In September of 2008 the HSE (European Health and Safety Executive) released a report on the findings of a recent study on Suspension Trauma. This study was an evidence based review of published medical literature on the effects of being suspended in a harness as a result of a fall from height in the work place or industrial applications, particularly in fall arrest systems.

The results of this study showed there is no real evidence supporting that a patient cannot be laid down flat immediately after being rescued from a harness suspended position. The often suggested recovery position of semi-recumbent or sitting position may even prove to be dangerous through prolonged lack of circulation to the brain. 

A presentation on this recent study was given by Dr. Anil Adisesh at the Technical Symposium 2008, hosted by Lyon Equipment in England.

It was pointed out the term "Suspension Trauma" is not an appropriate way to describe the condition of insufficient blood circulation due to being suspended in a harness. It's more appropriately referred to as Orthostatic Syndrome (symptoms caused by being upright and still) or Harness Induced Pathology. There is technically no "trauma" involved with this condition.  

The word syncope refers to the loss of consciousness due to a decrease in blood flow to the brain. A common term for syncope is fainting. Your body’s natural reaction to Orthostatic Syndrome is syncope; to temporarily become unconscious, limp and fall to the ground, or become horizontal, in order to allow the circulation throughout the body to improve. Being suspended in a harness does not permit the body's natural recovery and can greatly increase the danger of this condition and become fatal. There are many signs of syncope, referred to as "pre-syncope", that can be observed as warning signs; light headedness, nausea, sensations of flushing, tingling or numbness of the arms/legs, anxiety and feeling one is about to faint.   

It is commonly accepted the lack of circulation in the lower extremities can potentially generate toxins which could be fatal if released back to the brain and heart too quickly. Therefore, it has been considered the best practice not to allow a casualty to immediately lay flat on the ground and to keep them in an upright, seated position.

Interestingly, the conclusions presented by Dr. Adisesh showed their research provided no actual conclusive evidence of a fatality associated directly with a patient in suspension being rescued and laid down flat immediately. The often suggested recovery position of semi-recumbent or sitting position was considered to not have sound evidence and may prove dangerous through prolonged lack of circulation to the brain. Dr. Adisesh related it to a common practice during many surgeries; doctors will stop a patient’s blood flow to an appendage to enable the surgeons to work. The standard allowance of time for this practice is up to 3 hours, serious complications can begin to occur after 4. After 3 hours of no blood circulation, the blood is quickly returned to the appendage by releasing the tourniquet, or whatever method was used to block the blood during the surgery. Therefore, the concern of toxins building in the blood and shocking the heart or brain is not obviously relevant.  

There are of course other factors that may need to be taken into account when dealing with a patient in suspension that can greatly worsen the affects of "Orthostatic Syncope" (e.g. injuries, exhaustion, Hypoglycemia, Hypothermia, alcohol). These additional circumstances may affect whether the patient is laid down instantly or over a period of time.

This information does not change the need for immediate rescue and response. Many variables exist and the general window for prompt rescue is still considered 20 to 30 minutes. However, this does help us better understand the dynamics of "Suspension Trauma" and lets us know it is better to return the patient’s blood flow upon bringing them to the ground, unless other factors are an additional concern. As an additional side note; it’s also stated that elevating the suspended patient’s legs can greatly prolong the onset of pre-syncope. 

The HSE summary report can be found by following this link, http://www.hse.gov.uk/falls/harness.htm.

 

Chad Shearer

Skala Inc. | Ropeworks