Transcript

*Full references at end of page

If you have fallen over and you’re not sure what to do, or would like some additional information, please keep watching. If an ambulance crew have seen you and you have not attended hospital, this video is also for you.

If you or the person you are watching this for has just fallen and the following apply, please call 999.

If you or they fall again, and the following applies, please call us back:

SYMPTOMS:

• You are having difficulty breathing, or have chest pain
• You’re unable to move your arms or legs, or they’re numb
• You have sudden, new weaknesses
• You are dizzy and feel faint when you stand up
• You lost consciousness, or have had a seizure, which is not normal for you.
• You can’t remember what happened since, or before, you fell over
• You have continuous vomiting, or headaches, which is not normal for you.
• Your behaviour is different – you feel more confused, or more irritated

call 999

PAIN –

• You have neck or back pain
• You are unable to get up from the floor
• You have another injury that PREVENTS YOU FROM WALKING or causes EXTREME PAIN, for example, you think you might have broken your leg.

call 999

HOW IT HAPPENED –

• You have fallen from height – more than 1m
• You have landed on your head

call 999

If you have had alcohol, this may be hiding symptoms, making it more difficult for us to assess you. If you are intoxicated, you may be advised to attend a&e to rule out serious complications that are masked by the alcohol.

If you have been advised to attend a&e and have chosen not to, please make sure you have someone who can check in on you over the next 48 hours (NICE, 2014), and ask them to look out for these symptoms.

Also, if you take any medications to thin your blood, AND you have hit your head, you must attend a&e to be monitored and receive a scan of your head, a CT scan. Even if you have not drawn blood, you are still at risk of bleeding internally, especially in the brain because these medications are designed to prevent blood clots.

These medications might be called:

• Warfarin
• Rivaroxaban
• Dabigatran
• Apixaban
• Edoxaban
• Heparin (injection)

You might also be taking any of these antiplatelet medications:

• Clopidogrel, aspirin, and others shown on the screen:
• Dipyridamole 
• Prasugrel
• Ticagrelor
• Cangrelor

(BNF, n.d.)

*These are more concerning when taken in combination, e.g. clopidogrel + aspirin

You should also attend a&e when taking these, or at minimum maintain extreme caution for the same reason. For more information about blood thinners and antiplatelets, please scroll below the video.

What to do if you are on the floor because of a fall, and you’re not hurt

Don’t get up quickly. Roll onto your knees and use nearby stable furniture to push yourself up. Then, sit down until you feel able to continue with your day (NHS, 2021). If you are disabled, ensure use your mobility aids today to prevent yourself from falling again.

Remember, if you have hurt yourself, or you can’t get up, call for help. If you have one, you can press your personal alarm. You can call: family, friends, 999, or 111. Both 999 and 111 will lead to an ambulance arrival with a crew who can assess you and help you up. Both 999 and 111 result in the same ambulance service.

While you wait, the NHS recommends changing your position ‘at least once every half hour or so,’ (NHS, 2021) if you are able to and it is not painful to do so.

Keep yourself warm and let 999 know if anything gets worse.

PREVENTION –

To prevent yourself falling again, remove any objects that might have caused you to fall, avoid drinking too much alcohol, and ensure you wear appropriate safety equipment when performing sports, such as helmets when cycling.

Additional Information

https://natfonline.org/2020/08/falls-and-anticoagulation/

https://www.everydayhealth.com/news/need-know-side-effect-blood-thinners/

https://www.stoptheclot.org/living-your-best-life-while-taking-blood-thinners/

References

Age UK. (2020). Avoiding a fall. Available at: https://www.ageuk.org.uk/information-advice/health-wellbeing/exercise/falls-prevention/ (Accessed 12/10/2021).

Alter SM, Mazer BA, Solano JJ, et al. (2020). Antiplatelet therapy is associated with a high rate of intracranial hemorrhage in patients with head injuries. Trauma Surgery & Acute Care Open, 5(1), e000520

Alzheimer’s Society. (2021). Urinary tract infections and dementia. Available at: https://www.alzheimers.org.uk/get-support/daily-living/urinary-tract-infections-utis-dementia (Accessed 18/10/2021)

BNF. (N.D.). Antiplatelet drugs. Available at: https://bnf.nice.org.uk/treatment-summary/antiplatelet-drugs.html (Accessed 12/10/2021).

CDC. (2017). Assessment. Timed Up and Go. Available at: www.cdc.gov/steadi/pdf/TUG_Test-print.pdf (Accessed 12/10/2021).

The Chartered Society of Physiotherapy (CSP). (2015). Get up and go – a guide to staying steady. Available at: https://www.csp.org.uk/publications/get-go-guide-staying-steady-english-version (Accessed 12/10/2021).

CSP. (2017). Stay active at home – Strength and balance exercises for older adults. Available at: Stay Active at Home – Strength and balance exercises for older adults (Accessed 12/10/2021).

Dallas, M. (2015). The Need-to-Know Side Effect of Blood Thinners. Available at: https://www.everydayhealth.com/news/need-know-side-effect-blood-thinners/ (Accessed 18/10/2021).

Knott, L. (2021). Rhabdomyolysis and Myoglobinuria. Available at: https://patient.info/doctor/rhabdomyolysis-and-other-causes-of-myoglobinuria (Accessed 12/10/2021).

National Blood Clot Alliance. (n.d.). Living your best life while taking blood thinners. Available at: https://www.stoptheclot.org/living-your-best-life-while-taking-blood-thinners/ (Accessed 18/10/2021).

NHSa. (2021). Falls. Available at: https://www.nhs.uk/conditions/falls/ (Accessed 12/10/2021).

NHSb. (2021). Anticoagulant medications. Available at: https://www.nhs.uk/conditions/anticoagulants/ (Accessed 12/10/2021)

NHSc. (N.D.). Care Services, Equipment and Care Homes. Available at: https://www.nhs.uk/conditions/social-care-and-support-guide/care-services-equipment-and-care-homes/ (Accessed 12/10/2021).

NICEa. (2013). Falls in older people: assessing risk and prevention. Available at: https://www.nice.org.uk/guidance/cg161 (Accessed 12/10/2021).

NICEb. (2015). Falls in older people. Available at: https://www.nice.org.uk/guidance/qs86/chapter/About-this-quality-standard (Accessed 12/10/2021).

NICEc. (2019). Falls – risk assessment. Available at: https://cks.nice.org.uk/topics/falls-risk-assessment/ (Accessed 12/10/2021).

NICEd. (2014). Head injury: assessment and early management (NICE Clinical Guideline 176). Available at:  https://www.nice.org.uk/guidance/cg176 (Accessed 16/06/2020).

NICEe. (2016; 2021). Spinal Injury: assessment and initial management. Available at: https://www.nice.org.uk/guidance/ng41/resources/spinal-injury-assessment-and-initial-management-pdf-1837447790533 (Accessed 19/10/2021).

Nishijima, D. (2012). Immediate and delayed traumatic intracranial hemorrhage in patients with head trauma and preinjury warfarin or clopidogrel use. Annals of Emergency Medicine, 59(6), pp: 460-468.

North American Thrombosis Forum. (2020). Falls and anticoagulation. Available at: https://natfonline.org/2020/08/falls-and-anticoagulation. (Accessed 18/10/2021).

Probst, M. et al. (2020). ‘Prevalence of Intracranial Injury in Adult Patients With Blunt Head Trauma With and Without Anticoagulant or Antiplatelet Use’. Annals of Emergency Medicine, 75(3), pp: 354-364.

Public Health England. (2017). Falls and fracture consensus statement – Supporting commission for prevention. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/586382/falls_and_fractures_consensus_statement.pdf (Accessed 12/10/2021).

Saga, CSP, and PHE. (2015). Get Up and Go: A Guide to Staying Steady. Available at: https://www.csp.org.uk/system/files/get_up_and_go_0.pdf (Accessed 12/10/2021).

Soliman, Y., Meyer, R., And Baum, N. (2016). Falls in the Elderly Secondary to Urinary Symptoms. Reviews in Urology. 18(1), pp: 28-32.

Stiell, I. et al. (2003). ‘The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma’, The New England Journal of Medicine. 349. pp: 2510-2518.

Skellet, S. et al (2021). Paediatric advanced life support Guidelines. Available at: https://www.resus.org.uk/library/2021-resuscitation-guidelines/paediatric-advanced-life-support-guidelines (Accessed 18/10/2021).

WHO. (2021). Falls. Available at: https://www.who.int/news-room/fact-sheets/detail/falls (Accessed 18/10/2021).

Extra Info for HCPs

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Thank you,

Louise Sopher
HCPC Registered Paramedic
Article 999 Founder