A guide to 8 of the most common kinds of falls and the 14 questions you should ask.
Editor’s note: This is the third and final post in a series on evaluating fall-related claims and cases. The first installment covered why it’s critical to understanding the mechanism of injury and the resulting bodily injury that happen during a fall. The second explored the reasons why we fall.
Not all falls are created equal. The injury from a slip, for instance, could be completely different from a stumble or a trip. Knowing how the fall initially occurred will give you a foundation for what body part struck the ground or another object first.
According to literature, there are multiple kinds of falls. Rotational, same level, elevated level, tumble, free fall, trip, stumble and slip are among them. Many overlap in dynamics and biomechanic identifiers.
Here are some of the more common types of falls we have seen over the past 20 years in our practice and their associated hallmarks.
This is a fall from heights such as a roof, scaffolding, platforms or ladders. These falls usually results in severe injuries such as fractures and head trauma. Many are fatal. Elevated falls usually lead to a very costly case involving medical, rehabilitation and home health costs. Permanent physical damage often results. Early medical involvement such as case management and early evaluation, including an accurate claims reserve, are recommended.
Same level falls
These are falls that occur on a surface that is fairly level, including walkways, floors, sidewalks and stairs. The fall occurs when, for whatever reason, there’s a disruption in the step, gait or center of gravity.
However, the mechanism of the “kinds” of same level falls varies. Each has a fairly predictable mechanism of injury signature. Understanding each and their associated hallmarks is important to analyzing the injury, associated claim and bodily impact points.
As with many of these falls, there is a reflexive response initiated in the brain that extends an arm in an effort to “break” the fall. Additionally, the body’s center of gravity is changed in the fall and can follow the momentum of the gait.
Here are six different kinds of falls that typically happen at ground level:
A trip typically occurs when a person fails to navigate over an obstacle that’s sitting low to the ground. The trip jerks a person’s center of gravity away from its base of support. The victim typically falls forward on one or both knees and their belly or face and sustains injuries to their head, neck, hips, thigh, knees, ankle and foot, along with their hands, wrists, shoulders or elbows if they attempted to stop their fall. The primary impact points often typically are the hands, wrists and knees.
Tumble / Rotational
Like a trip, a tumble happens when the center of gravity moves out of a person’s base of support. But, in a tumble, the body strikes multiple areas until it comes to rest on the ground. There also tends to be a significant amount of energy with a tumble, which propels the body forward and to the side. In some cases, the body rotates. They can sometimes happen when the victim is thrown from a moving vehicle, motorcycle or down an incline.
Often, the victim might break their fall or land on their hands and knees. Tumble injuries include fractures to the upper body, head, face, knees, hands, arms and shoulders. A tumble can be catastrophic.
This is usually a same-level fall. Slips typically occur when the heel slides out from under a person, causing them to lose balance and fall. It could be caused by a slippery walking surface or unstable shoes.
Victims sometimes report that they “flew through the air,” but this is a bit of an exaggeration, though there is a moment in time in which the body is completely off the ground. The victim will typically land on their backside with an arm or shoulder extended in an attempt to break the fall. Depending on the amount of energy or torque, the victim may twist or rotate to one side or the other.
Injuries typically include bruises; fractures to the thigh, hip, compression fracture to the spine; shoulder or arm; and, sometimes, a head injury.
This is a misstep off a higher elevation that can happen on steps or a riser, for instance, or by stepping into a hole or depression in the ground or walking surface. The mechanism usually involves an ankle or knee twist with a fall to the same side. Initial impact points will usually be the ankle and then the hip or shoulder as secondary points. The person may fall to the side of the foot that missteps down to the lower surface point.
According to “Slips,Trips, Missteps, and Their Consequences,” by Gary M. Bakken and others, a crumple fall is characterized by a failure of lower extremity strength. Crumples happen when a person simply collapses to the ground.
Victims of crumples most often are elderly or handicapped and typically have an existing medical condition that would cause them to lose balance or strength and movement. Crumple-caused injuries include damage to the face, skull and brain, along with bruises and, in rare cases, fractures to the upper and lower limbs.
As with stumbles, which we get to next, crumples can indicate a pre-existing medical or chronic problem that impacts gait, balance and strength. In this kind of fall, a thorough investigation is necessary to verify the true cause of the fall.
A stumble might come from dragging a foot on the ground or transitioning to a new surface. People who are about to stumble – and fall – often take a couple of steps, called stutter steps, to attempt to correct themselves. Injuries can cover the entire body with fractures from the head and face and all the way down to the ankle and foot.
Again, a stumble is often seen with elderly or weak individuals as the lower extremities are not strong enough to correct the gait and regain the center of gravity. This type of fall is sometimes seen in cases in which the victim “tripped” over something, but, in fact, that particular item is sometimes unverifiable, such as in an unwitnessed fall. Instead, a stumble can actually indicate an underlying health or medical issue or age-related gait challenges.
To help pinpoint the exact kind of fall – and cause of it – it’s critical to ask the right questions.
Here are 14 questions to ask as you examine fall claims
- What was the situation at the scene of the fall? An early and detailed investigation, including photos of the scene, is a must for any serious look at a fall claim.
- What was the direction of the fall and exactly how did the victim land? What was their final landing position? For instance, did they land face down or on their back or side?
- What, if any, were the environmental influences of the fall? Was it raining, very windy or icy?
- What kind of clothing and shoes was the claimant wearing at the time of the slip?
- What were the conditions of the surface they were walking on?
- What is the claimant’s age?
- What is their medical history? Does it include illnesses or medications that may cause dizziness, confusion or disorientation
- What was the claimant doing just before the fall?
- How do they describe the fall? Did they “fly through the air,” “fall flat on their bottom” or feel that they just “fell out?”
- Were they carrying or holding anything when they fell?
- If there were witnesses, how do they describe the fall?