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that makes a lot of sense from a first principles point of view from an 'acute medicine' point of view ( havign been banished to an assessment unit by finanacial changes) it seems that some EPs belive that fainting no longer exists ... Martyn -----Original Message----- From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Jonathan Marrow Sent: 20 February 2008 11:57 To: [log in to unmask] Subject: Re: A proper question. People who are fully alert and physically fit when they fall tend to put out their hands to "save themselves" when they fall. Frontal impact without any hand injury suggests either impaired conscious level or preexisting slow response. Colles's fractures usually due to mechanical falls. Any head or face injury without upper limb damage suggests impairment. Always look where you are going Jonathan No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.5.516 / Virus Database: 269.20.8/1288 - Release Date: 19/02/2008 20:47