Taking A Tumble

Brett Patterson

Brett:

The Portland Airport is new to using the MPDS® Protocol and is looking for some help with regular calls for service that we see, e.g., someone falling on the escalator. Escalators are not the same as stairs and often can extend multiple stories (or more than 10 feet). We respond to a variety of falls: from people falling the full length of the escalator (tumbling head over heels from the top to the bottom) to people losing their balance (ending up sitting on the step and riding the escalator to the other end) and walking away once they reach the other end.

CC 17 – KQ2: How far did they fall?

• Axiom 3: Falling down stairs does not create the same inertia and potential injury as a LONG or EXTREME fall, but it may produce more serious injuries than a ground-level fall. Falling on, not down, stairs should be considered a ground-level fall.

Someone falling on the escalator apron (and not ending up on the steps of the escalator) or the person falling on the apron and then “riding” the escalator to the other end without falling any further are likely ground-level falls.

However, when someone falls “on” the escalator—8 or 15 steps—what kind of fall is this?

Does the fact that the steps are moving or the nature of the tread (teeth on the steps) impact any of the protocol decision pathways? If so, in what way?

Marc Huls, ENP

Communications Center Administrator at Port of Portland Portland Airport, Oregon (USA)

Hi Marc:

Thanks for the great question, and congratulations on your implementation at PDX!

If a patient falls down the escalator (tumbled, rolled, slid, whatever), choose the “Fall down (not on) stairs” option. It doesn’t matter how far they rolled or slid or tumbled because the inertia is not the same as a free fall. Because you are dealing primarily with escalators, and tall ones at that, you may want to consider what you assign to this unique code with this in mind. This is exactly why we created a separate code for this situation.

To clarify, the “Fall down (not on) stairs” option is for the patient who fell on the stairs and ended up at a lower place than where they fell, and it doesn’t matter how far. If they landed where they fell, it’s ground level. If they fell off the rail and over the side, it becomes a distance issue, i.e., less than 10 feet, or LONG or EXTREME FALL, as defined.

If they fell and landed where they fell, triage as ground level and consider the injuries. The movement of the escalator or its teeth need not be considered as a separate mechanism as we are triaging by injury; occult injury is less likely than with LONG or EXTREME FALLs.

Brett A. Patterson

Academics & Standards Associate Chair, Medical Council of Standards International Academies of Emergency Dispatch®

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