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I can’t say this as someone who’s run any large drops but I’ve been kayaking for a long time and watched plenty of large drops run and stared at large enough drops that I can usually tell if a waterfall is runnable and see the lines that could be runnable on waterfalls.
The water at the bottom of the drop is super aerated which makes for a much “lighter” landing than if you were landing in still water and generally prevents you from killing yourself upon impact. There are all kinds of techniques to running big drops like this but you start running smaller falls and work your way up. There’s some tricks and what not but with a drop this big you’d spend a lot of time observing it and probing it. You don’t want the water level to be too high and usually they’ll throw some logs over the drop to test lines and see how it goes. Usually if you’re the first to run a really big drop like this there will be a lot of care and thought and study of the drop itself before you go over the edge. Sometime it can be weeks, months or even years of studying a drop and watching the pattern of how the water is moving before the edge of the falls and where that water goes as it’s falling over the edge. You also would pay close attention to what the water does once it hits bottom. You can watch and see if the pool at the bottom is too shallow or might harbor hazards like random rocks or boulders. You would also have multiple people at the bottom in boats or on rocks with ropes should the guy going over the edge get injured or hurt. You’d also scout out the bottom to determine if there are any caves behind bottom that you might get sucked into or stuck in. I know there’s been at least one case where someone’s gotten stuck behind the curtain of the waterfall and had to get pulled up and out by a rope and pulley. This isn’t to say that people don’t get injured, compressed vertebrate, broken backs and all kinds of other injuries like dislocated shoulders as well. The people who do it though are in a class of their own and have huge balls.
It’s not really clear what the limits are to running waterfalls honestly. Every year someone finds bigger and bigger drops to run and survives. That said I’ve heard that a lot of the times after running these size waterfalls will result in being insanely sore and nearly physically incapacitated from being sore just from the impact.