These types of injuries occur commonly in construction sites, climbing mountains, trees, among children and alcohol intoxicated individuals. Falls mostly being accidental but can be suicidal or homicidal in intent. Height of the fall is the most important factor which determines the types as well as severity of the injuries received by the victim but other factors like place of the body impacted, angle of impact, nature of the terrain, and body weight also plays their roles. Therefore even relatively short fall can prove lethal in instances like falling head –on to a concrete/stone floor.
Most critical fact that has to be borne in mind in these victims is the possibility of a cervical spinal cord injury. Even without any apparent external injuries to head/neck there is a very high probability of occurrence of such an injury in these cases. These are quite unstable and any relative movement of the head or body can de-stabilize the fracture causing damage/compression of cervical spinal cord. This is the region that holds the most critical centers of respiratory and heart rate control and any damage there will result in immediate death. Therefore, inadvertent moving of these patients would do more harm than good and refrain from moving these victims as much as possible if the specialized emergency medical support is en route.
- Do not move the patient unless it is really needed.
- Reassure the patient and calm him down reducing movements of head.
- Call 911(emergency rescue) urgently.
- If the patient is not breathing attend to basic life support, be careful in head tilt and chin lift, open the airway and start chest compressions.
- If there is bleeding from any sustained wounds apply direct firm pressure on bleeding site using a clean cloth or if available a wad of gauze and tie it around the wound.
- If there are any fractures in limbs, keep a piece of wood/hard material behind it and splint the fracture to reduce movement hence the pain and bleeding.
- If the victim has to be moved away or need to be transported to a hospital,
- Call for help – at least 2 people is needed to move these victims.
- When moving remember not to allow any movement of head relative to the body.
- If the victim is conscious and complains of severe neck pain, tingling, numbness or inability to move the limbs be especially careful as this is a very dangerous sign of cervical cord injury.
- If available at the scene putting a hard cervical collar around the neck will be the best way to protect spinal cord.
- Synchronize by counting and move the victim as a whole on to a rigid surface (ideally a spinal board, but a hard wooden board will suffice).
- Then keep a pillow or a folded cloth around neck and fasten head and whole body using cloth or tape to prevent movement while transporting.
- If head injury is suspected, keep a close watch on signs of increased intracranial pressure (e.g. vomiting, drowsiness, deteriorating level of consciousness, headache, and seizures).
- Do not give any food items or water as it may interfere with any subsequent operative procedure requiring general anesthesia.
In a case of occupational accident or any non-accidental incident a clear record of proceedings will help subsequent legal actions