SUSPENSION TRAUMA

Viki Campbell
Intensive Care Paramedic, Registered Nurse
B. Health Science (Pre hosp care), B. Nursing
 Cases In Point

An electrical worker is lowered into a shaft

after testing for toxic gases. He is lowered
on a cable and is positioned at the right level
to repair a junction box. After five minutes
he is unconscious-- but his buddies tending
the line don’t realize it, and 15 minutes later
a dead body is hauled out.

A carpenter working alone is caught in

mid-fall by his safety harness, only to die 15
minutes later from suspension trauma.
 History
• Harnesses have been in workplaces and
recreation environments since the early 1970’s.
• Since then, approximately 100 deaths have been
attributed to suspension trauma.
• Discovered in France by Dr. Maurice Amphoux in
1978 after several unexplained deaths on rope
whilst caving were attributed to exposure.
• Dr. Amphoux concluded that remaining immobile
in a harness for as little as 10 mins could be fatal.
• In one case the subject lost consciousness in as
little as 3.5 minutes.
 What is suspension trauma?
• ‘Suspension Trauma’
- The medical effects of immobilisation in a vertical
position
- Medical term is ‘Orthostatic Incompetence’
• 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
 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)
• The danger is when someone is unable to
move, or forgets to bother!
• The onset and
progression of
Suspension Trauma are
rapid and unpredictable

• All those ‘working at

height’ must be trained in
how to recognise,
manage and prevent
suspension trauma
 Suspension Trauma
is also known as
Harness Hang Syndrome.

A SIMPLE FAINT
(SYNCOPE)
How does the blood
circulate?

3 pumps for the

blood to circulate
around the body
 2. Leg muscles 3. The valves stop the
1. Blood sitting
in veins in the contract. Squashing blood from going back
veins forcing blood down so all blood is
legs.
up and down veins. pumped upwards.
After Standing Still for a while blood
starts to pool in the legs.
Aproximately 60% after 2-3 minutes
Veins become engorged therefore less
blood returning to the heart than
being pumped out causing a drop in
blood pressure and
Less blood to the brain leading to a
faint
Syncopal Episode
SEQUELAE
•Blood pools in the legs
•Brain detects low O2
•Cardiac output increases
•Brain O2 still falls
•Emergency response:
Pulse drops
Loss of consciousness
Person falls over
Blood flows back to
brain
•Person wakes up.
 Syncope in a harness
SEQUELAE
•Blood pools in the legs
•Brain detects low O2
•Cardiac output increases
•Brain O2 still falls
•Emergency response:
Pulse drops
Loss of consciousness
Person CANNOT fall over
Brain cells start to die
•Person never wakes up.
 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
It is difficult to put a timeline on deaths, however from research
it is clear that death can result in as little as 10 minutes, more
typically between 15 and 40 minutes post-suspension. Death is
more rapid with existing injuries but can happen to anyone.

Anyone immobilised in an upright posture

is in immediate danger of death
 Signs and Symptoms associated with
Suspension Trauma

Signs Symptoms
•start as increased heart rate •feeling of passing out
•proceed to decreased heart •tingling in extremities
rate •shear panic (not know
•sweating why)
•“greying” or Loss of Vision •extreme pain all over
•Paleness •Breathless
•Hot Flushes
Factors that can increase the risk of Suspension Trauma

• Inability to move legs

• Hypothermia
• Pain
• Shock
• Injuries during fall
• Blood loss
• Cardiovascular disease
• Fatigue
• Respiratory disease
• Dehydration
 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, existing
cardiac conditions and illness increase the risks
Al l t hat mat t er s i s t hat t he l egs ar e l ower
t han t he hear t and t he l eg muscl es ar e i mmobi l e.
No ot her i nj ur y i s needed.
Any vertical lifts
must be done in
minimum time.
Photo by Alan Sheehan Oberon SES
 OK SO WE RESCUE THEM!
• Not so fast! There’s something important to deal
with:-

• The blood that is trapped in the legs may not be in

very good condition, and may even kill the person
if we let it all pour back into their brain!

• This is called the ‘reflow syndrome’ and is

medically very complicated – you will not be able
to control it once it starts, and the patient will die.
Luckily you can prevent it from happening if you
handle them with care!
 REFLOW SYNDROME
• Pooled blood in the legs is ‘stale’ after 10-20
mins
• Drained of oxygen, saturated with CO2
• Loaded with toxic wastes (from 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!
Recommended posture
as per Graeme Peterson – Suspension Trauma
at the ARC Conference August 2004

• Anyone who
experiences
suspension
trauma
should be
kept in a
sitting
position for at
least 30
minutes after
rescue
Compartmental syndromes

• condition in which increased pressure

within a limited space compromises the
circulation and function of the tissues
within that space.
• This condition is a cause of major loss of
function, limb and even life.
• Crush injury is the most common cause.
• Other Causes include:
 envenomation
 allergy
 post ischaemic injury
 intravenous infiltration
 burns.

So what is the treatment?

 Using a harness?

• Ensure a loose fit

when not on rope
• Never work alone
• Have a rescue
plan
• Practice the
execution of your
rescue plan
QUESTIONS?