Minutes for Survival

Suspension Syndrome: Introduction, Recognition and Treatment

Following a successfully arrested fall into a fall protection system and full body harness, the fall victim is not necessarily in the clear.  Negative effects can occur to the body while being suspended in a full body harness, including death.  These negative effects have historically been referred to by the safety and fall protection industry as “Suspension Trauma.”  However, current medical publications and studies have deemed this commonly used term “Suspension Trauma” as inaccurate.  To be consistent with medical pathology, current publications are now stating that the term, “Suspension Trauma” should be replaced with “Suspension Syndrome.”  Furthermore, in addition to the change in terminology, the proper treatment of a fall victim has changed from the previously recommended processes.

An introduction to Suspension Syndrome

Suspension Syndrome has been defined by the Journal of Emergency Medical Services as, “The condition in which a suspended person becomes unconscious due to orthostasis without traumatic injury.”  Orthostasis is defined as a sudden drop in blood pressure which can ultimately lead to the fall victim becoming unconscious.  Another publication writes, “Suspension Syndrome (formally suspension trauma) describes a potentially life-threatening event induced by passive hanging on a rope or in a harness system in a vertical or near vertical position.”

In addition to the term suspension trauma, another medically disproven and commonly referred to event is what is called “Reflow Syndrome” or “Rescue Death.” Reflow Syndrome or Rescue Death has been described as the sudden rush of toxins and blood clots that would accumulate in the legs of a fall victim that can cause cardiac arrest.  Current research has determined that this event is theoretical and there is no evidence to support this.  Therefore, it should no longer be taught in the industry.

How long does it take for death to occur due to suspension syndrome?

It is important that persons involved in a company’s fall protection program and employees working at height know how long it takes for a fall victim to become unconscious and for death to occur following a fall in a fall protection system and full body harness.  Various professional and medical sources state that a fall victim may become unconscious in as little as 5 minutes post suspension.  The average timeframe for a fall victim to become unconscious is between 14 – 15 minutes post suspension.  These studies state that the fall victim can experience brain damage leading to death within 4-5 minutes following loss of consciousness.  Therefore, a prompt rescue of the fall victim is essential for survival.

An additional consideration following a successfully arrested fall is that the fall victim will likely start to exhibit the signs and symptoms of shock.  Symptoms of shock include pale complexion, feelings of faintness, sweating, leg numbness, nausea, dizziness and confusion.

What is the treatment for a successfully arrested and conscious fall victim?

Following a successfully arrested fall, it is essential that the fall victim remain calm in this high stress situation.  They must do what they can to safely get comfortable in this suspended position, such as adjust their harness sub-pelvic strap underneath their buttocks, raise their knees and get into a “Cannonball-like” position.  It is important that the fall victim move their legs continuously at an even controlled pace and gain any potential footholds such as standing on rebar or a structure.  Most manufacturers offer a “Suspension relieving device” designed for use with a full body harness, such as web stirrups or relief steps.  If available, these can be deployed to provide the fall victim something to stand into and delay the onset of suspension syndrome.  If a suspension relieving device is unavailable, as a last resort the fall victim may be able to use a section of rope, positioning lanyard or equivalent to create a loop to stand into and relieve pressure caused by harness suspension.

As stated earlier, prompt rescue of the fall victim is essential for survival and trained rescuers must safely get the fall victim to the ground as soon as possible.  Once successfully rescued, the new medically proven position to place the fall victim in is flat on the ground in a fully horizontal/supine position.  If the rescuers are properly trained, they may follow Advanced Life Support (ALS) protocols and administer the CAB (Chest Compressions, Airway and Breathing) treatment process (if required).  Employees must ensure that first responders/medical professionals are contacted, an accurate timeline of the event is recorded and they communicate the specifics of the incident to the responders and allow them to treat the fall victim.

There are other advanced treatments and considerations of suspension syndrome that must be assessed.  The workers or rescuers that are first on scene may need to consider the prevention of cold and heat exposure to the fall victim.  The medical professionals providing advanced treatment to the fall victim may need to administer oxygen and IV fluids.  It is also likely that additional medical intervention and follow up treatment will be required for the fall victim.

A Summary of Suspension Syndrome

In summary, following a successfully arrested fall, workers must recognize the potentially fatal effects of Suspension Syndrome.  Post-fall and suspension, the victim may start to exhibit signs and symptoms of shock.  Suspended fall victims have been shown to pass out in as little as 5 minutes.  Brain damage leading to death starts to occur within 4-5 minutes following loss of consciousness.  Rescuing the fall victim and getting them to the ground ASAP is essential for survival.  Once the fall victim is rescued, they are to be placed flat on the ground in a fully horizontal/supine position.  And lastly, ALS protocols are to be followed by trained individuals and additional medical treatment and follow up may be required.

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Sources:

• Suspension Trauma - A Lethal Cascade of Events:  Dr. Norman Wood June 11, 2012
• An Evidence Based Review of Suspension Trauma Pathophysiology and Medical Management:  Joel Mohr, MD (candidate)
• Harness Suspension - A Working at Heights Organizational Analysis:  G Flagler, S Dorman, A Adisesh
• Flora 1972; Pasquier et al. 2011; Roggla et al. 2008