Suspension Trauma
Orthostatic Intolerance
The Medical term is ‘Orthostatic Intolerance’ or sometimes ‘Orthostatic Incompetence’.
An effect which occurs when the human body is held upright vertical position without any movement for a period of time. It presents an immediate threat of death to anyone immobilized in a vertical position (Hanging motionless in a harness).
- The onset and progression of Suspension Trauma can be rapid and is unpredictable.
- If not properly trained how to Recognize, Manage and Prevent suspension trauma, it can lead to serious injury or death.
Suspension trauma (Orthostatic incompetence from Harness Suspension) can start within 5 minutes.
- A fallen climber can become unconscious within 10 minutes and can die within 15.
- Anyone hanging vertically for more than 10 mins can die if they are allowed to lie down after rescue, stale blood returning from their legs and stopping the heart.
EFFECTS
- Leg circulation
- Straps impede blood return
- Muscle venous pump fails
- Blood becomes highly toxic & highly acidic
- Heart Circulation
- Anxiety and onset of shock
- Heart rate increases
- Cardiac Irritability
- Brain Circulation
- Diminished blood flow
- Blocked airway
- Cardiac arrest or brain damage death
Trauma Straps
Trauma Straps
Fortunately, there is a simple solution to protect against suspension trauma: personal protective equipment known as trauma straps. Trauma straps are a pair of straps, one with hooks in it and the other with loops for the hooks to attach to. They are coiled up in pouches and attached to the fall harness at the hips. When a worker falls and comes to rest, he would uncoil the straps, hook them together, and brace his weight against the straps. This allows the fallen worker to stand up in his fall harness, utilizing his leg muscles, taking weight off of his arteries, and restoring blood circulation until help arrives.
Suspension Trauma Straps allow a suspended worker to stand up in their harness to relieve pressure. Continuous loop design allows for either one- or two-foot suspension relief without pinching. Can be quickly attached to most harness brands right in the field – just choke off to the strap and it’s ready to go.
After a Fall
- Suspended workers should try to move their legs in the harness and try to push against any footholds, such as relief staps.
- If the worker is suspended upright, emergency measures must be taken to remove the worker from suspension or move the fallen worker into a horizontal posture or at least to a sitting position prior to the rescue.
- Rescuers must be aware that post-rescue death may happen if a victim is moved too rapidly to a horizontal position. Moving a worker too quickly to a horizontal position is likely to allow a large volume of used (deoxygenated) blood to move to the heart, causing cardiac arrest. Suspended workers should try to get their legs as high as possible and their heads as close to horizontal as possible.
- Rescuers must be aware of the first aid measures to prevent suspension trauma.
What does OSHA say?
Rescue Procedures
Under 29 CFR 1926.502 (d) (Fall Protection Systems Criteria and Practices), OSHA requires that employers provide for “prompt rescue of employees in the event of a fall or shall assure that employees are able to rescue themselves.” This should include identifying rescue procedures that address the potential for orthostatic intolerance and suspension trauma. Rescue procedures also should address how the rescued worker will be handled to avoid any post-rescue injuries.
Rescue procedures should include the following contingency based actions:
suspended worker
- If self-rescue is impossible, or if rescue cannot be performed promptly, the worker should be trained to “pump” his/her legs frequently to activate the muscles and reduce the risk of venous pooling. Footholds can be used to alleviate pressure,delay symptoms, and provide support for “muscle pumping.”
- Continous monitoring of the suspended worker for signs and symptoms of orthostatic intolerance and suspension trauma.
- Ensuring that a worker receives standard trauma resuscitation1 once rescued.
- If the worker is unconscious, keeping the worker’s air passages open and obtain first aid.
- Monitoring the worker after rescue, and ensuring that the worker is evaluated by a health-care professional. The worker should be hospitalized when appropriate. Possible delayed effects, such as kidney failure, which is not unusual in these cases, are difficult to assess on the scene.
Training
OSHA requires employers to train workers to use fall arrest systems and other personal protective equipment correctly while performing their jobs, in accordance with standards 29 CFR 1910.132 (Personal Protective Equipment) 29 CFR 1915.159 (Personal Fall Arrest Systems) and 29 CFR 1926.503 (Training Requirements for Fall Protection).
Workers who wear fall arrest devices while working, and those who may perform rescue activities, should also be trained in:
- How to ascertain whether their personal protective equipment is properly fitted and worn, so that it performs as intended;
- How orthostatic intolerance/suspension trauma may occur;
- The factors that may increase a worker’s risk;
- How to recognize the signs and symptoms identified in this bulletin; and
- The appropriate rescue procedures and methods to diminish risk while suspended.
References
- https://www.jems.com/2015/06/09/redefining-the-diagnosis-and-treatment-of-suspension-trauma/
- Chandler J. (Feb. 15, 2011.) Updated: San Juan Capistrano hiker was bright, adventurous. San Juan Capistrano Patch. Retrieved March 29, 2015, from www.patch.com/california/sanjuancapistrano/climber-dies-of-suffocation.
- Lee C, Porter KM. Suspension trauma. Emerg Med J. 2007;24(4),237–238.
- Adisesh A, Lee C, Porter K. Harness suspension and first aid management: Development of an evidence-based guideline. Emerg Med J. 2011;28(4),265–268.
- Wood N. (June 11, 2012.) Suspension trauma: A lethal cascade of events. Ellis Fall Safety Solutions. Retrieved March 29, 2015, from www.fallsafety.com/wp-content/uploads/2013/03/ NormanWoodsSuspensionTraumaALethalCascadeOfEvents.pdf.
- U.S. Department of Labor Occupational Safety and Health Administration. (2011.) Safety and health information bulletins: Suspension trauma/orthostatic intolerance. Retrieved March 29, 2015, from www.osha.gov/dts/shib/shib032404.html.
- https://www.osha.gov/dts/shib/shib032404.html
- Mortimer RB. Risks and management of prolonged suspension in an Alpine harness. Wilderness Environ Med. 2011;22(1):77–86.
- Madsen P, Svendsen LB, Jørgensen LG, et al. Tolerance to head-up tilt and suspension with elevated legs. Aviat Space Environ Med. 1998 Aug;69(8):781–784.
- Suspension trauma. (n.d.) Capital Safety Training & Services. Retrieved March 29, 2015, from www.tagsafety.com/library7.aspx.
- Suspension trauma explained. (April 22, 2013.) Roco Rescue. Retrieved March 29, 2015, from www.rocorescue.com/roco-rescue-blog/suspension_trauma_dangers.
- Raynovich B, Rwaili FT, Bishop P. Dangerous suspension trauma: Understanding suspension syndrome and prehospital treatment for those at risk. JEMS. 2009;34(8):44–51, 53.
- https://www.workzonesafety.org/files/documents/training/factheets/ARTBA_Fall_Fact_Sheet_Suspension_Trauma.pdf
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