Albertans are seriously injured by slipping and falling on ice at three times the rate of people in Ontario, according to years' worth of data from across the country.

The province has seen an average of 42.3 hospitalizations per 100,000 people between 2011 and 2016, based on statistics compiled by the Canadian Institute for Health Information.

That's the second highest rate in the country, just behind Saskatchewan

Hospitalizations typically involve serious injuries that require a patient to be treated or monitored for more than a day, said Dr. Raj Bhardwaj, an urgent care physician in Calgary.

"So that means a bone that didn't just break but needs to be operated on to set properly," he said. "Or something like broken ribs that have punctured a lung or a bad head injury that needs to be monitored in hospital rather than at home."

Doctors who see these injuries first-hand say there's no single reason behind Alberta's high rate, but suggest a variety of factors are likely at play, including the province's winter weather patterns and the condition of streets and sidewalks.

Melt-freeze cycles

Bhardwaj recalled one day last winter, in particular, when a light snow fell on Calgary just after a melt-freeze cycle, creating hidden patches of exceptionally slippery ice across the city.

The hospital where he works ran out of casting material that day, he said, as patient after patient came in with broken bones.

Dan Kulak, a meteorologist with Environment Canada, said icy conditions tend to be more persistent throughout the winter in Alberta, compared with southern Ontario.

"Once it forms out here, it tends to stick around longer — either because it stays cold … or because we're bouncing back and forth on a daily basis between above freezing and below freezing," Kulak said.

Ontario does contend with freezing rain more often, he noted, but Alberta isn't immune from that phenomenon, either.

A particularly nasty burst of freezing rain struck Edmonton in mid-December and hospitals there are still dealing with the aftermath.

"We now have a significant back-load of orthopedic surgeries," said Dr. Darren Markland, an intensive-care physician.

Edmontonians woke up on Dec. 15 to scenes like this one, in the area of 113th Street and 38th Avenue. (Trevor Wilson/CBC)

Markland said many of those injuries happened to people "who just stepped out of their front yards and slipped and fell" on the fresh ice.

"But there were a significant number of accidents that happened two or three days later," he added.

"That was preventable if there was more rigorous maintenance and perhaps more enforcement of private owners who weren't making their sidewalks and accesses safer."

Who's responsible for snow and ice control

Edmonton, like Calgary, relies on homeowners and businesses to keep the sidewalks adjacent to their properties clear of snow and ice.

In Ontario, by contrast, municipalities tend to handle most of that work, said Luc Gagne, director of road services with the City of Ottawa.

"It's something that we've always done ... and it's a level of service that the residents like and expect from us," he said.

Gagne said Ottawa clears about 90 per cent of its 2,300 kilometres of sidewalk and pathways, with varying levels of speed after a snowfall. Sidewalks in the downtown core are to be cleared within six hours, while the target for residential areas is 16 hours.

Ottawa devoted $8.7 million of its $64.3 million snow-removal budget in 2017 to pedestrian infrastructure, Gagne said.

In Toronto, the city is responsible for plowing about 6,000 of its 7,900 kilometres of sidewalk, said Mark Mills, superintendent of road operations.

Toronto devoted $17.5 million of its $90.7-million snow budget this year to pedestrians, he added.

"The city spends a lot on and emphasizes pedestrian safety," Mills said. "And I think we have the support of council and senior management people, who think that pedestrian safety should be at the forefront."

A pedestrian walks down a snow-covered sidewalk in Calgary as a truck turns onto a road that has been largely cleared. (Monty Kruger/CBC)

In Edmonton, about 1,400 of 5,500 sidewalk kilometres are maintained by the city, said Janet Tecklenborg, director of infrastructure operations.

She said Edmonton changed its policy in 2015 and now aims to clear sidewalks within 24 hours, down from its previous standard of 48 hours.

The annual budget for snow clearing in Edmonton is $64 million, but Tecklenborg said the city didn't have a breakdown of how much of that is devoted to pedestrians.

The City of Calgary wouldn't provide an interview on sidewalk clearing for this story but a spokesperson said by email the city is responsible for clearing 249 of 5,658 kilometres of public sidewalk.

Calgary's snow-and-ice control budget this year is $38.1 million, of which $2.43 million is earmarked for sidewalks, the spokesperson said.

Based on citizen complaints, the city has sent 5,301 letters this year to property owners for sidewalks that haven't been cleared within 24 hours of the end of a snowfall. That's up from 3,751 letters sent last year.

If a property owner doesn't comply within 24 hours of receiving a letter, the city can remove the snow itself and send an invoice. Data on how often this happens was not available.

Pathways lead Duane Sutherland said Calgary clears about 400 of its 850 kilometres of multi-use pathway of snow in the winter, within 24 hours after the snow stops falling. (Mike Symington/CBC)

Calgary also has 850 kilometres of pathway, which is maintained separately by the city's parks department.

Pathways lead Duane Sutherland said just under half of the network is cleared of snow, with an annual budget of $485,000.

"Our commitment to the public is to have it totally cleared to a safe, pavement surface within 24 hours of the completion of a snow event," he said.

Impact of injuries

Of course, not all slips and falls happen on sidewalks — something Alycia Barabash is well aware of.

The Calgary resident was out walking her dog in November when she cut through a paved back alley and accidentally stepped on a patch of black ice below a neighbour's downspout.

"It was already dark and I didn't even see it — it was just like clear, slick ice on asphalt," she said.

"And my foot just slipped out from under me and I fell forward, landing on my right knee."

The fall didn't land her in hospital but resulted in a nagging injury and ongoing visits to a physiotherapist.

"For something as simple as a fall a month ago, I'm still having pain and I'm still trying to recover," she said.

The impacts can be even more severe for older people, said Markland, who regularly sees patients suffer long-term health problems after a fall.

"If you're a previously healthy, 70-year-old person who falls down and breaks a hip unexpectedly and suffers a series of complications that lands you in my intensive care unit, the health-care costs for that are substantial," he said.

That's not to say young people are invulnerable.

Shalagh Aebig was 27 years old when she slipped on ice and hit her head while walking home from her job in downtown Calgary in November 2009.

She later died in hospital.

'The question of infrastructure'

If there's a bright spot for Alberta in the hospitalization data, it's that the injury rate has been on the decline for the past couple of years.

After peaking in 2013-14, the winter of 2015-16 had the lowest rate of injury in the past five years on record.

Still, Bhardwaj said the long-term disparity with Ontario suggests there's something more to be explored, in terms of prevention.

"It raises the question of infrastructure," he said.

"Are people falling more because the sidewalks are more treacherous, because they're not being cleared, or because they're in poor condition?"

As a physician who also advocates for pedestrian safety in Edmonton, Markland believes there is one immediate thing that could help reduce the rate of injury.

"If you want to look at how to prevent this from happening, snow clearing is probably the most important thing," he said.