First aid management for harness suspension when working at height

Following completion of an evidence based review of published medical literature on the effects of a fall triggering harness suspension, HSE confirms that no change should be made to the standard first aid guidance for the post recovery of a semi conscious or unconscious person in a horizontal position, even if the subject of prior harness suspension.

The sometimes quoted suggestion of recovery in a semi-recumbent or sitting position was considered to be without any sound evidence base and may prove dangerous through prolonging the lack of blood return to the brain.

When contemplating working at height, and in particular when considering the use of a fall arrest system, employers need to consider any emergency or rescue procedures that may be required and the drawing up of an emergency and rescue plan.  It is not acceptable just to rely on the emergency services. Emergency procedures need to be considered for reasonably foreseeable circumstances. The measures need to be covered in the risk assessment and planned prior to the work activity being carried out. The key is to get the person down safely in the shortest possible time and before the emergency service response. If employers cannot do this, then harness work is not the correct system of work. Motionless head up suspension can lead to pre-syncope [light headedness; nausea; sensations of flushing; tingling or numbness of the arms or legs; anxiety; visual disturbance; or a feeling they are about to faint] in most normal subjects within 1 hour and in a fifth within 10 minutes.

A report of the review and the full list of recommendations will be published shortly on the HSE website. Notification of when, will be posted on the latest news page.

See also:

• Basic advice on first aid at work

The other key recommendations on advice to first aiders responding to harness suspension incidents are:

• No change should be made to the standard UK first aid guidance of ABC management, even if the subject of prior harness suspension.
• A casualty who is experiencing pre-syncopal symptoms or who is unconscious whilst suspended in a harness should be rescued as soon as is safely possible.
• If the rescuer is unable to immediately release a conscious casualty from a suspended position, elevation of the legs by the casualty or rescuer where safely possible may prolong tolerance of suspension.
• First responders to persons in harness suspension should be able to recognise the symptoms of pre-syncope. These include light headedness; nausea; sensations of flushing; tingling or numbness of the arms or legs; anxiety; visual disturbance; or a feeling they are about to faint.

The literature review revealed no documented cases of suspension trauma occurring during industrial use of fall protection. The term “suspension trauma” is one that has developed as a parlance amongst many who work in the fall protection industry and training sector.  It is used to describe the situation of a person falling into suspension in a harness and then becoming unconscious. In this scenario the loss of consciousness is not due to any physical injury, but rather, it is thought that orthostasis, motionless vertical suspension, is responsible. “Trauma” is therefore an inappropriate term which may be better replaced by the descriptive term “syncope” which is the sudden transient loss of consciousness with spontaneous recovery, as may occur with a simple faint.