WAH/Rope Access/TBT-WAH-059

Suspension Trauma

Working at Height › Rope Access › Suspension Trauma

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Suspension trauma occurs when a person is held upright and motionless in a harness after a fall arrest.
Blood pools in the legs due to harness straps compressing the femoral veins, reducing return to the heart.
Loss of consciousness can occur within 5 to 15 minutes of suspension without leg movement.
Death from suspension trauma can occur within 30 minutes if the worker is not rescued promptly.
The Work at Height Regulations 2005 require a rescue plan before any work using fall arrest begins.
Suspension trauma is also called orthostatic intolerance or harness hang syndrome.
Even after rescue, laying a suspension trauma casualty flat can cause sudden cardiac arrest (rescue collapse).
Rescued casualties should be placed in a seated or W-position and monitored until paramedics arrive.
Trauma straps fitted to harnesses allow the suspended worker to stand in the straps and pump blood.
Every worker who wears a fall arrest harness must understand suspension trauma and the rescue plan.

Rapid fatality	Death from suspension trauma can occur within 30 minutes — rescue must be planned and practised before any work at height.
Post-rescue collapse	Laying a rescued casualty flat causes a surge of pooled blood to the heart, potentially triggering cardiac arrest.
Legal requirement	The Work at Height Regulations 2005 mandate a rescue plan for every activity involving fall arrest harnesses.

Don't

Ensure a rescue plan is in place and briefed before using any fall arrest harness.
Carry trauma straps on your harness and know how to deploy them if suspended.
Practise the rescue procedure with your team before starting any work at height.
If suspended, pump your legs continuously to maintain blood circulation throughout.
Raise the alarm immediately if you see a colleague suspended after a fall arrest.
Rescue a suspended worker within 10 minutes maximum using the planned method.
Place the rescued casualty in a seated or W-position — not flat on their back.
Monitor the casualty continuously and call 999 even if they appear to recover.
Inspect harnesses regularly for correctly attached and accessible trauma straps.
Include suspension trauma awareness in every harness training and refresher session.

DON'T begin work at height in a harness without a rescue plan in place.
DON'T hang motionless if suspended — keep pumping your legs to maintain circulation.
DON'T delay raising the alarm if a colleague is suspended after a fall arrest.
DON'T lay a suspension trauma casualty flat on their back after rescue.
DON'T assume the rescued worker is fine because they are conscious and talking.
DON'T remove trauma straps from harnesses to save weight or for comfort reasons.
DON'T rely on the emergency services alone — rescue within 10 minutes is critical.
DON'T send the casualty home — they must be assessed at hospital after rescue.
DON'T skip rescue plan rehearsals because the team has done them before.
DON'T forget that suspension trauma can kill a healthy person in under 30 minutes.

See also: Fall Arrest and Restraint Systems | Rescue Plan Requirements

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