Suspension trauma, also known as harness hang syndrome, suspension syndrome, or suspension syncope, is a life-threatening condition that occurs after a fall when the human body is held upright without any movement for a period of time. If an individual is strapped into a harness, this condition will occur more rapidly. If not rescued in time, the individual will eventually faint. Fainting, while remaining vertical, increases the risk of death from cerebral hypoxia (brain damage).

Suspension trauma is the main reason why it is imperative to perform a rescue as soon as possible after a fall has been arrested.

WHY DOES SUSPENSION TRAUMA OCCUR

When a person is suspended after a fall, the heart continues to pump blood to the body. Combining the effects of gravity with the pressure the harness leg straps place on the main blood vessels in the groin area (the femoral artery and the femoral vein), it becomes difficult for the blood to circulate througout the body. The result of this is a collection of blood in the leg areas.

Due to the inability of blood to return to the heart to be oxyginated, there is less oxginated blood available to circulate to the vital organs, such as the brain, lungs, heart and kidneys. When the brain becomes deprived of oxygen the victim will in turn faint. The consequences of this can be incredibly severe and even life-threating, with the victim having the potential to  experience brain damage, kidney failure or even death.

Without any movement, suspension trauma can cause a loss of consciousness to the victim in only a few minutes and the resultant knock-on effects occur rapidly thereafter.

For this reason, every individual who is suspended from a fall must be treated as if they are in a life threatening situation.

The process of suspension trauma simplified in steps:

1. The individual falls, leaving them suspended in their harness.
2. Leg straps cut off blood circulation in the body.
3. Blood pools in legs.
4. Blood becomes acidic due to lack of oxygen making it toxic to the body.
5. The Body experiences shock.
6. The Heart rate increases.
7. The body experiences cardiac instablility.
8. Diminished blood flow to the brain
9. Fainting.
10. Cardiac arrest.
11. Brain damage.
12. Death.

Because suspension trauma occurs over a period of time, the more time available to perform the rescue, the better the chances the victim has of making a full recovery. As a result, it is imperative for individuals who work at heights to be mindful of the following factors that can increase the rate at which suspension trauma kicks in:

• Dehydration
• Hypothermia/Hyperthermia
• Fatigue
• Respiratory or cardiovascular disease
• Unconsciousness due to a head injury experienced in a fall
• Pain
• Shock
• Blood loss in the event of an injury
• Inability to move legs

As the above points contribute to the speed of onset of suspension trauma, it is vital that the rescue team, first responder or even the supervisor maintain communication with the victim and assess the physical and psychological state of the victim. A person who is experiencing majority of the above symptoms will have mere minutes before experiencing severe suspension trauma whereas a person who is well hydrated, energised and is able to move their legs freely after a fall may be able to hang suspended a lot longer before feeling the effects of suspension trauma.

It is important to note that suspension trauma can be prevented with the right knowledge and training. How are a few tips on how to prevent suspension trauma.

• The first step to preventing suspension trauma is to prevent a fall from actually occurring. This can be achieved by doing proper planning, assessing the various risk factors, utilising the correct working at heights equipment and ensuring that all individuals who are working at a height have completed competency training.
• In the event that a fall occurs, it is encouraged that the victim climbs back onto the structure that they have fallen from, if possible, instead of waiting to be rescued. With a proper briefing before work commences on site, individuals will be better prepared to consider this as an option should they experience a fall, when the adrenaline is pumping. 
• In order to allow a suspended body to move, it is recommended that individuals working at a height make use of harnesses that are fitted with a standing step. This will enable the fallen victim to move his legs – one at a time, releasing pressure of the harness on the groin area, and better enabling oxygenated blood to flow throughout the body whilst awaiting rescue.
• In the event that an individual’s harness is not fitted with a standing step, but does allow for work positioning, a victim can utilise their work positioning lanyard to form a loop that acts in the same manner as a standing step. Alternatively, a make-shift standing step can be created with the use of an open round sling that is connected to a victims harness with the use of a carabineer.
• Timing is crucial in the prevention of suspension trauma. As a result, it is critical to have a suitable and efficient rescue plan in place in the event of a fall. It is also recommended that rescue kits are kept in easy reach to prevent unnecessary delays and the rescuer is trained periodically in the correct rescue procedures. This is important as after a fall, panic sets in and individuals experience an adrenaline rush. The better skilled and more rehearsed a rescuer is at performing a rescue, the more efficient the rescue will be.
• The effects of suspension trauma are not necessarily over when an individual has been rescued. Due to the potential toxicity in the blood, the individual will be required to remain in a seated position for a period of time after the rescue. As a result, it is imperative that proper medical surveillance is implemented post the rescue.  
• Avoid working alone. Individuals should never work at heights alone or without the presence of a competent individual who is trained in performing rescue.  

Ensuring your staff are well trained in their respective working at heights environments and making use of the correct equipment for their requirements goes a long way in ensuring their safety and equipping them with best practice in accordance with local legislation.

 For more information on an extensive range of working at heights equipment, visit www.bova.co.za. To register your employees for their respective working at heights training requirements, visit www.bbfsheqservices.com