campbell suspension trauma

8/8/2019 Campbell Suspension Trauma

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SUSPENSION TRAUMA

Viki CampbellIntensive Care Paramedic, Registered Nurse

B. Health Science (Pre hosp care), B. Nursing


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Cases In Point

A carpenter working alone is caught inmid-fall by his safety harness, only to die 15minutes later from suspension trauma.

An electrical worker is lowered into a shaftafter testing for toxic gases. He is loweredon a cable and is positioned at the right levelto repair a junction box. After five minuteshe is unconscious-- but his buddies tendingthe line dont realize it, and 15 minutes later

a dead body is hauled out.


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History

Harnesses have been in workplaces andrecreation environments since the early 1970s.

Since then, approximately 100 deaths have beenattributed to suspension trauma.

Discovered in France by Dr. Maurice Amphoux in1978 after several unexplained deaths on ropewhilst caving were attributed to exposure.

Dr. Amphoux concluded that remaining immobilein a harness for as little as 10 mins could be fatal.

In one case the subject lost consciousness in as

little as 3.5 minutes.


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What is suspension trauma?

Suspension Trauma

- The medical effects of immobilisation in a verticalposition

- Medical term is Orthostatic Incompetence

It presents an immediate threat of death toanyone immobilised in a vertical position

- Hanging still in an industrial, theatrical or sportharness

- Stretcher patients, performers, stuntmen, confinedspace workers


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Immobile is important!

Suspension trauma can only affectsomeone who is immobile specificallynot using their leg muscles to any greatextent

It does not normally affect people whowear a harness but who are:-

- Actively moving about (climbing, caving, etc)

- Suspended for only a minute or two(parachutists)

The danger is when someone is unable tomove, or forgets to bother!


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The onset andprogression ofSuspension Trauma arerapid and unpredictable

All those working at

height must be trained in

how to recognise,manage and preventsuspension trauma


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Suspension Traumais also known as

Harness Hang Syndrome.

A SIMPLE FAINT

(SYNCOPE)


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3 pumps for the

blood to circulatearound the body

How does the blood

circulate?


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1. Blood sitting

in veins in the

legs.

2. Leg muscles

contract. Squashing

veins forcing blood

up and down veins.

3. The valves stop the

blood from going back

down so all blood is

pumped upwards.


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After Standing Still for a while bloodstarts to pool in the legs.

Aproximately 60% after 2-3 minutes

Veins become engorged therefore lessblood returning to the heart than

being pumped out causing a drop in

blood pressure and

Less blood to the brain leading to afaint


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SEQUELAE

Blood pools in the legs

Brain detects low O2

Cardiac output increases

Brain O2 still fallsEmergency response:

Pulse drops

Loss of consciousness

Person falls overBlood flows back to

brain

Person wakes up.

Syncopal Episode


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Syncope in a harness

SEQUELAE

Blood pools in the legs

Brain detects low O2

Cardiac output increases

Brain O2 still fallsEmergency response:

Pulse drops

Loss of consciousness

Person CANNOT fall overBrain cells start to die

Person never wakes up.


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How long have you got?

Uninjured volunteers felt dizzy in as little

as 3 minutes

Typically 5 to 20 minutes

Loss of consciousness in as little as 5minutes

Typically 5 to 30 minutes

It is difficult to put a timeline on deaths, however from researchit is clear that death can result in as little as 10 minutes, moretypically between 15 and 40 minutes post-suspension. Death is

more rapid with existing injuries but can happen to anyone.

Anyone immobilised in an upright posture

is in immediate danger of death


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Signs and Symptoms associated with

Suspension Trauma

Signsstart as increased heart rate

proceed to decreased heartrate

sweating

greying or Loss of Vision

Paleness

Symptomsfeeling of passing out

tingling in extremitiesshear panic (not know

why)

extreme pain all over

Breathless

Hot Flushes


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Factors that can increase the risk of Suspension Trauma

Inability to move legs

Hypothermia

Pain

Shock

Injuries during fall

Cardiovascular disease

Fatigue

Respiratory disease

Dehydration

Blood loss


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WHAT ACTUALLY MATTERS? Constrictive leg loops contribute but are NOT

needed Even stretcher patients are at risk.

All makes of harness show almost identical

results Patient age, weight, height, sex and fitness seem

to make little difference to the time it takes beforeyou faint

Stress, panic, injury, smoking/drinking, existingcardiac conditions and illness increase the risks

Al l t hat matt ersi st hat t hel egsarel owert hant heheart andt hel egmusl esarei mmobi l e.

Noot heri nj uryi sneeded.


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Any vertical lifts

must be done in

minimum time.


18/26Photo by Alan Sheehan Oberon SES


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OK SO WE RESCUE THEM!

Not so fast! Theres something important to dealwith:-

The blood that is trapped in the legs may not be invery good condition, and may even kill the personif we let it all pour back into their brain!

This is called the reflow syndrome and ismedically very complicated you will not be ableto control it once it starts, and the patient will die.Luckily you can prevent it from happening if youhandle them with care!


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REFLOW SYNDROME

Pooled blood in the legs is stale after 10-20mins

Drained of oxygen, saturated with CO2

Loaded with toxic wastes (from fat burning process)

Re-elevating the legs returns this to the rest ofthe body in a massive flood

Heart can be stopped

Internal organs (especially the kidneys) can bedamaged

You have to stop this flood of stale blood butstill keep enough tricking to the brain to keep

the person alive!


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Recommended postureas per Graeme Peterson Suspension Traumaat the ARC Conference August 2004

Anyone whoexperiencessuspension

traumashould bekept in asittingposition for atleast 30minutes after

rescue


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Compartmental syndromes

condition in which increased pressurewithin a limited space compromises thecirculation and function of the tissueswithin that space.

This condition is a cause of major loss of

function, limb and even life. Crush injury is the most common cause.

Other Causes include: envenomation

allergy post ischaemic injury

intravenous infiltration burns.

So what is the treatment?


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Using a harness?

Ensure a loose fitwhen not on rope

Never work alone Have a rescue

plan

Practice theexecution of your

rescue plan


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QUESTIONS?

campbell suspension trauma

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