What to do if a patient falls out of bed?

Falls are a significant risk for older adults, with one in four Americans aged 65 and over falling each year. Knowing exactly what to do if a patient falls out of bed is critical for both the patient’s safety and the caregiver’s peace of mind. This comprehensive guide outlines the essential steps to take in this stressful situation, from immediate assessment to long-term prevention.

Quick Summary

Taking immediate action is vital if a patient falls out of bed. The first steps involve staying calm, assessing the patient for injuries without moving them, and calling for emergency medical help if necessary. Once immediate dangers are ruled out, safely assist the patient and document the incident to identify and prevent future risks.

Key Points

• Stay Calm: Your calm demeanor will help the patient and allow you to assess the situation effectively.

• Assess Before Moving: Never rush to lift a patient. First, check for visible injuries, severe pain, and signs of a head injury.

• Know When to Call 911: Call for emergency medical services immediately if the patient is unconscious, has a head injury, or complains of severe pain.

• Use a Safe Lifting Method: If a fall is minor, use a sturdy chair and follow a step-by-step process to help the patient stand up without risking further injury.

• Monitor and Follow Up: Watch the patient for 24–72 hours for delayed symptoms and schedule a follow-up with their doctor to address the fall and its cause.

• Prioritize Prevention: Implement environmental changes like removing hazards, improving lighting, and using assistive devices to minimize future fall risks.

Immediate Action: The First 60 Seconds

Witnessing a patient fall can be alarming, but maintaining a calm and clear-headed approach is paramount. Your initial response can significantly impact the patient’s outcome. Do not rush to help them up, as this could worsen potential injuries.

Step 1: Stay Calm and Reassure the Patient

Your calm demeanor will help keep the patient from panicking. Speak in a soothing voice and reassure them that help is on the way. This also provides you with the mental space to think clearly and follow the correct protocol.

Step 2: Assess the Situation Before Acting

Before you do anything, take a moment to look for immediate dangers. Is the patient near anything that could cause further harm? Observe their condition from a safe distance. Do they appear to be in severe pain? Are there obvious signs of bleeding, a head injury, or a deformed limb? Asking these questions quickly will inform your next steps.

Step 3: Determine When to Call Emergency Services (911)

Immediate professional medical help is required in several situations. You must call 911 (or your local emergency number) if:

• The patient is unconscious or unresponsive.
• They hit their head and are confused, dizzy, nauseous, or have a severe headache.
• There is severe pain, especially in the head, neck, back, or hip.
• A limb appears to be broken or deformed.
• There is uncontrolled bleeding.
• The patient reports chest pain or difficulty breathing.
• The patient cannot be moved or moved without causing immense pain.

The Fall Recovery Protocol

If you have assessed the situation and determined that immediate emergency help is not needed, you can proceed with the following steps. Always err on the side of caution; if you are in any doubt, do not hesitate to call for professional medical assistance.

Guiding a Patient to Stand Safely

If the patient is lucid, can move without severe pain, and wants to get up, you can assist them carefully. Never lift or hoist them by yourself. The goal is to guide them using a safe, step-by-step process.

1. Bring a sturdy chair nearby: Ensure it is a stable, non-rolling chair that will not tip over.
2. Help them roll onto their side: Guide them slowly to roll onto their side, and let them rest for a moment to regain composure.
3. Position them on their hands and knees: Help the patient move into a crawling position, using their arms for support.
4. Move toward the chair: Have them crawl to the chair and place their hands firmly on the seat of the chair.
5. Lift one leg: Have them lift their strongest leg and place their foot flat on the floor.
6. Slowly stand up: With your support, they should push off with both their arms and the leg on the floor to stand up slowly.

Post-Fall Monitoring and Care

After the patient is safely in a chair or back in bed, the caregiving doesn't stop. The next 24 to 72 hours are crucial for watching for delayed symptoms.

• Monitor for hidden injuries: Some injuries, particularly head injuries, may not be immediately apparent. Watch for any changes in behavior, increased pain, or unusual symptoms like confusion, drowsiness, or vomiting.
• Schedule a follow-up appointment: Even for a seemingly minor fall, contact the patient’s doctor. They may need an official assessment, and it helps identify underlying causes.

Preventing Future Falls

Prevention is the most effective strategy for managing fall risks. A fall is often a sign that a change in the care plan or environment is needed.

Environmental Changes

• Remove tripping hazards: Clear pathways of clutter, cords, and throw rugs.
• Improve lighting: Ensure there is adequate lighting in all areas, especially hallways and bathrooms. Use nightlights where appropriate.
• Install grab bars and handrails: Add grab bars in the bathroom and install sturdy handrails on both sides of stairways.
• Adjust bed height: Ensure the patient's bed is at a height that allows their feet to rest flat on the floor when seated on the edge, making it easier to get in and out.

Lifestyle and Medical Adjustments

• Regular exercise: Gentle exercises focused on balance and strengthening can reduce fall risk. Consider consulting a physical or occupational therapist.
• Medication review: Some medications can cause dizziness, drowsiness, or affect balance. Regularly review the patient’s medication list with their doctor.
• Vision check: Poor eyesight is a major fall risk. Ensure the patient has up-to-date vision prescriptions.

Comparison of Fall Prevention Techniques

Prevention Method	Key Benefits	Best For	Considerations
Physical Therapy	Improves strength, balance, and gait; develops personalized exercise plans.	Patients with balance issues, weakness, or prior falls.	Requires commitment and regular sessions.
Environmental Modifications	Reduces immediate, visible hazards; relatively easy to implement.	All patients, especially those with mobility issues.	May require an initial investment for home modifications.
Medication Management	Addresses medication side effects that contribute to dizziness or drowsiness.	Patients taking multiple prescriptions or new medications.	Requires regular communication with the healthcare provider.
Assistive Devices	Provides stability and support for ambulation.	Patients with mobility limitations or gait instability.	Ensure proper fitting and patient comfort; requires training for use.
Sensor Technology	Automatically detects falls and alerts caregivers.	High-risk patients needing continuous monitoring.	Can be expensive; technology may have limitations.

For additional authoritative information on fall prevention, you can visit the National Institute on Aging.

Conclusion

A fall is a stressful event, but by following a structured and calm protocol, you can manage the situation effectively and safely. The initial assessment is critical for determining the next steps, and calling for professional help is the safest course of action if there is any doubt. Beyond the immediate response, focusing on comprehensive fall prevention strategies—including environmental changes, medication reviews, and physical therapy—is the best way to protect the patient's long-term health and well-being. By being prepared, you can act with confidence and provide the best possible care during and after a fall.

Frequently Asked Questions

What is the very first thing I should do when I see a patient fall out of bed?

The very first step is to remain calm. Reassure the patient and tell them to stay still while you assess the situation for immediate danger and check for obvious signs of severe injury.

When should I call 911 after a patient falls?

You should call 911 immediately if the patient is unconscious, not breathing, has an obvious head injury, complains of severe pain (especially in the head, neck, or back), or has a potentially broken bone.

How can I tell if a head injury is serious after a patient falls?

Signs of a serious head injury include unconsciousness, confusion, dizziness, persistent headaches, nausea, vomiting, slurred speech, or changes in pupil size. If you notice any of these, call for emergency medical help immediately.

What if the patient insists on getting up immediately?

Encourage the patient to stay calm and still. Explain that rushing to stand could make an injury worse. Remind them that a thorough assessment is needed to ensure their safety. If they are insistent and seem uninjured, guide them through a safe, slow process using a sturdy chair for support.

Should I move the patient if they are blocking a doorway?

Only move the patient if they are in immediate danger, such as near a fire or toxic substance. If you suspect a head, neck, or spinal injury, do not move them. Instead, call 911 and wait for emergency medical professionals who are trained to move patients safely.

What information should I provide to the paramedics?

When paramedics arrive, be prepared to tell them what you observed leading up to and during the fall, the patient's medical history, current medications, and any changes in the patient's condition after the fall. Mention any first aid you administered.

How can I prevent a patient from falling out of bed in the future?

Consider lowering the bed height, installing side rails, using a bed alarm system that notifies you when the patient gets up, and ensuring the patient's room is free of clutter. A professional fall risk assessment can also identify other preventive measures.