Does Suspension trauma exist?????

[ando]

The HSE recently announced changes in the thinking in this area. It seems the term 'Suspension Trauma' is not strictly accurate, so they're moving away from that and towards using the term 'harness suspension' or 'pre-syncope'( had to take the dictionary out for that one!).

From the HSE
"Evidence-based review of the current
guidance on first aid measures for
suspension trauma"

The term “suspension trauma” is one, which has developed as parlance amongst
many who work in the fall protection industry and training sector. In an earlier Health
and Safety Executive (HSE) report1 and a number of published articles, suspension
trauma was used to describe the situation of a person falling into suspension on a
rope 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 epithet,
which may be better replaced by the descriptive term “syncope”.

More worrying is the following forum statement from an HSE insider

 We can however emphasize that Lee and Porter's report, and the BMJ article produced off the back of it, both stress more research is needed to draw meaningful guidelines and they can't really say what is or isn't going on until then. The HSE/HSLs position is, without wishing to be rude, that they've spent their money, put together a few bullet points that look OK, so the debate is closed

There's also been a U-Turn in the advice on how to deal with rescued faller - now to be treated as per standard first-aid case (recovery position) and NOT put in seated position............but maybe that's a topic for the medical thread

[Flash]

I have a friend who is a Paramedic and we were discussing this topic only a few days ago. He works in the inner city (can't say where) but has told me that he has been to several cases of suspesion trauma. We discussed that 2 of these where acually unconcious whilst still in situ on the end of a line. it took the fire service 40 minutes to retrieve the body.

Now if there was ever a case to have trained people waiting to prevent seeing you mate die this has got to be it.

I looked at it from another angle. What did my mate ever do to be presented with a dead body that could have been avoided. I think employers really need to look at their responsibilities closer.

[Boris]

There is not enough evidence, just the mechanics.  Elongated suspension Pts tend not to do well.  The more we know, the better we treat.  Legs full of K rich hypoxic and acidotic  blood will stop the heart, end of, on release.  What casues the arrest - the K, the Acidosis or the Hypoxia?  This is crush injury symdome by another name.  Why do we think they are two different conditions?

[The Fly]

Reading some of the threads and being a paramedic myself, I come to the conclusion that time suspended in a harness will no doubt cause compartment syndrome and this is a key thing to look out for. As mentioned in one of the threads, as soon as the harness/tourniquet is released the toxic hypoxic hyperkalaemic blood will be allowed to circulate where it may cause severe shock and possible cardiac arrest. Quick infusion may dilute the effects of compartment syndrome along with high oxygen input, but the K+  balance is hard to get back online in the field and slow release of pressured points may be the key? At height this is near impossible to control as its hard enough to simply rescue! It may be possible to keep the patient upright to avoid the pooled toxins from circulating quickly, or even (against the grain) add slow release tournequet's to both legs? but then there is the problem of vertical transportation to a recieving unit! Any way, keep up the brain storming and I am sure someone will come up with a better rescue technique and treatment for this type of patient. Signing out 'The Fly' alias 'Thermodore'