By Alice Allen, Registered Manager
Part of our Training Tuesday educational series providing practical home care guidance for family carers, care workers, and anyone supporting a relative at home across Whitchurch, Wem, Prees, rural North Shropshire, and beyond.
-
Week Zero: The Language of Care (Words We Use and Words We Avoid)
Week one: How to Use a Slide Sheet (and How Not To)
Week two: How to Use a Hoist and Sling (and How Not To)
Week Three: How to Identify Pressure Sores (and What to Avoid)
week Four: Why Washing Your Hands Properly Actually Matters
Week Five: How to Use a Sara Stedy (With Video and What to Avoid)
Week Six: Dressing and Undressing Assistance
Week Seven: How to Find the right shoes from care work
Week Eight: How to Support Someone Through a Panic or Anxiety Episode
Week Nine: Basic First Aid for a Fall — What to Check Before Helping Someone Up
Week Ten: How to Write Good Notes and a Proper Handover
Week Eleven: What Urine Can Tell You
Why Finding Someone on the Floor Demands a Calm, Medical Response
Finding a relative or client on the floor is terrifying. Your immediate, human instinct is to rush over, grab them under the arms, and pull them straight back up to their feet.
However, rushing to lift someone after a fall is one of the most dangerous things you can do. If they have sustained a hidden fracture or neck injury, pulling them up can turn a manageable injury into a catastrophic one. Furthermore, if they have been lying on the floor for a prolonged period before being found, there are serious, invisible medical risks that require urgent clinical attention—even if they claim they feel "completely fine."
This guide explains what a "long lie" is, why ambulance crews usually have to take long-lie patients to hospital, and the step-by-step protocol for responding safely when someone is on the floor.
What Is a "Long Lie" and Why Is It So Dangerous?
In medical terms, a "long lie" occurs when someone remains on the floor for more than one hour after a fall (or even shorter periods on cold or hard surfaces for vulnerable, frail individuals).
While many people assume the main danger of a fall is a broken hip, being unable to get up off the floor triggers severe, systemic health risks that develop silently:
1. Deep Vein Thrombosis (DVT) & Fatal Blood Clots
When someone is immobilized on a hard surface for hours, blood flow in the legs slows down dramatically. The static pressure of the hard floor against blood vessels creates the ideal conditions for a Deep Vein Thrombosis (DVT)—a blood clot in the deep veins of the leg—to form.
The Hidden Risk: A DVT formed during a long lie might not cause immediate pain. However, hours, days, or even weeks later, that clot can break free and travel to the lungs, causing a sudden, life-threatening Pulmonary Embolism (PE).
2. Rhabdomyolysis (Muscle Breakdown) & Kidney Failure
Prolonged, unrelieved pressure from a hard floor crushes muscle tissue. As muscle cells die, they release a protein called myoglobin and toxic breakdown products into the bloodstream.
The Hidden Risk: Once the person stands up and circulation returns to normal, this flood of myoglobin hits the kidneys, which can cause severe Acute Kidney Injury (AKI) or total kidney failure within 24 to 48 hours.
3. Hypothermia, Dehydration & Pressure Injuries
Even inside a warm house, a uncarpeted or draughty floor siphons body heat away rapidly, leading to hypothermia. Lying helpless for hours also causes severe dehydration, confusion, and deep tissue pressure ulcers on hips, elbows, and heels.
Why Do Ambulances Almost Always Take "Long Lie" Patients to Hospital?
Families are often surprised when paramedics insist on taking an elderly relative to the Emergency Department after a long lie, even when there are no broken bones and the person insists they want to stay in bed.
Ambulance crews follow strict clinical pathways for long lies because rhabdomyolysis, kidney strain, and DVT risks cannot be diagnosed visually on the living room floor.
At the hospital, doctors must run:
Blood Tests (CK / Creatinine levels): To check for hidden muscle breakdown and monitor kidney function.
Intravenous (IV) Fluid Therapy: To flush toxins through the kidneys before damage occurs.
DVT / Blood Clot Screening & Prevention: Assessing clot risk and starting blood-thinning medication or monitoring where appropriate.
Treating a long lie as a medical emergency prevents delayed, tragic outcomes days after the fall.
Step-by-Step: What to Do When You Find Someone on the Floor
If you walk in and find a relative or client on the floor, follow this emergency checklist:
Step 1: Stay Calm & Do Not Move Them Immediately
Take a deep breath. Kneel beside them at eye level. Tell them firmly to stay still and that you are there to help.
Step 2: Check for Injuries & Consciousness
Ask where it hurts and look for:
Head impact: Bleeding, swelling, or confusion.
Neck or spinal pain: Any pain along the back or neck.
Hip fracture signals: Look at their legs. Is one leg noticeably shorter than the other, or turned outward at an unusual angle?
Severe pain or deformity: Any obvious limb injury.
Step 3: Make Them Warm & Comfortable (While Waiting on the Floor)
If you suspect an injury, or if they have had a long lie and cannot get up:
DO NOT force them up.
Place a blanket or duvet over them to trap body heat and prevent hypothermia.
Gently place a small pillow or folded towel under their head for support (only if no neck/spinal injury is suspected).
Reassure them continuously.
Step 4: Call Emergency Services (999)
Call 999 immediately if:
They have been on the floor for over an hour (a long lie).
They hit their head, lost consciousness, or are confused.
They have severe pain, or you suspect a broken bone/hip.
They are unable to bear weight or move safely.
Note: Be explicit with the 999 call handler if it is a long lie , as this alters the clinical triage priority.
If They Are Uninjured & Alert: The Safe "Self-Lift" Technique
Only attempt to help someone up if they are 100% coherent, completely free of severe pain or deformity, and confident they can bear their own weight. Never pull or drag them up manually.
Guide them through this self-standing sequence using a sturdy armchair or bed:
Roll onto Side: Have them bend their knees and roll gently onto their side.
Move to Hands & Knees: Guide them to push up onto their hands and knees (crawling position).
Crawl to Sturdy Furniture: Have them crawl or shuffle to a stable armchair, dining chair, or bed.
Place Hands on the Seat: Ask them to place both hands firmly on the seat cushion.
Bring Stronger Foot Forward: Prompt them to bring one leg forward, placing that foot flat on the floor (kneeling on the opposite knee).
Push & Pivot: Encourage them to push down through their hands and front leg, lifting their bottom and turning slowly to sit back into the chair.
Rest & Observe: Keep them seated, wrap them in a warm blanket, offer a sip of water (if no surgery/hospital trip is anticipated), and monitor them closely.
Critical Safety Warnings: What NEVER to Do
❌ NEVER pull someone up by their hands, wrists, or armpits: You risk dislocating fragile shoulder joints, tearing delicate skin, or worsening spinal fractures.
❌ NEVER ignore a fall just because "nothing is broken": Always inform their GP or care manager. A sudden fall can be an early sign of a urinary tract infection (UTI), medication side effects, or heart issues.
❌ NEVER leave someone on a cold floor without cover: Indoor hypothermia sets in quickly and accelerates shock.
❌ NEVER give large amounts of food or drink immediately: If they have a hip fracture or require emergency hospital admission, having a full stomach can delay necessary surgery under anaesthesia.
How North Shropshire Homecare Protects Clients After a Fall
At North Shropshire Homecare, our carers are trained in emergency fall management, moving and handling safety, and post-fall reporting.
When a fall occurs, we:
Conduct immediate injury and long-lie assessments.
Liaise directly with NHS emergency services, GPs, and family members.
Utilize specialized, dignity-preserving transfer aids (such as inflatable lifting cushions) when appropriate and medically safe.
Review home safety and care plans to prevent future falls.
Need Local Care Support or Fall Safety Advice?
If you are supporting a relative in Whitchurch, Wem, Prees, or surrounding rural villages and are concerned about fall risks, mobility at home, or arranging emergency respite care, our friendly team is here for you.
🏢 Visit Our Whitchurch Office: The Coach House, 15/17 Green End, Whitchurch, SY13 1AD
📞 Call Our Team: 01948 411222 (Monday–Friday 9am–4pm, or 24/7 for urgent care advice)
✉️ Email Us: info@northshropshirehomecare.co.uk