Suspension Trauma: Symptoms and Treatment

This blog was originally posted on 12/27/2013 and reviewed on 2/11/2021.

Disclaimer: The staff of Rigid Lifelines are not medical experts. If a worker is experiencing suspension trauma, seek medical assistance immediately.

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Whenever workers need to use fall protection systems to work at height, it is CRUCIAL that a rescue plan is in place. Safety managers need to ensure that the facility either has equipment that can be used for rescue purposes or that local fire and ambulance companies are aware that they may need to perform a rescue at elevation. Prompt worker rescue is imperative after a fall has been arrested on a fall protection system because of suspension trauma. The dangerous effects of suspension trauma can occur in minutes, and even if a prompt rescue does occur, it is important that every person who interacts with the equipment understands the symptoms and the appropriate way to treat a worker for suspension trauma after they have been retrieved from a fall protection system.

Symptoms

The symptoms of suspension trauma can be broken down into several different phases. After a worker’s fall has been arrested, and all of their body weight is being suspended in the harness, the early signs of suspension trauma can begin to appear in a matter of minutes. In order to monitor the worker’s status during the rescue process, keep an eye out for the following signs and symptoms associated with suspension trauma.

Initially, the worker may develop cold, clammy skin. The worker’s may display shallow, rapid breathing coinciding with a rapid, but weak pulse. If these symptoms begin to happen for a worker, they may complain that they are feeling lightheaded.

If the worker continues to dangle in the harness after they begin to feel lightheaded, their blood pressure and pulse strength may plummet suddenly. This drop will cause an immediate loss of consciousness. And once the worker has lost consciousness, prompt rescue is imperative in order to increase the worker’s chances for survival.

For best results, an unconscious worker needs to be rescued within  five minutes. If a worker is unconscious and their brain is not receiving enough oxygen, they will have a higher chance of experiencing brain damage after five minutes without oxygen. After 10 minutes, the brain is likely to suffer severe damage in addition to organ system failure. At this point, the worker is at very high risk of death by suffocation.

Treatment

After a worker has been rescued, the proper treatment should be administered as quickly as possible to reduce the risk of permanent damage caused by loss of consciousness. For years, the actual treatment procedures for a rescued worker have been in question. Today, new research has led to a broad consensus in the safety and medical industries.

So, what is the proper treatment for a rescued worker who has experienced symptoms of suspension trauma? The consensus is that suspension trauma victims should receive the same treatment as any other kind of traumatic injury.

Once a worker is back on the ground after a fall has been arrested, former treatment guidelines advised placing the rescued worker the “W” position, or “semi-recumbent” position. While the worker is suspended in the harness, blood begins to pool in the workers legs. Because the blood is not circulating, it can become deoxygenated (hypoxic) and accumulate metabolic byproducts.

It was believed that laying the worker flat in a supine position would cause the hypoxic blood to rush back to the heart and brain too quickly, which could cause permanent damage. This phenomenon was termed “reflow syndrome.” However, recent studies have found “no evidence that returning victims to a horizontal position increased the risk of death” (8).

Additionally, several human trials have found no occurrence of reflow syndrome in study participants who were immediately placed in a horizontal position. Instead, “participants … showed rapid recovery when placed into the supine position.” Further research in the United Kingdom by the Health and Safety Executive (HSE), found no evidence of “reflow syndrome” and concluded that “only anecdotal evidence suggests that the standard first aid may have any adverse effect” (9).

OSHA’s guidance on Suspension Trauma rescue formerly recommended use of the “W” position but has been updated to reflect the new findings. The current guidance says to ensure that the worker “receives standard trauma resuscitation once rescued” (1), placing the worker in the supine position and monitoring vital signs.

Some research has also found that preventing a worker from lying flat can potentially cause further harm. Workers who are unconscious or semiconscious when rescued may have sustained other injuries during the fall. Failure to place the victim in a horizontal position may exacerbate those injuries (9).

Even though elevated rescues might seem like an unusual circumstance for safety managers and first responders, it is a good idea to address how to approach these situations. As always, training anyone who may be involved with this situation is very important. This  topic is unique and is not always discussed among safety professionals. Spread the word about how to respond to a worker who is suffering from suspension trauma. Remember, you could help save someone’s life by passing along this information. 

Quick List of Suspension Trauma Symptoms:

• Feeling faint or light-headed
• Breathlessness
• Profuse sweating
• Very pale
• Feeling very hot, quickly
• Nausea
• Increased heart rate or significantly decreased heart rate
• Exceptionally low blood pressure
• Dizziness
• Grey out or loss of vision
• Numbness in legs

Quick Reference for Suspension Trauma Treatment:

1. Loosen Harness Leg Straps**
2. Place worker horizontally in a supine position
3. ABC: Airway, Breathing, Circulation
4. Call paramedics and seek medical treatment

**NOTE: If you remove the used harness from the worker’s body, DO NOT put the harness back into service in the workplace AND save it in case OSHA requests to see the harness at a later date.

Quick List of Health Factors That Influence Suspension Trauma:

• Ability/inability to move legs
• Pain
• Injuries
• Fatigue
• Dehydration
• Hypothermia
• Shock
• Cardiovascular disease
• Respiratory disease
• Blood loss
• Stress/Panic
• Smoking/drinking
• Other illness

References:
1. Suspension Trauma/Orthostatic Intolerance. Retrieved from: https://www.osha.gov/dts/shib/shib032404.html
2. Robertson, David. Orthostatic Intolerance. Vanderbilt University, Nashville, Tennessee.
3. New York Medical College. Orthostatic Intolerance. Vahalla, New York.
4. Seddon, Paul. Harness Suspension: Review and evaluation of existing information. Health and Safety Executive. Research Report 451/2002. 104 pp.
5. Sheehan, Alan. Suspension Trauma. Training handout.
6. Weems, Bill and Bishop, Phil. Will Your Safety Harness Kill You? Occupational Health & Safety. 72(3): 86-88, 90, March, 2003.
7. National Association of Emergency Medical Technicians (NAEMT). Provider Textbook section in: PHTLS Basic and Advanced Prehospital Trauma Life Support Fifth Edition St. Louis, MO: Mosby; 2003: Section 1.
8. Weber, Sean A., Mackenzie M. McGahan, Christoph Kaufmann, and Saptarshi Biswas. “Suspension Trauma: A Clinical Review.” Cureus, June 8, 2020. https://www.cureus.com/articles/32357-suspension-trauma-a-clinical-review.
9. Adisesh, A, L Robinson, A Codling, and J Harris-Roberts. “RR708 – Evidence-Based Review of the Current Guidance on First Aid Measures for Suspension Trauma.” RR708: First aid measures for suspension trauma. Health and Safety Executive, 2009. https://www.hse.gov.uk/research/rrhtm/rr708.htm.