The Immediate Assessment: First Steps After a Fall
When a fall occurs, the first few moments are crucial. Your priority is to ensure the person is not in immediate danger and to perform a rapid but thorough assessment. Resist the urge to move them immediately, as this could worsen a potential spinal or head injury. Instead, stay calm and follow these steps:
- Do Not Move the Person. This is the single most important rule. If you suspect a serious head, neck, or back injury, or if they are unresponsive, call for emergency medical services (EMS) immediately. Keep them warm and comfortable with a blanket or jacket until help arrives.
- Check for Consciousness and Responsiveness. Speak to them in a clear, calm voice. Ask simple questions like, “Can you hear me?” or “Are you hurt?” Observe their responses for signs of confusion or altered mental status.
- Perform a Quick Visual Scan. From a safe distance, look for any obvious signs of severe injury, such as bleeding, bone deformities, or swelling. Check for any chest movement to ensure they are breathing normally.
- Ask for the 'Before and After' Story. If they are able to communicate, ask them to describe what happened leading up to the fall and how they feel now. This can provide important clues about the cause (e.g., did they feel dizzy?) and the extent of the injury.
Conducting a Head-to-Toe Physical Check
Once you have determined there are no immediate, life-threatening injuries and it is safe to proceed, you can begin a more detailed physical examination. This is still a preliminary assessment and does not replace a doctor's examination.
Assessing the Upper Body
- Head and Neck: Gently check for any cuts, bumps, or bruises on the head. Ask if they have a headache, neck pain, or blurred vision. Do not move their head or neck if they report pain.
- Shoulders and Arms: Ask them to move their shoulders, elbows, and wrists gently. Look for limited movement, pain, or any visible swelling.
Evaluating the Lower Body
- Hips and Legs: Ask if they can wiggle their toes. Observe if one leg appears shorter or is rotated unnaturally, which could indicate a hip fracture. Do not force any movement.
- Knees and Ankles: Look for swelling or pain around the knee and ankle joints. Ask them to bend and flex these joints slightly if they are able.
Investigating the Scene for Clues
After the person has been stabilized and attended to, turn your attention to the fall's location. This step is critical for preventing future incidents.
- Reviewing the Environment: What hazards were present? Look for loose rugs, cluttered walkways, poor lighting, or uneven surfaces. Was there a wet floor in the bathroom or kitchen?
- Considering the Person's Condition: Did any personal factors contribute to the fall? Was the person feeling unwell, dizzy, or lightheaded? Was new or ill-fitting footwear a factor?
- Examining Medications: A review of medications, both new and old, is essential. Some medications can cause dizziness or affect balance. Keep a detailed list to share with a healthcare provider.
Environmental Hazard Checklist
- Lighting: Are all areas, especially hallways and stairs, well-lit?
- Clutter: Is the path of travel clear of objects, cords, and furniture?
- Flooring: Are throw rugs securely fastened or removed entirely? Are there any uneven transitions between different flooring types?
- Bathroom Safety: Are there grab bars near the toilet and in the shower/tub? Is there a non-slip mat in the shower?
- Stairways: Are handrails secure and present on both sides?
Next Steps and Follow-up Care
Based on your assessment, you will need to determine the next course of action. If there are signs of serious injury, call 911. If the fall seems less severe, you still need to act decisively.
Action Comparison: Seeking Immediate vs. Delayed Medical Attention
| Observation | Immediate Action (Call 911) | Delayed Action (Monitor Closely) |
|---|---|---|
| Consciousness | Unresponsive, passed out, or confused | Alert and oriented |
| Mobility | Unable to get up, severe pain, inability to move limbs | Able to stand with assistance, mild pain |
| Injuries | Obvious deformity, heavy bleeding, head trauma | Minor scrapes, bruising, no signs of fracture |
| Vitals | Irregular breathing, changes in skin color, low blood pressure | Stable vital signs |
Regardless of the initial outcome, it is vital to contact a healthcare provider for a professional assessment. Many serious injuries, such as internal bleeding or concussions, do not show immediate symptoms. Increased monitoring for at least 72 hours is often recommended, as symptoms can worsen or appear later. For more information on creating a fall prevention plan, the Agency for Healthcare Research and Quality provides excellent resources, including sample post-fall assessment forms.
AHRQ's fall prevention resources
Conclusion and Proactive Steps
Performing a post-fall assessment is a critical skill for any caregiver or family member. It is not just about reacting to a crisis but also about gathering information to prevent the next one. By carefully evaluating the person and the environment, you can identify risk factors and take proactive measures to enhance safety. Remember that prevention is the most powerful tool. After the immediate incident is resolved, work with a healthcare team to address any underlying medical conditions, review medications, and implement home modifications that create a safer living environment. This thoughtful and systematic approach ensures the well-being of the person who has fallen and reduces the fear and anxiety associated with such events, promoting healthy aging.
