Ladder falls are a common cause of serious trauma, especially in older adults doing home repairs, and the height and landing surface predict how bad the injuries are. Typical injuries include heel and wrist fractures, spine and pelvic fractures, head injury and internal bleeding.
Key symptoms
- Pain at the landing points: heels, wrists, hips or back
- Neck or back pain, numbness or weakness
- Headache, confusion or loss of consciousness
- Chest or abdominal pain, or shortness of breath
- Dizziness or chest pain before the fall, suggesting a medical cause
What you find on exam
- Primary survey: airway with spine protection, breathing, circulation, disability
- Spine tenderness or deformity, with a motor and sensory check of all limbs
- Glasgow Coma Scale and pupils
- Chest, abdomen and pelvis for tenderness, bruising or instability
- Limbs for deformity, with pulses and sensation beyond each injury
Tests
- Glucose and ECG if a medical cause of the fall is possible
- CT of the head and spine guided by mechanism and decision rules
- X-rays of painful limbs; heel fractures often come with spine fractures
- FAST ultrasound and CT of chest, abdomen and pelvis in major trauma
Treatment basics
- Control major bleeding and manage the airway first
- Spinal motion restriction for spine pain, neuro deficits, altered mental status or distracting injury
- Splint fractures; pelvic binder for a suspected unstable pelvis
- Pain control with titrated fentanyl or ketamine
- Trauma center if the fall was over 10 feet (about 3 m) or other triage criteria are met
Red flags
- Falling level of consciousness or unequal pupils
- Low blood pressure, fast pulse or an unstable pelvis
- New weakness or numbness in the arms or legs
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic); National EMS Education Standards (2021). Written by Making Synapses. Making Synapses is not affiliated with these organizations.