An employee was cutting the bottom of metal duct work with a reciprocating saw while on the sixth rung of a 10-foot step ladder. The saw blade snapped and the employee started to fall. He grabbed the ladder, but his momentum carried him and the ladder over and onto the floor. He fell a distance of 68 inches onto the tile floor and sustained broken ribs, internal bleeding from the spleen and a laceration to the face. The employee was hospitalized.