Suspension Trauma : Frequently asked questions

Although our website has been in operation for several years and our staff have been involved in training and policy-making for hundreds of organisations across the world, the general levels of knowledge on the subject are still low and we regularly receive the same questions... so here are some of our replies!

Can you send me copies of the references on your website?: No. Copyright prevents us from distributing anything, but you should be able to locate most of the articles through library loans services, or from the original journal publisher. Only a few of the articles are free online and where this is the case we say so on the references list. Please do not ask for others.
How many cases happen each year?: Nobody knows. In terms of deaths, not that many are reported (mainly due to increased workplace health and safety, but also because many cases are not recognized) and we would estimate between 10 and 100 deaths per year. Very many more people suffer the first stages of suspension trauma but are released before they reach a critical stage, and these cases will number into the thousands or tens of thousands. Often when training people we find at least one in the room can remember feeing the early stages of suspension trauma but until that day hadn't realised what it was!; The cases reported in the literature tend to be centred on non-workplace users, such as those involved in sport climbing, caving or parachuting, where people are often suspended in a harness for long periods on a regular basis. We also see a significant number of cases where there is no harness involvement at all - such as where a person has been trapped in a vehicle following a crash, or has been buried in a free-flowing material such as sand or snow. In some areas of the world these 'entrapment' cases will outnumber the classical harness induced cases by a large margin.
Why is all the research so old?: Insurance! Performing clinical research on human subjects is very difficult these days, especially where the potential for some serious symptoms is predicted. Many researchers contact us asking how they can convince their insurers and funding bodies to let them run more in-depth trials, but end up getting turned down as the research has no obvious financial benefit (there will be no new drugs to sell). We also have problems in doing literature surveys as almost no countries collate and report suspension trauma as a specific industrial illness or cause of death.
Is this all just a load of hype? Why can't you tell me about real cases?: It's certainly not hype, and we know of many real cases where people have been critically ill or have died as a direct result of suspension trauma, but it is of course impossible to provide details that would identify anyone, for patient confidentiality reasons. We receive about 5 emails a month from people reporting that they have experienced the condition in the past. The problem with the public image of suspension trauma is that it's not part of everyday life unless you have a specific hobby or job, so it rarely enters the mainstream media. Governments have spent hundreds of thousands of dollars researching the condition, and it is certainly not an urban myth.
Do I need to train first responders differently?: If you are expecting possible cases of suspension trauma then yes. Normal first aid, EMS, paramedic courses don't mention suspension trauma at all, and so it's important to make sure those people are aware of the symptoms and how to manage them. Details are on our treatment pages.
Should I provide oxygen to a casualty?: Yes, if it's available (there is no real justification for purchasing it unless you need it for another reason, given the fact suspension trauma is relatively rare). You should provide 100% oxygen or the highest possible permitted given your training and experience, and maintain administration until a medical professional has assessed the case.
Is hanging a form of suspension trauma?: No. Hanging primarily causes death by asphyxiation (the aiway is closed and the victim cannot breathe). After death the blood will pool in the legs and cause a classic patten of lividity, but the reason for the death is not due to any redistribution of blood - the asphyxiation happens too quickly.
I hang in a harness all the time and never feel anything. Why not?: Firstly everyone is different, and even the same person will react differently from one day to the next. Most people who hang in harnesses keep some level of muscle activity in their legs (pushing against a wall when abseiling, etc.) and this can be enough to limit the onset of severe symptoms. It is however likely that you are still experiencing mild symptoms, but simply not noticing. One day if you're unlucky that will change.
Is this like the thing when you're rescued from the ocean and faint?: Yes, but in reverse. When someone has been immersed in water for a long time the blood supply adapts to the external water pressure on your body and legs, so when you're suddenly removed the veins cannot constrict fast enough, and a large volume of blood flows into your lower body, often resulting in unconsciousness. This effect is common when recovering shipwreck victims and was the cause of many deaths in the World Wars.
Are you aware of the new article by XXX?: Probably, as we trawl the literature carefully - but we are always very pleased to hear of any new publications, especially if they aren't in general circulation. Contact us using the menu link.
Why hasn't my doctor heard about this?: They aren't trained in suspension trauma as a topic in itself, but their physiology training will allow them to understand it and manage it once they have recognized what's going on. The most important thing to remember is that suspension trauma doesn't have any particularly strange symptoms, so unless you are looking for it, you'll miss it until it's too late.

Suspension Trauma

Suspension Trauma : Frequently asked questions

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