Background Falls remain a significant cause of morbidity in the Australian trauma population. Data exists correlating injury severity with fall height, but our anecdotal observations have been that even with a fall from standing height (FFSH) the patterns and severity of injury have been surprising. We present a narrative study describing how injury patterns differ across major trauma patients suffering from different fall heights. Methods A retrospective study of 1587 major trauma patients admitted to the Royal Melbourne Hospital having sustained a fall from 01/03/20 to 31/12/23. These patients were categorised into FFSH, low ladder, roof height and greater heights to compare mortality and injury patterns. Results Overall males were more likely to be admitted with major injuries from a fall than females (71%, n = 1126), although 42% of FFSH were female. Head and neck injuries (AIS > 3) were most common in all heights but more so in FFSH. Thoracic injuries increased with height of fall. FFSH had the highest mortality rates with age > =65 having a larger impact on odds of mortality than fragility (age OR = 5.45, 95% CI: 2.74-10.83 vs CFS > =5 OR = 2.10, 95% CI: 1.48 – 2.98). Traumatic brain injury (TBI) was the most common cause of death in all falls (83%), but this was only a slight majority in FFSH with other causes approaching 48%. Conclusion Having an awareness of expected injury patterns in different groups of fall heights aids clinical assessment. Identifying at risk patient groups may assist with fall injury prevention initiatives.