In NSW, fall-related injury costs the health system more than any other single cause of injury. A public health surveillance database containing information routinely recorded by the Ambulance Service of NSW was used to define the epidemiology and characteristics of fall-related calls in the Sydney metropolitan area in 2008. The dataset contained 37488 fall-related calls, representing a crude rate of ambulance call-outs for falls of 843 per 100000 population. Females accounted for 57% of all fall-related calls, and the female rate of injury to the 'hip to foot' region increased with age. Males in all age groups reported 'head and neck' injury most often. In an analysis of a random sample of 1200 calls, 70% of ambulance dispatches were to a home or residential institution. The findings of this study on the risks for fall-related injury can be used to guide policy for ambulance service delivery. Expansion of data linkage to emergency department and admitted patient databases would provide information to further describe the epidemiology of falls in NSW.