In 2016, it is estimated that 991 construction-related deaths occurred. Deaths as a result of fall topped the list, accounting for 39% of deaths.

While one may think that this number applies exclusively to deaths as a result of impact with the ground, former firefighter and current Pearl Engineering safety consultant Scott Burkart points to another less-known reason contributing to these deaths: suspension trauma.

Suspension Trauma and Inherit Dangers

Suspension trauma can occur following a fall if the victim is wearing a fall arrest device, a full body harness. While these devices can prevent free fall, the harnesses and straps can cut off the femoral vein and impede blood flow from properly circulating through the body. One of the contributing factors in the onset of suspension trauma is improper size or adjustment of the harness.

Gravity pulls blood down, pooling in the lower part of the body and without a proper way to pump the blood back up the body, as would normally happen as you walk or push on solid ground, blood flow back to the heart and other vital organs is drastically reduced.

These blood flow issues can result in cardiovascular shock, lightheadedness, the victim falling unconscious and even suffocating. Most problematic of all, these symptoms can occur within just 10 to 15 minutes. Death can quickly follow as fast as 30 minutes following the fall.

While safe from a free fall, once a victim wearing a fall arrest system is freely suspended, they are on a ticking clock and the race to rescue needs to be prompt and precise. Scott points out that while many construction and general industry sites have a fall protection plan in place, few precisely have a plan in place to cover a timely rescue from fall arrest.

This being the time of year where companies are updating and examining their plans and procedures, here’s what you need to know about implementing a and speedy and proper fall arrest rescue plan.

Fall Protection and Rescue Plan Basics

Every fall protection and rescue plan needs to include two things:

  1. How to prevent a fall
  2. How to SUCCESSFULLY rescue a fall victim

Scott puts extra emphasis on the second point, in that every plan needs to be designed to end in a successful rescue and that includes an effective rescue that can remove the worker in time to prevent additional injury or add to the cascading effects of being suspended in a harness.

Every plan needs to be site-specific, meaning there is no standard template to follow. Every plan must include different fall protection mechanisms, rescue equipment, rescue procedure and must take into account the risks specific to the environment. However, all plans must be designed to execute a successful rescue in less than 30 minutes or sooner to minimize additional injury done from suspension.

If your Rescue plan is “call 911”, it is not adequate. Most fire departments don’t have time to practice the rescue of a suspended worker at height. Many have limited rope access training. Ladder trucks, trained high angle rescuers, or other support equipment could be miles and many minutes away. Before any trained worker dons a fall protection harness to perform a task at height their rescue should already be determined in advance.

Stating that you call “911” is not a rescue plan. Please consider, when was the last time you asked your local rescue service out for a visit to pre-plan a rescue on your property? Take accountability for their safety and your workers safety close this gap quickly.

Based on the site, fall protection mechanisms may range from simple guardrails to fall restraints, equipment used to help workers avoid working at heights altogether, to fall arrest systems (anchor points, body harness, connecting device, and decent control device).

Devices used to initiate a successful rescue will also vary depending on the site. These can range from self-rescue, assisting rescue devices, using a ladder, a scissor or boom lift, or a trained “go-type” rescue team.

There are also systems available for self-rescue for the victim but need to be carefully considered. Automatic decent devices may be installed on harnesses, but if the victim is above a potential risk, lowering into the risk may only prove to worsen the situation. Similarly, self-controlled decent devices are available, but the operator must be conscious to use.

One device that Scott highly recommends and can find a place in most fall protection and rescue plans, is the use of a suspension strap. Attached at the hips of a fall arrest harness, this strap gives the user a place to position their feet and shift weight off the harness obstructing the femoral vein. This strap gives a point of resistance for legs to help pump blood back to the heart and vital organs.  All fall arrest harnesses should be equipped or retrofitted with suspension straps.

After the Rescue

When it comes to suspension trauma, the rescue isn’t necessarily over once the victim is back on solid ground. Suspension trauma victims are at risk of certain lingering effects and therefore need to be closely monitored and cared for by medical professionals once they have been rescued.

However, the proper post-rescue procedure is somewhat up for debate.

Stagnant, de-oxygenated pooling blood may harmful bi-products that, if recirculated throughout the body and vital organs too fast can be dangerous. Therefore, it is recommended from one school of thought that keeping the victim seated upright so that blood can slowly recirculate and not overwhelm the heart and other vital organs. The victim can then be slowly returned to a supine or horizontal position.

However, some studies contradict this theory instead suggesting that a prompt return to a horizontal position is important to simply get circulation back on course.

OSHA does not take a strong stance one way or the other, meaning there is no “prescribed’ way to treat a suspension trauma victim after rescue. Consult your local medical professional to determine what protocol is used in your area. What is more important is simply monitoring the victim closely and adapting to the situation based on their status.  A prompt rescue to get the victim down is most important.

From his years as a firefighter, Scott Burkart is qualified to help businesses and construction sites plan and implement these kinds of fall protection and rescue plans as well as training rescue teams. His services are available as a consultant, inspector and educator of several fall safety and prevention courses and training sessions.

For questions or inquiries, contact Scott at