Introduction: Death after falls from height are relatively common in urban areas. However, risk factors for early mortality are not clearly established, even fall height is still debated. The aim of this study was to identify risk factors for death on scene, after fall from a height, in patients aged 16 and over. Method: An Emergency Medical Service’s (EMS) database was used, it included all Advanced Life Support interventions. This EMS was located in an urban area with 300,000 inhabitants. All patients aged 16 and over, who fell from a height over 6.6 feet, between 2003 and 2018, were included. Age, gender, cause of fall (suicide or accidental), height of fall, landing surface (hard or soft), how the body hit the ground (headfirst landing or other), Index Severity Score (ISS) and initial Glasgow Coma Score (GCS) were collected. A backward stepwise logistic regression was used with occurrence of death on site as main outcome. Results: Six hundred and eighteen patients were included. The average age was 43.5 years (min 16-max 102) and sex ratio 2. Forty-eight percent were suicides. The average fall height was 36 feet (SD ± 35). The landing surface was hard in 51% of cases and landing was on head in 6%. The average ISS was 32 (SD ± 29.5) and mean GCS was 10 (SD ± 5.6). One hundred and ninety two (31%) patients died on scene. Results of the final logistic regression model are in table 1. Conclusion: In this study, age over 60, head first landing, suicide attempt, height of fall over 33 feet and hard landing surface, were significantly associated with on scene mortality after fall from height. Suicide prevention is one obvious way to reduce mortality from falls from heights.