Suspension trauma

Suspension trauma, also known as orthostatic intolerance or harness hang syndrome, can occur due to a natural physiological reaction when an individual remains upright while unable to stand. Workers may find themselves in this position after their personal protective equipment (PPE) stops a fall and prevents impact with the ground. A worker’s risk of serious injury or death from suspension trauma begins soon after their fall is arrested.

Fall protection typically consists of a harness and lanyard attached to an anchor point. When this system arrests a worker’s fall, the individual is often left suspended in an upright position, with their legs dangling and partially immobile.

This vertical orientation, combined with the lack of leg muscle contractions and the pressure on the individual’s veins from the harness, can cause blood to pool in the worker’s lower extremities instead of recirculating. With reduced circulation, the worker’s brain and vital organs may be deprived of oxygenated blood, potentially resulting in unconsciousness, organ damage or death in a matter of minutes. Thus, reacting quickly and utilizing suspension trauma prevention strategies are essential to keep workers safe.

Maintaining a comprehensive fall rescue plan, equipping workers with trauma relief straps and providing regular training on fall protection can help prevent suspension trauma.

Fall rescue plans—These plans can help ensure suspended workers are retrieved quickly. Fall rescue plans should be documented and include detailed information on promptly rescuing a worker after a fall. They should address procedures for:

• Self-rescue—When a suspended worker can safely lower themself to the ground
• Assisted rescue—When a rescue worker helps retrieve a suspended worker

These plans should discuss different situations, such as when the suspended worker can assist rescue workers and when they cannot (e.g., due to lack of equipment or unconsciousness).

A fall rescue plan should describe the types of rescue equipment (e.g., lifts, ladders), what is available on-site, how and when to use such equipment, and where it is located. Plans should include where to find medical equipment (e.g., first-aid kits) and contact information for key personnel, authorized rescuers, those trained in first aid, safety managers, nearby hospitals, first responders and OSHA.

Trauma relief straps—These devices can be useful tools to help prevent suspension trauma. Trauma relief straps are attached to safety harnesses and can be deployed by a worker after an arrested fall. When uncoiled, they make a loop that allows the individual to push their legs against and simulate standing. This results in leg muscle contractions and pressure relief, which can improve blood circulation.

Training—Regular training is essential for preventing suspension trauma. Employees need to know how to respond if a fall occurs. Individuals who work at height and rescue workers should be trained on various topics, including:

• Suspension trauma, how it occurs and how to recognize it
• The need for suspended workers to be rescued as quickly as possible to reduce the risks associated with suspension trauma
• Factors that increase the risk of a worker experiencing suspension trauma (e.g., the environmental conditions, suffering an injury during the fall)
• Hazards that cause falls at a job site
• Types of personal fall protection equipment and how to use them
• Fall rescue plans and how a worker can reduce risks while suspended (e.g., pumping legs to improve circulation and utilizing trauma relief straps)
• Signs of suspension trauma

Additionally, rescue workers should be trained on keeping an unconscious worker’s airway open, as well as treating and monitoring the worker after rescue since the effects of the event may not be immediately detectable.

Ehdinsurance.com – 3 ways to prevent suspension trauma
ARTBA – The American Road & Transportation Builders Association