Suspension Trauma = Intolerance

One of the dangers I have been warned about in this industry is “If you fall, in 15 minutes you will develop Suspension Trauma and can die”. I never questioned it a lot. It seemed like an old-wives tale, so I never gave it much thought. When I took my first rescue class outside of the company, we were told we had 15 minutes to get the person off the tower, and to curl the person in a supine position immediately after getting them off the tower. And that some companies taught to not lower the person right away. To gradually lower the person to restore blood-flow.


This is when I started looking into “Suspension Trauma”. I thought it seemed like a strange concept. As a climber I have spent a lot of time suspended from ropes. I had never heard of this condition before coming to the tower industry. When you Google Suspension Trauma, you are immediately inundated with companies selling many aides to help prevent it. The rationale is that harness straps cause blood to clot in the legs. When the blood is released the clots can make their way to the heart and kill you. This sounded suspiciously like the murder-mystery plot of injecting an air bubble into a person and causing death. When I asked fellow climbers who were doctors and surgeons, they unanimously agreed that this scenario does not fit how we understand human physiology today.


The concept of Suspension Trauma came about in the 60’s. After several mountaineers died days after being rescued from their ropes. DBI in conjunction with the Armed Forces did a brief study. The study only involved a handful of subjects, and the results were not conclusive. In the 90’s a death after a rescue from suspension in Australia was also labelled Suspension Trauma. This prompted a paper to be published by the Emergency Medical Journal detailing how Suspension Trauma could lead to death. OSHA recognized this paper in 2004 and edited it in 2011.


It is very hard to find actual data on this topic. One researcher inquired of IRATA (Industrial Rope Access Technicians Association) for data. IRATA is known for diligently logging every occurrence from an injury to a dropped tool. Out of 4.8 million hours logged on ropes, they had none.


The phenomena that the rescue community is speaking about is more accurately called “Suspension Intolerance”. It is essentially Orthostatic Intolerance: What we see in students or soldiers who stand for long periods. The human body does not handle remaining upright for long periods without movement. The lowering of blood pressure reduces blood flow to the brain and can cause a person to faint. Also known as syncope. But there is a big leap from fainting to death in 15 minutes.


The same journal that OSHA used to write its original statement published new findings in 2009. Refuting the idea that being suspended will cause death to the person.


“This suggestion is not supported by the original series that demonstrated sudden deaths after rescue nor by modern understandings of physiology. Search-and-rescue teams and party members assisting a colleague suspended unconscious on rope should follow standard resuscitation measures to restore circulation to vital organs immediately.”

Roger B. Mortimer, MD, Emergency Medical Journal 2009;26[12]:896


In essence, most doctors agree that a person may have other medical issues that can contribute to death and may be exacerbated by hanging in a harness, but the physical act of hanging in a harness for an extended period or syncope is not the actual cause of death. If I were to ride a rollercoaster, for example, and die of a heart attack, we would say I had a pre-existing condition that was exacerbated by the rollercoaster.


The most thorough study was completed in two phases in 2012 by C.A.M.P. and the University of Milan Bicocca (Department of Health Sciences, Clinical Physiology and Sport Centre). In this study, Project Sospesi (suspended), 40 participants were suspended from different harnesses for up to 54 minutes. The project included climbers, athletes, and sedentary persons. During Project Sospesi, 4 people succumbed to syncope. They also collected data showing that the syncope was not caused by the harness straps, but by the same factors that contribute to orthostatic intolerance.


One of the factors that can also lead to syncope is our 100% tie-off point. The United States is unique in the way that we use our harnesses. In other countries, climbers use the dorsal connection for rescue only, and are warned against using it as a tie-off point because it can cause greater injury during a fall and it hinders the climber’s ability to perform a self-rescue. Hanging from the dorsal connection keeps the body more vertical, and thus makes the person more susceptible to syncope. This is something we should keep in mind when training and performing rescues. If a person has succumbed to syncope or appears to be losing consciousness, then perhaps it would be beneficial to connect to the person’s sternal attachment to change the body position and encourage blood flow.


Is the belief that a fallen worker’s life is in mortal danger if they are not quickly evacuated to the ground? Of course not. But what happens when the person reaches the ground should be treated appropriately. The person should not be hung or placed in a supine position unless we are aware of prior medical conditions that are unique to the victim. In all other instances, we should follow standard protocol for dealing with an injured person. At Meridian Blue Construction, we follow American Red Cross protocols. If a person is unconscious but is breathing and has no other life-threatening conditions, they should be placed in the recovery position. If the person is uninjured and conscious, doctors advise that elevating the legs can help to encourage blood flow.


For these reasons, we need to start thinking of “suspension trauma” as “suspension intolerance”. A harness should be properly fitted for both work and rescue. We need to recognize that though the victim may have suffered a medical trauma as the result of an injury that may have caused the fall, or that medical trauma may be brought on by past medical conditions, the trauma is not in itself caused by the fall. But the body may be intolerant to being suspended for a long period of time. If syncope is the result of orthostatic intolerance after the fall it may introduce further complications. Part of any rescue program needs to be making sure that we are abreast of the latest research when it comes to our industry, and following sound medical practices as prescribed by medical professionals.

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