They’ve fallen—but should you get them up?
A person has fallen. They are awake, talking and asking for help to get up. The instinctive response may be to lift them from the floor as quickly as possible.
But the safest first question is not “How do we get them up?” It is “Could they be injured, and what response do they need?”
A fall does not automatically mean calling an ambulance, but neither should it automatically lead to an immediate lift. Care staff need a structured post-fall assessment, a clear local procedure and the right training and equipment.
What is iSTUMBLE?
iSTUMBLE is a structured post-fall assessment tool designed to support care staff after a person falls. It takes the user through a sequence of checks that helps identify possible injury and indicates whether ambulance assessment is needed.
This makes the response more consistent. Rather than relying on one worker’s confidence, assumptions or previous experience, staff follow an agreed process and record the information used to make the decision.
NHS England’s Enhanced Health in Care Homes framework says care homes should have access to post-fall assessment tools, including iSTUMBLE, alongside suitable mechanical lifting aids.
iSTUMBLE supports decision-making; it does not replace professional judgement, first aid, the person’s individual care plan, local policy or emergency action when someone is seriously unwell or injured.
First: make the situation safe
Approach calmly, explain what you are doing and protect the person’s privacy and dignity. Check for immediate danger and obtain emergency help if there is an immediate threat to life.
Do not rush to sit, stand or lift the person. A fracture, head injury or spinal injury may not be immediately obvious, and movement could increase pain or cause further harm.
If the person is in immediate environmental danger, staff should follow their first-aid training and local emergency procedure. Otherwise, keep them comfortable and warm while the post-fall assessment is completed. Do not leave them alone.
Use iSTUMBLE as intended
Staff who have been trained and authorised to use iSTUMBLE should work through every step rather than selecting the answers they expect to see.
The assessment supports checks for injury and changes in the person’s condition. Answers must reflect what staff actually observe and what the person reports. If the situation is unclear, worsening or outside the worker’s competence, seek clinical or emergency advice in line with the tool and local procedure.
An app or checklist is only effective when staff can access it, understand it and know what to do with the outcome. Managers should therefore check that:
- staff know where and how to access iSTUMBLE
- users have received suitable instruction and practice
- the local escalation pathway is current
- staff understand when they must call 999, seek other clinical advice or continue monitoring
- use of the tool and the resulting action are documented
When urgent or emergency help may be needed
Call 999 for an immediate threat to life and follow iSTUMBLE and the service’s emergency procedure. Examples of serious concerns include a person who is unresponsive or not breathing normally, uncontrolled bleeding, a suspected serious head or spinal injury, severe pain, obvious deformity, or a rapidly deteriorating condition.
This is not an exhaustive diagnostic list. Staff should not delay emergency help in order to finish an assessment tool when the need for urgent action is already clear.
Where a head impact is known or suspected, follow the organisation’s head-injury pathway. Anticoagulant medicines, new confusion, vomiting, loss of consciousness, worsening drowsiness or neurological changes may affect the urgency of assessment. Observations and monitoring must be completed only by staff who are trained and competent, using the local procedure.
If assessment indicates that recovery from the floor is safe
Finding no indication for an ambulance does not automatically authorise any method of lifting.
The recovery method must reflect:
- the outcome of the post-fall assessment
- the person’s individual moving-and-handling plan
- their usual mobility, ability and preferences
- the equipment available
- the number and competence of staff required
- the environment and space around them
Suitable mechanical equipment, such as an appropriate lifting cushion or lifting chair, may reduce the risk of injury and shorten time spent on the floor. It must be maintained, immediately accessible and used only by trained, competent staff.
Never drag the person, pull them up under the arms or improvise a manual lift. If safe recovery cannot be achieved with the available people and equipment, follow the escalation procedure and continue protecting the person’s comfort, warmth, dignity and safety while help is arranged.
The response continues after the person is up
Getting someone safely from the floor is not the end of the incident. The person may require ongoing observations or monitoring in accordance with the assessment outcome, local protocol and clinical advice.
Record promptly:
- when and where the person was found
- whether the fall was witnessed
- what the person said happened
- assessment findings and iSTUMBLE outcome
- any injury, pain or change from normal
- advice sought and actions taken
- the method and equipment used for recovery
- who was informed
- the monitoring or follow-up required
Information should also be handed over clearly to the next staff team.
Review why the fall happened
Current NICE guidance emphasises comprehensive, individual assessment and action to reduce future falls. A post-fall review may identify factors such as an acute illness, medicine effects, poor footwear, continence needs, vision problems, unsafe equipment, environmental hazards or a change in mobility.
One explanation should not be accepted without considering the person’s wider health, circumstances and pattern of falls. Update the care plan and risk-management measures where required, involve the person, and seek appropriate professional review.
The practical message
After a fall:
- Make the situation safe and respond to immediate danger.
- Do not automatically lift.
- Use iSTUMBLE and the service’s agreed post-fall procedure.
- Escalate according to the findings.
- Recover the person only when it is safe, using the right equipment and competent staff.
- Record, monitor, hand over and review.
A structured response protects the person from the harm of an inappropriate lift while helping staff avoid unnecessary delay after a genuinely non-injurious fall.
Safe Skills Training provides practical, care-focused training in falls response, moving and handling, clinical observation and escalation. To discuss training for your team, visit www.safeskillstraining.com.
GUIDANCE LINKS
NICE NG249 — Falls: assessment and prevention in older people and in people 50 and over at higher risk:
https://www.nice.org.uk/guidance/ng249
NHS England — Enhanced Health in Care Homes framework:
https://www.england.nhs.uk/long-read/providing-proactive-care-for-people-living-in-care-homes-enhanced-health-in-care-homes-framework/
South Western Ambulance Service NHS Foundation Trust — Falls resources:
https://www.swast.nhs.uk/falls/