By their nature, falls tend to happen suddenly and unexpectedly. But you can still be prepared. When someone hits the ground hard, what you do in the first few minutes can have a huge impact on their outcome and the safety of anyone else with you, says Cory Jones of the First Aid Training Co-operative.

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Accidents on the crag or in the hills often happen fast—and unexpectedly. From a slip descending wet slabs, to a tumbling fall from a scramble, or a serious incident with a lead or solo climber, when someone hits the ground hard, what you do in the first few minutes can have a huge impact on their outcome and the safety of the rest of the group.

This article outlines how to manage a casualty immediately after a fall in the mountains, with a focus on calm, safe, and effective first aid.

Step 1: Keep yourself and the group safe

Before you rush in to help, pause and check the surroundings. Is the terrain still unstable? Could you or others also fall? Are rockfall, avalanche, hard-frozen snow slopes, weather or exposure adding risk?

Make the scene safe before touching the casualty:

• Stabilise the area (e.g. move loose kit, ropes, rocks)
• Warn others if it's a hazard zone
• Use helmets, ropes or shelters if needed

If the situation is unsafe and can't be stabilised, do not become a second casualty. That includes on steep ground, crags, river crossings, or avalanche-prone slopes.

Step 2: Approach and assess responsiveness

When safe to do so, approach the casualty and speak to them:

• "Are you okay?"
• "Can you hear me?"
• "Where does it hurt?"

If they're responsive, ask them not to move. Let them tell you where the pain is before helping.

If they're unresponsive, follow the primary survey process. The standard ABC mnemonic is helpful:

• Airway – Is it open? Do they need their airway cleared or repositioned?
• Breathing – Are they breathing normally?
• Circulation – Is there significant bleeding?

If the casualty is not breathing, start CPR and call for emergency help immediately.

Step 3: Control bleeding and treat immediate injuries

Once you've ruled out (or dealt with) life-threatening airway or breathing problems, check for serious bleeding or obvious trauma.

• Apply direct pressure to wounds
• Use sterile dressings or improvisations like a t-shirt or scarf
• Elevate limbs if appropriate, unless you suspect a fracture

Don't get distracted by dramatic-looking injuries—always treat the most life-threatening problems first.

Step 4: Immobilise the casualty and prevent further injury

Falls in the mountains often involve suspected fractures, head injuries, or spinal trauma. If in doubt, assume a spinal injury and minimise movement:

• Encourage the casualty to stay still
• Support the head and neck if needed
• Don't attempt to move them unless absolutely necessary for safety

If they're in a safe spot and not at immediate risk, your goal is to prevent further harm while help is on the way.

Step 5: Keep them warm and reassured

After a fall, casualties can deteriorate quickly—not just from injury, but from shock and cold. Even in summer, lying still on the ground can lead to rapid heat loss.

Do the following:

• Place an insulating layer between the casualty and the ground (e.g. foam mat, backpack)
• Wrap them in jackets, group shelter, survival bag or bivvy
• Offer reassurance and stay calm yourself—your tone sets the mood
• Monitor breathing, pulse and responsiveness at regular intervals

Step 6: Decide on evacuation or calling for help

Not all falls require a call to Mountain Rescue—but some absolutely do. Use your judgment based on:

• The casualty's level of consciousness
• Their ability to walk or be safely moved
• Suspected serious injuries (e.g. spine, pelvis, head, internal bleeding)
• Weather, terrain and how far you are from help

If in doubt—call early. Mountain Rescue teams would rather be stood down than called too late.

When calling 999 or 112:

• Ask for Police and then Mountain Rescue
• Give precise location (grid ref or What3Words)
• Explain the nature of the fall, injuries, and terrain

Aftercare: debrief and document

After any incident:

• Record what happened, what treatment was given, and what decisions were made
• Debrief the group—reassure, clarify, and process the event
• Encourage the casualty to seek medical attention even if they walk off the hill

Documentation helps emergency teams and can protect you if there's ever a question about the response.

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Want to learn more?

Falls are unpredictable—but your response doesn't have to be. Outdoor First Aid courses teach how to assess a scene, treat injuries, and make evacuation decisions with confidence.

With the right training, you can stay calm under pressure and help someone recover from what could otherwise be a life-changing fall.

Be prepared. Get trained. Stay safe in the mountains.

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About the Author

Cory Jones has been an International Mountain Leader for two decades and is a wilderness first aid trainer. He is a founder member of First Aid Training Co-operative which runs outdoor and wilderness first aid courses globally.