As OR workplace dangers go, falls don't get nearly the attention that sharps injuries, wrenched backs, scalpel-throwing surgeons and bullying nurses get. But it's time to treat slips, trips and falls like the serious hazards they are.

As we detail in this issue's cover story (see "Watch Your Step" on page 24), we're not talking about bumps and scrapes from schoolyard falls. OR falls can cause serious, sometimes career-threatening injuries: fractures, concussions, contusions requiring stitches and, in the case of Paula Watkins, RN, CNOR, contusions that get infected and require surgery.

A year ago, Ms. Watkins, our Behind Closed Doors columnist, tripped over an unsecured C-arm cord. Her head (concussion) and thumb (sprain) hit the OR door, and the rest of her landed with a thud on the floor. She was on a stretcher and in the emergency department before she realized that the blood on the sleeve of her scrubs was from her elbow, not her last patient. The impact of the fall split open the skin on her elbow wide enough that it required a few stitches to close the next morning.

Ms. Watkins healed up. When she returned to work, she took care to keep her elbow covered. Everything seemed fine until she accidentally bumped her elbow while getting into her car. The skin broke open again at the elbow. A burst of clear fluid gushed out. That's what happens when you rupture an infected elbow bursa sac.

She was on the surgery schedule within a week. The surgeon extended the incision past her elbow where the infection had tracked and sutured up the bursa. Twenty-six staples and a Jackson-Pratt drain were in her left elbow for 3 weeks.

And now, a year later, despite occupational therapy, the arm's "acting up." If she sets it down on a flat surface, Ms. Watkins says she feels pain, cramping and spasms. She estimates she has 60% usage of her arm.

All this pain and suffering from tripping over a cord and falling to the floor.

"There are falls every day. It's not carelessness," says Ms. Watkins. "You're always in such a hurry, but you can't always be careful. You try, but ..."

The dangers are always there, she says — the clutter, the cords (equipment and, ahem, extension), the fluid, the need for speed.

"It's like roulette: Am I going to slip or fall today?" she says. "We're in such a hurry. It's move, move, move. You turn a room over and you mop the floor and the floor's soaking wet. Then you're moving equipment in and rushing things out.

"Time doesn't allow us to be careful," she adds. "We go to great lengths for patient safety, but we don't worry about our own safety because we're all hurrying around trying to please the powers that be."

Don't wait for a surgeon or staff member to lie sprawling on the floor before you cover cords or soak up fluid. Fall-proof your ORs now, before there's another casualty. Tomorrow might be too late.