What is the next step in management after a patient falls from their own height?

Management of Patients After a Fall from Own Height

After a patient falls from their own height, the next step is to assess for injuries and stabilize the patient, with special attention to potential spine injuries if risk factors are present. 1

Initial Assessment and Management

1. Ensure scene safety

   • Move to a safe location if the area is unsafe 1
   • Assess the patient where they fell unless unsafe to do so

2. Check responsiveness and breathing

   • If unresponsive and not breathing normally, begin CPR immediately 1, 2
   • If responsive, proceed with assessment

3. Position the patient appropriately

   • If responsive and breathing normally with no evidence of trauma, place in supine position 1
   • If unresponsive but breathing normally with no trauma, consider lateral recovery position 1
   • Do not move the patient if there is suspicion of spine, neck, back, hip, or pelvic injury 1
   • Only move enough to open airway if blocked or if area is unsafe 1

Injury Assessment

Assess for risk factors suggesting spinal injury 1:

• Age ≥65 years
• Fall with evidence of head or neck trauma
• Pain or tenderness in neck or back
• Tingling in extremities
• Sensory deficit or muscle weakness
• Altered mental status or intoxication
• Other painful injuries, especially of head and neck

Assess for other injuries:

• Fractures (especially in elderly patients) 1
• Soft tissue injuries 1
• Head injuries 1
• Chest injuries (especially in older adults) 1

Specific Management Based on Findings

1. For suspected spinal injuries:

   • Manually stabilize the head to minimize motion 1
   • Do not use immobilization devices unless properly trained 1
   • Do not roll the patient onto their side 1

2. For soft tissue injuries:

   • Apply cold to decrease hemorrhage, edema, and pain 1
   • Use ice-water mixture in a plastic bag with a barrier between the cold container and skin 1
   • Limit application to 20 minutes (or 10 minutes if uncomfortable) 1

3. For suspected fractures:

   • Do not move or straighten injured extremities 1
   • Cover open wounds with dressings 1
   • If far from definitive care, stabilize the extremity with a padded splint in the position found 1
   • If an extremity appears blue or extremely pale, activate EMS immediately 1

4. For shock:

   • If showing evidence of shock but responsive and breathing normally, maintain supine position 1
   • If no evidence of trauma, consider raising feet 6-12 inches (30-60°) while awaiting EMS 1
   • Do not raise feet if movement causes pain 1

Special Considerations for Elderly Patients

Elderly patients require particular attention as they are at higher risk for serious injuries from ground-level falls 1:

• Ground-level falls are the most common mechanism of injury in patients ≥65 years 1
• 6% of ground-level falls result in fractures, and 10-30% result in polytrauma 1
• Mortality rate can be as high as 7% 1
• Elderly patients are more likely to sustain fractures of cervical spine, ribs, hip, and extremities 1
• Pre-existing medical conditions and frailty contribute to poor outcomes 1

When to Activate EMS

Activate EMS immediately if:

• Patient is unresponsive 1, 2
• Evidence of significant injury (fractures, head injury, etc.) 1
• Signs of shock 1
• Patient is elderly with any significant injury 1
• Patient has an extremity that appears blue or extremely pale 1
• Patient reports chest pain or other signs of heart attack 1

Follow-up Care

• All patients who have fallen should be evaluated for fall risk factors to prevent future falls 1
• Consider mobility assessment using tools like the Timed Up and Go (TUG) test for elderly patients 1
• Address modifiable risk factors for falls using the P-SCHEME approach: Pain, Shoes, Cognitive impairment, Hypotension, Eyesight, Medications, and Environmental factors 1

Remember that falls, especially in the elderly, can have serious consequences even if they initially appear minor. Thorough assessment and appropriate management are essential to prevent morbidity and mortality.