Suspension Trauma

Suspension Trauma

There’s been a lot of debate about Suspension Trauma also known as suspension intolerance, harness suspension trauma, harness hang syndrome, suspension syndrome, orthostatic intolerance and a few other names I’ve heard over the years.

Something else that has been debated is the first aid treatment. I’ve heard once again a variety of treatments, however when ask about it, most don’t know where the got the information from, they were just told it on their initial training, they googled it or simply its what is on the PowerPoint presentation so that’s what they tell the students.

This can be very dangerous as if you use an invalidated technique you could actually end up doing more harm to the casualty. One example I’ve heard often, even by medical professionals is for rescuers to maintain the victims in a sitting position and avoid laying them flat for 30 minutes. There is NO EVIDENCE to support this practice as a treatment of suspension trauma and it may be harmful. Care of the airway takes precedence over any injury. This is straight from the Australian Resuscitation Council  Guidelines in bold and outlined underneath the management of suspension trauma.

So just to clear it up this is straight from the Australian Resuscitation Council/Guidelines/Section 9.1.5 available from https://resus.org.au/the-arc-guidelines/

Update as of April 2021

Summary

Who does this guideline apply to?

This guideline applies to adults, adolescents and children
Who is the audience for this guideline?
This guideline is for use by bystanders, first aiders and first aid training providers

Recommendations

The Australian and New Zealand Committee on Resuscitation (ANZCOR) makes the following recommendations:
1. Send for an ambulance [Good Practice Statement]
2. Rescue the person and place in a lying position as soon as it is safe to do so [Good Practice Statement]

Abbreviations Abbreviation Meaning/Phrase

ANZCOR Australian and New Zealand Committee on Resuscitation

ANZCOR Guideline 9.1.5 – First Aid Management of Harness Suspension Trauma

Introduction

Suspension trauma, or orthostatic shock, has been reported to affect people who are suspended within a body harness for a prolonged period of time (more than 10 min).1,2,3 It may result in loss of consciousness or death. This is thought to occur as a result of low blood pressure due to blood pooling in the legs combined with an increase in the activity of a part of the nervous system that slows the heart (vagal tone).

Recognition

The signs and symptoms of suspension trauma are the same as shock. Harness suspension trauma should be considered where the person has been suspended by a harness, and are exhibiting any of the following:4
• feeling faint or dizzy
• breathlessness
• sweating
• looking pale
• nausea
• low blood pressure
• loss of responsiveness

Management

Call for an ambulance.
• If safe to do so, free the person from the harness.
• If not responding, manage as per ANZCOR Basic Life Support flow chart [Refer to ANZCOR Guideline 8]
• Rest the responding person in a position of comfort, ideally lying down, and provide reassurance.
• Loosen or remove harness.
• Administer oxygen if available.
• Look for and manage any associated injuries, particularly for those who may have fallen or been electrocuted.
• Monitor level of response and breathing at frequent intervals

Some agencies have previously recommended that those with suspension trauma are maintained in a sitting position and avoid lying flat for 30 minutes. This review has found no evidence to support this practice and it may be harmful.

Further Reading
• ANZCOR Guideline 3 Recognition and First Aid Management of the Unconscious Person
• ANZCOR Guideline 4 Airway
• ANZCOR Guideline 8 Cardiopulmonary Resuscitation
• ANZCOR Guideline 9.1.6 Management of Suspected Spinal Injury
• ANZCOR Guideline 9.2.3 Shock

Guidelines superseded:
ARC Guideline 9.1.5 – July 2009

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