It isn't just about having your pistol out. I've died twice now to ladders, both times I had my main weapon out and held down w. Last night I fell trying to get up a hunter's stand. I took a tiny bit of damage and started bleeding, didn't have a bandage on me, ended up losing a full set of gear including an M4 with 6 mags because I couldn't get a bandage in time. Not a big fan of ladders.