Harness Suspension Pathology - fact or fiction?

Blog - The Raven Speaks

Harness Suspension Pathology - fact or fiction?

October 28, 2011

If you have spent any time trying to find any substantial evidence based research on Suspension Trauma you will know that the subject is convoluted and speculative at best. At this point there is not really any substantial research and what does exist is largely opinion based.

Some experts have even questioned the validity of its existence with the advances in modern day equipment.

However most research still indicates that suspension trauma or orthostatic shock is a legitimate concern for those who work at height. It has been reported to affect victims who are suspended in a heads up position by a body harness in as little time as 5 minutes.

The term itself is actually problematic as it implies trauma when in fact the core problems that we are talking about here will happen with no trauma at all. Some experts suggest that a better term for this would in fact be suspension syncope (a sudden transient loss of consciousness). Syncope occurring with vertical suspension is largely a result of the body position and gravity which creates a pooling effect of blood in the lower body. The leg straps of the harness could also be a complicating factor in venous blood flow returning to the heart as well. These factors may produce a range of symptoms which result in reduced cardiac output and arterial pressure which will eventually lead to syncope or ultimately death.

So what do you need to know? The following list of recommendations emerge as the most sound based on current research.

If you work at height you should be able to recognize the signs and symptoms of pre-syncope during suspension which are light headedness; nausea; sensations of flushing; numbness or tingling in the arms and legs; or a visual disturbance.

Dehydration may be a complicating factor and speed up the onset so STAY Hydrated.

Rescuers should try to free the victim from suspension as quickly as is safe to do so when any signs or symptoms of pre-syncope are present. If this is not an immediate option elevation of the legs, flexing of leg muscles or reducing pressure on the leg loops may buy some time. Asking the victim to move his legs as if riding a bike may prove helpful.

Head down suspension should be treated as urgently as head up.

When feasible rescuers should consider removing a suspended subject downwards vs upwards to avoid any further negative hydrostatic force.

Suspension from the dorsal attachment on a harness (read D) seems to accelerate the symptoms.

Once rescued the patient should be placed in a position of comfort. If unresponsive it is OK to place the patient in a horizontal position. There is NO substantial evidence to support the practice of not lying a patient flat or horizontal for 30 min post rescue and such practice may in fact cause further harm. Management of critical systems and basic life support need to take priority in this regard. Exercise some logic and common sense in determining the best post rescue posture for the patient.

References and further reading:
-Australian Resuscitation Council Guideline 9.1.5
-Evidence-based review of the current guidance on first aid measures for suspension trauma. Prepared byHealth and Safety Laboratory and the University of Birmingham for HSE 2009.

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