A fall can result in injuries ranging from simple bruises to life-threatening trauma. The moments immediately following the incident are crucial for assessing potential damage. This guide helps identify signs of injury in the immediate aftermath and the hours that follow, but it is not a substitute for professional medical advice, diagnosis, or treatment. Understanding these signs is important for making informed decisions about seeking care.
Immediate Assessment: Checking for Head and Spine Trauma
The first priority after a fall is to quickly assess the person’s level of consciousness and check for signs of head or spinal injury. Determine responsiveness using the AVPU scale: Alert, responsive to Voice, responsive only to Pain, or Unresponsive. If the person is not fully Alert or lost consciousness briefly, it signals a potential brain injury requiring immediate medical attention.
Look for obvious head wounds, such as deep cuts or bruising, or signs of a skull fracture like clear fluid or blood leaking from the ears or nose. Check the person’s pupils to see if they are equal in size and react to light; unequal or fixed pupils can indicate severe pressure on the brain. Ask about pain in the neck or back, or any numbness or tingling in the limbs, which are warning signs of a spinal injury.
If a neck or back injury is suspected, do not move the person unless they are in immediate danger, as movement could worsen spinal cord damage. Maintain the head and neck in the position they were found until emergency medical services arrive. Even if the person denies pain, any fall involving a significant impact to the head or trunk should be treated with caution.
Identifying Musculoskeletal Injuries
After assessing the head and spine, focus on the extremities, checking for injuries to bones, joints, muscles, and ligaments. Look for severe, rapid swelling or deep, extensive bruising suggesting underlying tissue damage. The most telling sign of a severe injury, such as a fracture or dislocation, is an obvious deformity where a limb appears unnaturally angled.
A person with a potential fracture may report hearing or feeling a “pop” during the fall, and the area will be extremely painful. Inability to bear weight on a leg or foot, or a complete loss of function in an arm, strongly suggests a fracture or severe sprain requiring professional imaging. Less severe injuries, like sprains or strains, cause pain, stiffness, and reduced range of motion, but usually lack dramatic deformity.
Pain that persists or worsens over time, even without visible deformity, can still indicate a significant injury. A small hairline fracture, for example, results in persistent, sharp pain that limits movement. Any significant restriction of movement or new numbness and tingling in the extremities should prompt a medical evaluation to rule out nerve involvement or serious joint injury.
Signs of Internal Injury and Delayed Symptoms
Serious injuries are often not immediately apparent because adrenaline and shock can temporarily mask pain. Internal injuries, such as bleeding or organ damage, can progress silently, requiring monitoring for several hours after the fall. Persistent or escalating severe abdominal pain, especially with swelling or new bruising, may signal internal bleeding or trauma to organs like the spleen or liver.
Chest pain or difficulty breathing could indicate fractured ribs or a collapsed lung. Watch for delayed neurological issues, which can occur hours after a head bump as pressure increases from a slow bleed in the brain. Red flags for a developing traumatic brain injury include persistent, worsening headaches, repeated vomiting, or increasing confusion.
Delayed symptoms also include increasing drowsiness, difficulty waking up, slurred speech, or noticeable changes in behavior, indicating a deteriorating neurological status. Even mild symptoms appearing the next day, such as dizziness, nausea, or sensitivity to light and sound, may point to a concussion. Monitoring for these signs is necessary, as seemingly minor injuries can become medical emergencies.
Decision Tree: When to Go to the Emergency Room
The decision to seek emergency care depends on the presence of specific, high-risk symptoms indicating a life-threatening or major injury. Immediate emergency services should be called if the person lost consciousness, is unresponsive, or is difficult to rouse.
Immediate ER attention is required for:
- Severe, sudden neck or back pain, or new weakness, numbness, or tingling in the arms or legs (due to spinal injury risk).
- Any visible bone deformity, a compound fracture (bone breaking through the skin), or inability to bear weight on a limb.
- Signs of internal issues, such as severe, persistent abdominal or chest pain, difficulty breathing, or uncontrolled bleeding.
- A head injury in a person taking blood thinners, due to the high risk of intracranial bleeding.
For less severe symptoms, such as a suspected sprain, significant swelling, or a minor cut needing stitches, urgent care may be an appropriate alternative. However, if symptoms worsen over the first 24 to 48 hours, or if new signs of neurological or internal injury appear, visit the ER immediately. When in doubt about the severity of an injury, seeking a medical evaluation is the safest course of action.