How to fall to your death and live to tell the tale

Alcides Moreno, center, with the New York Fire Department workers who helped save him.

Story highlights

  • Falls are the second leading cause of death by injury, after car accidents
  • Nearly three times as many people die in the US after falling as are murdered by firearms

Alcides Moreno and his brother Edgar were window washers in New York City. The two Ecuadorian immigrants worked for City Wide Window Cleaning, suspended high above the congested streets, dragging wet squeegees across the acres of glass that make up the skyline of Manhattan.

On 7 December 2007, the brothers took an elevator to the roof of Solow Tower, a 47-storey apartment building on the Upper East Side. They stepped onto the 16-foot-long, three-foot-wide aluminium scaffolding designed to slowly lower them down the black glass of the building.
    But the anchors holding the 1250-pound platform instead gave way, plunging it and them 472 feet to the alley below. The fall lasted six seconds.
      Edgar, at 30 the younger brother, tumbled off the scaffolding, hit the top of a wooden fence and was killed instantly. Part of his body was later discovered under the tangle of crushed aluminum in the alley next to the building.
      Brothers Edgar Moreno, left, and Alcides Moreno.
      But rescuers found Alcides alive, sitting up amid the wreckage, breathing and conscious when paramedics performed a "scoop and run" -- a tactic used when a hospital is near and injuries so severe that any field treatment isn't worth the time required to do it.
      Moreno was rushed to New York-Presbyterian Hospital/Weill Cornell Medical Center, four blocks away.

      A forgotten danger

      Falls are one of life's great overlooked perils. We fear terror attacks, shark bites, Ebola outbreaks and other minutely remote dangers, yet over 420,000 people die worldwide each year after falling.
      Falls are the second leading cause of death by injury, after car accidents. In the United States, falls cause 32,000 fatalities a year (more than four times the number caused by drowning or fires combined). Nearly three times as many people die in the US after falling as are murdered by firearms.
      Falls are even more significant as a cause of injury. More patients go to emergency rooms in the US after falling than from any other form of mishap, according to the Centers for Disease Control and Prevention (CDC), nearly triple the number injured by car accidents.
      The cost is enormous. 
      As well as taking up more than a third of ER budgets, fall-related injuries often lead to expensive personal injury claims. In one case in an Irish supermarket, a woman was awarded 1.4 million euros compensation when she slipped on grapes inside the store.
      It makes sense that falls dwarf most other hazards. To be shot or get in a car accident, you first need to be in the vicinity of a gun or a car. But falls can happen anywhere at any time to anyone.
      Spectacular falls from great heights outdoors like the plunge of the Moreno brothers are extremely rare. The most dangerous spots for falls are not rooftops or cliffs, but the low-level, interior settings of everyday life: shower stalls, supermarket aisles and stairways.
      Despite illusions otherwise, we have become an overwhelmingly indoor species: Americans spend less than 7% of the day outside but 87% inside buildings (the other 6% is spent sitting in cars and other vehicles).
      Any fall, even a tumble out of bed, can change life profoundly, taking someone from robust health to grave disability in less than one second.
      Falling can cause bone fractures and, occasionally, injuries to internal organs, the brain and spinal cord. "Anybody can fall," says Elliot J Roth, medical director of the patient recovery unit at the Shirley Ryan AbilityLab in Chicago. "And most of the traumatic brain injury patients and spinal cord injury patients we see had no previous disability."
      Scientists are now encouraging people to learn how to fall to minimize injury -- to view falling not so much as an unexpected hazard to be avoided as an inevitability to be prepared for.

      How we fall

      You can trip or slip when walking, but someone standing stock still can fall too -- because of a loss of consciousness, vertigo or, as the Moreno brothers remind us, something supposedly solid giving way.
      However it happens, gravity takes hold and a brief, violent drama begins. And like any drama, every fall has a beginning, middle and end.
      "We can think of falls as having three stages: initiation, descent and impact," says Stephen Robinovitch, a professor in the School of Engineering Science and the Department of Biomedical Physiology and Kinesiology at Simon Fraser University in British Columbia, Canada.
      "Most research in the area of falls relates to 'balance maintenance' -- how we perform activities such as standing, walking and transferring without losing balance," he said.
      By "transferring", he means changing from one state to another: from walking to stopping, from lying in a bed to standing, or from standing to sitting in a chair. "We have found that falls among older adults in long-term care are just as likely to occur during standing and transferring as during walking," says Robinovitch, who installed cameras in a pair of Canadian nursing homes and closely analyzed 227 falls over three years.
      Only 3% were due to slips and 21% due to trips, compared to 41% caused by incorrect weigh shifting -- excessive sway during standing, or missteps during walking. For instance, an elderly woman with a walker turns her upper body and it moves forward while her feet remain planted. She topples over, due to "freezing", a common symptom of Parkinson's, experienced regularly by about half of those with the disease.
      In general, elderly people are particularly prone to falls because they are more likely to have illnesses that affect their cognition, coordination, agility and strength.
      "Almost anything that goes wrong with your brain or your muscles or joints is going to affect your balance," says Fay Horak, professor of neurology at Oregon Health & Science University.
      Fall injuries are the leading cause of death in people over 60, says Horak.
      Every year, about 30% of those 65 and older living in senior residences have a fall, and when they get older than 80, that number rises to 50%. A third of those falls lead to injury, according to the CDC, with 5% resulting in serious injury.
      It gets expensive. In 2012, the average hospitalization cost after a fall was $34,000.
      How you prepare for the possibility of falling -- what you do when falling, what you hit after falling -- all determine whether and how severely you are hurt. And what condition you are in is key.
      A Yale School of Medicine study of 754 over-70s, published in the Journal of the American Medical Association in 2013, found that the more serious a disability you have beforehand, the more likely you will be severely hurt by a fall.
      Even what you eat is a factor: a study of 6,000 elderly French people in 2015 found a connection between poor nutrition, falling and being hurt in falls.

      Training to stay upright

      Christine Bowers is 18. She hails from upstate New York, and is a student at the Moody Bible Institute in Chicago. One day she hopes to teach English abroad.
      In January 2016 she had a cavernous malformation -- a tangle of blood vessels deep within her brain -- removed.
      "It paralysed my left side," she says, as her physical therapist straps her into a complex harness in a large room filled with equipment at the Shirley Ryan AbilityLab. "I'm working on preventing a fall."
      Under the supervision of Ashley Bobick, the therapist, Bowers is walking on the KineAssist MX, a computerized treadmill with a robotic arm and harness device at the back. The metal arm allows patients freedom of motion but catches them if they fall. Bowers has fallen several times, and those falls made her very skittish about walking, a serious problem in the rehabilitation of those who have fallen. "It's huge," says Bobick. "Fear of falling puts you at risk for falling."
      "We've been doing what's called 'pertubation training', where I pick a change in the treadmill speed," says Bobick. "She's walking along, I hit the button, and the treadmill speeds up on her and she has to react... Her biggest fear was slipping on ice, so I said, 'You know what? I have a really great way for us to train that.'"
      The treadmill hums while Bobick speeds it up and slows it down, and Bowers, her right hand clasping her paralyzed left, struggles to maintain her balance.
      "You're getting better at this," says Bobick. "You're getting way better."
      The KineAssist is an example of how technology once used to study ailments is now used to help patients. Advanced brain scanning, having identified the regions responsible for balance, now diagnoses damage that affects them.
      Accelerometers attached to people's ankles and wrists have been used in experiments, plotting induced falls directly into a computer for study, and are now being used to diagnose balance problems -- or to detect when someone living alone has fallen and summon help.
      Researchers at the Massachusetts Institute of Technology took the "wearable" out of the e