer from major
shortcomings, the more serious of which are that the definition of an "incident" can be subjective
and, at times, ambiguous and that no relationship has been identified between such proxies and
accidents.

If future research is to establish the existence or absence of a causal relationship between

riser/tread geometry and accidents, it would appear pointless to pursue further "incident" studies
unless they also address, in a quantitatively reliable manner, the relationship to accidents. Absent
this, further research should directly focus on falls occurring on stairways.

Direct research into stair accidents is likely to be expensive. Accidents occur infrequently on
stairs. Estimates contained in Guidelines for Stair Safety indicate that a minor stair accident
occurs once in 63,000 flight uses whereas "noticeable missteps" occur once in every 7,398 uses.
The need to include a sufficient variety of stair dimensions and to control for the interaction of
other factors suggests that an extensive effort would be required to produce a sufficiently large
sample.

Several approaches are possible, though none is without drawbacks. A multiyear videotaping
effort is one possibility. Such research would require researchers to record and study accidents
on public stairs but would likely introduce some distortion into the results because traffic
patterns, tread materials, and maintenance practices in public buildings could differ greatly from
those in residential structures. Home owner concerns about privacy and the lower use rate of
residential stairs would seem to preclude residential studies. In addition, the identification of
dangerous stairs during the taping process and the subsequent failure to alert potential victims to
hazards pose ethical problems. Last, sufficient variations in riser and tread dimensions are likely
to be difficult to identify.

Considering these difficulties, an alternative approach that depends on personal interviews is

recommended. If researchers could gain personal data associated with the accidents reported in
the NEISS database, they could formulate a truly random sample of victims. Personal interviews
and the physical measurement and assessment of the stairways for a statistically valid set of both
victims of stair accidents and nonvictims could be gathered in conjunction with other background

41
information and used to assess stair safety in terms of falls. Unfortunately, this type of research
must rely on the recollection of participants for much of the detail surrounding the accident.
Therefore, research should concentrate on recent victims and be designed to minimize the effect
of recall. In conjunction with such research, efforts should be made to improve established data
gathering efforts. Working with the CPSC, researchers could identify changes that would
improve tracking of stair-related accidents in the NEISS. The research would likely require a
multiyear effort and, although the costs may be high relative to incident studies, they would
likely be slight compared to the potential cost of design changes.

Whatever the exact nature of the study, the research goal should be broader than identifying the
role of stair geometry in accidents. To provide a basis for changes in design aimed at improving
stair safety, the research must address other design issues such as stairway lighting, handrails,
stair coverings, and other factors described in Appendix A, along with their associated costs.
Design changes for overall safety could then be considered in light of solid and reliable research
findings.

42
 APPENDIX A
ALTERNATIVE STAIRWAY SAFETY FEATURES

Many articles make suggestions for improved stair safety outside the realm of changing
geometry. These suggestions usually involve design of stairway elements. Data from the NEISS
are often used to generate estimates of injuries sustained and accident location. However, no
effort has been made here to assess any claimed statistically valid relationship between accidents
and the design features of stairs. Thus, the suggested alternatives may suffer from the same lack
of data as may the arguments in favor of 7-11 geometry.

BOSTI (1978) stands out from the other articles in its analysis of the NEISS data by area of home
accidents. It describes situations that are viewed as contributing to home accidents and attributes
a percent of all stair accidents to each set of circumstances. Recommendations for design
changes are made for each situation, but no statistically valid estimate of accident reduction can
be imputed for any change.

Below are articles that suggest changes in stairway design. The bibliography contained in
Appendix B of this review provides complete citations.

• BOSTI, Home Safety Guidelines for Architects and Builders

• HUD (Teledyne), A Design Guide for Home Safety

• Hay and Barkow, Personal and Building Factors in Stair Safety

• DOC (Archea, Collins, and Stahl), Guidelines for Stair Safety

• Templer, The Staircase

• Asher, "Toward a Safer Design for Stairs"

• Hay and Barkow, "A Study of Stair Accidents"

• Harrison, "Design Guidelines for Safe Stairs"

• McGuire, "Preventive Measures to Minimize Accidents among the Elderly"

• Archea, "Environmental Factors Associated with Stair Accidents by the Elderly"

Most of the suggested design changes can be pooled into several categories as follows:

Floor Covering

• Provide a stable walking surface

• Use slip-resistant treads
• Ensure a tight, uniform covering

A-1
Construction and Design

• Use round nosings

• Ensure consistent stair dimensions
• Ensure structural integrity
• Place doors to avoid striking other people

Surrounding Environment

• Remove glass objects near stairway

• Use energy-absorbing materials

Visual Enhancements

• Make distinct stair edges

• Use contrasting colors between stairs and walls
• Reduce glare
• Reduce shadows
• Shield light sources
• Eliminate visual distractions

Stair Illumination

• Place light switches at top and bottom away from first riser
• Use contrast lighting
• Ensure consistent light levels between stairway and surrounding areas
• Illuminate one- and two-step risers
• Provide low-voltage permanent bulb
• Provide redundancy in light sources

Handrails and Guardrails

• Make continuous
• Make comfortable
• Use dual handrail (where possible)
• Install properly
• Use terminations (where appropriate)
• Provide a child's handrail (where appropriate)
• Ensure proper dimensions, height, materials, wall clearance

Restricted Use

• Control stair use by children

A-2
 APPENDIX B
REVIEW OF OTHER LITERATURE

Archea, John C. "Environmental Factors Associated with Stair Accidents by the Elderly,"
Clinics in Geriatric Medicine. Vol. 1, No. 3 (August 1985): 555-569.

Contents

The author focuses on the diminished eyesight of the elderly as a major cause of stair falls and
accidents. Design can help the elderly through better delineation of step edges and elimination of
shadows and glare. The author promotes the use of handrails.

Comments

This article neither offers original research nor mentions stair geometry.

Asher, Janet K. "Towards a Safer Design For Stairs," Job Safety and Health (September
1977): 27-33.

Contents

The author presents findings of studies on stair use as well as design suggestions for promoting
safer stair use. The author reports on Fitch, Templer, and Corcoran's 1974 study of stair
geometry, which shows a range of possible stair dimensions: for descent, treads of at least 12.3
inches and risers of 4.6 to 7.2 inches; for ascent, risers of 6.3 to 8.9 inches and treads of 7.7 to
14.2 inches.

Comments

This article neither offers original research nor specifically mentions 7-11 geometry.

Baker, Susan P. and Ann Hall Harvey. "Fall Injuries in the Elderly," Clinics in Geriatric
Medicine. Vol. 3, No. 3 (August 1985): 501-512.

Contents

The authors discuss injuries suffered in falls by the elderly, with emphasis on injuries in nursing
homes. Areas of concern include exposure to hazards, susceptibility to injury, and death rates. A
discussion between the authors and several physicians follows the text.

Comments

This article does not address stair geometry.

B-1
Baker, Susan P., Brian O'Neill, and Ronald S. Karpf. The Injury Fact Book. Lexington,
MA, D.C. Heath and Co. (1984).

Contents

This book provides a quantitative assessment of injuries. It contains statistics pertaining to major
types of injuries, including falls, and presents an analysis of demographic and other
characteristics. One chapter is devoted to various statistical aspects of falls. Additional data in
the appendices address stair-related falls, but the statistics do not address the role of stair
geometry.

Comments

This book contains no original research into the role of riser and tread dimensions in falls.

Boulet, J.A.M., J.A. Templer, and S. Hanagud. "Computer-Based Simulation of a Human

Falling on a Stairway," in Proceedings of the Human Factors Society 33rd Annual
Meeting - 1989: Perspectives, Vol. 2: 1145-1149.

Contents

The authors describe a computer model designed to simulate both a person falling down a flight
of stairs and the objects that a person strikes during the fall.

Comments

This article does not address stair geometry.

Brill, Michael, Bonnie See, and Terry Collison. "Home Accidents: The Hidden
Epidemic," Progressive Architecture. Vol. 4 (1974): 76-81.

Contents

The authors cite some cursory statistics on accidents and offer thoughts on who is injured in
home accidents, the source of the problem, possible solutions, and efforts underway to reduce
home accidents. Trends are cited that have raised public awareness of home accidents. The
authors' assumptions are stated and applied to an example stair accident. Performance criteria are
presented for design to prevent stair injuries. The authors detail their past research and plans for
future research.

Comments

This article does not comment on stair geometry.

B-2
Bureau of Labor Statistics. Injuries Resulting from Falls on Stairs: Bulletin 2214.
Washington, D.C.: U.S. Department of Labor (August 1984).

Contents

The bureau surveyed over 1,000 workers injured in stair accidents. Workers are described by
industry, age, sex, occupation, injuries sustained, hospitalization, lost work days, activity at the
time of the accident, description of the accident, contributing factors, and location and
description of the stairs, including dimensions. Fifteen percent of the injured workers fell on
stairs with risers higher than 8 inches, and 22 percent were injured on stairway treads of less than
10 inches.

Comments

This report addresses accidents categorized by stair geometry. Since the overall distribution of
stair size and frequency of use are unknown, the surveyed injury rates cannot be equated to risk.
The statistics presented are inconsequential.

Centers for Disease Control. "Premature Mortality in the United States: Public Health
Issues in the Use of Years of Potential Life Lost," Morbidity and Mortality Weekly
Report Supplement, Vol. 35, No. 2S (December 19, 1986).

Contents

This article outlines a measure of mortality known as years of potential life lost. Calculations are
made and tables presented for causes of mortality by age, sex, and race.

Comments

The article does not address stair accidents or riser/tread geometry.

Cohen, H. H., J. Templer, and J. Archea. "An Analysis of Occupational Stair Accident
Patterns," Journal of Safety Research. Vol. 16 (1985): 171-181.

Content

This report recounts an analysis of occupational injury data from the worker's compensation
agencies of Ohio and California. The results of the analysis include a classification of the
accidents by precipitating events or conditions as identified in the injury reports. The study
attributes only 4 percent of the accidents to "Design Conditions," and 50 percent to "Performance
Factors," which reflect various behaviors of the user. Within this context, the authors express
reservations about attributing falls to single factors. They note that multiple factors are likely to
interact in precipitating a fall. According to the authors, one of the most significant findings was
that 92 percent of the injuries occurred in descent.

B-3
Comments

This report does not present any statistical analysis of the role of riser/tread dimensions in falls.

Dacquisto, David J. and Jake Pauls. "The 7-11 Stair Story: Should It Be Required in
Residential Construction?" The Building Official and Code Administrator (May-June
1985): 26-35.

Contents

In a point/counterpoint piece, Dacquisto presents the argument against establishing 7-11

geometry as a minimum code requirement while Pauls takes a proponent position. The
disagreement hinges on the relevance and validity of cited research.

Comments

This article does not offer original research but speaks directly to the 7-11 controversy.

Etter, Irvin B. "The National Safety Council's Estimates of Injury Costs," Public Health
Reports. Vol. 102, No. 6 (November-December 1987): 634-636.

Contents

The author outlines and recites estimates of the six components used by the National Safety
Council to measure accident costs. These components are wage losses, medical expenses,
insurance administration costs, fire losses, motor vehicle property damage, and indirect loss from
work accidents.

Comments

This article neither offers original research nor addresses stair geometry.

Fitch, James Marston, John Templer, and Paul Corcoran. "The Dimensions of Stairs,"
Scientific American (1974): 82-89.

Contents

This paper recounts some of the history and theory of stairs and discusses the research described
in the author's Ph.D. dissertation, which is examined in detail elsewhere in this review.

Comments

This paper offers no original research results on the role of riser and tread dimensions other than
that described in the author's dissertation.

B-4
Hanagud, S., J.A. Templer, K.E. Cummerford, and T. Boulet. "Development of
Standardization Test Techniques for Materials That Are Capable of Reducing
Injuries During Stairway Falls," in Proceedings of the Human Factors Society 33rd
Annual Meeting--1989: Perspectives. Vol. 2: 1153-1157.

Contents

The authors report on an experiment that contrasts the force exerted on a dummy by materials
commonly used in stairway construction versus energy-absorbing materials such as foam.
Procedures, results, and conclusions are presented.

Comments

This article does not address stair geometry.

Harrison, Gregory. "Design Guidelines for Safe Stairs," Fine Homebuilding. No. 65
(March 1991): 66-68.

Contents

The author, who describes himself as a safety engineer, addresses the role of building codes in
stair safety. The article discusses handrails, riser and tread design, surface texture, short flights,
guardrails, and other elements of stair design.

Comments

This article does not present original research but recommends guidelines, including the use of 7-
11 geometry as a minimum standard.

Hay, Thomas F. and Ben Barkow. "A Study of Stair Accidents," presented at the Human
Factors Association of Canada Conference (1985).

Contents

The authors interviewed 81 Canadians who required medical attention for injuries suffered as the
result of falls on stairs. Statistics are presented on the physical features of the stairs, the behavior
of the individuals at the time of the accident, injuries sustained, and the cost of medical
treatment. The study shows that the stairs involved in accidents averaged 7.12 inches for riser
height and 11.2 inches for tread depth, near the authors' recommended dimensions.

Comments

This study addresses stair geometry as part of stairway design. Some of the researchers' opinions
on stair "problems" and recommendations for geometry are vague. For example, the study's
evidence does not statistically support or counter any specific riser or tread dimension.

B-5
Hay, Thomas F. and Ben Barkow. Personal and Building Factors in Stair Safety: Accident
Reduction Methods in Homes, at Work, and in Public Places. Toronto, Behavioral
Team (1985).

Contents

The authors discuss the second stage of the team's stair accident and stair safety project. The
second stage consists of two studies: in-depth research of 81 stair accidents to determine
structural and environmental features, personal and behavioral characteristics, and injuries
sustained and costs incurred; and a separate group's perception of risk based on photographs of
stairs from the former study. Based on the stair safety literature and the authors' study, the
researchers recommend tread depths of 11.2 to 14 inches and riser heights of 4.4 to 7.2 inches.

Comments

This report studies only dimensional irregularities and does not refer to 7-11 geometry. The basis
for tread and riser recommendations is vague. The authors do not equate risk with their study
group.

Heimplaetzer, P.V. and L.H.J. Goosens. "Risks and Accidents in the Built Environment,"
Safety Science. Vol. 14 (1991): 87-103.

Contents

The authors suggest that more research should be conducted on accident modeling and scenarios,
risk factors, and measures of safety. Architects are encouraged to use value judgments instead of
regulations and standards when considering safety. The authors suggest that stair accidents can
be eliminated by removing stairs altogether; by reducing the likelihood of stair-related accidents
through a number of measures, including augmenting dimensions; and by reducing the extent of
injury by changing the materials used on stairs and in the surrounding environment.

Comments

This article does not report original research but presents statistics from other studies (reviewed
elsewhere in this report) regarding the relative safety of various stair dimensions and orientations.

Heimplaetzer, P.V., L.H.J. Goosens, J.H.M.M. Musson, and R. Clement. "Accident

Scenarios for Domestic Stair Accidents, Characteristics of Households, Stairs and
Dwellings as Risk Factors," in Safety in the Built Environment. Jonathan I. Sime,
ed. (1988): 186-197.

Contents

The authors conducted a survey of 440 dwellings in The Hague (Netherlands) and categorized
the dwellings by household composition and stairway type. They found that accident frequency
was highest in households with younger children and that stairs with winders had more accidents.
The authors made no attempt to measure frequency of use in view of the small sample size.

B-6
Comments

The authors address the stair dimensions and geometry of the five types of staircases in the study.
The study focuses on a limited range of stair dimensions but does not consider 7-11 stair
geometry.

Hyde, Deborah Hayes. "Building Accident Statistics," in Educational Workshop on

Building Safety. Georgia Institute of Technology (1992).

Contents

The author refers to frequently cited statistics and data sources. She outlines data and research
needs and recommends steps for improving research into building accident statistics.

Comments

This article neither offers original research nor addresses stair geometry.

Irvine, C.H., S.H. Snook, and J.H. Sparshatt (Liberty Mutual Insurance Co.). "Stairway
Risers and Treads: Acceptable and Preferred Dimensions," Applied Ergonomics
(September 1990): 215-225.

Contents

The authors describe the procedures and results of an experiment designed to study stairway
preference and acceptability. Sixty-six individuals were instructed to ascend and descend 19 sets
of stairways and asked to identify preferred and acceptable steps. Results are presented in tables
and graphs.

Comments

This article addresses stair geometry within the framework of user preference. It provides no
original research that relates riser and tread measurements to stair safety.

Kose, S. Study of Accidents Associated with Building Features. BRI Research Paper No. 93.
Tsukuba, Japan, Building Research Institute (1982).

Contents

The author examines several sources of injury data in Japan. Concentrating on ambulance
activity records, investigators found that about 8 percent of injuries were associated with
building-related activities. Residential buildings accounted for most accidents. Accidents are
described by location and type. Detailed analysis is performed for falls on stairs, on level
surfaces, out of buildings, and from one level to another, among other things. Further research
needs are outlined.

B-7
Comments

This article mentions stair geometry only in the context of future research.

Kose, Satoshi and Hidetaka Uno. "Investigation of Maximum Pitch for Domestic Stairs
through Energy Expenditure Tests," in Proceedings of the International Conference
on Building Use and Safety Technology (1985): 139-143.

Contents

The authors present details of experiments performed to measure two groups' energy expenditure
from stair climbing. Three male students were measured for heart rate and oxygen consumption
on a treadmill and for heart rate only on variously pitched laboratory stairs and office building
stairs. An attempt was made to measure an elderly group, but the environment was not properly
controlled.

Comments

The researchers conclude that energy expenditure has little to do with injury on domestic stairs.

Kose, Satoshi, Yoshihiro Endo, and Hidetaka Uno. "Experimental Determination of Stair
Dimensions Required for Safety," in Proceedings of the International Conference on
Building Use and Safety Technology (1985): 134-138.

Contents

The researchers conducted both field observations and laboratory experiments to determine
minimum required dimensions for safe stairs. Jutting ratios were measured in the field and
compared with laboratory subjects. Movement behavior and the force of foot impact were also
studied in the laboratory. The researchers conclude that tread length should be no less than 210
mm (8.3 inches) and riser height no more than 180 mm (7.1 inches).

Comments

This article addresses stair behavior and geometry in terms of proxies such as jutting ratios and
impact force but provides no quantitative relationship to accidents or falls.

Maki, Brian E., Sheryl A. Bartlett, and Geoff R. Fernie. "Effect of Stairway Pitch on
Optimal Handrail Height," Human Factors (June 1985): 355-359.

Contents

The authors report on an experiment to study various handrail heights at two different slopes (41
and 49 degrees) and the force exerted on the handrails by 40 subjects. The experiment duplicates
procedures used in the authors' 1984 article. The authors postulate an optimal range for handrail
height by using their data and participants' comments on comfort.

B-8
Comments

This article does not address stair geometry in regard to safety.

Maki, Brian E., Sheryl A. Bartlett, and Geoff R. Fernie. "Influence of Stairway Handrail
Height on the Ability to Generate Stabilizing Forces and Moments," Human
Factors. Vol. 26 (1984): 705-714.

Contents

The authors report on an experiment to study various handrail heights (at a constant pitch) and
the force exerted on the handrails by 35 subjects. The authors postulate an optimal range for
handrail height by using their data and participants' comments on comfort.

Comments

This study does not address stair geometry.

McGuire, Marie C. "Preventive Measures to Minimize Accidents among the Elderly,"

Occupational Health Nursing (April 1971): 13-18.

Contents

The author cites statistics on America's aging population and on accidents involving the elderly.
Tables relate statistics from a U.S. Department of Housing and Urban Development study on
home accidents. The author makes recommendations for making the home a safer place.

Comments

This article does not present original research. It contains a brief reference to stair dimensions.

Medford, Ronald. Status Report on Safety in Architecture and Construction: Stairway

Safety. Consumer Product Safety Commission (1983).

Contents

The author reports on the status of the CPSC's Household Structural Products Team study of
stairways and injury data. The report also presents economic data on the stair manufacturing
industry; factors affecting stairway safety, including dimensions and conditions; user behavior;
and building codes.

Comments

This paper does not offer original research.

B-9
Nagata, Hisao. "Analysis of Fatal Falls on the Same Level or on Stairs/Steps," Safety
Science. Vol. 14 (1991): 213-222.

Contents

The author cites the number of occupational injuries and fatalities in Japan, concentrating on
elderly workers. Outlining the method of survey, the author develops estimates for fatalities by
age, fatalities by year and age group, and the nature of the injury by age group. Discussion
revolves around alcohol consumption, the effects of fragile bones in the elderly, the risk of
falling, and application to occupational safety.

Comments

This article does not address stair geometry.

Nagata, Hisao. "Occupational Accidents While Walking on Stairways," Safety Science.

Vol. 14 (1991): 199-211.

Contents

The author selected and surveyed 425 stair accidents in the Tokyo area and analyzed the data for
sex, age, type of injury, lost work, and month and hourly distribution. Visits to accident sites and
interviews with the injured were conducted to examine walking direction, footwear, pace, carried
objects, and tread surface. Attention was paid to design factors, including types of flights,
dimensions of treads and risers, and tread covering. The author concludes that, among other
factors, "steep" stairs may induce falls but notes that many accidents occur on "low flights."

Comments

This article addresses the incidence of occupational stair accidents, in part, by ranges of tread and
riser dimensions. However, it estimates neither the frequency of stair use nor the distribution of
dimensions for the study stairs, providing no indication of the risk of injury given the particular
dimensions. The author makes reference to "non-accident stairs" but, in estimating the
distribution, surveys only the drawings of buildings submitted for design review. These stairs are
non-accident partly because they had not yet been built and may only reflect the trend in stair
construction at the time of survey. The use of these stairs as a standard for comparison to
accident stairs is questionable.

B-10
Nagata, Hisao. "Quantitative Assessment to the Dimensions of Stairs," in Ergonomics
International 85. I.D. Brown, R. Goldsmith, K. Coombes, and M.A. Sinclair, eds.:
928-930.

Contents

The author summarizes a preference study of various stair geometry combinations. Ten young
men, 10 young women, and 10 elderly men ascended and descended laboratory stairs, evaluating
the combinations of tread and riser for difficulty and instability. They also judged handrails. The
article includes graphs that represent the test groups' responses, and the authors present the tread-
riser combination that proved least difficult for each group.

Comments

This article studies stair geometry preference but does not estimate changes in accident risk
among the different dimensions.

National Research Council. Injury in America: A Continuing Public Health Problem.

Washington, D.C., National Academy Press (1985).

Contents

This report discusses injury in general and specifically focuses on epidemiology, prevention,
biomechanics and impact, treatment, rehabilitation, expenditures for injury-related research, and
administrative issues.

Comments

The report discusses fall injuries only in passing and does not mention stairs or 7-11 geometry.

National Research Council. Injury Control: A Review of the Status and Progress of the
Injury Control Programs at the Centers for Disease Control. Washington, DC,
National Academy Press (1988).

Content

This report looks at the progress made in implementing the recommendations outlined in Injury
in America: A Continuing Public Health Problem.

Comments

The report does not present information on stair falls or riser/tread geometry.

B-11
Office of Research and Technology. A Design Guide for Home Safety. Washington, D.C.,
U.S. Department of Housing and Urban Development (1972).

Contents

This report, prepared by Teledyne Brown Engineering, looks at safety in the home, with
emphasis on stairs, bathrooms, windows, doors, kitchens, floors, electrical and exterior environs.
The authors offer a maximum riser height of 7.5 inches and minimum tread depth of 11.25 inches
as guidelines for interior stair geometry.

Comments

The report does not cite specific research as a basis for its recommendations on stair dimensions,
stating only that the dimensions are based on "intensive engineering and human factors research."

Pauls, Jake. "Another Look at Residential Stair Design and Safety in Relation to Debate
over Riser/Tread Geometry." Draft paper (1991).

Contents

The author makes observations on estimates of injury and related costs. The costs and benefits of
changes in stair geometry are contrasted with the costs and benefits of residential fire safety
features. Recent developments are described, along with the role of code bodies in the code
change process.

Comments

This article does not offer original research but does address stair geometry and 7-11 as a
minimum standard in the code approval process.

Pauls, Jake. "Are Functional Handrails Within Our Grasp?" The Building Official and
Code Administrator (March/April 1991): 25-33.

Contents

The author defines a handrail and its functions on stairs. Typical handrail shapes are critiqued
for shape, size, surface, and cost. Minimum standards are suggested for both new construction
and retrofit. Estimates of the cost of injury from inadequate handrails are presented. Comments
from representatives of stair manufacturers and home builders follow the article.

Comments

This article neither offers original research nor comments on stair geometry.

B-12
Pauls, Jake L. "Are Functional Handrails within Our Reach and Our Grasp?" Southern
Building (September-October 1989): 20-30.

Contents

The author advocates a distinction between railings and handrails; the former for preventing falls
to a lower level, the latter for guidance or support. The article reviews the literature and
recommends design standards, especially with regard to stairs.

Comments

This article neither offers original research nor comments on stair geometry.

Pauls, Jake. "Cost of Injuries in the United States and the Role of Building Safety,"
Building Standards (July-August 1991): 18-24.

Contents

The author makes observations on estimates of injury and related costs. Further, falls in
buildings are compared to injury in general and specifically to structural failure and fire. Recent
developments are described, along with the role of code bodies and opponents to code change.

Comments

This article does not offer original research. It cites stair geometry and other safety-related
articles.

Pauls, Jake L. "Review of Stair-Safety Research with an Emphasis on Canadian Studies,"

Ergonomics. Vol. 28, No. 7 (1985): 999-1010.

Contents

The author outlines studies, statistics, and recent research on stair safety. The report contains a
detailed look at Canadian work on handrails and stairs. It concludes with remarks on the
building code bodies.

Comments

This article does not offer original research but does comment specifically on stair geometry.

B-13
Pauls, J. L. "Safety Standards, Requirements, and Litigation in Relation to Building Use
and Safety, Especially Safety from Falls Involving Stairs," Safety Science. Vol. 14
(1991): 125-154.

Contents

The author presents estimates of falls in general and on stairs for the United States, international
estimates, and comparison to fire and structural failure. The elderly and non-elderly are
contrasted in the incidence of injury. The author contends that inadequate attention is paid to
stair falls and that litigation is a useful tool to prod the building industry to action, citing
impediments to "improved building codes." The author promotes large, easily seen stairs with
reachable handrails.

Comments

This article does not offer original research but makes general remarks on stair geometry.

Pauls, Jake L. "Stair Safety: Review of Research," in Proceedings of the 1984 International
Conference on Occupational Ergonomics, Vol. 2: Reviews, Michael L. Matthews and
Robert D.G. Webb, eds., Human Factors Conference Inc. (1984): 171-180.

Contents

The author cites U.S. and international studies of stair accidents and safety. U.S. building code
bodies are listed with their references to stairs, including a 7-11 rise/tread configuration. Pauls
offers his comments on necessary conditions for safe stairs.

Comments

This article does not offer original research but cites international experiences with stair
geometry.

Pauls, Jake. "Stair Use, Safety, and Design: An Introduction," Proceedings of the
International Conference on Building Use and Safety Technology (1985): 114-115.

Contents

The author recounts historical guidelines for stair geometry and estimates of accidents and their
consequences. After making reference to some widely read reports, the piece includes some
comments for designers.

Comments

This article makes a few general comments on stair geometry. It does not offer original research
but cites earlier work by others.

B-14
Pauls, Jake L. "What Can We Do to Improve Stair Safety? Part I," Building Standards
(May-June 1984): 9-12, 42-43.

Contents

The author cites current research and traditional guidelines on stair safety and construction
dimensions. The article refers to studies by the U.S. Consumer Product Safety Commission
(CPSC), the Buffalo Organization for Social and Technological Innovation (BOSTI), the U.S.
National Bureau of Standards (NBS), John Archea (1979), and John Templer (1974).

Comments

This article does not present original research but concentrates on and advocates adoption of 7-11
stair geometry.

Pauls, Jake L. "What Can We Do to Improve Stair Safety? Part II," Building Standards
(July-August 1984): 13-16, 42.

Contents

More wide-ranging than Part I, this article discusses potential stairway hazards, including carpet,
lighting, tread markings, visual distractions, and handrails.

Comments

This article neither offers original research nor addresses stair geometry.

Ray, Wayne A., Marie R. Griffin, William Schaffner, et al. "Psychotropic Drug Use and
the Risk of Hip Fracture," New England Journal of Medicine. Vol. 316, No. 7
(February 12, 1987): 363-369.

Contents

The authors studied over 1,000 Medicaid patients with hip fractures and 5,600 control subjects to
investigate any relationship between those fractures and the use of psychotropic (mind-affecting)
drugs. The researchers found that drugs with long half lives increased the risk of hip fracture
from falls and accidents.

Comments

The article addresses neither stairs nor 7-11 geometry.

Rice, Dorothy, Ellen J. Mackenzie, and Associates. Cost of Injury in the United States: A
Report to Congress. Washington, D.C., U.S. Department of Health and Human
Services (1989).

Contents

B-15
This is the third in a series of reports on injury in the United States. It was presented in response
to a congressional directive to evaluate the impact of injury and associated disability.

Comments

This report contains no new original research into the role of stairs or stair geometry. It develops
estimates of the annual number of injuries for broad categories of injuries. These estimates then
serve as the basis for developing the estimated cost of those injuries. While the report estimates
the annual number of falls, it provides no figure associated with stairs. The text contained some
bibliographic references to stair-related accidents.

Svanstrom, Leif. "Falls on Stairs: An Epidemiological Accident Study," Scandinavian

Journal of Social Medicine. Vol. 2 (1974): 113-120.

Contents

The author looks at the extent of stair accidents in Sweden and reviews research on the
background of the injured, possible causes of accidents, behavior during a fall, and injuries
sustained. Proposed accident prevention revolves around information, education, legislation, and
design and construction. Recommendations include a stair geometry of 6-inch risers and 10-inch
treads.

Comments

This article does not present original research but does address stair geometry in general. The
author offers only a conjectural basis for the stair dimension recommendation.

Templer, John. "Studies of Safer Stairs and Ramps," in Educational Workshop on

Building Safety. Georgia Institute of Technology (1992).

Contents

The author cites statistics on fall injuries and stair injuries in the United States and reviews the
recommendations of earlier studies for tread, riser, and nosing dimensions and for the surface of
tread materials. Stairway design recommendations are outlined. Comments address
construction, maintenance, behavior, injury reduction, and ramps.

Comments

This article does not offer original research. Templer (1974) is cited as anecdotal evidence of
causation, but no statistical evidence is given to support a change in geometry for increasing
safety on stairs.

B-16
Templer, John A. "The Unforgiving Stair," in Proceedings of the International Conference
on Building Use and Safety Technology (1985): 122-126.

Contents

The author presents statistics on stair falls that address body orientation, reflexes, types of injury
by age group, element of stairway causing injury, and severity. The author suggests that while
falls cannot be prevented, their severity can be reduced by changes in design and materials.

Comments

This article neither offers original research nor comments on stair geometry.

Templer, John and Deborah Hyde. "Towards the Empathetic Stair," in Safety in the Built
Environment. J.D. Sime, ed. (1988): 198-207.

Contents

The authors describe a research program (then underway) aimed at reducing the severity of
injuries caused by falls on stairways. The article identifies six phases: collecting and analyzing
fall data from previous research, characterizing stair falls by laboratory experiment, computer-
based simulation of falls, modifying these models, assessing energy-absorbing materials, and
testing energy-absorbing materials for injury reduction. At the time of publication, the program
had completed the computer model driven by the laboratory experiments.

Comments

This article does not address stair geometry.

Templer, J.A., J.A.M. Boulet, S. Hanagud, and D. Hyde. "The Soft Stair: Falls Induced by
a Laboratory Stair," in Proceedings of the Human Factors Society 33rd Annual
Meeting (1989): 1150-1152.

Contents

The authors describe a laboratory experiment that involved 35 subjects. The test apparatus is a
set of stairs that induces subjects to fall. Results are shown as trajectory projections. Plans for
future work are outlined.

Comments

This article does not address stair geometry.

Tinetti, Mary E., Mark Speechley, and Sandra F. Ginter. "Risk Factors for Falls among
Elderly Persons Living in the Community," New England Journal of Medicine. Vol.
319, No. 26 (December 1988): 1701-1707.

B-17
Contents

The authors sampled 336 persons over the age of 75 to study risk factors related to falls. Of the
group, about one-third fell during the one-year study period. Those who fell are categorized by
age, sex, abode, environmental hazards, mental state, overall health, use of medication, and
specific physical symptoms and impairments. The authors find that the risk of falling increases
linearly with the number of risk factors.

Comments

This article does not address stair geometry.

van Erdewijk, J.P.M. "Constituent Parts of Dwellings and Accident Processes," in Safety
in the Built Environment. Jonathan B. Sime, ed. (1988): 164-173.

Contents

The author reviews 1986 data from the Home and Leisure Accident Surveillance System (The
Netherlands), which maintains records from emergency rooms. The data show that stairs were
involved in the most accidents (both in absolute and proportional terms) for the parts of the home
that contribute to or cause injury from an accident.

Comments

This article does not present data or findings on stair geometry.

B-18
 APPENDIX C

DISCRIMINANT ANALYSIS AND TESTING

IN STAIR SHAPE AND HUMAN MOVEMENT

As stated in the text of this review, the researcher used a statistical technique called "discriminant
analysis" to classify the stair setups, presented as Tables 3-2 through 3-7 in the text of the review.
A brief explanation of that technique follows to facilitate an understanding of the study results.

Discriminant analysis is a statistical technique in which some combination of independent

variables (or predictors) serves as the basis for the classification of some phenomenon into
groups. In this case, the independent variables are riser height, tread depth, angle of the stair, and
rate of vertical speed. The groups are performance groups ranging from "best" (fewest missteps)
to "worst" (most missteps).

To illustrate, the data are separated for analysis by ascent and descent categories and, within each
of those groups, into subcategories by toe-switch, heel-switch, and combined toe-switch and
heel-switch. Discriminant analysis is then applied separately to the data in each subcategory,
such as toe-switch walks in ascent. The data for each walk in the subcategory--consisting of
values for riser height, tread depth, angle of stair, rate of vertical speed, and the number of
missteps or arrhythmic distortions of gait--are then entered. The classification criteria, which
reflect the grouping scheme developed by the researcher, is entered into the program that sorts
the data for each walk into the appropriate performance group (designated either 1 through 3 or 1
through 4).

The statistical software then relates the independent variables to the group classification to
produce a set of coefficients for the independent variables. This maximizes the probability of
assigning the walk to the correct category based on the characteristics of the independent
variables. The process produces an equation (or a derived function) for each of the performance
groups within each subcategory. The equations as given by the author are: (pp. 401-402)

• For toe-switch during ascent,

Group 1 P1 = 1.22270R + 0.16465V - 10.04901

Group 2 P2 = 1.48275R + 0.08049V - 8.56786
Group 3 P3 = 1.71570R + 0.08049V - 8.56786

• For heel-switch during ascent,

Group 1 P1 = 0.37408Θ + 0.26878R + 0.08382V - 9.07442

Group 2 P2 = 0.43706Θ - 0.17032R + 0.12407V - 10.21841
Group 3 P3 = 0.48552Θ - 0.36459R + 0.14463V - 11.70229
Group 4 P4 = 0.65819Θ - 1.06651R + 0.15847V - 13.58109

C-1
• For combined toe- and heel-switches during ascent,

Group 1 P1 = 4.18153T - 23.85158

Group 2 P2 = 4.14656T - 23.45424
Group 3 P3 = 3.61698T - 17.84592
Group 4 P4 = 3.67619T - 18.43492

• For toe-switch during descent,

Group 1 P1 = 5.59884T + 0.32060V - 43.03412

Group 2 P2 = 4.97944T + 0.29444V - 34.57863
Group 3 P3 = 4.64051T + 0.31155V - 32.27112

• For heel-switch during descent,

Group 1 P1 = 3.65086T + 0.26036V - 26.83647

Group 2 P2 = 3.64590T + 0.27490V - 27.65250
Group 3 P3 = 3.79978T + 0.29222V - 30.40816
Group 4 P4 = 3.61499T + 0.27756V - 27.49432

• For combined toe and heel-switches during descent,

Group 1 P1 = 1.80654Θ + 8.21792T - 0.22812V - 68.50288

Group 2 P2 = 1.87562Θ + 8.15916T - 0.24020V - 69.41609
Group 3 P3 = 1.82035Θ + 8.06932T - 0.21436V - 68.15712
Group 4 P4 = 1.84128Θ + 7.73428T - 0.21731V - 65.26889

where Θ = Stair angle in degrees,

R = Riser in inches,
T = Tread in inches,
V = Speed in (vertical) feet climbed per minute, and
P# = Probability of being classified into Group #.

The value that results when the data for riser height, tread depth, angle of the stair, and rate of
vertical speed are weighted by the appropriate coefficients within the function is a measure of
probability that the function correctly assigns the stair to its performance group. The derived
function for each of the performance groups is applied in turn to the characteristics of that stair.
The stair is then reassigned to the performance group for which the highest measure of
probability was produced. The classification reflected in the tables in the main text are the
results of that reclassification.

An understanding of both the reclassification and its potential implications for the data in those
tables requires an examination of the resultant functions and the related statistical tables
contained in the appendix of the dissertation. Those tables and the researcher's accompanying
remarks are reproduced below. The upper section of the tables addresses the original data used
in deriving the functions; the lower section reflects data from observations omitted in the earlier
phase and used to test the findings.

C-2
 TABLE C-1
TOE-SWITCH...ASCENT CLASSIFICATION
Number of Cases Classified into Group

Group 1 2 3 Total Test Significance

"The test results indicate the
1 209 19 82 310 ability of the discriminant
2 37 8 40 85
functions to identify the best
and worst groups, i.e., the
3 30 18 102 150 variable combinations which
Test 1 31 12 17 60 .0026 lead to best and worst
performance. The intermediate
Test 2 10 2 8 20 --
group is not readily identified."
Test 3 8 4 15 27 .0107

TABLE C-2
HEEL-SWITCH...ASCENT CLASSIFICATION
Number of Cases Classified into Group
"The test results indicate the
Group 1 2 3 4 Total Test Significance
ability of discriminant analysis
1 57 18 15 10 100 to detect variable combinations
2 34 15 22 26 97
which lead to good and bad
performance. The variable
3 29 17 46 55 147 combinations leading to
4 35 10 35 129 209 intermediate performance are
not so easily identified, partly
Test 1 10 6 5 2 23 .0409
because of an inability to
Test 2 7 2 6 5 20 -- discriminate between the two
Test 3 4 2 6 5 20 -- intermediate groups. If groups
two and three are pooled, then
Test 4 6 7 8 15 36 .0217 the significance level for this
single intermediate group is
about 0.12."

C-3
 TABLE C-3
TOE AND HEEL SWITCH...ASCENT CLASSIFICATION
Number of Cases Classified into Group

Group 1 2 3 4 Total Test Significance

1 78 24 21 37 160
2 60 15 20 31 126 "Results indicate ability to
identify variable
3 46 14 120 60 240
combinations leading to poor
4 5 3 14 12 34 performance. Most
Test 1 9 3 3 10 25 -- misclassified results of group
4 are classified into
Test 2 6 3 6 5 20 -- neighboring group 3. Other
Test 3 6 2 22 7 37 .0001 categories of performance are
Test 4 3 0 4 3 10 --
not readily identified."

TABLE C-4
TOE-SWITCH...DESCENT CLASSIFICATION
Number of Cases Classified into Group

Group 1 2 3 Total Test Significance

1 123 47 30 200
"Results indicate good ability to
2 31 63 56 150 discriminate between variable
3 21 46 113 180 combinations that lead to
different levels of
Test 1 22 15 4 41 .0039
performance."
Test 2 3 19 10 32 .0011
Test 3 7 11 18 36 .0207

C-4
 TABLE C-5
HEEL-SWITCH...DESCENT CLASSIFICATION
Number of Cases Classified into Group

Group 1 2 3 4 Total Test Significance

1 42 5 32 32 111
2 61 21 71 56 209 "Results indicate ability to
identify variable combinations
3 28 13 68 41 150
leading to all levels of
4 18 7 27 18 70 performance except group 2.
Test 1 12 0 3 5 20 .1469 In particular, ability to identify
poor performance is sharp."
Test 2 8 0 5 16 29 --
Test 3 2 3 17 5 27 .0500
Test 4 8 0 12 3 23 .0001

TABLE C-6
TOE- AND HEEL-SWITCH...DESCENT CLASSIFICATION
Number of Cases Classified into Group
Group 1 2 3 4 Total Test Significance
1 82 27 39 22 170
2 40 35 27 38 140
3 28 15 14 27 84
4 20 24 23 79 146
Test 1 12 10 2 12 36 1.02
Test 2 2 9 6 13 30 .61
Test 3 2 0 6 6 14 --
Test 4 2 4 0 13 19

Although the researcher provided no detailed explanation of the nature of the tables, an
understanding of discriminant analysis and the contents of relevant text and appendices seem to
indicate the following: the numbers down the left margin of the upper section of the table
represent the performance groups. The "Total" column on the right margin represents the
number of walks that are classified into that group by the researcher's performance criteria. The
numbers across the top margin represent the performance groups. The column of numbers
beneath each of these group designators represent the number of walks reclassified into that
group by the program. For example, based on the toe-switch data for walks in ascent, the
researcher classified 310 walks into group 1. The result of the discriminant analysis was a
reclassification of those walks as follows: 209 as group 1; 19 as group 2; and 82 as group 3.

The researcher subjected the developed equations to testing by applying them to data omitted
from the discriminant analysis. The results are contained in the lower portion of the statistical

C-5
tables presented above and reflect the number of walks assigned to each category in a manner
similar to the top portion of the tables. The practice of testing results by using test data that were
not part of the equation development process is standard in discriminant analysis because it is not
as likely to result in the inflation of results that can occur if the equations are applied to data used
in their development.

C-6
 APPENDIX D

STAIR-RELATED SCENARIOS FROM

HOME SAFETY GUIDELINES FOR ARCHITECTS AND BUILDERS

DESIGN CONSIDERATION
Adult women in a hurry, elderly people, people with poor eyesight
or those under the influence of alcohol or medication, misjudge
tread length while descending. They overstep the nosing and fall,
resulting in injuries to limbs.
There are approximately 505,000 of these
accidents each year, or 19 percent of all
stair accidents.

Adult women who are carrying children, groceries or other objects There are approximately 290,000 of these
down a flight of stairs have their view of the treads obstructed, or, accidents each year, or 10.9 percent of all
unable to activate light switches while so encumbered, attempt to stair accidents.
descend stairs in the dark. Victims overstep the nosing and fall,
often resulting in fractures to the lower arm, back, skull, or ankle.
Attempts to save whatever they are carrying (especially children)
often increase the severity of the victim's injuries.

Adult women in high heels descending a staircase catch their heel There are approximately 239,000 of these
on the nosing as their leg swings from the upper tread to the lower accidents each year, or 9 percent of all
and fall forward, causing injuries. Children who are ascending a stair accidents.
flight of stairs don't or can't lift their foot high enough to clear the
next higher nosing and fall forward, resulting in injuries. Both
accidents occur as a function of altered gait, high-heeled footwear,
or children's short legs.

People, unable to locate a nearby light switch or finding that the
light bulbs are burned out, attempt to climb or descend a dark flight
of stairs. The victim misjudges the number of treads and oversteps
the nosing, fails to locate the handrail, and falls. Such accidents
often occur at night in settings with which the victim is unfamiliar.
There are approximately 173,000 of these
accidents each year, or 6.5 percent of all
stair accidents.

Persons who place their foot too close to the nosing edge of a tread There are approximately 162,000 of these
while descending a flight of stairs create a small amount of forward accidents each year, or 6.5 percent of all
horizontal movement between the tread covering material(s) and the stair accidents.
subfloor or within the tread covering material itself. The small
horizontal movements may transfer the user's point of support over
the edge of the nosing, initiating a fall, resulting in injuries.

Persons descending wet or icy exterior stairs slip over the nosing, There are approximately 152,000 of these
often resulting in head or back injuries. Such accidents are far more accidents each year, or 5.7 percent of all
likely when the user is wearing crepe or rubber-soled shoes. stair accidents.

People who have lost their balance reach for a handrail, find it There are approximately 152,000 of these
missing or improperly positioned, and fall. Handrails mounted in accidents each year, or 5.7 percent of all
such a way that users' knuckles or fingers rub against a wall during stair accidents.
use, or which are too wide to allow the index finger and thumb to
meet in a circle around it, are not providing adequate protection
against falls. Misplaced or missing rails greatly increase the
chances of falling for children who cannot grasp adult-positioned
rails and for the disabled who require a handrail for guidance and/or
stability.

D-1
 DESIGN CONSIDERATION
A stair user's line of sight passes the edge of an adjacent wall or There are approximately 133,000 of these
ceiling and abruptly reveals a distracting object, view, or activity accidents each year, or 5 percent of all
causing the person to be distracted and to disrupt the rhythm of his stair accidents.
or her foot movements, overstep or understep the nosing, and fall.
This kind of accident may also occur if the victim, while using the
stairs, is suddenly exposed to streams of water from an overhead
gutter or is startled by continuous or intermittent streams of air as
from an exhaust fan.
Treads that are too shallow to accommodate the length of the There are approximately 112,000 of these
human foot or footwear may cause the victim to overstep the nosing accidents each year, or 4.2 percent of all
and fall. Some people, in order to gain a full foothold on stairs with stair accidents.
short treads, twist their feet in or out (crabbing), losing their balance
and falling.
While ascending or descending a flight of stairs with irregular risers There are approximately 101,000 of these
and/or treads, people fail to adequately compensate for variations accidents each year, or 3.8 percent of all
between adjacent steps, overstep or understep the nosing, and fall. stair accidents.
A dimensional irregularity of as little as 1/4-inch between adjacent
risers or treads can disrupt the rhythm of foot movements and cause
an accident. When the irregularity occurs at the top or bottom of a
flight, accidents can occur because the user is unable to determine
proper foot placement. Many times irregularities result from
uneven settling over the life of the stair.
Persons walking on an apparently level floor fail to notice a one or There are approximately 77,000 of these
two riser flight of stairs in their path of travel. The victim oversteps accidents each year, or 2.9 percent of all
or understeps the first nosing and falls. Such accidents often occur stair accidents.
on stairs that are located in the middle of rooms or walkways which
provide no cues to their presence.
Persons ascending or descending a flight of stairs unexpectedly step There are approximately 77,000 of these
on or in something which has fallen, collected, or been left on a accidents each year, or 2.9 percent of all
tread or landing, lose control of their foot movements, and fall. stair accidents.
Although the objects that cause many of these accidents were
dropped on the stairs inadvertently (candy wrappers, leaves, seed
pods, etc.), just as many are left on the stairs intentionally (books,
shoes, magazines, etc.).

D-2
 APPENDIX E
BIBLIOGRAPHY FROM
GUIDELINES FOR STAIR SAFETY

The literature reviewed as part of the work described in Guidelines for Stair Safety included the
following:

Agate, J. "Accidents to Old People in Their Homes," British Medical Journal (1966): 5, 785-
788.

Dickson, D.G., E.R. Schlesinger, and J.R. Westaby. "Medically Attended Injuries among Young
Children: Observations in a Suburban Area," American Journal of Disabled Children
(1964): 618.

Esmay, M.L. Home Stairway Safety Research Results. Lansing, MI, Michigan State University,
Department of Agricultural Engineering (1961).

Gowings, D.D. "Accidental Falls in the Home," New Building Research (Spring 1961): 151-158.

Harper, F.C. "The Mechanics of Walking," Research (January 1962): 23-28.

Harper, F.C., W.J. Warlow, and B.L. Clarke. The Forces Applied to the Floor by the Foot in
Walking. London: HMSO, National Building Studies Research Paper No. 32 (1967).

Iskrant, A.P. and D.F. Sullivan. "Accidental Falls in Public Places," National Safety Congress
Transactions (1960): 6, 73-78.

Joliet, P.V. and E.L. Lehr. "Home Safety." In M. N. Halsey, ed. Accident Prevention: The Role
of Physicians and Public Health Workers. New York, NY, McGraw-Hill (1961): 93-117.

McGuire, M.C. "Preventive Measures to Minimize Accidents among the Elderly," Occupational
Health Nursing (April 1971): 13-18.

Miller, J.A. and M.L. Esmay. "Natures and Causes of Stairway Falls," Transactions of the
American Society of Agricultural Engineers (1961): 4, 112-114.

Neutra, R. and R.A. McFarland. "Accident Epidemiology and the Design of the Residential
Environment," Human Factors (1972): 14, 405-420.

Sheldon, J.H. "On the Natural History of Falls in Old Age," British Medical Journal (1960):
1685-1690.

Templer, J.A. Stair Shape and Human Movement, Doctoral dissertation, New York, NY:
Columbia University (1974).

E-1
Texas State Department of Health. A Study of Non-fatal Accidental Injuries among Residents of
Selected Nursing and Custodial Homes in Texas. Austin, TX, Division of Chronic
Diseases (1961).

Wheatley, G.M. "Relationship of Home Environment to Accidents," Archives of Environmental

Health (1966): 13, 489-495.

E-2
 APPENDIX F

RESULTS OF EXTERNAL REVIEW

BY DR. CAROL MEEKS
 INDEX

Article Titles

A Design Guide for Home Safety A.1. B-12

A Study of Stair Accidents A.1. B-5
Accident Scenarios for Domestic Stair Accidents. Characteristics of Households.
Stairs and Dwellings as Risk Factors B-6
An Analysis of Occupational Stair Accident Patterns B-3
An Analysis of the Behavior of Stair Users 8, 9, 24
Analysis of Fatal Falls on the Same Level or on Stairs/Steps B-10
Another Look at Residential Stair Design and Safety in Relation to Debate
over Riser/Tread Geometry B-12
Are Functional Handrails Within Our Grasp? B-12
Are Functional Handrails within Our Reach and Our Grasp? B-13
Building Accident Statistics B-7
Computer-Based Simulation of a Human Falling on a Stairway B-2
Constituent Parts of Dwellings and Accident Processes B-18
Cost of Injuries in the United States and the Role of Building Safety B-13
Cost of Injury in the United States: A Report to Congress B-15
Design Guidelines for Safe Stairs A.1. B-5
Development of Standardization Test Techniques for Materials
That Are Capable of Reducing Injuries during Stairway Falls B-5
Effect of Stairway Pitch on Optimal Handrail Height B-9
Environmental Factors Associated with Stair Accidents by the Elderly A.1. B-1
Experimental Determination of Stair Dimensions Required for Safety B-8
Fall Injuries in the Elderly B-1
Falls on Stairs: An Epidemiological Accident Study B-16
Guidelines for Stair Safety 3, 9, 29, 30,41, A.1. E-1
Home Accidents: The Hidden Epidemic B-2
Home Safety Guidelines for Architects and Builders 9,28, A.1. D-1
Influence of Stairway Handrail Height on the Ability to
Generate Stabilizing Forces and Moments B-9
Injuries Resulting from Falls on Stairs: Bulletin 2214 B-3
Injury Control: A Review of the Status and Progress of
the Injury Control Programs at the Centers for Disease Control B-11
Injury in America: A Continuing Public Health Problem B-11
Investigation of Maximum Pitch for Domestic Stairs through Energy Expenditure Tests B-8
Occupational Accidents While Walking on Stairways B-10
Pedestrian Falling Accidents in Transit Terminals 9, 10, 39
Personal and Building Factors in Stair Safety: Accident Reduction Methods
in Homes. at Work. and in Public Places B-6
Premature Mortality in the United States: Public Health Issues in the Use of
Years of Potential Life Lost B-3
Preventive Measures to Minimize Accidents among the Elderly A.1. B.9. E-1
Psychotropic Drug Use and the Risk of Hip Fracture B-15
Quantitative Assessment to the Dimensions of Stairs B-11
Review of Stair-Safety Research with an Emphasis on Canadian Studies B-13
Risk Factors for Falls among Elderly Persons Living in the Community B-18
Risks and Accidents in the Built Environment B-6
Safetyon Stairs 9, 27
Safety Standards. Requirements. and Litigation in Relation to
Building Use and Safety. Especially Safety from Falls Involving Stairs B-14
Stair Safety: Review of Research B-14
Stair Shape and Human Movement 8-10, 39, 40, C-1. E-1
Stair Use. Safety. and Design: An Introduction B-14
Stairway Risers and Treads: Acceptable and Preferred Dimensions B-7
Status Report on Safety in Architecture and Construction: Stairway Safety B-10
Studies of Safer Stairs and Ramps B-16
Study of Accidents Associated with Building Features B-8
Study of Factors Associated with Risk of Work-Related Stairway Falls 9, 10, 32
The 7-11 Stair Story: Should It Be Required in Residential Construction B-4
The Dimensions of Stairs 3, B-4
The Injury Fact Book B-2
The National Safety Council’s Estimates of Injury Costs B-4
The Soft Stair: Falls Induced by a Laboratory Stair B-17
The Staircase-Studies of Hazards. Falls. and Safer Design 18, 39
The Unforgiving Stair B-17
Towards a Safer Design For Stairs B-1
Towards the Empathetic Stair B-17
What Can We Do to Improve Stair Safety? Part I B-15
What Can We Do to Improve Stair Safety? Part II B-15

Author Surnames. Organizations. Acronyms, Periodicals. and Other

Agate E-1
American Journal of Disabled Children E-1
American Society of Agricultural Engineers E-1
Applied Ergonomics B-7
Archea 24,27, 30, 32, A-1. B-1. B-3. B-15
Archives of Environmental Health E-2
Asher A-1. B-1
Baker B-1. B-2
Barkow A-1. B-5. B-6
Bartlett B-9
BOSTI 9,10, 28,29, A-1. B-15
Boulet B-2. B-5. B-17
BRI B-8
Brill 28, B-2
British Medical Journal E-1
BSS 3,27, 30
Buffalo Organization of Social and Technical Innovation 28
Building Standards B-13, B-15
Carson 27, 31
Clement B-6
Clinics in Geriatric Medicine B-1
Cohen 32, B-3
Collins 30, A-1
Collison B-2
Columbia University 10. E-1
Consumer Product Safety Commission ........................... 2, 6, B-10. B-15
Corcoran B-1. B-4
CPSC 6, 29,30,42, B-10. B-15
Cummerford B-5
Dacquisto B-4
Department of Commerce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24,27, 28, 30
Department of Health and Human Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-15
Department of Housing and Urban Development . . . . . . . . . . . . . . . . . . . . . . . . B-9. B-12
DepartmentofLabor B-3
Department of Transportation 39
Dickson E-1
Endo B-8
Ergonomics B-7. B-11. B-13. B-14
Ergonomics International B-11
Esmay E-1
Etter B-4
Fernie B-9
FineHomebuilding B-5
Fitch B-1. B-4
Fruin 39
Georgia Institute of Technology .................................... B-7. B-16
Ginter B-18
Goosens B-6
Gowings E-1
Griffin B-15
Guha 39
Hanagud B-2. B-5. B-17
Harper 31, E-1
Harrison A-1. B-5
Harvey B-1
Hay A-1. B-5. B-6
Heimplaetzer B-6
HUD A-1
Human Factors ......................... 39, B-2. B-5. B-9. B-12. B-14. B-17. E-1
Human Factors Association of Canada .................................... B-5
Human Factors Society B-2. B-5. B-17
Hyde B-7, B-17
International Conference on Building Use and Safety Technology B-8, B-14, B-17
International Conference on Occupational Ergonomics B-14
Irvine B-7
Iskrant E-1
Job Safety and Health B-1
Joliet E-1
Journal of Safety Research 32, B-3
Karpf B-2
Kose 18, B-8
Lehr E-1
Liberty Mutual Insurance B-7
Mackenzie B-15
Maki B-9
Margulis 24, 27
Marshall 39
McFarland E-1
McGuire 31, A-1, B-9. E-1
Medford B-10
Michigan State University E- 1
Miller E-1
MITP r e s s 18, 39
Morbidity and Mortality Weekly B-3
Mullet 24
Musson B. 6
Nagata B-10, B-11
National Building Studies E-1
National Bureau of Standards 3, 24, 27, 28,30, B-15
National Electronic Injury Surveillance System 2 ,6
National Institute of Occupational Safety and Health 32
National Research Council 2, B-11
NBS 3,24, 31, B-15
NEISS 2, 6-8, 27-30, 32,41, 42, A-1
Neutra E-1
New BuildingResearch E-1
New England Journal of Medicine B-15, B-18
NIOSH 10, 32
O’Neill B-2
Occupational Health Nursing B-9, E-1
Pauls B-4, B-12,B-13, B-14, B-15
Port Authority of New York and New Jersey 39
Progressive Architecture B-2
Public Health Reports B-4
Ray B-15
Rice B-15
Safety in the Built Environment B-6, B-17, B-18
Safety Science B-6, B-10, B-14
Schaffner B-15
Schlesinger E-1
Scientific American 3, B-4
See B-2
Sheldon E-1
Snook B-7
Southern Building B-13
Sparshatt B-7
Speechley B- 18
Stahl 30, A-1
Sullivan E-1
Svanstrom B-16
Teledyne Brown B-12
Templer 10. 24, 31, 32, 37, 39, A-1, B-1, B-2, B-3, B-4, B-5, B-15, B-16, B-17, E-1
Texas State Department of Health E-2
The Building Official and Code Administrator B-4, B-12
Uno B-8
Urban Mass Transportation Administration 39
van Erdewijk B-18
Westaby E-1
Wheatley E-2