Suspension Trauma references

References from published literature

We often receive enquiries asking how 'official' the research into suspension trauma is - how many medical studies, who did them, why and when. The usual response is that the literature is extensive, but actually getting hold of a copy is difficult - many publications were closed-issue and are not on the general electronic databases.

The following references are probably the easiest to locate, and the most interesting to consult:-

Lee C and Porter K M Suspension trauma (2007) Emerg. Med J. 2007, No. 24, pp237-238.
A short review of current opinions (such as Madsen, Seddon etc.) and conclusion that more human testing is required to examine the current styles of industrial and sport harnesses, and the physiology at work. Not an article worth paying for, but important to keep the subject active in the journals, given the lack of anything in recent years. There are e-letters replying to this article on the emj.bmj.com website which also contain useful information.
Seddon P HSE Contract Research Report CRR2002/451 Published on HSE website.
A large literature review of past publications including many of those listed here. No original contributions or clinical testing but a useful summary of everything pre-2000. A second HSE research project (JN3547) is due to complete in 2008, which aims to decide if the HSE should or should not release any official guidance. Again this will have no original information or clinical trial data to report, and any guidance will be created by yet another future research project.
Madsen P, Svendsen L B, Jørgensen L G, Matzen S, Jansen E and Secher N H Tolerance to Head-up Tilt and Suspension With Elevated Legs (1997) Aviation, Space and Environmental Medicine, Vol. 69, No. 8, pp781-784. August 1998
Extensive physiological data on compensatory processes in medically fit adults subjected to various static postures, conducted as part of research after several fatalities involving suspension. Includes proof of the knee-raising double strop procedure giving no significant symptoms for at leat 50 minutes.
Orzech M A, Goodwin M D, Brinkley J W, Salerno M D, Seaworth J Test program to evaluate human response to prolonged motionless suspension in three types of fall protection harnesses (1987) Harry G Armstrong Aerospace Medical Research Laboratory, Wright Patterson Air Force Base, Ohio, USA
5 volunteers suspended in various harnesses for up to 30 minutes. 3 reported severe discomfort and one lost consciousness at ~28 minutes.
Patscheider H Pathologico-anatomical examination results in the case of death caused by hanging on the rope (1972) Papers of the Second International Conference of Mountain Rescue Doctors (Austria) (1972) GERMAN
Stulinger W, Dittrich P, Flora G and Margreiter R Circulatory and renal function changes in test subjects suspended from the upper half of the body (1972) Papers of the Second International Conference of Mountain Rescue Doctors (Austria) (1972) GERMAN
Reports of deaths upon release from prolonged suspension, both immediate and in the folowing weeks, led to a series of medically-monitored suspension tests as reported here. Many of the test subjects showed critical circulatory collapse within 30 minutes.
Bernard W, Haselbach H, Scharfetter H, Aigner A and Michaeler R Radiological, blood chemistry and lung function findings in the hanging test (1972) Papers of the Second International Conference of Mountain Rescue Doctors (Austria) (1972) GERMAN
Suspension tests including cardiac radiography while suspended, showing significant respiratory distress and alteration of stroke volume.
Noel G, Ardouin M G , Archer P, Amphoux M, Sevin A Some aspects of fall protection equipment employed in construction and public works industries (1978) FRENCH
Comparative suspension tests in sit, full-body, chest, waist-belt and parachute harnesses, all using a dorsal fixing point and no dynamic event. Apart from chest and waist-belt designs, all styles showed similar results.
Nelson B Climbing harnesses. How long can you safely hang in your harness? (1979) Off Belay Magazine (USA) (August 1979)
Comparative tests of several sit harness designs and one full-body harness, with 65 tests conducted. Mean suspension times tolerated were 0.5 to 17 minutes, with many symptoms reported including narrowing of pulse pressure.
Mallard M et al Secours et prevention en spéléologie et en plongée souterraine (Rescue and prevention in caving and cave diving) (1985; revised and supplemented 1990) published by Medical Commission of the French Federation of Speleologists FRENCH
Includes reports of 12 caving deaths due to suspension on rope.
Amphoux M Hanging after a fall: an extremely urgent rescue (1984) Translated text of a recorded lecture. (Wuppertal, Germany, 1998)
Study of caving sit-harnesses, showing orthostasis was almost certain in any case of prolonged suspension. Tests famously aborted after several volunteers suffered severe symptoms.
Bariod J, Théry B On the pathology introduced by the harness (1984) Medical Commission of the French Federation of Speleologists republished in English in Toronto Caver Magazine May 1994
Pathologie induite par le harnais (Pathology induced by the harness) (1986) Video plus English translation of the French transcript Medical Commission of the French Federation of Speleologists
Videos of the tests conducted by Amphoux et al in 1984
Weber P and Michels-Brendel G Physiologie beanspruchungen beim hägen in Auffanggurten (Physiological limits of suspension in harnesses) (1990) Johann Wolfgang Goethe University, Frankfurt, Germany.
Program to develop rescue techniques for telecommunications workers, following a fatal accident in the same year. Comparative tests of dorsal, sternal and waist attachment points.
Mattern R and Reibold R Optimisation of intercepting devices - Biomechanical stress limits of humans Appendix 5: Part III: Investigation of personal safety equipment to protect against falls (1991) Deutsche Montan Technologie (DMT), Bochum, Germany
Fodisch J Morphological findings in the case of death after hanging on a rope for four hours (1972) Papers of the Second International Conference of Mountain Rescue Doctors (Austria) (1972) GERMAN
Report of death of one female, who died at the point of rescue after 4 hours in suspension. Great detail of the metabolic processes involved including coagulopathy.
Dawes R Suspension trauma - a medical perspective (2000) Technical Rescue, Issue 27 September 2000 (p20)
Basic guidance on the effects and proposed treatment, but critically failing to detail the risks of reflow syndrome and actions needed to prevent it.
Lieblich M and Rensing W Rettung von Abgestürzten und Erste Hilfe nach Hangen im Gurt Rescuing people who have fallen and first aid following suspension in a safety harness (1997) ASvorORT (Magazine) January 1997 (p12)
Includes advice on reflow syndrome and cardiac overload.

Suspension Trauma

References from published literature

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