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TRAUMA
Recognition, prevention and treatment for First
Responders
©2005 www.SuspensionTrauma.info
Introduction
• ‘Suspension Trauma’
– The medical effects of immobilisation in a vertical position
– Medical term is ‘Orthostatic Incompetence’
• The effects are nothing new
– Crucifixion is death from suspension trauma
• It presents an immediate threat of death to anyone
immobilised in a vertical position
– Hanging still in an industrial, theatrical or sport harness
– Stretcher patients, performers, stuntmen, confined space workers
• The onset and progress are rapid and unpredictable
• All those ‘working at height’ must be trained in how to
recognise, manage and prevent suspension trauma
©2005 www.suspensiontrauma.info
Immobile is important!
• Suspension trauma can only affect someone who is
immobile – specifically not using their leg muscles to any
great extent
• It does not normally affect people who wear a harness but
who are:-
– Actively moving about (climbing, caving, etc)
– Suspended for only a minute or two (parachutists)
©2005 www.suspensiontrauma.info
Who may be at risk?
• The ‘classic group’ are people who wear harnesses
– Sport climbers, cavers, parachutists, parascenders, etc
– Industrial climbers
– Confined space workers lowered using a harness and winch
– Theatrical and circus performers, stuntmen and artists
©2005 www.suspensiontrauma.info
So what happens?
• General feelings of unease
– Dizzy, sweaty and other signs of shock
– Increased pulse and breathing rates
• Then a sudden drop in pulse & BP
• Instant loss of consciousness
• If not rescued, death is certain
– From suffocation due to a closed airway, or
from lack of blood flow and oxygen to the brain.
©2005 www.suspensiontrauma.info
A little biology…
• Humans are not designed to stand upright
– Our circulatory system was built for life on all fours
– Volume of blood vessels is much greater than that of the blood
©2005 www.suspensiontrauma.info
Muscular pumps
• The veins in your legs are entwined within the skeletal
muscles, and when you move your legs, these muscles
squeeze the veins, pushing the blood out of the way
• We have one-way valves in these veins, so each squeeze
can pump the blood a short distance towards the heart
• Providing you are walking around, this process makes a
‘heart in each leg’ – and it’s very effective!
– Try it – take your socks off and stand still – look at your feet and
you’ll see the veins all standing out and the skin red.
– Now walk around in a little circle and look again – the veins are
empty and flat, and the skin goes pale. Pumping in action!
©2005 www.suspensiontrauma.info
But what if we’re not pumping?
• If the muscles are not pumping the blood upwards, it pools
in your legs
– You can ‘lose’ several pints and go into shock
• Your brain tries ‘shock’ for a while, but of course it doesn’t
help – blood is still stuck in your legs.
• After a few minutes, it goes for the last-ditch method
If I faint, I fall over. I get the blood back.
• It assumes you must fall over. If you stay upright:-
– Your brain has no oxygen supply
– Your airway is at risk
– You will probably die within 10 minutes
©2005 www.suspensiontrauma.info
How long have you got?
• Uninjured volunteers felt dizzy in as little as 3 minutes
– Typically 5 to 20 minutes
• Loss of consciousness in as little as 5 minutes
– Typically 5 to 30 minutes
©2005 www.suspensiontrauma.info
Feeling faint?
©2005 www.suspensiontrauma.info
What actually matters?
• Constrictive leg loops contribute but are NOT needed
– Even stretcher patients are at risk.
• All makes of harness show almost identical results
• Patient age, weight, height, sex and fitness seem to make
little difference to the time it takes before you faint
• Stress, panic, injury, smoking/drinking, extant cardiac
conditions and illness increase the risks
©2005 www.suspensiontrauma.info
OK, so we rescue them!
• No so fast! There’s something important to deal with:-
©2005 www.suspensiontrauma.info
Reflow Syndrome
• Pooled blood in the legs is ‘stale’ after 10-20 mins
– Drained of oxygen, saturated with CO2
– Loaded with toxic wastes (from the fat burning process)
• Re-elevating the legs returns this to the rest of the body in
a massive flood
– Heart can be stopped
– Internal organs (especially the kidneys) can be damaged
• You have to stop this flood of stale blood – but still keep
enough tricking to the brain to keep the person alive!
©2005 www.suspensiontrauma.info
Preventing suspension trauma
• If you’re in a a harness by CHOICE:
– Keep your legs moving as much as you possibly can
– If you’re not using your legs much, you need a workseat
– Take regular rest breaks, eat and drink normally
• If you fall accidentally and are suspended:
– AVOID using your legs. You don’t want blood sent there.
– Lift your knees into a sitting position
– Relax as much as possible. Panic makes things worse
– If you can, every few minutes swing yourself upside down
• If you’re trapped and cannot move
– Strain your leg muscles as hard as you can every 5 seconds
– Breathe slowly and deeply
– You’re going to be needing rescue!
©2005 www.suspensiontrauma.info
Lifting those knees
• All you need is to get your knees level or higher than your
hips – the position you’d be in if you were sitting on a chair
• You can either sit ON something (a ledge, a plank of
wood, etc) or put something under your knees (rope,
strap, hose, wire.. Anything!)
• Behind your knees there’s no fat, so padding is very
helpful if you’re going to be there a while!
• Carrying something as simple as an 8ft length of webbing
or thin rope is all you need – but being able to DO this
depends on how your harness was attached!
©2005 www.suspensiontrauma.info
Rear attachment points
• Using a knee-loop is possible but only with a separate
anchor point
• The head drops forwards and so the airway is at risk
• Many people can’t even reach their attachment points
after a fall
©2005 www.suspensiontrauma.info
Front attachment points
• For sport climbing or caving harnesses, or fall arrest with a
front attachment point, access and knee-lifting is easy!
• Everyone can reach what they’re hanging from
• The airway is still at risk, but not quite as much
©2005 www.suspensiontrauma.info
Emergency action
• If at all possible, climb out of suspension
– Using self-rescue equipment, improvised or otherwise
• Get into a sitting position straight after the fall
– Use a loop under the knees (rope, wire, clothing, etc)
– Pass the casualty a workseat or improvised platform
• All casualties must be ‘immediately rescued’
– Abseil rescue kits, winches, hydraulic platforms, cranes, ladders
– Suspension trauma is more important than other injuries –
remember life over limb. Don’t be afraid of hurting someone to
rescue them!
• On-site first responders and communications are vital
• Never work alone! Who’s going to help you?
©2005 www.suspensiontrauma.info
Hitting the ground
• Lowering systems must be controlled
to prevent the patient’s body being laid
flat as it reaches the ground
– Keep them sitting up for 30 minutes
• Normal first-response and paramedic
rules are WRONG
– This is not ‘fainting’ !
– You need to stop ‘professionals’ doing the
wrong thing and laying your patient flat on
a trolley or hospital bed
©2005 www.suspensiontrauma.info
The Law - UK
In the UK, working at height is controlled by
The Work at Height Regulations 2005
If operatives are using fall arrest equipment i.e. harnesses and
lanyards/fall arrest blocks
– Workers must have on-site rescue equipment and training
– They must be rescued ‘immediately’ from suspension
– Workers must be aware of the risks of suspension trauma
– Any First Aiders must know how to treat suspention trauma safely
– Any work in suspension must be minimised whenever possible
• Work seats, rest periods, etc. must be used when needed
©2005 www.suspensiontrauma.info
And finally…
• Remember although suspension trauma is rare, it can
happen to anyone.
• It’s true what you’ve known all along – sitting down all the
time is the best way to survive the day!
©2005 www.suspensiontrauma.info