Slip-Resistance Testing: Deriving Guidance from the National Electronic Injury Surveillance

System (NEISS)

Over the past few years there has been a quantum leap in the evolution of slip resistance
testing. In the last two years several new testing ma-chines have been designed, test methods
for using testers have been developed, two slip resistance safety specifications have been
written. and one of these has received ASTM approval. The ultimate interest in all of this is in
the application of these recent advances to improved product safety, that is, to see these new
testers and test methods prevent some of the hundreds of thousands of slipping accidents
which injure and occasionally kill people in this country each year. There are. however, many
intricate steps involved in the process of converting an innovation in the measurement of a
basic property, such as friction. into specific product safety specifications.

This paper gives some personal safety standard philosophy, information about the Consumer
Product Safety Commission (CPSC) and its National Electronic Injury Surveillance System
tNtISS) and information about slipping accidents. It should be noted that the paper's content
should not be considered as official policy of CPSC. There are several recently developed,
versatile testing machines which measure the coefficient of friction (COF) between two
surfaces with precision and accuracy. A great deal of effort and expense has gone into the
development of each of these machines. However, they have not yet passed from the state of
being interesting innovations to the state of being valuable tools. These testing machines
would be valuable, for example, in the area of safety specifications for the products involved in
pedestrian slips and falls: flooring materials, floor coatings and coverings, shoe soles and heels.
The concept of friction between shoe sole and a floor is so basic that one would think it a
straightforward task to develop a specification for traction of walking surfaces. However, As-
rm Committee F-13 on Safety and Traction for Footwear has been debating such a
specification for several years, reflecting the complication of this issue. Another ASTM task
group, working under Subcommittee FIS.03 on Safety Standards for Bathtub and Shower
Structures of Committee F-1S on Consumer Product Safety, has been working on four bathing
area safety specifications for over two years. In those two years there have been about ten
two-day meetings of the entire 80-person task group. as well as numerous other meetings of
subgroups. The task group of Subcommittee FI5.03 is made up of many highly trained
engineers, home builders, and professional consultants, as well as consumers and
manufacturers representatives. The task group finished work on its four draft specifications in
the fall of 1976 and sent them through the ASTM approval process, but they were recently
sent back to the task group for further work. Of the four specifications, it is worthwhile noting
that the most complicated is one which sets a minimum coefficient of friction for the bottoms
of bathtubs and showers. One can get a good sense of the complexities which arise in the
development of safety standards by tracing the evolution of one element in the ASTM bathtub
slipperiness standard, such as the soap and water solution to be used for slip resistance tests.

The Need for Detailed Injury Data

Injury data of the CPSC indicates that most slips in the bathtub and shower occur when people
are bathing, and since people who are bathing generally use soap, it was decided that the slip
resistance tests should be run in a soap and water solution. As early as the second meeting,
the task force was able to agree that Ivory soap would be used, and it was thought that the
soap requirement for the specification had been solved. As it turned out, the task force
debated soap requirements for the next 16 months, and, at almost every meeting, a new, valid
complication to the soap issue was raised. An abbreviated history of the issues that emerged
follows. The first issue was the concentration of the soap solution. The task force easily agreed
to a IC percent solution of Ivory Snow in distilled water and proceeded to run a series of slip
resistance tests using that solution. At the meeting which followed the first series of tests it
was reported that the soap solution did not appear stable—at the beginning of the tests it was
liquid: by the end it had gelled. It was suggested that the soap solution be kept warm and a
temperature of about 38T (100°F) was agreed upon. A soap chemist then pointed up that Ivory
Snow is a detergent. not a soap. and that there is a real and significant difference between the
chemical composition of a detergent and that of a hand soap. That difference in chemical
makeup could lead to a difference in slip resistance. This put the soap requirement and the slip
resistance back to its starting point. Throughout the development of the specification, a long
list of questions was raised: Isn't a bath oil more slippery than soap? Does bath oil dissolve in
bath water or does it float on the surface and how is this affected by water temperature? Is
bubble bath a bath oil or a soap? What brand of bath oil is slipperiest? Should the specification
require a liquid soap or a solid soap, and what is the difference between the two? What should
the concentration of soap be? Should the concentration match that of a bathtub when it is full
of water, or that after the water has run out? Or should the soap concentration match that of
a shower? How deep should the soap and water solution be? What if soap is unstable at the
low concentrations found in bathtubs? Should the solution match the "worst-case" soap
solution or a normal case? Answering all these questions required hours of discussion in each
of the meetings during the entire 16-month period. It was necessary to run slip resistance tests
in many different soap solutions and to hire two professional soap chemists to give the task
force advice on what soap solution to use. In the end, the task group selected a room
temperature, 3 percent solution of a liquid soap used for hand washing in public buildings, a
far cry from the 10 percent solution of Ivory Snow at 38°C which the task force started with. In
the end there remained many objections to the soap solution which the task force had agreed
upon: There is evidence that the solution has over 300 times the soap concentration of normal
bath water. Being a liquid hand soap, it does not resemble anything commonly used in the tub
or shower. The solution is so slippery that when it is poured into a tub at the normal 1.5 deg
slope, it will make an unanchored person standing in the tub slide toward the drain. A smooth
porcelain or fiberglass tub with this 3 percent soap solution may be one of the most slippery
surfaces known to mankind, such that its low COF goes off the scale of the testing machine
used in the standard. With all these problems with this soap solution, one might think that the
task force should have kept looking. One would think that all the bathtub manufacturers,
whose products would be made to appear abnormally slippery by such a high concentration of
soap, would have objected vehemently to the soap requirement. But that was not the case.
After arguing for 18 months and learning more about the intricacies of soap solutions than
they ever wanted to know, most manufacturers, as well as other task group members, reached
almost unanimous agreement on the 3 per-cent soap solution. Soap was just one such issue.
Others debated at length were whether the test should measure static or dynamic COF; what
material should be used on the pad of the tester to simulate the skin of the-human foot; what
kind of water should be used; how many readings should be taken; should the tests be run on
flat surfaces or on real bathtubs and showers; and what statistical method should be used to
determine whether a given set of readings passed or failed the standard. And of course, after
all the other issues were resolved, the task force had to agree upon where the minimum COF
value should be set. Each of these questions had a history that read like the search for a soap
solution. Many of those issues were resolved very early; then objections arose; then the task
force searched for better information: then the task force found that little additional
information existed and that it would be both expensive and time-consuming to develop the
required data. Finally, realizing that an incontrovertable answer was not readily available, and
acknowledging that a specification was needed now, the task force culled all available
information and hammered out a "best guess" requirement. In the final analysis, the
development of voluntary safety specifications seems to be a balancing test between the
possible adverse effects of issuing a standard based on incomplete information, and the
assured adverse effects on the wellbeing of society caused by a delay in bringing safe products
to the marketplace.

NEISS

Many of the complications which arose during the development of the bathing area standards
had to do with disagreements and lack of information about the minute details in the various
accident patterns being addressed. When safety standards were developed in the past, those
minute details regarding accident patterns very often had to be supplied by speculation on the
part of the standard writers. If it happened that one of the participants had experienced or
observed the type of accident being addressed, he would describe it in detail, and his accident
would have a major influence on the final requirement in the standard. Recently, however,
with the advent of the CPSC and NEISS, safety specification writing has been made a bit less
haphazard and less subject to question by improved information about injury patterns. In
order to carry out its responsibility for identifying and eliminating unreasonable risks of injury,
the CPSC has set up a nationwide data collection system which provides basic information
about product-related injuries. NEISS is comprised of 119 U.S. hospitals which report to the
CPSC on a daily basis all product-related accidental injuries treated in their emergency rooms.
These hospitals were selected statistically and allow demographically valid projections to be
made from the NEISS data regarding emergency-room-treated injuries nationwide. The daily
injury reports are comprised of ten data items, which include codes for the product involved,
the age and sex of the victim, the body part injured, and the nature and the severity of the
injury. Based on these data, the CPSC develops periodically the Hazard Index which rank-
orders all major products according to the frequency and mean severity of in-juries. Injuries to
children under IS years of age are weighted more heavily. The CPSC uses the Hazard Index as
one of several mechanisms for determining the order in which hazards will be addressed. The
ten NEISS data items, while very useful for setting priorities and for measuring trends and
changes in accident behavior, are only the starting point. From them it can be determined
what products are most often associated with injury-causing accidents. In order to determine
whether a product is causing injuries directly or indirectly much more specific information is
needed about the relationships between victim and product in specific accidents. Whether the
product was causally involved or merely an innocent bystander, and whether the injury could
be prevented by redesigning the product must be determined. To get this more detailed
information, the Directorate of Hazard Identification selects a number of NEISS cases for in-
depth investigations (IWO. IDIs are conducted by trained investigators who interview accident
victims in order to obtain specific information about the products involved and the
circumstances surrounding the accident. The investigator asks the victim to describe the
accident in great detail and to describe how the product was involved. From these narrative in
depths, which run several pages in length. it is possible to get a very clear picture of how a
particular accident occurs. Often diagrams are drawn, photographs are taken, and when
possible, a sample of the product is obtained. Ideally, IDls provide all the information needed
to develop a safety standard. If there had been a large number of highly detailed IDls avail-able
during the development of the bathtub slipperiness slantlard, the task group would have had
far less trouble resolving many of the soap issues. The task group might have had an objective
record of issues such as how many slips were occurring with bath oil as compared to soap.
instead of relying on the collective judgment of task group members. The task group might
have had records of how deep the water in the tub was when the slip occurred, what
temperature the soap and water solution was. or what the concentration of soap was.
Unfortunately, the set of IDIs for a given group of product. related injuries are rarely
sufficiently detailed to answer all the questions that arise in the development of safety
standards. At times one or two IDIs will describe the accident in sufficient detail to answer all
the questions that arise: other IDIs will have less detail, making it necessary for the task group
to draw inferences from the accident descriptors which are present. In some cases. even a
large number of IDIs do not provide any guidance at all about some of the minute details of
requirements in a specification.

Major Injury Patterns of Slips and Falls

From the in-depth investigations of accidents related to floors and floor. mg materials. several
prominent slipping accident patterns emerge. The most common is that of accidents which
occur when the victim is merely walking around the house. The victims of this accident pattern
are usually not running or jumping or doing anything else that we might normally consider to
be hazardous, but there are several factors which help to explain these accidents. First. most
of the floors in these accidents are wet and those that are dry are wand. Most of these injuries
occur in the kitchen, which explains why the floor is wet. The victims are of all ages. but the
majority are middle-aged, and most are wearing shoes. The victims of this first accident
pattern who slip on dry flooring have several factors which explain the slips. First, the floor is
usually waxed. Second, the victims wear footwear which can be considered slippery, such as
socks. nylon stockings, or leather sole shoes. Third. the victims slip just after they have stepped
from a slip resistant floor covering, such as carpeting, onto waxed vinyl or linoleum flooring.
Finally, the victims appear to slip as they make a slight change in direction. Any one of these
four factors may not be sufficient in itself to cause a slip while walking normally on dry
flooring, but the combination of two or more appears to be sufficient. The second major
accident pattern occurs when victims are stepping out of bathtubs onto the wet bathroom
floor. All of these victims art, of course, barefoot. These accidents can occur to victims of any
age or either sex. and on vinyl or ceramic the which is either waxed or unwaxed. A third
accident pattern occurs when victims are running. Most of these victims are young children.
They slip on either wet or dry surfaces, but those that slip on dry surface arc generally wearing
socks. The fourth major pattern is slips which occur when the victim, usually a young woman.
is mopping a floor. The floor is usually wet, but no other factors predominate regarding
flooring material. footwear, room of the house, or whether the floor is waxed. Viewing these
and other slipping accident patterns as a whole. a number of factors emerge. The victim is
invariably moving, occasionally vigorously, as in running, but is more often simply walking.
turning, mopping. or stepping out of a tub. An overwhelming majority of the floors insolved in
slipping accidents are wet, usually with water, occasionally with a cleaning or floor polishing
agent. It is therefore not surprising to find that most slips occur in either the kitchen or the
bathroom, the two rooms where water is available. Accordingly, many of the victims are
barefoot while the footwear of the rat coven a wide variety. Of the smaller number of slips—
those which occur on dry flooring—the victims art usually wearing socks or stockings, and the
floor is usually waxed. These dry slips occur when the victim is either running or walking
quickly, and when the victim is changing directions and stepping from carpeted to uncarpeted
flooring, or both.
Application of Injury Patterns to Friction Test Methods

What can be learned from these patterns with regard to test methods for pedestrian friction?
First, in measuring the COF between some flooring material and some footwear, a reasonable
choice would be to do the testing in wet conditions. And if the product being tested is to be
used as flooring or footwear for use in the kitchen or in another place where water is likely to
be on the floor, then wet conditions appear to be especially relevant. The patterns also
indicate that if a flooring material to be used in the bathroom is to be tested, a simulated
human skin should be used on the tester's pad since most bathroom slip victims are barefoot.
When a flooring material is to be tested which cannot or should not be used in wet conditions,
then it appears that the tester pad should simulate a stockinged foot rather than a shoe sole.

Gait Patterns of Accident Victims

In developing test methods for dynamic slip resistance, another (actor which NEISS can assist
in defining is the varying gait patterns of accident victims. Gait patterns affect the way a foot
contacts a floor surface in relation to the position and balance of the rest of the body, as well
as the area the foot covers. For example, young children between the ages of 9 and IS months
who are learning to walk. have a wide-based gait (feet far apart). arc flat-footcd. tend to hold
their arms up in a flexed position near the shoulders for balance. and are head heavy. Their
center of gravity is therefore different from that of an adult who has a proportioned body, a
midline heel-toe gait, and reciprocal arm motion. The young child tends to propel himself with
mass muscle groups while the adult tends to glide with refined, segmented movements. It is
not until 3 years of age that a child reciprocates his arms while ambulating. It is not until a
child is about six that the gait is truly refined. The teenager goes through a period of growth
when movements are often arrhythmic and awkward. Often the feet and hands grow faster
than the rest of the body; and then, all of a sudden, the whole trunk grows, the spine modifies
its curve, the center of gravity shifts and the body must readjust. As a person begins to age,
chronic problems may set in. Often the gait again becomes wide-based in order to
accommodate changes in body structure. Frequently some form of arthritis (which affects 80
percent of the population by age 65) sets in. This results in loss of muscle strength and tone.
decrease in joint range of motion, and decrease in sensation. Often the individual will begin to
round his shoulders. thrusting his head forward rather than maintaining a straight axis, and
may also begin to either shuffle or circumduct when he walks. Each of these stages in human
development has a different gait pattern and must be considered in test methods for
measuring the COF between flooring and footwear. If, for example, a particular flooring
material were associated with accidents of a particular age group, and if the test method were
to measure the dynamic COF, then the velocity of the tester pad and the nature and direction
of the force it applies should be derived from the study of human gait patterns. The population
at risk. whose gait patterns should be studied. whether it be an age group. a sex group. or
another specific group, can be derived from NEISS.

Conclusion

These are a few examples of the types of guidance that can be derived from NEISS data in the
development of slip resistance specifications. NEISS cannot be used to specify all the
requirements of a specification. and some of the guidance from NEISS points up the need for
further and extensive research. NEISS can be used to narrow the band of uncertainty in the
development of many safety specifications and thereby promote better, more relevant
specifications.