What are appropriate questions for Emergency Medical Services (EMS) to ask a 52-year-old female who experienced a fall down the stairs?

From the Guidelines

When assessing a 52-year-old female who fell down stairs, EMS should prioritize questions that determine injury severity and appropriate care, focusing on the mechanism of fall, current pain, mobility limitations, medical history, and circumstances leading to the fall, as these factors are crucial in identifying potential trauma and guiding transport decisions, as recommended by the national expert panel on field triage 1. The EMS should ask about the mechanism of fall, including the number of stairs, if she hit her head, and if she lost consciousness. Inquiring about current pain locations, intensity (1-10 scale), and any numbness or tingling is also essential.

• Key questions to ask include:
  • Can she move all extremities or bear weight?
  • Does she have neck or back pain, which might indicate spinal injury requiring immobilization?
  • Does she take blood thinners (like warfarin, apixaban, or aspirin), which increase bleeding risk?
  • Does she have osteoporosis or other conditions affecting bone strength?
  • Were there any symptoms suggesting a medical event caused the fall, such as dizziness or chest pain?
  • What are her current medications, allergies, and when she last ate or drank? These questions help EMS determine appropriate interventions, whether spinal precautions are needed, if IV access should be established, and the urgency of transport, as outlined in the guidelines for field triage of injured patients 1. The information gathered guides hospital staff in ordering appropriate imaging and treatment upon arrival, and considering the patient's age, EMS personnel should be aware that the risk of injury or death increases after age 55 years, as noted in the guidelines 1.

From the Research

Assessment and Management of a 52-Year-Old Female Who Fell Down the Stairs

When assessing a 52-year-old female who has fallen down the stairs, it is crucial to consider the potential for head and spinal cord injuries, as these can have severe and long-lasting consequences 2, 3, 4.

• Key areas to assess include:
  • Neurological function, including any signs of trauma to the head or spinal cord
  • Potential for other bodily injuries, such as visceral, pelvic, or long bone injuries 3
  • Respiratory mechanics, as spinal cord lesions above T11 can disrupt breathing 3

Initial Evaluation and Care

The initial evaluation should focus on detecting head and spinal cord injuries, as well as providing critical care to prevent further complications 2, 3.

• This may involve:
  • Maintaining a mean arterial pressure >85-90 mm Hg for at least 1 week to ensure adequate perfusion and oxygenation 3
  • Using a cervical collar and full spinal precautions until the spinal column has been fully evaluated by a spine surgeon 3
  • Obtaining computed tomography (CT) scans and magnetic resonance imaging (MRI) to assess the spinal neural elements, soft tissues, and ligamentous structures 3

Ongoing Management and Rehabilitation

Ongoing management and rehabilitation are critical for optimizing outcomes in patients with spinal cord injuries 3, 5.

• This may involve:
  • Daily grading using the American Spinal Injury Association classification to monitor progress and guide treatment decisions 3
  • Aggressive rehabilitation to promote neurologic recovery, particularly in the first year following injury 3
  • Measures to prevent pulmonary emboli, pressure ulcers, and other complications 3