Suspension trauma can kill you!

Suspension trauma, also known as harness hang syndrome, suspension syndrome, or suspension syncope, is a life-threatening condition that occurs after a fall when the human body is held upright without any movement for a period of time.

If an individual is strapped into a harness this condition will occur more rapidly and, if not rescued in time, the individual will eventually faint. Fainting while remaining vertical increases the risk of death from cerebral hypoxia (brain damage).

Suspension trauma is the main reason why it is imperative to perform a rescue as soon as possible after a fall has been arrested.

Why does suspension trauma occur?

When a person is suspended after a fall, the heart continues to pump blood around the body. Combining the effects of gravity with the pressure the leg straps of the harness place on the main blood vessels in the groin area (the femoral artery and the femoral vein), it becomes difficult for the blood to circulate throughout the body. This results in blood collecting in the legs.

Because blood is unable to return to the heart to be oxygenated, a lower amount of oxygenated blood is available to circulate to the vital organs (such as the brain, lungs, heart, and kidneys). When the brain becomes deprived of oxygen, the victim faints. The consequences can be incredibly severe and even life-threatening, with the victim likely to experience brain damage, kidney failure, or potentially even death.

Without any movement, suspension trauma can cause a loss of consciousness in a matter of minutes; the resultant knock-on effects also occur rapidly. For this reason, every individual who is suspended from a fall must be treated as if they are in a life-threatening situation.

The process of suspension trauma:

1. The individual falls, leaving them suspended in their harness.
2. Leg straps cut off blood circulation in the body.
3. Blood pools in the legs.
4. Blood becomes acidic due to a lack of oxygen, making it toxic to the body.
5. The body experiences shock.
6. The heart rate increases.
7. The body experiences cardiac instability.
8. Blood flow to the brain diminishes.
9. Knock-on effects progress from fainting to cardiac arrest, brain damage, and finally death.

Because suspension trauma is a process, the more time available to perform the rescue, the better chance the victim has of making a full recovery. As a result, it is imperative for individuals who work at heights to be mindful of the following factors that can increase the rate at which suspension trauma kicks in:

• Dehydration
• Hypothermia/hyperthermia
• Fatigue
• Respiratory or cardiovascular disease
• Unconsciousness due to a head injury experienced in a fall
• Pain
• Shock
• Blood loss in the event of an injury
• Inability to move legs

As this list contributes to the speed of onset of suspension trauma, it is vital that the rescue team, first responder, and/or even the supervisor maintain communication with the victim and assess their physical and psychological state. A person experiencing most of these symptoms will have mere minutes before suffering severe suspension trauma. On the other hand, a person who is well hydrated, energised, and able to move their legs freely after a fall may be able to hang suspended a lot longer before feeling the effects of suspension trauma.

It is important to note that suspension trauma can be prevented with the right knowledge and training.

Here are a few tips on how to prevent suspension trauma:

• The first step is to prevent a fall from occurring in the first place. This can be achieved through proper planning, assessing the various risk factors, using the correct working at heights equipment, and ensuring that all individuals working at a height have completed competency training.
• In the event of a fall, victims are encouraged (if possible) to climb back onto the structure from which they have fallen, instead of waiting to be rescued. With a proper briefing before work commences on site, individuals will be better prepared to consider this as an option should they experience a fall, when the adrenaline is pumping.
• In order to allow a suspended body to move, it is recommended that individuals working at height make use of harnesses fitted with a standing step. This will enable a fallen victim to move their legs one at a time, releasing the pressure from the harness on the groin area, and better enabling oxygenated blood to flow throughout the body whilst awaiting rescue.
• In the event that an individual’s harness is not fitted with a standing step, but does allow for work positioning, a victim can use their work positioning lanyard to form a loop that acts in the same manner as a standing step. Alternatively, a makeshift standing step can be created with the use of an open round sling connected to a victim’s harness with the use of a carabiner.
• Timing is crucial in the prevention of suspension trauma. Therefore, a suitable and efficient rescue plan is vital in the event of a fall. Rescue kits should be kept within easy reach to prevent unnecessary delays and the rescuer should be trained periodically in the correct rescue procedures. This is important because after a fall, panic sets in and individuals experience an adrenaline rush. The better skilled and more rehearsed a rescuer is at performing a rescue, the more efficient the rescue will be.
• The effects of suspension trauma are not necessarily negated after an individual has been rescued. Due to potential toxicity in the blood, the individual will be required to remain in a seated position for a period of time after the rescue. As a result, it is imperative that proper medical surveillance is implemented post-rescue.
• Avoid working alone. Individuals should never work at heights alone or without the presence of a competent individual trained in performing rescue.
• Ensure your staff are well trained in their respective working at heights environments. Making use of the correct equipment for their requirements goes a long way in ensuring their safety and equipping them with best practice in accordance with local legislation.