Suspension
trauma can start within 5 minutes. A fallen climber can become unconscious
within 10 minutes and can die within 15. Also, anyone hanging vertically for
more than 10 mins can die if they are allowed to lie down after rescue, due to
the stale blood returning from their legs and stopping the heart. Suspension
trauma will affect anyone hanging motionless with his or her legs dangling. No
injury is needed and the harness does not need to be constrictive. It is
sudden, unpredictable and always kills. It is caused by blood pooling in the
legs due to gravity. Without the pump effect from leg muscles as they contract,
the brain is starved of oxygen and begins to die. The only way to stop the
progress is to raise the legs immediately after the fall or continually use the
leg muscles. Rapid rescue is essential.
While fall
protection is designed to save a worker’s life, it also can create risks in
certain situations. If a worker is suspended for too long, he or she may
develop what is known as orthostatic intolerance. Often occurring when
individuals remain immobile for extended periods of time, orthostatic
intolerance is caused by venous pooling, or the accumulation of too much blood
in the veins, which reduces the flow of oxygenated blood to the heart and
brain. Venous pooling most often occurs in the legs due to a combination of
immobility and gravity. When this happens to someone in a standing position,
the victim loses consciousness and falls to a horizontal position, placing the
heart, legs and brain on the same plane and normalizing blood flow.
However, if a worker who
falls and remains suspended upright in a harness develops orthostatic
intolerance, the body’s natural response will be hindered. Because the worker
cannot fall to the horizontal position and normalize blood flow, serious health
problems – even death – can occur. This is known as harness-induced pathology
or, more commonly, “suspension trauma.”
SYMPTOMS:
· Hot flushes, sweating, anxiety, numbness
· Rapid pulse and breathing
· Sudden loss of consciousness
(fainting)
· Death within 10-30 minutes if not
rescued
ACTIONS AFTER A FALL:
· If at all possible, recover the climber within 5-10 minutes
· If recovery is
delayed, raise the knees into a sitting position within 5 minutes
ü If this is
not possible, only raise the legs very gradually and carefully.
·
If the climber is
unconscious they must be reached and the airway protected
·
If recovery is
impossible, go for help after raising
the knees
· During recovery, never allow the body to lay flat
· Keep the climber in a sitting
position for at least 30 minutes.
·
Anyone who has fainted or been suspended for over 10
minutes must go
to hospital.
PREVENTION:
·
Always keep legs active. Use a workseat if hanging for long periods.
·
Keep hydrated and avoid
smoking or alcohol
·
Carry an emergency knee
sling at all times
·
Avoid rear-attachment if there’s a risk of free-hanging after
a fall
·
Rescue should always be possible within 10
minutes
·
Your risk assessments must plan for suspension trauma & rescue
EMERGENCY MEDICAL TREATMENT
The patient is likely to have suffered
a period of significantly restricted
venous return from the lower
extremities leading to localised hypoxemia and symptoms of distributive shock. Postural syncope may have occurred, however with fixed vertical positioning in a harness this fails to correct
the circulatory insufficiency and a carotid
hypobaric response will result. Loss of life in suspension is
subsequent from cerebral hypoxia. Constrictive harnesses
and venous stasis may have caused limited
crush injury in some cases. Hypothermia is likely and can
increase cardiac fragility during rescue.
Venous reflow from the legs must be prevented post-rescue, or there is a likelihood of acute cardiac
arrest and renal failure from localised hypoxemia and right ventricular overload.
After 10 minutes of
vertical immobile suspension blood
in the lower extremities may
be significantly chemotoxic.
The legs should be considered as for crush injury release. Even in cases reporting
minor symptoms but no Loss of Consciousness (LOC) there is a requirement for post-rescue postural
management and transfer
for renal monitoring. Post-recovery the patient should be maintained in a sitting position for a minimum
of 30 minutes. This should override non-critical trauma management.
Prior to recovery from the harness, immediate leg-raising or muscular activity will delay onset. Beyond 5 minutes of suspension, leg-raising is counterproductive unless conducted gradually. Prior to
release provide 100% oxygen and secure airway only. Do not provide fluids except to manage
associated trauma. There is usually no pain so analgesia
is not required however if requested avoid opiates as bradycardia is
likely before or during rescue.
Immediate Treatment at
Scene
·
Provide 100% oxygen and secure airway for seated transport
·
Minimise initial fluid therapy to that required
for haemostasis
·
Monitor blood glucose
and correct hypoglycaemia as required
·
Stabilise unrelated trauma
without inducing vascular reflow
·
Preserve patient
in sitting position with legs
maintained below the cardiac
altitude
·
Do not permit the
patient to self-ambulate if suspension time exceeds
10 minutes
·
Monitor ECG (electrocardiographic) and expect sudden bradycardia or symptoms of Right Ventricular Failure (RVF). Tachycardia is NOT indicative of haemorrhage and is to be expected, as are Premature Ventricular
Contractions (PVCs).
Accident and Emergency Admission
·
Maintain in sitting position on arrival. Minimise active lower limb exercise.
·
Gradual reduction to supine position only with immediate cardiac
support. Monitor for RVF.
·
Catheterise and increase fluid therapy with adjuvant diuresis. Renal
damage is probable for
suspension times exceeding 20 minutes
and dialysis should be a consideration.
·
In cases where suspension times are excessive and/or harness webbing has been constrictive
there is an associated issue of primary crush damage to tissues of the thighs and pelvic girdle.
Under no circumstance
must the patient be placed in a horizontal
position
Recommendations
Safety harnesses save many lives and injuries. However, continual vigilance is needed to train and supervise workers to ensure harnesses are used safely. All phases of fall protection need to be examined for each particular application. Workers and emergency response personnel must be trained to recognize the risks of suspension trauma.
Before the potential fall:
Safety harnesses save many lives and injuries. However, continual vigilance is needed to train and supervise workers to ensure harnesses are used safely. All phases of fall protection need to be examined for each particular application. Workers and emergency response personnel must be trained to recognize the risks of suspension trauma.
Before the potential fall:
- Workers should never be permitted to
work alone in a harness.
- Rope/cable tenders must make certain
the harness user is conscious at all times.
- Time in suspension should be limited
to under five minutes. Longer suspensions must have foothold straps or
means for putting weight on the legs.
- Harnesses should be selected for
specific applications and must consider: compliance (convenience),
potential arrest injury, and suspension trauma.
- Tie-off lanyards should be anchored
as high and tight as work permits.
After a fall:
- Workers should be trained to try to
move their legs in the harness and try to push against any footholds.
- Workers hanging in a harness should
be trained to try to get their legs as high as possible and their heads as
close to horizontal as possible (this is nearly impossible with many
commercial harnesses in use today).
- It the worker is suspended upright,
emergency measures must be taken to remove the worker from suspension or
move the fallen worker into a horizontal posture, or at least to a sitting
position.
For harness rescues:
- The victim should not be suspended
in a vertical (upright) posture with the legs dangling straight. Victims
should be kept as nearly horizontal as possible, or at least in a sitting
position.
- Rescuers should be trained that
victims who are suspended vertically before rescue are in a potentially
fatal situation.
- Rescuers must be aware that
post-rescue death may occur if victims are moved to a horizontal position
too rapidly.
Recommendations on harnesses:
- It may be advantageous in some
circumstances to locate the lanyard or tie-off attachment of the harness
as near to the body's center of gravity as possible to reduce the whiplash
and other trauma when a fall is arrested. This also facilitates moving
legs upward and head downward while suspended.
- Front (stomach or chest) rather than
rear (back) harness lanyard attachment points will aid uninjured workers
in self-rescue. This is crucial if workers are not closely supervised.
- Any time a worker must spend time
hanging in a harness, a harness with a seat rather than straps alone
should be used to help position the upper legs horizontally.
- A gradual arrest device should be
employed to lessen deceleration injuries.
- 5) Workers should get supervised
(because this is dangerous) experience at hanging in the harness they will
be using.
Keys for Rescue & EMS Treatment
A patient who is experiencing pre-sync
opal symptoms or who is unconscious while suspended in a harness should be
rescued as soon as safely possible.
- If you cannot immediately release a
conscious patient from a suspended position, instruct them to elevate
their legs and contract their leg muscles periodically.
- Watch for signs and symptoms of
pre-syncope: light-headedness, nausea, sensations of flushing, tingling or
numbness of the arms or legs, anxiety, visual disturbance or a feeling
they’re about to faint. „
- After rescue, do NOT allow the
patient to lie flat (unless CPR is required).
- Do NOT allow the patient to stand
up. Risk of syncope and rapid weakness should be anticipated.
- For a semi-conscious or unconscious
person who has already been placed in a horizontal position, follow
standard first aid guidelines. Do not raise an unconscious or pre-sync
opal patient back to a sitting or standing position.
- Maintain a patent airway and follow
standard procedures for ABCs.
- Administer only minimal fluid via IV
administration in the absence of blood loss. (After 20Ï40 minutes
following the rescue and fluid administration, the rate of infusion can be
increased to facilitate dieresis, as renal failure is a common complication.)
- Hypoglycemia should be corrected
with an IV bolus of 25 g of 50% dextrose-in-water.
- Monitor the ECG for electrical
abnormalities, such as hyperkalemia (peaked T waves, prolonged QT
intervals, widened QRS complexes).
- Monitor the blood pressure. (Hypertension
may indicate hyperkalemia and the onset of crush syndrome.)
- Consider additional drugs (IV
bicarbonate, calcium chloride, albuterol„or insulin).
- Transport in a sitting position for
at least 30 minutes post-release from the vertical motionless position.
NOTE:
This information is presented as guidance only and specific treatment protocols must be adapted for the patient and local policies. The authors base this guidance on published
research and developed rescue protocols and accept no liability for
application or resultant pathology. Specialist advice should be sought as required. Rescue and treatment of suspension trauma requires advanced medical skills and equipment. This is NOT First Aid. In remote areas the priority is to recover
to ground, then keep the
legs lowered and summon advanced
aid with all possible speed.
Reference
·
Seddon
P. Harness Suspension: review and evaluation of existing information. Health and Safety Executive. Research Report 451/2002. 104
·
Health & Safety Executive The
Work at Height Regulations. UK: Her Majesty's
Stationary Office.
·
Dobson J. Put suspension
trauma in perspective.
Post by Indian Safety Association
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