Survival following a vertical free fall from 300 feet: The crucial role of body position to impact surface

Vertical deceleration injuries represent a significant cause of preventable deaths and long-term morbidity in survivors [1]. The amount of energy absorbed by the falling body is dependent on the fall height and the characteristics of the contact surface. For example, a fall onto concrete results in an instantaneous loss of speed, whereas falling onto a soft surface will allow for a more gradual deceleration over time [2]. In addition, the position of the body relative to the impact surface represents an important determinant of injury severity. The American College of Surgeons' Committee on Trauma (ACS-COT) defines a critical threshold for a fall height in adults as > 20 feet (6 meters), as part of the field triage decision scheme for transport to a designated trauma center [3]. A retrospective analysis of 101 patients who survived vertical deceleration injuries revealed an average fall height of 23 feet and 7 inches (7.2 meters), confirming the notion that survivable injuries occur below the critical threshold of a falling height around 20-25 feet [1]. A more recent study on 287 vertical fall victims revealed that falls from height of 8 stories (i.e. around 90-100 feet) and higher, are associated with a 100% mortality [4]. Thus, a vertical falling height of more than 100 feet is generally considered to constitute a "non-survivable" injury.The present case report describes the rare survival of a 28-year old rock climber who survived a free fall from 300 feet onto a solid rock surface. This report emphasizes the crucial relevance of body positioning at the time of impact, and the importance of standardized institutional "damage control" management protocols for survival.A 28-year old woman was free climbing with her boyfriend near Gunnison, Colorado. Both were wearing a helmet and a harness for safety. The girl had 20 years of experience of rock climbing, being taught early tricks by her father at the age of 8 years. The ascent consisted of three pitches of 90-100 fe