What is the first aid treatment for suspension trauma?

React First teaches in accordance with current guidelines.  Since September 2008 HSE guidelines are that when dealing with suspension trauma no change is to be made to the standard UK Resuscitation ABC management if the casualty has been subject to prior harness suspension.

This means that for an unresponsive casualty the treatment remains the same regardless of whether they have been previously suspened in a harness; they should be placed in a safe airway (recovery) position.

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What is Suspension Trauma?

"The term “suspension trauma” is one that has developed as a parlance amongst many who work in the fall protection industry and training sector. It is used to describe the situation of a person falling into suspension in a harness and then becoming unconscious. In this scenario the loss of consciousness is not due to any physical injury, but rather, it is thought that orthostasis, motionless vertical suspension, is responsible. “Trauma” is therefore an inappropriate term which may be better replaced by the descriptive term “syncope” which is the sudden transient loss of consciousness with spontaneous recovery, as may occur with a simple faint." - HSE 2008

Due to the fact that gravity is strong and blood is viscous veins in the legs needs to be squeezed from outside by muscle contractions to pump blood up out of the legs and return it to the rest of the body. Evolution has moved veins in legs between muscles, so they can be squashed and released over and over as we walk to carry out this action.

But there is a design fault with the adult human body, If you can't use your legs or move them you will eventually faint as bllod collects in your legs and is not returned to the rest of the body and, most essentially, the brain.

Normally when you faint you will fall over, blood will rush back to the brain and all is well but if you are prevented from falling over your brain waits to wake up, it waits, it waits, it dies waiting!

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What is the First Aid Treatment for Suspension Trauma?

In Spetember 2008 the HSE issued the following guidelines for First Aiders responding to harness suspension incidents:

Following completion of an evidence based review of published medical literature, HSE has clarified guidance on the first aid management of a person falling into suspension in a harness who may develop 'suspension trauma'.

The key recommendations are:

• No change should be made to the standard first aid guidance for the post recovery of a semi-conscious or unconscious person in a horizontal position, even if the subject of prior harness suspension.
• No change should be made to the standard UK first aid guidance of ABC management, even if the subject of prior harness suspension.
• A casualty who is experiencing pre-syncopal symptoms or who is unconscious whilst suspended in a harness should be rescued as soon as is safely possible.
• If the rescuer is unable to immediately release a conscious casualty from a suspended position, elevation of the legs by the casualty or rescuer where safely possible may prolong tolerance of suspension.
• First responders to persons in harness suspension should be able to recognise the symptoms of pre-syncope. These include light headedness; nausea; sensations of flushing; tingling or numbness of the arms or legs; anxiety; visual disturbance; or a feeling they are about to faint. (Motionless head up suspension can lead to pre-syncope in most normal subjects within 1 hour and in a fifth within 10 minutes.)

[ref: https://www.hse.gov.uk/firstaid/whats-new/harness.htm ]

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Myth Busting

Following completion of an evidence based review of published medical literature on the effects of a fall triggering harness suspension, HSE confirms that no change should be made to the standard first aid guidance for the post recovery of a semi conscious or unconscious person in a horizontal position, even if the subject of prior harness suspension.

The literature review was completed in September 2008 and "revealed no documented cases of suspension trauma occurring during industrial use of fall protection."

When contemplating working at height, and in particular when considering the use of a fall arrest system, employers need to consider any emergency or rescue procedures that may be required and the drawing up of an emergency and rescue plan.  It is not acceptable just to rely on the emergency services. Emergency procedures need to be considered for reasonably foreseeable circumstances. The measures need to be covered in the risk assessment and planned prior to the work activity being carried out. The key is to get the person down safely in the shortest possible time and before the emergency service response. If employers cannot do this, then harness work is not the correct system of work. Motionless head up suspension can lead to pre-syncope [light headedness; nausea; sensations of flushing; tingling or numbness of the arms or legs; anxiety; visual disturbance; or a feeling they are about to faint] in most normal subjects within 1 hour and in a fifth within 10 minutes.

[ref: https://www.hse.gov.uk/research/rrhtm/rr708.htm]

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Downloads

RR708 Evidence-based review of the current guidance on first aid measures for suspension trauma

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