Suspension Trauma Treatment – The Great Debate

This blog was originally posted on 10/22/2014 and reviewed 3/9/2021.

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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Historically, rescue planning is the part of a fall protection program that most workplaces forget. This forgotten planning usually happens because workplaces are so focused on protecting the worker from a fall that they forget about returning the worker to an appropriate walking surface. When a worker is exposed to long periods of inactivity in a harness after having their fall arrested, they are more likely to experience the complications of suspension trauma (or orthostatic intolerance).

If a worker begins to show the signs and symptoms of suspension trauma, it’s important to employ an appropriate first-aid response. Due to the unique nature of suspension trauma, it is not a topic that is generally covered in your local first-aid class. For many years, a lack of research regarding the cause, effects, and treatment of suspension trauma meant that medical professionals had no formal protocol for how to handle a person exhibiting the symptoms of suspension trauma. As a result, safety professionals disagreed over the best way to approach the first-aid treatment for a person experiencing suspension trauma.

In the United States, many fall protection training courses promote the use of the “W-Position” (or semi-recumbent position) as an effective way to provide first-aid for a worker who is potentially experiencing suspension trauma. However, safety professionals in places like the United Kingdom and Australia are encouraging the use of a horizontal recovery position. There is clearly a difference in the reasoning behind each position.

Because blood pools in the legs of a person experiencing suspension trauma, the blood becomes deoxygenated (or hypoxic) and accumulates metabolic waste. Once the pressures of fall arrest equipment have been removed from the body, the hypoxic blood can flow freely and can carry the metabolic waste to other parts of the body.

Workplace safety professionals believed that the freely flowing hypoxic blood could return to the heart and brain too quickly and cause permanent damage. This phenomenon was termed “reflow syndrome.” To prevent damage from reflow syndrome, safety professionals recommended treatment to slow the return of the hypoxic blood after a worker is rescued from suspension after a fall is arrested. The W-Position and the Recovery Position are currently the most commonly taught methods.

The W-Position

In the past in the United States, fall protection training programs tend to encourage the use of the W-Position as a means of treating suspension trauma symptoms. When someone is sitting in the W-Position, their legs are bent at the knees and pulled relatively close to their chest. The idea is that this position will force blood to return back to the heart at a slower rate because it is working against gravity, and the heart can take on smaller portions of the toxic blood and re-establish the correct balance within the bodily fluids. If a worker is unconscious, it can be difficult to keep a worker in this upright seated position.

The Recovery Position

In the United Kingdom and Australia, fall protection training programs recommend using the recovery position for treating suspension trauma symptoms. The recovery position involves laying the person on their side on the ground and positioning them so their head is tipped down. The concept behind this position is that when someone is lying on their side, they are able to let their body naturally re-balance without stressing the heart to work against gravity. If a worker is unconscious, this position can still be applied.

More recent research by medical professionals has cleared up some of the uncertainties surrounding suspension trauma in fall arrest situations. An article published in the Cureus Journal of Medical Science found “no evidence that returning victims to a horizontal position increased the risk of death.” The results of the study were consistent with research conducted by the UK Health and Safety Executive (HSE), which found that participants in a suspension trauma experiment recovered rapidly when placed in a horizontal position.

The advice of medical professionals regarding suspension trauma treatment agrees: rescued workers should be placed in a horizontal position, not the W-position. Rather than blood toxicity, airway, breathing, and circulation (ABC) should be the primary concerns. The recovery position and the supine position both prioritize these concerns. Rescued workers should also receive medical attention, regardless of the severity of symptoms.