Will Your Safety Harness Kill You ? - Suspension Trauma

Awareness on Suspension Trauma

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:

1. Workers should never be permitted to work alone in a harness.
2. Rope/cable tenders must make certain the harness user is conscious at all times.
3. Time in suspension should be limited to under five minutes. Longer suspensions must have foothold straps or means for putting weight on the legs.
4. Harnesses should be selected for specific applications and must consider: compliance (convenience), potential arrest injury, and suspension trauma.
5. Tie-off lanyards should be anchored as high and tight as work permits.

After a fall:

1. Workers should be trained to try to move their legs in the harness and try to push against any footholds.
2. 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).
3. 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:

1. 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.
2. Rescuers should be trained that victims who are suspended vertically before rescue are in a potentially fatal situation.
3. Rescuers must be aware that post-rescue death may occur if victims are moved to a horizontal position too rapidly.

Recommendations on harnesses:

1. 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.
2. 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.
3. 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.
4. A gradual arrest device should be employed to lessen deceleration injuries.
5. 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

www.doshti.com