A Real Life Story
Over the many months of writing to you, I have written to you about fall risk factors, environmental risks that contribute to falls and injuries, health promotion strategies and educational resources. And, I have written about how to recover from a fall. But, I have not written to you about ensuring that you get rescued. You might ask, why I am writing to you how about this? Because, I must share with you a personal story.
Lived Experience – “I can’t get up”.
On May 23rd, during Nurses Month 2022, a dear colleague of mine, a rehabilitation nurse for over 4 decades, made public through her editorial in a rehabilitation nursing journal about a fall that she sustained during a winter’s day (Larsen, 2022). On a brisk morning, she walked to her mailbox to collect her mail, ever so careful because her road had several inches of snow and ice. As she crossed the road to her mailbox, she slipped and fell hard onto the ice. You may recall that in January of this year, I wrote about “Winterizing Fall Prevention” and provided evidence about the dangers of black ice outside and falls. This happened to my colleague. I had talked with her the week before her article reached my table. She had told me about her fall, but not the details. She told me that I would read about it.
No matter how hard she tried, she could not get up. She had no pain and could not understand why she could not get up. She yelled for help, but no one heard her. There was no one there to help her. She was in the middle of the road. Fortunately, a car approached her, driving slowly due to the road conditions – the driver saw her. The driver called for EMS, neighbors come out, and yes, she was rescued!
By the time she got to the hospital’s ER, her husband is there waiting for her. As she moved for xrays and examinations, the pain in her hip became real, more and more intense. Yes, she was diagnosed with a fractured right hip. Thus, her journey began – surgery for her hip fracture, post op acute care, discharge to subcute rehab, progressive mobility with a walker, and, discharged home with a walker and other necessary equipment for activities of daily living – dressing, bathing, and mobility. Now, she is still receiving therapy and has progressed to a standard cane for walking.
When we talked about our of concern for her future safety and risk for a repeat fall and injury, I initiated conversations about making sure that she can always call for help, to get rescued when down, and protecting herself from a future hip fracture. It is essential that she protect her hips from future hip fracture when she falls again because of the risk for greater loss of function and independence after a second hip fracture. As I spoke to her, I thought of you, to offer you the same advise that I shared with my friend.
Get Rescued When You Fall
In any trauma emergency situation, there is a Golden Hour to get rescued and treated. This term is used in medicine and trauma care to suggest that if definitive treatment is initiated within the first 60 minutes from the time of injury or appearance of symptoms, the risk of long term complications and death is significantly reduced (Uttekar & Allarakha, 2021). In the US, for years, older adults have had access to technology to call for help when a fall occurs or have a medical condition that requires accessing emergency medical services – wearable medical alerts, of which some are available here Some of these devices have fall detection technology, in-home and on-the-go. Today, even more innovative technology exists, accessible on your wrist! There are several watches that have a fall detection system and can activate EMS directly from your watch on your wrist. I researched watches and found these resources with fall detection functions here. Some phones are smart phones that have apps that can detect your fall, and you can speak into the phone and activate emergency response. Other phones even monitor your heart rate, capture the number of steps you take in a day, andtrack your location.
Ladies and gentlemen, these options are worthy of exploration. Maybe some of you have already taken advantage of this technology and can share with others. But for those of you who have not, I ask that you take time to find a solution that works for you – to make sure you can always access EMS when you are alone, unable to get up to call for help; or, you are in a situation where your family members are unable to help you. Your Harmony Team wants to ensure your safety and make sure you get rescued in your Golden Hour.
Protecting Your Hips
Currently, only two solutions exist that are designed to protect hips from fracture during a fall. The first solution is hip protector clothing. The second solution is airbag technology built into a belt. For adults with osteopenia, osteoporosis, and / or hip fracture history, hip protector clothing (pants, sweat pants, shorts and undergarments) has been shown to reduce hip fractures by absorbing force of impact by 37%–95%, depending on type, model, and applied force impulse during impact. Hip protectors have been available to adults are risk for hip fractures for 10 years. Multiple products are available to you as seen here. In my clinical practice, hip protectors were provided to patients with history of prior hip fracture or were at risk for hip fracture if a lateral fall was to occur. These clothing products can be worn over incontinent briefs. Ladies and gentlemen, I have provided these injury prevention products to veterans for years, written about then (Quigley, 2016), and presented about hip protectors at conferences widely. These hip protector clothes are placed in your washer and dryer with your regular laundry – very easy to care for.
However, many adults do not want what to wear hip protectors, to pad their hips – and that includes men and women! So, an innovative clothing accessory exists – a belt with air bags built into the belt that deploys during the fall descent to protect the hips – the Tango Belt. You can watch a video at this site and see how the tangle belt works during a fall. I have presented and published on these as well (Quigley & Tarbert, 2021). The airbags are protective. Other program functions exist to help you monitor balance and activities. I have published and presented to clinical and public health audiences about this technology. This belt is battery charged with instructions for operation. Once the airbag is deployed, however, the belt needs to be returned to the vendor for airbag replacement, which I know is a limitation. This requirement will be eliminated within the next year. Still, the Tango Belt is an option for those who do not want to wear hip protectors.
Autonomy is Choice
When I mentioned both of these solutions to my friend and colleague, expectedly, her reply was that she would be extra careful and would not fall again. She has her cane. We all know that response in denial, not protective. To protect yourself, you have to have rescue plans in place for when you fall. And if you know you are at risk for injury, you have to protect yourself from injury. Remember, when my colleague was walking, she was being careful, slipped in a millisecond and landed on her hip – she fell.
You know, all of us have experienced a fall in the past and all of us will fall again at some point in the future. Remember, falls can be a marker for an underlying medical condition. Falls can also simply occur as an accident. We know that accidents happen. We work together to do all that we can to reduce the risks of falling. At the same time, we want to plan for and be prepared to manage a fall, get up after a fall, to the best of our ability reduce the complications sustained from a fall. Your Harmony Team is dedicated to help you be better prepared for dealing with a fall when it occurs and to not be afraid.
I hope this information is helpful to you by helping you to plan and be prepared when you experience a fall, safely recover, and call for help when needed. Always remember to tell your primary care provider that you experienced a fall – don’t keep it a secret.
Stay strong, active, and connected with your healthcare team. We, together with you, are dedicated to improving your health, function and safety.
Your Harmony Team is here to help you!
Thank you for reading this message and in advance for sharing with others.
Larsen, P. (2022). Editorial. From rehab nurse to rehab patient. Rehabilitation Nursing Journal, 47(3); 83.
Quigley, P. (2016). Evidence Levels : Applied to Select Fall and Fall Injury Prevention Practices. Rehabilitation Nursing, 41(1) 5-15. Feature Article; Approved for CEUs
Quigley, P., & Tarbert, R. (2021). Innovative smart belt: Outcomes of predictive analytics to measure adherence, balance, gait and hip fracture prevention. Online Journal of Issues in Nursing. 26(3). Manuscript 5.
Uttekar, P.S., & Allarakha, S. (2021, Feb 26) What is the golden hour in medicine? Medicine Net. Available at https://www.medicinenet.com/what_is_the_golden_hour_in_medicine/article.htm
Accessed May 26, 2022.