A worker falls. The harness catches them. They are now hanging unconscious 4 metres up. The clock has started: roughly 15-20 minutes before suspension trauma becomes life-threatening, then another 10-15 before death. This is the rescue and first aid frame every Irish site needs.
Suspension trauma in 30 seconds
When a person hangs motionless in a harness, leg straps compress femoral veins. Blood pools in the legs. The heart receives less return blood. Cardiac output drops. Brain perfusion fails. This is suspension trauma (also called orthostatic intolerance or harness-induced pathology). It happens fast - much faster than most people expect.
Time matters
- 0-5 minutes: casualty conscious, may complain of leg pain or dizziness
- 5-15 minutes: drowsy, low blood pressure, may lose consciousness
- 15-20 minutes: high risk of cardiac arrest if motionless
- 20+ minutes: rescue must be in progress
In freezing weather, with wet clothing, or for casualties in poor health, the timeline is shorter. Plan for 15 minutes maximum.
The five-step rescue protocol
- Alert. Activate site emergency procedure. Call 999, give the Eircode.
- Stabilise. Talk to the casualty if conscious. Encourage them to "pump" their legs (push against harness leg loops) to maintain circulation.
- Reach. Named rescuer accesses the casualty using on-site rescue device (descender, MEWP, climbing rope).
- Recover. Lower the casualty in a controlled descent. Keep them as upright as possible during transit.
- Position and treat. Once on the ground, follow the recovery position guidance below.
The recovery position - the controversial bit
For decades the standard advice was "lay the casualty flat" after a suspension event. Modern guidance is more nuanced. The current consensus from HSE UK, ERC, and the Irish Resuscitation Council:
- If the casualty is conscious and breathing: sit them up at 30-45 degrees for the first 30-60 minutes, then gradually lay them flat
- If the casualty is unconscious: standard recovery position, watch for cardiac arrest
- If cardiac arrest occurs: standard CPR, get the AED on
The reason for the gradual recovery: laying the casualty completely flat too quickly returns the pooled, cold, deoxygenated leg blood to the heart in one slug. Some sources call this "rescue death". Modern guidance: gradual return to flat over 30-60 minutes if the casualty's condition allows.
Trauma straps and self-rescue
Harness manufacturers now provide trauma straps - small webbing loops attached to the harness that the casualty can stand into. This relieves pressure on the femoral veins and buys 30-60 minutes. Train your workers to deploy them: it could be the difference between full recovery and a hospital admission.
When CPR is needed
If the casualty is unresponsive and not breathing normally:
- Start chest compressions immediately
- 30 compressions to 2 rescue breaths
- Get the AED on
- Continue until paramedics arrive
Other fall injuries to assess
If the fall arrest activated, the casualty may have:
- Spinal injury from the deceleration spike (especially if the system bottomed out)
- Internal injury from the harness loading - kidney, liver, spleen
- Limb injury from striking the structure during fall
- Psychological trauma - mandatory follow-up after any fall
Always treat as if a spinal injury is present until cleared in hospital. Do not move the casualty unnecessarily once on the ground.
Equipment that must be on every site
- Rescue device (descender) sized for the working height
- Trauma first aid kit
- AED within 3 minutes
- Casualty stretcher (full body if possible)
- Trauma straps fitted to every harness
- Comms with 999, Eircode posted at access
The training piece
The Working at Heights Course online covers suspension trauma awareness, rescue planning, recovery position and the 5-step rescue protocol. Pair with a 2-day approved First Aid + AED course for crew leaders. 45 minutes online, 35 euro, instant Working at Heights Certificate.
FAQs
Can I rely on the ambulance arriving in time?
For most Irish urban sites, ambulance ETA is 8-15 minutes. For rural sites it can be 25+ minutes. The ambulance is reinforcement - your on-site rescue must work without it.
Is suspension trauma actually common?
Suspension events are uncommon. Suspension trauma deaths are rare, mostly because rescue happens fast. The 15-minute window is what makes it survivable.
Do I need to retrain rescuers every year?
The rescue protocol should be drilled in toolbox talks every shift. Formal rescue training renewed at least every 2 years.
Make sure every site has the protocol drilled. Start the Working at Heights Course online for the whole crew, 45 minutes, instant Working at Heights Certificate.
