What is Suspension Syndrome? Everything you need to know!

Suspension Syndrome – Suspension Trauma – Harness Syndrome – Harness Hang Syncope

Whether you work at height, climb, rescue people in harnesses or with stretchers – or find yourself hanging around people who could end up suspended – you need to know about life threatening Suspension Syndrome.

What is Suspension Syndrome?

Suspension syndrome is a term used to describe the loss of consciousness and potential subsequent cardiac arrest that can occur from being suspended for extended periods of time. This could be on a rope, in a harness, in a stretcher etc. It can start to occur within 10 minutes of passive hanging. It is rare and a casualty would have to be suspended with little to no movement for it to occur, e.g. unable to reach a wall or structure with their feet. Rescuers are also at risk. 

What causes Suspension Syndrome?

Although numerous cases have been reported there are limited studies available to draw evidence from. Much of its hypothesis on the cause and treatment is based on expert opinion. A leading hypothesis is that suspension syndrome is where blood pools in lower limbs leading to reduced blood return to the heart causing a drop in output (and therefore drop in blood pressure). Other hypotheses suggest a neurocardiogenic reflex may lead to bradycardia (slow heart rate), arterial hypotension (low blood pressure), loss of consciousness and subsequently, cardiac arrest.

Is Suspension Syndrome the same as Suspension Trauma or Harness Hang?

These terms have been used to describe the same sequence of events, however a recent scoping review concluded that “All terms with harness, such as “harness hang syncope” or “harness syndrome” should be avoided, as being in a harness is not a prerequisite to develop suspension syndrome. For example – a person being rescued vertically in a stretcher is also at risk. The review also concluded that all terms with trauma such as “suspension trauma” are inappropriate, because often there is no or only minimal trauma.” A scoping review and recommendations from the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) 2023.

What are the signs and symptoms of Suspension Syndrome?

The scoping review states “For an early diagnosis and a prompt intervention it is important to know and pay attention to the typical signs and symptoms: light-headedness, dizziness, confusion, pale skin, cold sweating, warmth/hot flashes, blurred vision or nausea (feeling sick), bradycardia (slow pulse/heart rate). The orthostatic tolerance varies individually, and symptoms of pre-syncope (fainting) may occur at any time during passive hanging on a rope.”

What’s the treatment for Suspension Syndrome?

A person stuck on a rope is an emergency and needs rescuing quickly.

In a workplace, it’s appropriate to activate emergency response plans early to rescue the person.

If the suspended person is still conscious but unable to self rescue, tell them to keep their leg muscles active if possible as this may reduce the potential for blood to pool in the legs whilst a rescue is initiated. Using specially designed loops typically stored in pouches attached to the harness, allow a suspended worker to stand up, relieving pressure on their legs and improving blood circulation. If these aren’t available a sling, work positioning lanyard or similar may be used.

If climbing or mountaineering, belayers should lower or raise a person who is freely hanging to a place where they can make contact with whatever they are climbing to pump the legs and potentially improve circulation. If this isn’t an immediate option – say in a crevasse rescue where it takes time to set up the rescue, creating foot loops or similar may provide something for the person to push their feet against to improve circulation.

If the casualty is no longer able to act and it is safe to do so, the first rescuer reaching the casualty should protect their airway and raise the victim’s legs to create a more horizontal position as quickly as possible while measures are taken to lower the patient to the ground. Improvisation my be needed with slings etc. to achieve a more horizontal position to reduce the chance of blood pooling in their legs.

Rescue Teams should be properly equipped and trained to recover a person stuck on a rope in the shortest possible time. In a remote environment in the UK, you can activate Mountain Rescue by calling 999, asking for the Police, then Mountain Rescue.

In an urban environment, the Fire and Rescue service may be required to help with a rescue. 

If safe to do so, the suspended person should be rescued immediately and placed in the supine position (horizontal, on their back) so you can start your thorough Primary Survey. The scoping review, 2023, also stated that “previous recommendations suggested not laying a patient down abruptly, but there is no evidence to support this”. 

If there’s also a defibrillator nearby, it’s worth bringing this to the casualty (discreetly) so that it’s ready to be used if they do go into cardiac arrest.

The casualty also needs to be taken to hospital for further assessment.

In summary…

Recommendations for the prevention, diagnosis and treatment of the suspension syndrome have been developed by ICAR – the International Commission for Mountain Emergency Medicine (ICAR MEDCOM):

1. Rope work should be done only with proper equipment and knowledge on how to use it correctly. Rope work should never be conducted alone.
2. Persons suspended in a harness should be rescued as soon as possible, even if the casualty is not showing any symptoms, as time to near or actual syncope (fainting) and potentially cardiac arrest is variable and unpredictable.
3. While awaiting rescue, persons suspended freely on a rope should move their legs to reduce the potential for blood to pool in the legs.
4. If no adjoining structures are in reach, foot loops should be used to step in and increase the activation of the muscle pump.
5. If the casualty is no longer able to act and it is safe to do so, the first rescuer reaching the casualty should raise the victim’s legs to create a more horizontal position while measures are taken to lower the patient to the ground. A wide sling may be useful for this.
6. Once the casualty is on the ground, the casualty should be positioned flat on their back. Assessment and treatment should follow standard basic and advanced life support algorithms. If trained to do so, reversible causes of cardiac arrest, including hyperkalaemia and pulmonary embolism, should be considered, and managed appropriately.
7. After prolonged hanging (over 2 hours), patients are at risk of developing hyperkalaemia and acute kidney injury and should therefore be transported to a hospital with the capability of performing emergent renal replacement therapy.

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If you have any questions or would like to learn or refresh life saving skills, then we’d love to help and you can contact us here. Being able to learn and practice these skills in a safe training environment, with specialist equipment and having the opportunity to ask questions and interact with a knowledgeable trainer – can’t be replaced by a blog!