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Falls From Height: Injury and Mortality
  1. Capt A Dickinson, General Practice Registrar Royal Army Medical Corps1,
  2. M Roberts2,
  3. A Kumar, Speciality Trainee in Anaesthetics Royal Army Medical Corps3,
  4. A Weaver, Consultant in Emergency Medicine & Prehospital Care4 and
  5. DJ Lockey, Consultant in Anaesthesia5
  1. 155 Old Exeter Road, Tavistock, PL19 0JE 07920 760995 andrewkeithdickinson{at}
  2. 2Research Fellow Peninsula College of Medicine & Dentistry
  3. 3
  4. 4Lead Clinician for HEMS, The Royal London Hospital
  5. 5Intensive Care Medicine and Prehospital Care, Frenchay Hospital, Bristol


Objectives To determine how Injury Severity Score (ISS) and mortality relate to height fallen, and to determine other predictors of mortality including intent and body region injured.

Methods A pre-hospital retrospective, observational database study was conducted. Injured or deceased patients following a fall from height (FFH), aged 16 or over, attended to by London Helicopter Emergency Medical Services (HEMS), between Jan 2008 to July 2009 were included in the study. In addition to the database, HEMS mission ‘run sheets’ provided further information.

Results 117 (91 males and 26 females) patients met the inclusion criteria. The mean age was 37 years (range 16 - 85). 34/117 (29%) died. The mean ISS was 28.6 (median 17) and the mean height fallen 9.9m (3rd floor). In the group that died the mean height was 16.7m (5th floor). Height fallen was found to be a significant predictor of mortality (p<0.001), as were injuries to the chest and/or head (p<0.05). In patients with head and chest injuries, a 50% mortality rate was estimated to occur at falls from 10.5m, compared to 22.4m in those without injuries to head or chest. Deliberate falls were more common amongst females than males (chi-squared test, p=0.001), were associated with greater ISS (Mann Whitney test, p<0.001) and were more likely to result in death (chi-squared test, p<0.001).

Conclusions Height fallen correlates with ISS and is a significant predictor of death. Chest and/or head injuries significantly increased the likelihood of death following a FFH. This information may enhance triage criteria applied to tasking of emergency response vehicles, and strategies in injury prevention. Other potential predictors of mortality were not found to be significant.

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