The Three-Metre Fall on the Limassol Site
On a construction site in Limassol a 42-year-old worker falls about three metres from scaffolding and lands on his back on packed earth. You arrive as the designated first-aider at 10:05. He is conscious but confused, answers questions slowly, and cannot remember the fall. He complains of neck and lower-back pain and of numbness in both hands. There is a small amount of blood coming from his right ear, his left forearm is bent at an angle with a visible deformity, and he is breathing 24 times a minute. His colleague is trying to sit him up and give him water. The site foreman wants two workers to carry him to the site office so that he is "out of the sun". The ambulance has been called and is 15 minutes away.
1. State your first four actions in order and explain why the colleague must be stopped.
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Order of actions
- Stop all movement and take charge of the scene - one voice, clear instructions. Confirm the ambulance is coming, the exact location and the access gate.
- Assess danger and then the casualty using ABCDE: response, airway, breathing, circulation, disability. Breathing at 24/min with confusion is abnormal and needs monitoring, not reassurance alone.
- Hold the head in a neutral, in-line position with your hands and keep it there until the ambulance crew take over, unless the airway is threatened.
- Keep him still, shaded and warm, and monitor consciousness and breathing continuously, recording times.
Why the colleague must be stopped
- A fall from three metres onto the back with neck and back pain is a potential unstable spinal injury. Sitting him up can shear the spinal column and convert a recoverable injury into permanent paralysis - the single worst thing anyone on that site could do.
- No water and no food. With a reduced level of consciousness, vomiting and aspiration are real risks, and any surgery will require an empty stomach. Water also gives false reassurance and encourages sitting up.
- Do not remove his boots or clothing by pulling, and do not test his limbs by asking him to move them.
2. Explain what the blood from the ear and the numbness in both hands suggest, and how each finding changes your management.
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Blood from the right ear
Suggests a possible fracture of the base of the skull, particularly with the fall and the confusion. If it is clear fluid mixed with blood it may be cerebrospinal fluid.
- Do not pack, plug or irrigate the ear. Packing risks driving contamination inward and causing infection.
- Allow it to drain and place him so that the ear can drain freely while the head stays neutral, keeping spinal alignment.
- Do not put anything into the nose either, and watch for the "raccoon eyes" or bruising behind the ear that may develop later.
Numbness in both hands
Bilateral tingling after a fall onto the back points to a cervical spinal cord injury, not a wrist problem. It is a red flag that raises the injury from "back pain" to "possible cord damage".
- Spinal motion restriction becomes mandatory: manual in-line stabilisation, no log-roll except to clear an airway or manage vomiting, and a jaw thrust rather than a head-tilt if the airway must be opened.
- Report the numbness, its exact distribution and the time of onset to the paramedics - deterioration or improvement before arrival is clinically important.
- The deformed forearm is splinted in the position found, without straightening it, only after the airway and spine are addressed.
3. The foreman insists the worker be carried to the office. Write what you actually say, and list what you record.
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What to say
"We are not moving him, and that is a decision I am making as the first-aider on this site. He has fallen onto his back, his neck hurts, both hands are numb and there is blood from his ear. Lifting him now could leave him paralysed for life. The ambulance is fifteen minutes away and it will come to him. What you can do is bring me a parasol or a sheet for shade, keep the other men back, and send someone to the gate to guide the crew in."
Then repeat the instruction to the colleague holding the water bottle, and make sure nobody else starts lifting.
What to record
- Time of the fall (estimated) and time you arrived (10:05) and time of each observation.
- Mechanism: fall of about three metres onto packed earth, landing on the back.
- Findings: confused, cannot recall the fall, neck and back pain, bilateral hand numbness, blood from right ear, deformed left forearm, breathing 24/min.
- What you did: manual in-line stabilisation, no movement, no fluids, shade, continuous monitoring.
- Who was present, what was said to the foreman, and who gave which instruction.
- Time the ambulance arrived, the handover given to the crew, and the name of the receiving paramedic.
- Any refusal or resistance by site management, recorded factually and without comment.