Suspension trauma is an emergency medical shock condition that can also be described as orthostatic shock. In this condition, the victim hangs in an upright position so that his blood pools in his drooping legs. If he is moved too quickly to a lying position, death can result.
What is suspension trauma?
Suspension trauma is a shock that can occur from prolonged hanging in a harness. In a harness, the victim is forced to maintain an upright posture. His or her extremities usually hang downward. This posture can cause blood to pool in the extremities due to gravity. If the affected person is released from his upright position, then this release can result in a so-called rescue collapse, as the circulatory regulation cannot cope with the rapid change in posture. The phenomenon of suspension trauma has been known since the 1970s and is a rather rare event. Nevertheless, several deaths have been documented since its discovery that are believed to be solely attributable to this phenomenon. Amphoux, a medical doctor, first described suspension trauma in connection with cave explorers who had suffered only a minor fall and mysteriously died anyway as a result of the fall.
Causes
When a person changes from a lying position to a standing position, this can cause about 600 milliliters of blood to pool in the veins of the legs. Arterial blood pressure and cardiac output briefly decrease with this phenomenon. The body reacts to this phenomenon by constricting the blood vessels. The heart rate increases and catecholamines are released. The blood vessels of the brain are equipped with self-regulating mechanisms and thus ensure blood flow. However, if there is not enough counter-regulation, then the cerebral blood flow is extremely reduced. As a consequence, dizziness occurs. However, orthostatic shock does not occur as a result, because the affected person sits down or moves into a lying position at the first dizziness or a feeling of faintness. In this way, the orthostatic change is compensated again. No compensation can take place in a belt system. The counter-regulatory mechanisms of the organism are overtaxed and the blood redistributes. A volume deficiency occurs, which can even be exacerbated by constrictions caused by the belts.
Symptoms, complaints and signs
The symptoms of suspension trauma are to some degree individual. In particular, the time of onset over time is determined by the individual’s constitution. As a rule, the first symptoms appear after a minimum of one minute and a maximum of 20 minutes. The affected persons become pale in the face. They begin to sweat and feel dizzy. The legs usually become numb after some time. Other false sensations also sometimes occur. Often, those affected suffer from swelling nausea, which can increase to vomiting. Shortness of breath and dizziness also occur. Disturbances of the perceptual system may occur. Visual disturbances occur most frequently. Sometimes, in addition, there is a bloodless bloodletting at the attachment sites of the belts. Even necrosis or varicose veins may occur spontaneously at the strangulation sites. The pooled blood in the extremities may possibly contain toxic substances, as seen in postischemia syndrome.
Diagnosis and course of the disease
Diagnosis of suspension trauma is usually made by extrication teams and paramedics and is based on visual diagnosis and vital signs. Making the diagnosis at the scene is imperative for a favorable outcome, as the victim should not be moved too rapidly to the supine position. Too rapid repositioning can lead to cardiac death because of overtaxing of the heart muscle.
Complications
If suspension trauma is not treated, the patient will usually die relatively quickly. For this reason, prompt medical treatment of the trauma is necessary to prevent secondary damage and patient death. The longer the patient is attached to the harness, the more discomfort and complications usually occur. Vomiting and severe nausea occur, and the patient continues to suffer from dizziness and gasping for breath.Malfunctioning sensations and paralysis occur in various regions of the body and the quality of life decreases sharply. Furthermore, severe visual disturbances also occur, although they return to normal with treatment. The general condition of the patient deteriorates and after a few minutes the affected person usually loses consciousness and faints. Complications can occur if the patient is moved too quickly during treatment. In this case, the heart can become overloaded and cardiac death occurs. In many cases, resuscitation is necessary if the suspension trauma has lasted for a long period of time. It cannot be predicted whether there will be permanent damage to the patient as a result of the suspension trauma.
When should you see a doctor?
An emergency physician must be alerted immediately if suspension trauma is suspected. The trauma is a medical emergency that should be treated immediately and then requires a comprehensive examination in the hospital. If symptoms such as numbness, nausea and vomiting, or shortness of breath occur a few minutes after an accident, often associated with external injuries, emergency medical services must be called. Visual disturbances, dizziness and pain may also be warning signs that require prompt evaluation. Externally, a hanging trauma can be recognized by the pale color of the face and the sweating that usually occurs. In addition, if the legs or other limbs become numb, a physician should be alerted. First responders must provide first aid until a physician is available. After a suspension trauma, the victim must spend several days to weeks in the hospital, depending on how severe the injuries are. After discharge from the hospital, regular checkups with a physician are indicated, as complications can still occur weeks later.
Treatment and therapy
Recovery of the patient is the first step in the treatment of suspension trauma. The victim should be positioned in an upright position for the next 20 minutes. If this principle is ignored, the orthostatic change may have life-threatening consequences. This is especially true if toxic substances have accumulated in the extremities. Further treatment of suspension trauma depends on the symptoms. For example, first responders remove constricting clothing. The victim’s breathing and circulation are monitored continuously. If normal breathing stops and the patient loses consciousness, conventional cardiopulmonary resuscitation is performed. If there is only a loss of consciousness but breathing remains normal, the victim is transferred to the recovery position. When emergency medical personnel reach the scene, oxygen administration is initiated. Venous access is established. In combination, blood glucose testing takes place. If hypoglycemia is present, emergency medical technicians give the patient glucose as a crystalline solution. At times, sympathomimetics such as epinephrine are administered intravenously. If the circulation does not stabilize this way, adequate volume administration is indicated.
Prevention
Suspension trauma can be prevented to some extent by using only appropriate harness systems and rope loops. In these loops, the affected person places his legs in the event of a fall to stimulate the muscle pump. However, the suspension trauma is not excluded safely even with this.
Aftercare
Anyone who has experienced suspension trauma as a height worker can suffer from the typical complaints again at any time. This is because a fall can occur again by accident. In certain occupations and during certain recreational activities, there is simply an increased risk. Aftercare mainly refers to preventive measures aimed at ensuring that the affected person uses positioning systems with step slings and work seats that reduce the risk of suspension trauma. Doctors, as well as insurance carriers, have information available around appropriate fall protection systems. However, the use of such systems is the responsibility of the patient or their employer. Beyond preventing reoccurrence, aftercare targets the management of consequential injuries. These occur primarily if the patient has been in the harness for too long or has suffered a shock. In this case, aftercare is based on the existing complaints.From lifelong continuous treatment to short-term therapies, many forms of aftercare are conceivable. Physicians provide suitable aids and medications. Examinations include a detailed medical history as well as imaging procedures, if necessary. Sometimes a psychological stress disorder occurs as a result of a suspension trauma. Psychotherapy provides relief and points the way to a symptom-free everyday life.
What you can do yourself
People who have found themselves trapped in a harness for a long time should change their body position only slowly. For example, blood circulation can be continuously stimulated by moving fingers or toes. Gradually, further movements of the limbs, such as the wrist or ankle, can be instigated by circling or tilting. Sudden loading of the limbs with body weight should generally be avoided in cases of suspension trauma. Helpers who wish to free affected persons from the harness system must be informed of the approximate time of the current position and any existing complaints. If there is numbness in the arms or legs, the organism lacks the strength to support its own weight. The muscles have not been sufficiently supplied with oxygen and other nutrients by the vessels, so they usually need several minutes to be able to function again. After an accident, those providing assistance should immediately contact a paramedic. This person usually has sufficient experience not to be overtaxed. The person concerned should avoid overestimating his condition after a long period in a rigid position in the harness. A good reflection of his physical possibilities are danger-reducing for him and helpful for the recovery process. The urge to free oneself often prevails and leads to a further risk of accidents.
