June 13, 2019

How do falls assessment tools, like I STUMBLE, help care home staff manage falls?

“Peter has had a fall, we need an ambulance…”

…around 30% of people aged 65 or older have a fall each year.*  Many of these falls occur in care homes or in community settings where domiciliary carers are visiting. A large proportion of falls in care homes are ‘non injury falls’ – where no injury has occurred following the fall – and yet various factors can mean that uninjured or frequent fallers spend long periods of time on the floor.

The historical action for managing falls has been to call the ambulance service, but times are changing and ambulance trusts are raising awareness that it is not their responsibility to lift a resident who is a frequent faller and/or is uninjured.

There are several tools or ‘algorithms’ to help you decide whether you can lift a fallen person following a fall. One of the better-known algorithms is ‘I STUMBLE’ as originally piloted by West Midlands Ambulance Service. I STUMBLE is a falls assessment tool aimed at helping care staff decide whether it is safe to lift a fallen person using appropriate lifting equipment or whether they are injured and need an ambulance.


“I STUMBLE” a falls assessment tool

Intense Pain

• New Pain since Fall
• Includes Headache, Chest Pain and Abdominal Pain
• Consider both pain from injury caused by fall or medical causes

Suspected Collapse

• Ask resident if this was a trip or collapse (do they remember falling?)
• Any dizziness, sudden nausea or pain before the fall
• Includes “near fainting” episodes

Trauma – to Head/Neck/Back

• New pain in Head/Neck or Back following the fall
• New visible or physical injury, lump or dents to head – with or without bleeding
• Any new numbness or paralysis in any limbs or face

Unusual Behaviour

• New Confusion
• Acting Different to Normal Self e.g. agitated, combative, aggressive, sleepy, quiet
• Difficulty Speaking e.g. Slurred Speech, words mixed up, unable to verbalise objects, stuttering

Marked Difficulty in Breathing/Chest Pain

• Severe shortness of breath, not improved when any anxiety is reduced
• Unable to complete full sentences
• Blue/Pale lips or fingers, becoming lethargic or confused
• New Onset of inability to mobilise/lay still without difficulty in breathing

Bleeding Freely

• Free flowing, pumping or squirting blood from a wound
• Widespread swelling and bruising to face/head or injured limb
• Apply constant direct pressure to injury with clean dressing, elevate if possible
• Try to “estimate” blood loss, in mugful’s (often difficult)

Loss of Consciousness

• Knocked Out
• Drifting in and out of consciousness
• Limited memory of events leading up to, during or after fall (unusual for resident)
• Unable to retain or recall information, repetitive speaking (unusual for resident)

Evidence of Fracture

• Obvious Deformity – e.g. shortened and rotated limb, bone visible, severe swelling
• Reduced range of movement in affected area
• Unusual movement in affected area

In all 999 cases remember to keep resident: CALM, STILL & COMFORTABLE. If any bleeding is present, apply constant pressure with a clean dressing.

If the answer to any of the above is ‘Yes’ then 999 must be called.

If not, then the caregiver must turn their attention to lifting the person off the floor.

Source; EEAST/NWilliams Adapted from West Midlands Ambulance Service


What are the benefits of implementing I STUMBLE?

Ambulance crews are under a lot of pressure, dealing with a variety of incidents demanding a fast response. When reporting falls in care homes without injury you may end up waiting several hours for an ambulance to arrive, simply because the call is not priority.

However, if your care organisation implements a simple procedure such as I STUMBLE for staff to use, you could save your local ambulance service thousands of pounds in time and resources!

You will also greatly improve the care you provide. By lifting an uninjured fallen person using appropriate lifting equipment you will save them spending hours on the floor which is uncomfortable and undignified, and is often associated with other health complications developing.

What if we have a “no lift” policy?

A no-lift policy calls for staff to avoid manual handling of residents wherever possible. While this decreases the likelihood of staff injuries and makes their work safer, it can be detrimental to providing good care for residents – which is what every care home aspires to achieve! By implementing a post falls assessment tool for lifting a fallen resident, it decreases pressure on the emergency services whilst providing excellent resident care.

So what is safe lifting equipment?

There are a variety of methods available to lift a fallen but uninjured resident, but we think the safest solution is the Raizer Emergency Lifting Chair.   It’s stable, fast and dignified, and enables you to get the fallen person back on their feet in just 3 minutes! The CQC have recently awarded Home Instead Senior Care in Devon a 5 Star Outstanding Rating; the Inspector was particularly impressed with the Raizer Chair, describing it as innovative in the Safe category of inspection!

If you’d like to find out more about how the Raizer can help manage falls in care homes or arrange your free of charge demonstration, please get in touch with us on 01473 741144! We look forward to helping you improve care for your fallen residents.



Back to Blog