Trauma

Jan. 03, 2019

Seemingly simple, everyday actions such as padding out the front door in slippers, stepping out of a car in a parking lot or going on an afternoon walk can suddenly become treacherous in Minnesota in the dead of winter, leading to falls and injury.

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“Anywhere outside can be somewhere hazardous in winter in our state,” says Kimberly (Kim) J. Lombard, injury prevention coordinator at Mayo Clinic Trauma Center in Rochester, Minnesota.

Orthopedic injuries from falls, such as broken bones in the wrist, arm, ankle or hip, are common in all seasons. For older adults, falls are the most common cause of traumatic brain injury, which ultimately can be fatal. Even for elderly patients who do not die due to injury from a fall, consequences can lead to nursing home stays and subsequent health decline.

According to the May 11, 2018, Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, Minnesota has the third highest fall mortality rate in the U.S.

According to Minnesota Department of Health 2013 Death Certificate Data, 5.3 percent of the state’s falls occur in the outdoors. Of total fatal falls, 1 percent was due to snow and ice (ICD-10 code W00).

Risk factors for falls

General risk factors for falling, in winter or in other seasons, include:

• Age
• Previous fall
• Poor vision
• Chronic conditions
• Use of multiple medications
• Fear of falling

Fall prevention

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What can be done to decrease the number of winter falls, or at least diminish morbidity from a fall?

Lombard offers the following tips to share with patients and community members to help prevent or lessen injury from wintertime falls:

Take care in risky locations

Lombard suggests treating many areas as risky or unsafe in the winter, as it’s not always possible to see icy spots. When getting in or out of a vehicle, first check to see if the ground is slippery.

Be cautious and allow for extra time

Being in a hurry and scrambling into the service station for a gallon of milk can be asking for trouble.

Change your walking style for greater stability

Use a slower and wider gait to better protect against falls.

Dress appropriately

Though it may seem harmless to go out to get the mail in your robe, doing so increases your chances of injury or exposure if you take a tumble on an icy driveway or walk. Wear gloves, warm clothing that covers you well, and footwear with treads and good traction — even consider purchasing ice grippers for your shoes.

Bring a cellphone

If you should fall, you will be glad you brought your phone along to call a neighbor, spouse or emergency medical help.

Clear your walks

Even if this requires asking for help from others to accomplish, it’s worth the trouble to prevent a fall.

Carry kitty litter or sand in a bag

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These can be tossed onto the ground in front of you to provide better traction while walking.

Ask your doctor to assess your personal risk of falling

If certain factors put you at higher risk, such as low vision, a physician can help develop a preventive action plan.

Protect your bone health

Taking in calcium from food sources or supplements and getting vitamin D from sun exposure are important for bone health, which protects against falls. As all northern U.S. states are too far away from the sun to get adequate vitamin D in the winter, ask your physician about supplementation.

Immediate action steps when a fall occurs

What are the best actions for patients to take if they fall or someone nearby takes a tumble on the ice and snow?

Lombard suggests that if a winter fall occurs, patients and community members should be encouraged to follow these steps:

• Don’t get up right away or let anyone help you up immediately; this avoids the potential of causing further injury. Don’t worry about feeling embarrassed. Rather, take your time, lie there for a moment and assess how you are feeling.
• After making an assessment of your injury status, if you can get up, roll to one side. Bend your knees toward you, push up with your arms and then use your legs to stand up the rest of the way.
• If someone assists you to your feet, ensure that he or she doesn’t get hurt, too.
• Use your cellphone or mobile medical alert device if you need assistance getting up from a fall. In many communities, fire departments are available to help citizens get up from falls, even if no injury is present.
• Call 911 or emergency medical help if the fall has led to an emergency situation.

Learning from a fall

After a winter slip on the ice or snow, analyzing one’s fall story can be helpful to avoid repeating it, says Lombard. Helping patients reflect on questions such as “What was I doing?” and “What could I have done differently?” can help determine preventive action for the future.

For more information

Minnesota Death Certificate Data, Minnesota Department of Health, 2013.

Burns E, et al. Deaths from falls among persons aged ≥ 65 years — United States, 2007-2016. Morbidity and Mortality Weekly Report. 2018;67:509.

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