SINGAPORE, Oct 23 — Homemaker H. Lee’s four-year-old child narrowly escaped injury last week when her stroller buckled backwards on a moving escalator.

Her child was seated in the stroller while Lee was trying to get from the basement to the first floor of a shopping mall.

“I held on (to the stroller) for dear life and managed to push it back up. I miscalculated how heavy the stroller, with my bags on it, would be,” said Lee, who was carrying her younger child, aged two, in a carrier at the time.

She had decided to use the escalator instead of the elevator located further away, as her children were cranky and tired after a doctor’s appointment and she wanted to get home quickly.

While they ease the strain of climbing stairs, escalator near-misses are not uncommon in Singapore.

Not everyone emerges unscathed from using more than 6,000 registered escalators here.

The emergency department of KK Women’s and Children’s Hospital (KKH) has seen more children sustaining injuries related to escalator use in recent years.

The number of escalator-related injuries among children at KKH’s emergency department more than doubled from 2012 to 2016, growing from 35 to 85. From about 15.2 per cent per 10,000 trauma cases seen in 2012, the rate of escalator-related injury increased to 31.8 per cent per 10,000 trauma cases seen in 2016, KKH experts reported in a study published in August in the journal Annals by the Academy of Medicine, Singapore.

A factor could be the greater number of shopping malls here, which have become common places for young families to visit, said Dr Sharon Goh, the study’s first author.

More than half of the escalator-related injuries (153 of 300) seen at KKH from 2012 to 2016 occurred in shopping centres. Falls were the most common mechanism of injury, followed by entrapment injuries.

The youngest patient was only one month old and the oldest was 17 years old. Injuries ranged from the superficial — abrasion — to bruises, open wounds, fractures, dislocations and head injuries.

A danger spot for adults too

Adults have not been spared.

Last month, a 39-year-old woman sustained an 8cm-long wound that required surgery after a dislodged side panel on one of the escalators at City Hall MRT station cut through her leg.

In 2016, a retiree in his sixties reportedly fell into a coma after falling down an escalator at an MRT station.

Like the young, the elderly are at risk of falls and injuries if they are unsupervised or do not adhere to safety recommendations when using the escalators, said Adjunct Associate Professor Lim Hoon Chin, chief and senior consultant of accident and emergency at Changi General Hospital.

“(The elderly) may have instability in their gait due to chronic health conditions like diabetes or previous strokes that can predispose them to falls and injuries. Also, due to frailty in elders, injuries may be more severe following a fall,” said Adjunct Assoc Prof Lim.

From November 1 to December 29 in 2016, those above age 60 were involved in about 78 per cent of the 63 escalator incidents reported to the Building and Construction Authority (BCA), the authority said previously.

Since November 2016, the BCA has put in place regulations on escalator maintenance, among them notifying BCA of incidents involving death or injury to passengers, or malfunction of safety-critical components.

Majority of incidents linked to improper use

Many escalator-related injuries are linked to improper use and are preventable.

For instance, among the 300 escalator-related injuries reported in the KKH study, more than one in 10 (12.7 per cent) involved strollers. Nearly six in 10 (57.9 per cent) of the children who sustained injury associated with stroller use required inpatient admission.

Wearing certain types of shoes, such as robber clogs, could also increase the risk of entrapment injuries.

In its December 2016 press release, the BCA said 95 per cent of the 63 escalator incidents were attributed to user behaviour such as carrying heavy or bulky objects and losing balance when travelling on escalators, inattentiveness, intoxication, being unwell or leaning against the sides of the escalator.

In the KKH study, only two children sustained injuries related to machinery fault. However, “cases of machinery fault were likely to be underestimated because they were determined by chart review”, according to the authors.

Deep cuts and head injuries

Escalator-related injuries can be severe and, in some cases, may require surgery, said Dr Arif Tyebally, deputy head and senior consultant at KKH’s department of emergency medicine.

“Admission for surgery is required for children with deep open wounds that require wound management under general anaesthesia or for complicated fractures that require surgery. Some patients require admission for close observation due to significant head injuries,” said Dr Tyebally.

“The need for hospital admission, anaesthesia and surgery can be very traumatic for the child, as well as the parent or caregiver. These are completely preventable with adequate precaution and supervision.”

Dr Goh said an escalator’s structure consists of sharp step edges. “This means that even a minor trip or accidental knock (against) the steps of escalators may result in deep wounds,” she said.

In KKH’s study, more than seven in 10 children (76.7 per cent) required procedures in the emergency department; 49 children were hospitalised.

In infants, head injuries were the most common.

Children under age two typically have a relatively large head in comparison to the rest of their body, which predisposes them to falls and head injuries while engaging in daily activities such as climbing the escalators or stairs, said Dr Chong Shu-Ling, staff physician at KKH’s department of emergency medicine.

“The most serious complication that can result from a head injury is bleeding in the brain, which can result in permanent disability and even death,” said Dr Chong.

All three KKH experts interviewed were involved in the study on paediatric escalator-related injuries.

Don’t use strollers on escalators

More should be done to reduce the incidence of injuries involving prams and strollers, the study authors said.

They recommended structural modification to the escalators, such as placing a pole in the middle to deter parents from pushing strollers onto the escalators.

“For example, in some countries, to enhance safety on escalators, barriers are installed at the starting point of the escalator,” said Dr Goh.

Other modifications recommended by the experts include reducing the gap between steps and sidewalls, and fitting escalators with brush borders to reduce the incidence of entrapment injury.

Escalator users can also adjust their behaviour.

“We strongly advise parents not to push their children who are seated within prams and strollers directly onto escalators,” said Dr Tyebally.

Despite the close shave last week, Lee said she may still use a stroller on an escalator when the “situation calls for it” — for instance, during peak hours when the wait for the elevator is too long.

“I understand the safety aspect, so if I can help it, of course I won’t do it. But sometimes, after waiting for so long, the lift is still full. How many prams, wheelchairs and elderly people can you cram into a lift, not counting inconsiderate people who use the lifts because they are lazy to walk?” said Lee.

Preventing escalator mishaps

Dr Arif Tyebally from KKH offers the following escalator safety tips:

  • Children must be supervised on escalators and their hands should be held, just as when crossing a road
  • Parents or caregivers carrying their child/children while using the escalators need to hold them tightly in an upright position, and remind their child/children to remain as still as possible and to avoid standing too close to the edges of the escalators
  • Use the lift if prams or strollers are being used. Do not use strollers or prams on escalators
  • Parents with a stroller and who are unable to use a lift can consider folding the stroller and carrying the child tightly in their arms
  • Entrapment injuries are common and parents/caregivers should ensure that their children avoid standing at the edges of the escalators. Stand within the yellow lines marked on the steps of escalators
  • Avoid wearing footwear with loose hanging parts or straps. Certain shoes made of high-friction materials such as rubber or plastic can increase the risk of entrapment and extra vigilance is required when such shoes are worn on escalators.
  • Avoid wearing or carrying items with loose or dangling parts, such as long flowing skirts or dresses and unfastened shoelaces, which may cause entrapment when in contact with the escalator. — TODAY