ZB - 02 - Suspension Trauma

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ETA ASCON STAR GROUP - Corporate HSE Department

INFORMATION ON

RECOGNISING, PREVENTINGAND TREATING SUSPENSIONTRAUMA

Continuing Professional Development Reading Material

A person left suspended in a harness after falling experiences a lack of blood

flow back into the heart, as the muscles in the legs are not active. If the person

suspended and is not rescued promptly, injury or death may result

Information contained within this document has

been compiled by Mr. Zahid BashirConstruction

Business UnitHSE Vertical Head

Publication 2 of SeriesMarch 2014


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ZBPubn 02 - 2014Page 1of 9

Table of Contents

Information on - Recognising, Preventing and Treating Suspension Trauma .............................................. 2

Introduction ................................................................................................................................................ 2

How does it occur? .................................................................................................................................... 2

Recognising the Symptoms ....................................................................................................................... 2

Timing and Onset of Symptoms ................................................................................................................ 3

Prevention Measures for the Victim .......................................................................................................... 4

1. Move/lift the knees above the hip level .............................................................................................. 4

2. Pushing against a solid surface ......................................................................................................... 4

3. Perform a cycling motion with the legs .............................................................................................. 4

Rescue and Treatment .............................................................................................................................. 5

Rescue ................................................................................................................................................... 5

First Response ....................................................................................................................................... 6

Conscious Victim ................................................................................................................................... 6

Unconscious Victim ................................................................................................................................ 7

Need for Victim to be Sent to Hospital ................................................................................................... 7

Additional Information ................................................................................................................................ 8

Pathological Effects of a Fallen Worker in Danger of Suspension Trauma ........................................... 8

Further Information ................................................................................................................................ 9


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INFORMATION ON - RECOGNISING, PREVENTING AND TREATINGSUSPENSION TRAUMA

INTRODUCTION

Suspension trauma is a term used to describe the condition where a person is trapped in an upright

position and is unable to move; blood is trapped in the persons legs and is unable t o recirculate back intothe heart efficiently.

As a result, the cardio-respiratory system of the person is unable to function properly, which can result in

the fatal condition of oxygen starvation of the brain or other vital organs. Another name for such a

condition is Harness Hang Syndrome.

For work activities at height, workers who wear safety harnesses are subject to this condition, should they

fall and be left in a vertical, hanging position.

Although suspension trauma is considered a rare occurrence, the effects of mishandling or neglecting a

victim can be lethal or severely damaging. Hence, there is the need to raise the awareness of such a

hazard and the measures for preventing and treating such a condition.

HOW DOES IT OCCUR?Blood is pumped out of the heart and travels through the body,

including the legs.

Due to gravity and the density of blood, the heart is unable to draw

the blood back. Normally, muscle contractions in the legs force the

blood back towards the heart and thus, there is little or no danger.

This system is especially effective when a person runs or walks, but

less so when standing still, as the muscles are less active.

However, should leg movements be restricted or a person is

suspended and the leg muscles are not engaged, blood flow from

the legs may be restricted.

Additionally, harness straps may constrict veins and aggravate the

problem. This is known as venous blood pooling and it can result in

fainting, due to the reduced re-circulation of blood from the legs.

Over time, if the person remains in the upright position despite being

unconscious, the brain and other vital organs such as the kidneys

will be deprived of oxygen.

RECOGNISING THE SYMPTOMS

As blood is accumulated in the legs, the amount of blood in circulation will decrease. Attempting to re-

establish blood flow to the brain, the human body will attempt to go into a state similar to shock in order to

compensate by increasing the heart rate and breathing rate. There may also be an attempt to shift blood

from the surface of the skin to provide more blood for vital organs. This results in the following possiblesymptoms:

Breathlessness

Increased heart rate

Excessive perspiration

Nausea


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Paleness of the skin

Dizziness

Hot flashes

If the condition of insufficient blood in circulation persists, the human body will attempt further measures

by slowing the heart rate, resulting in lowered blood pressure in the arteries. This can cause the followingsymptoms:

Unusually low heart rate

Greying or loss of vision

Unusually low blood pressure

Eventually, as the oxygen received by the brain decreases, unconsciousness sets in. Other vital organs

may also be affected by the lowered amount of oxygen.

In particular, the kidneys are very vulnerable to insufficient oxygen and renal failure may result.

When a person is unconscious, there is the additional risk of suffocation, as the tongue may obstruct the

airway. Should the situation be left to develop unchecked, the consequences can be fatal, due to oxygenstarvation of the brain.

TIMING AND ONSET OF SYMPTOMS

The amount of time for a person to experience the initial symptoms of shock, as described above, can be

as little as three minutes, although it was known that the average time is between five to twenty minutes.

Unconsciousness will set in within a few minutes after the initial symptoms occur.

A few minutes after the onset of unconsciousness, death may result due to oxygen starvation of the brain.

Physical factors such as fitness level, height, weight or ethnicity do not affect the amount of time needed

for suspension trauma to set in. In fact, the same person may react differently from one day to the next;

therefore, where time is concerned, it is not predictable.

However, the following conditions have been known to affect the degree of risk due to suspensiontrauma.

Inability to move the legs

Hypothermia *

Pain

Shock

Injuries

Cardiovascular disease

Fatigue Respiratory disease

Dehydration

Blood loss

*Extremely low body temperature, due to exposure to cold weather


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PREVENTION MEASURES FOR THE VICTIM

Should a person be suspended in a harness after falling, the rescue of that person should take place

promptly. It is highly recommended to provide training in self-rescue techniques for workers required to

wear fall arrest harnesses. If self-rescue is not possible, while awaiting rescue, there are basically three

methods that the suspended person can employ to prevent the onset of unconsciousness and the ill-

effects of venous pooling.

1. MOVE/LIFT THE KNEES ABOVE THE HIP LEVEL

By lifting up the knees above the hip level, blood pooling is reduced and thus the risk is also reduced;

even a sitting position is better than a completely vertical posture. To help maintain such a posture,

supports such as a strap, a rope or even improvised materials such as a long strip of cloth or clothing can

be used.

There are also specially designed suspension trauma straps available to prevent or delay suspension

trauma.

2. PUSHING AGAINST A SOLID SURFACE

However, certain harnesses may not allow for the lifting of the persons knees. In this case, the person

should attempt, where possible, to move their legs and push against a solid surface with either the legs orfeet. This would cause the legs to pump blood back into the heart.

This method is somewhat less preferable to the first, as the muscle exertions will cause more blood to be

pumped into the legs, which may add to the problem. Additionally, a solid surface needs to be close

enough to push against.

The use of a separate rescue line for the victim to step on is also possible.

3. PERFORM A CYCLING MOTION WITH THE LEGS

This method is the least preferable as the cycling motion would cause more blood to be pumped into the

legs to support the activity.

In addition, once the person starts the cycling motion, stopping (perhaps due reasons such as to fatigue

or pain from injuries) would cause the blood pooling to occur.

Due to muscle usage, the flow of blood into the legs is increased, compounding and accelerating the

effect. This method should be used only if there is no other option available.


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RESCUE AND TREATMENT

Due to the relatively short time needed for the

onset of the ill-effects of suspension trauma, it isnot enough to solely rely on emergency services

to provide rescue.

Where work is to be carried out at height, plans to

rescue suspended workers must be created.

Certain precautions are needed when treating or

caring for victims of suspension trauma.

RESCUE

While it is possible to call upon emergency services (such as the SCDF) for purposes of rescue, it is

possible for unexpected conditions, such as traffic congestion to delay the arrival of help. Hence, it is vitalfor workplaces where work at height is carried out to prepare emergency rescue procedures, and

equipment, as well as appointing and training rescuers.

An effective way to prepare the rescue procedures is during the risk assessment process.

When planning for rescue, consideration should be given to the type of situation from which the victim

may need to be recovered and the type of fall protection equipment which the victim would be using.

Some situations may create difficulties, for example, a remote victim who is suspended out of reach or the

need to perform rescue over an edge.

The load placed on some of the equipment during a rescue may be higher than they have been originally

designed for. If equipment is intended for use in rescue, the manufacturer should be consulted. It is

critical that such equipment has suitable performance and loading characteristics when used for rescuepurposes.

When considering rescue methods, always attempt to minimise the risk to rescuers. Avoid placing

additional personnel at risk, whenever possible.

The type of rescue procedure that is required will depend on the specific circumstances.

Below are some examples:

If the suspended person is low enough to the ground, the lanyard can be detached or cut and the

person can be lowered to the ground manually.

Use a MEWP that is positioned near to the work area to reach the suspended person.

Competent and trained rescuers using a suitable type of rescue kit that can be quickly and effectivelydeployed to the point of rescue.

Such kits are available from most manufacturers of equipment for work at height. However, this

method is less preferable, as it will result in additional loading on all parts of the system including the

anchor, which may be required to support the load of two persons, placing the rescuer at risk.

The rescue plan must cover both scenarios of conscious and unconscious victims. Ideally, the rescuer

should be able to communicate with the victim at all times or see the victim at all times or communicate

with someone who is able to see the victim at all times.


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Certain precautions are needed when treating or caring for victims of suspension trauma. This is mainly

due to the risk posed by Reflow Syndrome, as outlined below.

REFLOW SYNDROME

Due to the blood remaining in the legs for extended periods of time, the oxygen and nutrients in the blood

are still consumed by cells. When the oxygen is used up, the cells start to perform anaerobic metabolism

on the fatty tissue in the legs to continue functioning.

The toxic byproducts formed during such a process during vigorous exercise are normally kept at a low

level by increased blood flow. However, during suspension, blood flow is very low and the level of toxicity

can reach dangerous levels within a short period of time.

Should the trapped blood be allowed to flow back rapidly to the rest of the body, the presence of the

toxins and the low level of oxygen can cause serious problems.

The heart may stop, the kidneys and brain may be damaged; in certain cases, death may follow shortly.

This can happen if the victim is made to lie flat on the floor immediately after rescue.

FIRST RESPONSE

Any extent of suspension trauma will result in reduced blood flow to the brain. The symptoms of shock, ifleft untreated may result in unconsciousness.

This, in turn, can cause blockage of the airway and the death of the victim. In addition, the low oxygen

level in the blood can lead to brain or organ damage or even death.

POSITIONING OF THE VICTIM AFTER RESCUE

The primary goal of the rescuer is to return oxygen supply to the brain while preventing Reflow

Syndrome. Therefore, in the initial 20-40 minutes after rescue, the victim should never be allowed or be

made to lie down on the floor, even for an instant, unless there is the need to perform CPR.

The victim should be moved first into a kneeling position

and then subsequently into a sitting or huddled position,

with the legs slightly bent at the knees.

This will reduce the pooling effect of gravity, but will keep

most of the pooled blood in the legs, preventing reflow.

A normal symptom is that the victim will feel some

numbness in the legs; this should subside. However, if the

victim has suffered no injuries, yet complains of great pain

in the legs, especially when the victim is being moved, a

severe condition called Compartment Syndrome may

have developed.

Faced with Compartment Syndrome, as a rescuer, there

is nothing more that can be done except placing the victim

in a sitting position and summoning an ambulance withutmost urgency.

CONSCIOUS VICTIM

Prevention measures may be used if there is no immediate way to remove the victim from suspension

provided the victim can be reached and can follow instructions. The victim can be instructed to lift his

knees above the hip level using a sling, a rope or material such as cloth or clothing. There are also

suspension trauma belts that are designed for such purposes.


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If the victim cannot be repositioned or be removed from suspension immediately, they must be monitored

closely as unconsciousness is expected to set in at some point in time. The priority then is to maintain a

clear airway in the victims mouth (by tilting the victims head slightlybackwards after ensuring it is clear of

objects) and arrange for urgent rescue.

The first thing to do after the victim is released from suspension is to make him sit with the torso upright,

with the knees slightly bent. The victim may feel weak or dizzy and may need assistance to prevent him

from collapsing onto the floor, where reflow may occur.

The victim should not be allowed to stand up, exercise and consume any food or drinks.

Medication or other types of fluids should not be given to the victim, unless the rescuer is medically

trained and is aware of certain urgent need. The victim should be kept as calm and relax as possible; this

is to reduce effects of stress on the victims heart rate.

UNCONSCIOUS VICTIM

Similar to the conscious victim, if immediate rescue is not possible, but the victim can be reached, the

victims knees may be lifted and held in position by a strap, rope or material such as cloth orclothing. This

will prevent further venous pooling from occurring in the legs.

An unconscious victim is an indication that venous pooling of blood in the legs had already developedover time. Therefore, the level of toxins in the pooled blood is expected to be high and the victim must not

be allowed to lie flat immediately after being released from suspension.

The victims airway must be kept clear and the body moved into a sitting position. The exception is where

CPR is required, since without a heartbeat, the reflow effect will not occur. Also, the circulation due to the

application of CPR is not strong enough to cause reflow syndrome.

However, the cause of the unconsciousness may be due to another factor, such as being struck by an

object or electrocution. If the cause of unconsciousness is due to other factors and the victim is released

from suspension within 10 to 20 minutes, the victim can be made to lie flat. If the length of suspension is

too long, or the cause of unconsciousness is not clear, the sitting position must still be adopted.

NEED FOR VICTIM TO BE SENT TO HOSPITAL

As a general rule, the victim should be sent to the hospital for blood tests if suspension had occurred for

more than 10 minutes, even if there are no noticeable injuries.

A fully conscious and aware victim may be conveyed to hospital in a private vehicle.

Should an ambulance be called, there is a need to inform the crew on the nature of the injury; that it is not

a normal case of unconsciousness. In addition, the crew must also be informed that the victim is not

allowed to lie down too soon (within 10 to 20 minutes) after being released from the suspended position.


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ADDITIONAL INFORMATION

PATHOLOGICAL EFFECTS OF A FALLEN WORKER IN DANGER OF SUSPENSIONTRAUMA

LEG CIRCULATION:

A fall arrest harness does a great job of dissipating the energies generated during a fall arrest through thelong axis of the human body. After all motion has stopped, that same harness particularly the dorsal

attachment configuration will most likely impose pressure to the femoral vein that is the primary blood

vessel that returns blood from the legs towards the heart. In fact, in order to pass certification testing,

these harnesses must not allow the test mannequin to assume greater than a 30 degree forward lean

upon suspension.

Any degree of forward lean will exert leg strap pressure on the femoral vein which impedes blood return.

To compound this, the human body relies on what is known as the muscle/venous pump to assist the

blood return from the legs to the heart. In suspension, the worker often forgets to bicycle their legs to

create this muscle/venous pump.

The trapped blood in the legs creates what is known as distributive shock as more and more blood is

trapped in the legs; there is less to circulate for the rest of the body (brain, heart, lungs, and kidneys).Additionally this blood becomes highly acidic and toxic with metabolic wastes.

HEART CIRCULATION:

As the body goes into distributive shock, the heart must increase the rate and strength of its contractions

to compensate. To compound this, the suspended worker may be experiencing a high degree of fear and

anxiety, which releases adrenalin into the blood stream which also causes the heart to work harder and

faster.

This places increased demands on the heart, which is receiving less blood flow and thus less oxygen.

The heart becomes irritable and is prone to localized tissue damage, dysrhythmias or both. This is

especially a concern once the worker is rescued and the toxic blood is allowed to surge from the legs to

the irritable heart.

This is known as reflow syndrome and has caused several victims to go into sudden cardiac arrest upon

rescue.

BRAIN CIRCULATION:

As the victim goes into distributive shock, or worst case, suffers cardiac arrest, the brain is deprived of

adequate blood supply and this can lead to unconsciousness.

If the victim faints the airway can be blocked by the head position or even by a poorly adjusted harness

that allows the chest strap to block the airway.

That is a difficult statement to write into a fatality report Cause of Death: Strangulation by Victims Own

PPE.

If the victims heart stops, we can expect permanent brain dam age or death in as little as four minutes.

So it should be obvious that a prompt rescue capability must be ensured by any employer that has

Authorized Persons using PFAS.

This can be accomplished in many ways. Roco has a variety of training courses that are specifically

designed to provide that prompt rescue capability for fallen/suspended workers.


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FURTHER INFORMATION

1. SuspensionTrauma.info - http://www.suspensiontrauma.info/

2. The Work at Height Safety Association, Technical Guidance Note 5 - Guidance on rescue during

work at height- http://www.wahsa.co.uk/component/option,com_docman/task,doc_download/gid,5/

Documents

ZB - 02 - Suspension Trauma