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Thanks for asking! Yes, the Pixel Watch 4 includes fall detection. When a hard fall is detected, it will wait about 30 seconds, then vibrate, ring loudly, and ask if you want to call emergency services. If you don't respond, your watch vibrates and alarms, then calls emergency services after 60 seconds with an automated voice message. Here's a link with more information: https://support.google.com/googlepixelwatch/answer/12663810?hl=en
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