AUCTORES
Globalize your Research
Review Article | DOI: https://doi.org/10.31579/2690-4861/688
1 Department of Enviromental and Technical Research of Accidents, Gazi University, 06500, Ankara, Türkiye.
2 Ministry of Labour and Social Security, Directorate General of Occupational Safety and Health, 06520, Ankara, Türkiye.
3 Department of Manufacturing Engineering, 06500, Gazi University, Ankara, Türkiye.
*Corresponding Author: Ali Kaan Çoktu. Department of Enviromental and Technical Research of Accidents, Gazi University, 06500, Ankara, Türkiye.
Citation: Ali Kaan Çoktu, Fatih Erel, Hasan Basri Ulaş, (2025), Postural Ventricular Tachycardia from Peripherally Inserted Central Catheter Line Placed Using a Tip Confirmation System, International Journal of Clinical Case Reports and Reviews, 22(4); DOI:10.31579/2690-4861/688
Copyright: © 2025, Ali Kaan Çoktu. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 18 December 2024 | Accepted: 23 January 2025 | Published: 29 January 2025
Keywords: tower cranes; work accident; safety
Booming construction sector requires extensive use of tower cranes. Lacking safety precautions may lead to severe tower crane accidents due to inherent risks. This study provides an in-depth overview of the construction sector, highlighting the significant risk of falling from height as a prevalent hazard and emphasizes the importance of vocational training for employees in the construction sector in Türkiye and presents global statistics on accidents in the construction industry, particularly focusing on tower crane accidents. Starting with worldwide tower crane accidents, their causes, hazards, installation procedures, and the impact of accidents on individuals this study also delves into the analysis of tower crane accidents in Türkiye between 2013-2017, examining various factors such as age, location of injuries, accident causes, and sector involvement. The study underscores the need for enhanced safety measures, training programs, and regulatory enforcement to mitigate accidents in works involving tower crane use.
In Türkiye, 1704 tower crane accidents were reported between 2013 and 2017. The distribution of these accidents by year shows an increasing trend from 2013 to 2017. Additionally, it highlights that 86% of all tower crane accidents occurred in the construction sector. The analysis also uncovers that there is a significant disparity among variables such as age, location of injuries on the body, accident causes, victims' occupations, and the province where the accidents occurred. However, no significant differences were observed among variables like accident time, experience, OSH training, professional education attainment, educational status, season of the accident, and day of the accident.
Construction Sector Overview
The construction sector continues its activities in response to the increasing population and evolving industrial needs. Various branches of construction industry encompass activities ranging from building construction to infrastructure projects such as bridges, tunnels, and metros, as well as repair and reinforcement works, underwater and above-water constructions.
Due to the inherent nature of the work, falling from height is considered the most significant risk factor in the construction sector (Gürcanlı and Müngen, 2013). In addition to falls from height, other risks include electric shock, falling objects or materials, and incidents involving being trapped under vehicles (ILO).
According to the Regulation on Occupational Safety and Health in Construction Works (2013) issued in Türkiye, working at height refers to tasks performed in areas with level differences and in locations prone to causing injuries due to falls, meanwhile this corresponds to 1.8 meters in Malaysia (Rafindadi et al., 2022).
Vocational Training in the Construction Sector in Türkiye
Employees in the sector, provided they perform the tasks listed in Annex-1, are obligated to undergo vocational training in accordance with Article 5 of the Regulation on the Vocational Training of Workers Engaged in Hazardous and Very Hazardous Works (2013) and must substantiate this training with one of the documents specified in Article 6. Operators using equipment such as mobile cranes and tower cranes, included in Annex-1, must possess operator certificates issued by institutions authorized by the Ministry of National Education, as stipulated in Article 6 (c).
Those working in jobs requiring vocational training cannot start work without undergoing at least 2 hours of on-the-job training before using the work equipment, being assigned to their tasks, and without receiving practical training on the specific risks associated with the equipment, tasks, and work environment, as well as measures for protection against these risks.
Accidents in the Construction Sector Worldwide
In Malaysia, 38.16% (108) of the 282 reported construction sector accidents between 2010 and 2018 were related to falls (Rafindadi et al., 2022). According to OSHA data, in the United States, between 2002 and 2011, 3124 people lost their lives and 5210 suffered serious injuries in 9358 construction sector accidents. Of these accidents, 4110 were falls from height or same-level falls, 2409 were caused by object impacts or strikes, and 934 were due to being trapped (Chi and Han, 2013). In China, 9189 construction sector accidents occurred between 2004 and 2016, resulting in 1324 deaths in 2004, 624 deaths in 2011, and 734 deaths in 2016 (Zhang et al., 2019). In Europe, 782 fatal construction accidents were reported in 2013, with 26% due to falls from height, 20% due to material deterioration/falling/collapse, and 19% due to machine, equipment, or tool control loss (ESAW, 2013). In Korea, the most common accident causes in 2009 were reported as falls from height, caught in objects, same-level falls, struck by objects, and collisions (Kang and Kwon, 2011).
Cost of Accidents in the Construction Sector
A study conducted by Allison, Hon, and Xia (2019) in Australia, based on values from 2012 and 2013, determined that the ratio of direct costs to indirect costs for short-term job loss accidents was 8:13. For long-term job loss accidents, this ratio was 3:8, for accidents resulting in partial disability, it was 8:13, and for fatal accidents, it was 1:21.
Worldwide Tower Cranes Accidents
In the construction sector, various equipment such as facade scaffolding, tower cranes, mobile cranes, construction hoists, mast climbing working platforms, dump trucks and excavators are utilized according to the requirements of the job. Particularly in high-rise buildings, tower cranes are commonly employed due to their capacity and boom length, and incidents of work accidents may occur when necessary safety precautions are not implemented.
During a study on tower crane accidents conducted by Swuste between 2008 and 2009, it was indicated that load imbalance was the most common cause of crane accidents. A detailed technical investigation into the accident that occurred in Rotterdam on July 10, 2008 revealed that the tower crane selection was inappropriate, and necessary checks related to design were not conducted (Swuste, 2013).
In the United States, between 1992 and 2006, 632 workers lost their lives in 611 fatal crane accidents (U.S. Bureau of Labor Statistics, 2008). In Korea, 2100 crane-related accidents are reported annually, with 23.7% of these occurring on construction sites. Cranes rank fourth in equipment related accidents in construction, following temporary structures (scaffolding, etc.), construction equipment (excavators, loaders, etc.), and construction vehicles (Shin, 2014).
Beavers and Moore (2006) reported that, between 1997 and 2003, out of 119 fatal crane accidents reported to the Occupational Safety and Health Administration (OSHA) in the United States, only 12 of the deceased were crane operators. The remaining 107 were individuals performing other tasks such as riggers, laborers, carpenters, etc.
Tower Crane
General Terms
The concepts of winch and crane are sometimes confused. Technically, the terms "winch" and "crane" represent different aspects. In the TS EN 14492-1-A1 standard, a winch is defined as a machine designed to lift or lower loads suspended on hooks or other load lifting devices, transport loads on inclined surfaces (pulling or lowering), or pull loads in a special way on flat surfaces (TS EN 14492, 2010).
In the TS ISO 4306-1 standard, a crane is defined as a machine designed for lifting and transporting a load suspended by a hook or other load-bearing device, repeatedly operated, and for tower cranes, it is specifically defined as a rotating jib crane placed on top of a vertical tower (TS EN 4306, 2009).
The Turkish Science Terms Dictionary (TÜBA) defines a tower crane as a type of crane, usually used in construction, consisting of a cage-structured tower with a horizontally positioned load lifting part, based on the principle of balancing the load like a concrete block, and having lifting equipment that can be stationary or movable; synonym: construction crane.
Education and Awareness
The TS ISO 9926-1 standard specifies that crane operators should not have issues related to vision, hearing, or working at height, such as vertigo, and should not be substance-dependent (TS ISO 9926-1, 1997). In the Ministry of National Education's Directive on Driver Training Courses for Construction Equipment (2018), the term "having no condition that prevents operating" is used as a health requirement, and health reports obtained from relevant health institutions are utilized in this context.
Tam and Fung (2011) mentioned that in Hong Kong, the subcontracting system is widely used, where the main contractor outsources the provision of tower cranes to a subcontractor, and the subcontractor, in turn, sources tower crane operators from external sources. Due to subcontracting conditions, high labor mobility leads to insufficient training and site control, resulting in low employee loyalty and consequently higher accident rates.
Sertyeşilışık (2010) conducted research in the United Kingdom on lifting operations from the planning stages, concluding that crane teams need to enhance their experience and knowledge. Additionally, he determined that training on maintenance and inspection requires close monitoring.
Tower Crane Installation
According to the Regulation on Health and Safety Conditions in the Use of Work Equipment, Article 5 (2013), appropriate equipment must be selected for the job. When choosing a suitable tower crane, factors such as lifting capacity and space adequacy should be considered. Once the components of the tower crane are brought to the construction site, the first part of the cage is fixed with a concrete slab. The remaining parts are gradually assembled using a mobile crane. Subsequently, after the installation of the operator's cabin, tower head, jib, counter jib, and hook block, the interlocking process is completed (Shin, 2014).
According to Article 7-(1)-a) of the aforementioned Regulation (2013), tower cranes are subject to periodic inspections by authorized individuals defined in the Regulation, considering any changes made after each elevation or modification.
Tower Crane Hazards
The TS EN 14439+A2 standard is focused on the safety of tower cranes and is a Type-C standard based on equipment. Therefore, its provisions take precedence in cases of conflict with Type-A or Type-B standards. Since this standard is specific to tower cranes, its provisions do not apply to other cranes, such as loader cranes or mobile cranes. The hazards list of the standard includes significant risks such as crushing, shearing, impact, contact with live parts, neglecting ergonomic principles, malfunctioning of the control system, failure of the control circuit, access to the working area, inappropriate seating, inadequate evacuation in emergencies, inappropriate design and placement of controls, and inadequate design (TS EN 14439, 2010).
Shin (2014) lists hazards in tower crane installation as asymmetric loads due to improper foundation connections, improper installation of the telescopic shoe (incomplete fixation), weak connection of blocks to the mast, non-use of harnesses, and working without scaffolding or work platforms. Additionally, hazards during dismantling include unsafe dismantling of telescopic supports, inappropriate selection of the boom lifting position, rope breakage during dismantling, and imbalance due to not using the balance mast.
In their study, Zhou et al. (2018) created a list of 61 factors affecting tower crane safety through a literature review. This list was updated based on interviews with experienced engineers from China's top 10 leasing companies, and after a competency test at Huazhong University involving 113 construction managers, a final list of 56 factors was established. Results were analyzed using the AcciMap model, examining regulatory bodies (4 factors), crane stakeholders (manufacturers and contractors) (5 factors), construction site management (14 factors), field personnel (17 factors), and equipment with environmental impacts (16 factors). Nine fundamental dimensions of the tower crane safety system were identified through principal component analysis, including tower crane equipment quality and reliability, tower crane safety management and maintenance, tower crane safety program, employee safety practices, working environment, working conditions for tower crane use, inspector safety practices, auxiliary safety equipment, and government safety oversight.
Kim (2013), in his research on tower crane operators, found that workers faced more difficulties regarding climate, psychological, and physiological conditions when working on multi-story buildings compared to normal buildings.
Tower Crane Accidents
In Korea, tower cranes with a lifting capacity of more than 3 tons are required to be registered as construction equipment (Ministry of Land, Marine and Transportation, 2012). As of 2008, there were 3133 registered T-type and 276 L-type tower cranes, accounting for 7.2% of all lifting equipment accidents (Shin, 2014). According to the Occupational Health and Safety Standard updated in 2005, employers must prepare a safe installation and dismantling plan for tower cranes, and employees must comply with these plans (Ministry of Employment and Labor, 2005).
Between 2001 and 2011, 38 fatal accidents involving tower cranes occurred in Korea. Of these accidents, 68.4% occurred during installation and dismantling, with 31.6% resulting from violations of work procedures, 23.7% from inadequate safety procedures, 10.5% from damage due to inadequate supervision, 7.9% from unsafe use of the tower crane, and 26.3% from other causes (Ministry of Employment and Labor, 2013).
In Hong Kong, between 1998 and 2005, there were 12 tower crane accidents resulting in 14 fatalities (Tam and Fung, 2011). The primary causes of these accidents were identified as falling from height, impact of moving objects, impact of falling objects, and crushed under collapsing objects. Falling objects resulted in six deaths and were identified as the predominant cause.
In the detailed examination of the tower crane accident in Rotterdam in 2008, it was noted that despite deficiencies in the equipment during the production phase, the crane, which did not undergo additional checks due to obtaining the CE mark, was involved in the accident (Swuste, 2013).
Objective and Method
In Türkiye, work accidents must be reported to the Social Security Institution (SSI) within 3 working days by e-declaration administrators in accordance with the Occupational Safety and Health Act (2012). Data on work accidents reported through the system prepared according to the European Statistics on Accidents at Work (ESAW) methodology is maintained by the SSI and published annually. Data obtained from the Social Security Institution was classified in this study, considering all accidents reported between 2013 and 2017, and described as tower crane (winch) in the accident descriptions. In this study:
The accident data cover 1704 tower crane accidents that occurred in 81 provinces of Türkiye between January 1, 2013, and December 31, 2017.
In this study, descriptive statistical techniques were employed to comprehensively examine the dataset. These techniques are crucial for understanding the characteristics of variables in the dataset, gaining insights into the overall structure, and identifying potential relationships. Descriptive statistics provide summary information about the sample and the observations made. Univariate frequency analysis and cross-tabulation analysis represent two types of descriptive statistics.
Univariate analysis is generally the first analysis used by researchers who perform statistical analysis on various databases in different fields. The same can be said for studies in the field of occupational safety (Kazan, 2013). In this study, univariate frequency analysis was used to better understand the database and determine which information was available for cross-tabulation analysis. Also, univariate frequency analysis was used in the classification of variable categories. The results obtained in these analyses were examined through frequency tables.
After applying univariate analysis to investigate whether there is a significant relationship between pairs of independent variables, cross-tabulation analysis (binary analyses) was conducted. Cross-tabulation is a tabulation form with a matrix structure where one categorical variable is represented in rows and another in columns. After constructing the cross-tabulation and presenting frequency distribution in cells, the second stage involves examining the relationship between variables. In this stage, the Pearson chi-square test is one of the tests that can be used to interpret this relationship successfully (Sims, 1999). The Pearson chi-square test is a statistical test used to determine if there is a relationship between two categorical variables (Elliott, 2007). The chi-square statistic measures the difference between observed and expected frequencies and evaluates whether these differences are random. If these differences are statistically significant, we can infer that there is a relationship between the two variables.
In this study, the outcome of tower crane accidents was categorized into two groups: death and injury. This dependent variable was evaluated in relation to categorical independent variables related to accident parameters, accident time, and factors related to the accident victim, using the chi-square test. Descriptive parameters and their values were further detailed in Table 1. All statistical analyses in this study were conducted using the IBM SPSS 26 statistical package program, and a significance level of p<0>
Table 1 Descriptive Parameters and Parameter Values
Findings and Discussion
General Information about the Construction Sector
In Türkiye, out of 17,332,991 insured employees in 2022, 1,808,486 individuals were employed in the construction sector. The numbers of insured individuals in the construction sector during the time period when tower crane accidents were examined, from 2013 to 2017, are indicated in Table 2.
Table 2: Number of Insured in the Construction Sector by Year
Tower Crane Accident Statistics
Descriptive Statistics
Between the years 2013-2017, parameters related to tower crane accidents were classified and recorded under a total of 27 different parameters
containing detailed information about the accidents. All parameters were individually examined within the scope of the study, and accident reports were submitted by workplace personnel. The summary accident report table containing these description details is presented in Table 3.
Table 3: Accident Notification Screen Summary
Between the years 2013 and 2017, a total of 1704 tower crane accident reports were examined for 1627 insured individuals in the annual reports of the Social Security Institution (SGK). The distribution of these accidents by year reveals that in 2013, there were 259 cases (15.2%), in 2014, 218 cases (12.8%), in 2015, 341 cases (20%), in 2016, 415 cases (24.4%), and in 2017, 471 cases (27.6%) of tower crane accidents as indicated in Figure 1.
Figure 1: The Number of Tower Crane Accidents
During the specified period, 20.95% of all tower crane accidents occurred in winter, 28.29% in spring, 26.47% in summer, and 24.3% in autumn. Among the individuals involved in accidents, 34.1% were reported to be single, while 63.5% were married. It is noteworthy that 95.8% of the accident victims received occupational safety and health (OSH) training, and 84.9% had professional training.
As indicated in Table 4, only 4.2% of the accident victims did not receive OSH training, while this rate is 15.1% in terms of lacking vocational training. Considering the high rates, it can be observed that these training programs fall short in terms of awareness. In this context, a study conducted by Brahm and Singer, involving 2787 Chilean firms, found that doubling the content of safety training and making it more engaging led to a 3.7% reduction in accidents, and employing the most effective training method with the same content resulted in a 12.5% reduction (Brahm & Singer, 2013). More effective methods tailored to specific workplace risks should be applied in training programs. Similarly, Li (2012) suggests providing safety training using virtual reality during installation.
Table 4: Vocational and OHS Training Status of Accident Victims
A total of 27 accidents (1.6%) occurred between 00:00-05:59, 824 accidents (48.4%) between 06:00-11:59, 747 accidents (43.8%) between 12:00-17:59, and 106 accidents (6.2%) between 18:00-23:59.
Of the incidents, 985 (57.8%) occurred in Istanbul, 243 (14.3%) in Ankara, 62 (3.6%) in Izmir, 32 (1.9%) in Bursa, 44 (2.6%) in Kocaeli,
and 338 (19.8%) in other cities. Thus, during the specified period in Türkiye, 80.2% of the tower crane accidents occurred in Istanbul, Ankara, Izmir, Bursa, and Kocaeli (Figure 2). In 10 cities, only one tower crane accident occurred during the specified date range.
Figure 2: Distribution of Accidents by Provinces
The insured involved in accidents include 595 (34.9%) who completed primary school, 510 (29.9%) with middle school education, 276 (16.2%) with high school education, and 48 (2.8%) who graduated from university (Figure 3).
Figure 3: Educational Level of the Accident Victim
When examining the individuals affected by accidents based on their professions; 1412 insured are reported as other workers affected by accidents (82.9%), 123 insured as caregivers (7.2%), 69 insured as tower crane operators (4%), 52 insured as riggers (3.1%), and 48 insured (2.8%).
Relational Analyses
Tower crane accidents have occurred in all 81 provinces of the country. The results of the analysis on the impact of the province where the accident occurred on the accident outcome are presented in Table 5
Table 5: Impact of the Province where the Accident Occurred on the Accident Outcome
The chi-square value for the table with 5 degrees of freedom between the accident outcome of death or injury and the province where the accident occurred is 17.365, indicating a significant difference (p<0>
industrialization is observed in parallel with the increased use of tower cranes.
It should be noted that not only operators but also those involved in installation or dismantling, maintenance personnel, workers in the vicinity during loading and unloading, and even visitors can be affected in tower crane accidents. The results of the analysis examining the impact on operators and other individuals are provided in Table 6.
Table 6: Impact of Equipment Usage during Accidents on Accident Outcome
There is a significant difference between the occupation and the outcome of death and injury in accidents (p<0>
Table 7 shows that there is a significant relationship between the age of the accident victim and the outcome of the accident (p<0>
Table 7: Impact of the Age of the Accident Victim on the Accident Outcome
As indicated in Table 8, there is a significant difference between the location of the injury on the body and the outcome of death and injury in accidents (p<0>
the head are identified as the second most affected region. Due to the nature of the work, accidents involving work at heights or material handling at heights often result in the head being particularly affected in falls involving the entire body and materials, leading to a higher incidence of fatalities originating from head injuries.
Table 8: Impact of the Wound Region on the Accident Outcome
The heightened lethality associated with injuries to the head in accidents, particularly in the context of tower crane installation, operation, and dismantling activities that inherently necessitate elevated work, emphasizes the imperative of ensuring optimal access conditions. This entails prohibiting personnel transportation in the tower crane basket, and mandating the provision and proper utilization of personal protective equipment against falls from height.
There is a significant difference between the cause of the accident and the outcome of death or injury (p<0>
classified according to the main headings of ESAW methodology. Among fatal accidents, the most common cause is individuals slipping, stumbling, or falling, accounting for 37%. For accidents resulting in injuries, the most prevalent cause is identified as external accidents, accounting for 38.9% outside of the eight main ESAW accident reasons. A study on crane accidents worldwide between 2011-2015 revealed that crane collapse constituted 38% of tower crane accidents, which is also identified as a significant cause in this study (Milazzo et al., 2017).
Table 9: Impact of the Accident Cause on the Accident OutcomeThere is no significant difference between the season and the outcome of death or injury (p>0.05). The analysis examining the relationship between the sector where the accident occurred and the accident outcome is presented in Table 10.
Table 10: Impact of the Season in which the Accident Occurred on the Accident Outcome
A total of 11 different sectors were identified to have experienced tower crane accidents, and 86% of all accidents occurred in the construction sector. Therefore, accidents in the 10 sectors excluding construction were collectively considered under the 'other' category. An analysis was
conducted to examine whether there is a significant difference between the occurrence of fatalities or injuries and the sector in which the tower crane accident occurred. The analysis results showed p>0.05, indicating that there is no significant difference between the sector and the accident outcome according to the obtained data (Table 11).
Table 11: Impact of the Sector in which the Accident Occurred on the Accident Outcome
Shin (2014) asserts, in his investigation, that human error stands as the predominant cause of accidents during tower crane installation and dismantling, as reported by interviewed individuals. It is noteworthy that this study, conducted within the scope of the ESAW methodology, does not delve into the examination of the influence of the human factor on accidents based on reported incidents.
The examination of tower crane accidents in Türkiye spanning the years 2013 to 2017 has provided insights into the incidents and their associated factors. Chi-square analyses revealed a significant disparity among the dependent variables, specifically the outcomes of death and injury, in relation to age, location of injuries on the body, accident causes, victims' occupations, and the province where the accidents occurred. However, no significant differences were observed among variables such as accident time (p=0.0523), experience (p=0.331), OSH training (p=0.636), professional education attainment (p=0.626), educational status (p=0.505), the season of the accident (p=0.137), and the day of the accident (p=0.382).
The analysis is constrained by the limitations of the existing dataset. Subsequent studies should undertake a more comprehensive examination of accident reports and other documents, following the acquisition of additional permissions. Moving beyond the constraints of the ESAW methodology, a thorough reevaluation of the causes of accidents is warranted. The ESAW methodology only allows for the identification of the primary visible cause, precluding an exploration of managerial issues and the impact of regulatory applicability and enforcement deficiencies on accidents.
Some or all data, models, or code generated or used during the study are proprietary or confidential in nature and may only be provided with restrictions. (All the data used in the study is confidential)
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
