“I’ve fallen and can’t get up!” How often have you heard this chief complaint from an elderly person? No doubt the answer likely is a lot, but sometimes, we forget to realize that it could be an actual crisis for your patient.
About 36 million falls are reported annually among citizens who are 65 years of age and older. These falls account for more than 32,000 deaths. Are first responders missing something? This type of incident can be a lift assist, or it can turn out to be a more serious medical or traumatic event.
Numbers don't lie
According to the Centers for Disease Control and Prevention, one out of four older adults falls annually. Each year, about three million are treated in an emergency department for a fall injury. One in every five falls causes an injury, such as a broken bone or a head injury. Annually, at least 300,000 older people are hospitalized for hip fractures. How many experienced a genuine medical problem that caused the fall?
Women fall more often than men do, and women account for three-quarters of all hip fractures.
Each year, the medical cost for falls totals about $50 billion, with Medicare and Medicaid paying for about 75 percent. Elderly falls are an actual health crisis in the United States.
Remember, a fall can occur because of someone simply losing his or her balance, someone suffering from a cardiovascular event, such as a stroke or heart attack, or even a diabetic emergency.
How can you safeguard your assessment and adequately care for these patients?
Fall risk factors
Many conditions contribute to falling. These risk factors include lower body weakness; vitamin D deficiency, particularly in women; difficulties with walking and balance; use of medicines, such as tranquilizers, sedatives, antidepressants and hypertensives (over-the-counter medications can affect balance and how steady patients are on their feet); vision problems, including cataracts and glaucoma; foot pain; poor footwear; chronic medical conditions (previous heart and lung disease or hip fractures); and home hazards or dangers, such as broken or uneven steps, bad carpeting or throw rugs, and poor lighting.
A combination of risk factors causes most falls. The more risk factors that a person has, the greater the individual’s chances of falling, and the greater the chance of severe injury or death.
Assess a good history of what, why and how long ago the fall occurred. Remember that rhabdomyolysis, which can lead to kidney failure, can occur when a person fell and was in that position for some time. Common signs of rhabdomyolysis include abdominal pain, nausea or vomiting, fever, rapid heart rate, confusion, dehydration and lack of consciousness.
Do a full medical assessment, starting with a chief complaint other than the fall, such as dizziness or weakness. Do a full head-to-toe trauma assessment to rule out any injuries that could have occurred during the fall. Did the patient strike his/her head, feel something give or break or receive a laceration? Is the patient bleeding externally or internally (complicated by anyone taking blood thinners)?
Get a good set of vitals and reassess the patient in different positions: lying, sitting and standing. Doing so will check for any orthostatic changes. An EKG, if available, is a wise decision.
Even if you don’t find significant medical or trauma issues, particularly if you don’t find any home hazards, advise your patient to seek medical care at the emergency room to be safe. You don’t want to return to the incident scene to find your previous patient worse or dead.
Avoid the easy route
Hopefully, your local protocols dictate what I just spelled out, which should include contacting medical command for advice.
Please be mindful of how the fall occurred by completing a full medical and trauma assessment. Don’t just make it a “lift assist.” It’s easier to put someone back into bed or in a chair but safer to transport a patient who has a possible broken hip or underlying medical condition. Always err on the side of the patient and transport when in doubt.
Your organization can help to reduce the number of falls through good community involvement. In turn, this can help to reduce the number of injuries and deaths, which would reduce your total run volume and the entire cost to the healthcare community and to patients.
Be safe and not sorry.
Richard Bossert
Richard Bossert is a retired operations chief for the Philadelphia Fire Department. He started in the fire/rescue services in 1970, volunteering for the Warminster, PA, Fire Department. He worked for three career fire departments: Chester, Bensalem and Philadelphia. Bossert became a certified EMT in 1973, then paramedic in 1980. He received a bachelor’s degree in pre-med from Pennsylvania State University in 1977 and a master’s degree in public safety administration from St. Joseph’s University in 2003.
