Suspension Trauma

[Bob Mehew]

Thanks Bob. To clarify, the BCA advice is to place in the recovery position following rescue if unconscious; would BCA advise a supine position if conscious?

To confirm, the BCA advice states "A casualty suspended in their harness who is unconscious should be rescued from the rope to a safe position as soon as possible and then laid in the recovery (safe airway) position." Sorry for possible confusion.

 

[ChrisB]

To confirm, the BCA advice states "A casualty suspended in their harness who is unconscious should be rescued from the rope to a safe position as soon as possible and then laid in the recovery (safe airway) position." Sorry for possible confusion.

Thanks, no confusion there, that's what I understood.

What I was asking is whether BCA has any advice on the position that a conscious casualty should be put in, after being rescued to a safe place. For example, should they be encouraged to remain supine, rather than sitting or standing?

 

[Bob Mehew]

What I was asking is whether BCA has any advice on the position that a conscious casualty should be put in, after being rescued to a safe place. For example, should they be encouraged to remain supine, rather than sitting or standing?

Apologies. Simple answer is there is no advice since they are conscious. But the advice does go onto to state "If a person has suffered from symptoms of suspension trauma, then they should seek medical advice immediately after exiting the cave."

 

[BikinGlynn]

I only know a small amount what we have been taught in MEWP training. falling with a fall arrest harness & rear mount point they say you can become unconscious in 3 min.
Again Im not sure there was any evidence to support this, it was the usual H&S training scare tactics I believe

 

[Mark Wright]

Suspension Trauma / Syncope would be the least of anyones worries if they fall out of a cherry picker with a harness and lanyard. More likely to pull the cherry picker over. It doesn't take much force to topple them. I've seen one go over by simply dropping a +/- 100kg weight 60cm into the basket.

 

[Bob Mehew]

I only know a small amount what we have been taught in MEWP training. falling with a fall arrest harness & rear mount point they say you can become unconscious in 3 min.

I suggest you read Paul Seddon's paper. The HSE web site is showing an error message if you try there, so PM me with your email address if you want a copy. Seddon quotes Madsen's work where volunteers were rested on a table angled at 50 degrees from the horizontal held in position by a suitably mounted bicycle seat. He states: "One subject near-fainted after only two minutes".

 

[hannahb]

Whatever it's called (Suspension Trauma was the term back in 2006), it astonished me how quickly it could happen.

From first encountering issues that limited her movement, to becoming unconscious was probably around 15 minutes.

At the time, I was under the belief that she had gone unconscious due to suspension trauma. Is this incorrect? Or is this just incorrect terminology these days? Either way, it was alarming how quickly a tired and stationary caver in a harness can succumb to this and I have always been surprised that it has never been a bigger issue in caving. Anyway, it can only be a good thing for BCA to be making cavers aware.

This is indeed astonishing! I've never heard of anything like this. So glad everyone was ok at the end.

I understand "suspension trauma" to be the ill effects caused by circulation of blood out of the limbs and back into the rest of the system. In DUSA we were taught about it early on and it was taken seriously.

It sounds like what happened in your account was maybe "suspension syncope" which I've never heard of before this thread and didn't know it could happen. Thank you for making us aware!

 

[ChrisB]

I suggest you read Paul Seddon's paper. The HSE web site is showing an error message if you try there

It's available on the archive.org copy of the HSE website here

 

[mikem]

Suspension trauma is any effect of being hung up, the most serious of which is believed to be the backflow of toxins once released (similar effect to people spending long periods in cold water & then dying once rescued) - see links I've posted further back in thread.

 

[hannahb]

Sorry for not following properly mikem, must read more carefully

 

[ChrisB]

the most serious of which is believed to be the backflow of toxins once released … … see links I've posted further back in thread.

My understanding, from your links, is that more recent research has found no evidence that backflow of toxins is an issue, so avoiding it isn't now part of the recommendations, and that the main hazard is that "too much blood gets trapped in your legs and you aren't able to adequately supply your brain with sufficient oxygen".

 

[mikem]

Problem is that they can't suspend people for long enough to find out. But putting someone unconscious in a sitting position risks their airway, which is just as effective a way of finishing them off.

 

[Bob Mehew]

I would urge caution when discussing this topic, even if you do have medical qualifications. My position is based on a letter that Ellerton and others wrote (see https://cjen.ca/index.php/cjen/article/view/122/120 ) in response to a paper by Drew (see https://cjen.ca/index.php/cjen/article/view/18 ) about the topic of recumbent verses supine position. (Note Ellerton's position.) In addition, there is a simple argument of physics that the difference in heights of parts of the body between the supine and the recovery position is small or minimal. In line with the KISS doctrine, the advice went for the recovery position.

 

[sorslibertas]

I found a good systematic review on the topic: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8390355/

"As a take-home message, the basics of STS management can be summarized as follows: (1) remove the person from the rope: be sure that the scene is safe, if the patient can cooperate, ask to move and raise his/her legs; (2) lay the patient flat and start ATLS protocols with no delay: airway, breathing, circulation (ABC), plus hypothermia prevention; (3) oxygen, monitoring, intravenous fluid if available (alternate saline and half-normal saline with added bicarbonate); (4) remove the harness and transport the patient to a facility capable of dialysis if he or she has been suspended passively for more than two hours."

 

[Bob Mehew]

I found a good systematic review on the topic: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8390355/

It was the latest review that I also found in my literature search. Only problem is the conclusion is focused on a medical response and not for your typical caver responding (one hopes) quickly to a developing situation.

 

[i think it goes]

I attended a wilderness first aid course over the weekend and had a great time and learned a lot. Admittedly, the course was not covering suspension trauma so this advice should be taken with a pinch of salt but the topic was brought up. The instructor mentioned a case regarding the army and a drill to do a mid-rope rescue where the pretend casualty actually ended up with suspension trauma after roughly 6 mins due to being fully inverted for this time. Was surprised how fast it could come on!

The instructor went on to say that suspension trauma was treated as a crush injury and about how relieving the pressure on the legs may result in CO2 rich blood rushing back into the core, causing further issues. They suggested that the appropriate course of action was to apply a tourniquet further up the legs (in this case) to replicate the crush injury and then move the casualty to a safe position as quickly as possible - the thinking being that once a tourniquet is applied it should not be removed. This makes sense to me but I also see the idea in other suggestions in the thread. Will have to do more research.

 

[ian.p]

Fundamentally:
- anyone incapacitated on a rope needs to be got of the rope safely without endangering anyone else as quickly as possible.
- anyone who is unconscious needs there airway protecting by being put in the recovery position.
- there are a number of factors at play which could cause the casualty to go into cardiac arrest there is no magic position you can put the casualty into to guard against these.

There is an awful lot of nonsense floating about with regards suspension syncope / trauma because the condition has been very poorly understood for a long time and unfortunately this does extend into industry and first aid training where I have observed trainers training out of date myths out as facts IRATA training is generally ahead of other areas such as confined space / IPAF.

I have a big axe to grind with regards to first aid courses and training around suspension syncope, crush and major bleeding. cavers should be aware that the requirements to provide a first aid course are to hold a first aid course at the level your teaching and some form of teaching qualification (which can be a two day how to plan and deliver first aid courses) as a result the actual level of knowledge held by some trainers is extremely variable from outdoor instructors looking to diversify there income through mountain/cave rescue volunteers to paramedics. I would strongly advise anyone organising a first aid course to check the trainers background and experience before undertaking there course and my advice for cavers would be to use trainers with cave or mountain rescue backgrounds as the most likley to give useful appropriate advice.

 

[ian.p]

Do not put tourniquets on anyone who has been in suspension. that is not going to help and will mean they loose there legs. my biggest axe to grind with first aid instructors is about awful advice with regards to using tourniquets.
Ian Peachey
Assistant underground leader
UWFRA

 

[Ed]

Do not put tourniquets on anyone who has been in suspension. that is not going to help and will mean they loose there legs. my biggest axe to grind with first aid instructors is about awful advice with regards to using tourniquets.
Ian Peachey
Assistant underground leader
UWFRA

Catastrophic bleed - in life threatening situation only.

Generally after direct pressure failure..... Though in some circumstances (within you skill set) first action ie some RTCs

 

[ian.p]

Yes for clarity:
- If someone on a rope has had there leg ripped of by a boulder consider a tourniquet
- if someone has been stuck in there harness for 15 mins do not even consider anything tourniquet related.
Quite apart from anything else how exactly are you going to apply a tourniquet to the leg above a harness leg loop?