Unintentional falls from balconies are a distinctive type of fall but not uncommon as previously thought. A closer look at the behaviors and demographics of the injured population shows the commonalities. In addition to falling off of balconies while under the influence of alcohol, victims are seldom alone prior to falling and often attended social events with peers. Because the fall event is sudden during these social events where others are also drinking and distracted with the party atmosphere, these occurrences are seldom witnessed and, in many cases, result in a delay to medical treatment.
A similar public health issue called “balconing” has been reported from some European vacation locations (Segura-Sampedro et al. 2017; Pérez-Bovet et al. 2015). This term refers to the practice of tourists jumping from hotel balconies or roofs into swimming pools, or between hotel balconies (BBC Newsbeat 2016). Although “balconing” specifically relates to a playful situation during a tourist holiday, it has similarly caused severe trauma in young groups of people, especially where alcohol intake, is apparent. Postings in social media of “balconing” have increased and have spread the popularity of this very dangerous behavior. In the United States, “balconing” has not been recognized as a problem compared with Europe. However, unintentional falls from balconies among young adults, on or near college campuses, or while participating in a college-related event has been recognized.
Search in the media and internet produced a large number of incidents throughout the United States and often involved young inebriated adults on, near, or in a college campus-related social activity. One example was a patient who fell from a third-story dormitory balcony after drinking excessively at the university near our trauma center. The patient’s injuries were very serious, and included a fractured skull, extensive chest trauma, and multiple extremity fractures. The patient had an extensive hospital stay and rehabilitation, and eventually returned to school. The event was life changing. Grateful for survival and recovery, the patient shared the experience on social media in a personal outreach to peers about the dangers of underage drinking. Social media has been used to spread the news of these types of events, especially among young adults. More common than an educational posting about dangers of alcohol and risky behavior are postings of dangerous activities, often involving alcohol and drugs. Unfortunately many of these postings of high risk behavior have led to copy-cat actions to mimic the behavior.
As this study has summarized, balcony-related falls that have resulted in severe injuries have costly outcomes, not only in monetary terms, but include lost time from school and work. There is, of course, loss of a productive life for those who die or become disabled due to their fall injuries. Although the number of patients injured from falls from balconies is small in this report compared with other fall-related mechanisms, these events continue to occur with a risk of a fatal outcome. Balcony falls are a preventable public health problem that should not be ignored.
Universities generally have strict policies for students, under 21 years of age, on the possession, purchase, and consumption of alcohol and being intoxicated while on campus. Although these policies are directed toward students who reside on campus, parties involving alcohol still occur and often in campus housing. Multi-story dormitories and university affiliated apartments on or near universities are common and, as universities continue to expand and build more multi-level housing options, more balconies and risks are available. While most educational institutions provide structured alcohol and drug prevention programs for students, especially those living on campus, the issue of drinking in residences and environmental risks related to balconies needs to be an active part of the curriculum.
As shown from the collected social worker interviews with patients, peers present at time of the fall event frequently demonstrate poor decision-making with respect to assisting the injured person. That is, they transport the injured back to the resident dormitory without a report to emergency responders. The reasoning for this is unclear, but interviews conducted by hospital staff with the patient often described that all members of the “party” might have been intoxicated and feared disciplinary action for underage drinking. Unfortunately, the decision to not report these injuries leads to delay in medical treatment and likely under reporting of the true number of cases with the potential exacerbation of the injuries themselves.
The university near our trauma center, where several patients have fallen from a dormitory or apartment balcony on campus, has begun to address this problem of balcony falls as part of their residential life program. Information is provided to students at time of orientation to increase awareness about risks associated with balconies (and drinking) in their housing. Information is also directed at the limits of the number of people on a balcony at one time, the hazard of sitting on a rail, and climbing or jumping from balcony to balcony. Rules on drugs and underage alcohol consumption are addressed as part of normal college student orientation, but with the increase in balcony falls on campus, the combined hazard of a balcony environment and alcohol consumption are now part of residential life orientation. This education also includes the critical importance and responsibility of students to assist and alert authorities without delay when medical attention is warranted rather than avoiding or reporting the incident for fear of the consequences. Another means of outreach for students on campus in the past few years was sporadic social media alerts about the hazards of drinking and awareness of the party environments, including “hanging out” on the balcony.