The following advice is based upon an evidence-based review of the current guidance on first aid measures for suspension trauma funded by the Health and Safety Executive. For the full report please go to http://www.hse.gov.uk/research/rrpdf/rr708.pdf.

“The jury is still out” as to whether there is actually such a condition – the need for further research into the topic is called for.

However, there is a need to rescue persons who have fallen into harness suspension as quickly as possible as different mechanisms within the body can affect the normal flow of blood:

• Because the legs are hanging freely, gravity induces the pooling of blood in them
• The harness may easily constrict the venous return to the heart from the legs
• The harness may constrict the chest, increasing the pressure within it and reduce cardiac output

Most persons suspended in a heads up position as they would be in a harness will develop a condition called presyncope (pronounced pre-sin-ko-pee) within 1 hour and a fifth of people will develop it within 10 minutes.

It is important to recognise the symptoms of presyncope:

• Light-headedness
• Nausea
• Sensations of flushing
• Tingling / numbness of the arms or legs
• Anxiety
• Visual disturbances
• Feeling that they are about to faint

The person who is experiencing the above symptoms may develop syncope (sin-ko-pee) — they will “faint” but should regain consciousness. Should they become unconscious and stay unconscious they must be rescued promptly or they may die due to lack of oxygen (hypoxia).

What can be done

A strap attached to the harness with a loop attached would allow the person to stand by putting their foot in the loop. This would remove the normal pressure exerted by the harness and allow for normal blood flow thus increasing the time available for safe rescue.

If the suspended person can be put into a sitting position (e.g. a strap under their knees, feet up against a structure or supported by rescuers) whilst suspended, this will slow down the onset of presyncope and allow more time for safe rescue.

After the person has been rescued

If conscious:

• Remove their harness, keep them in a sitting position and if oxygen is available give it.
• If they have experienced symptoms of presyncope send them to hospital in an ambulance.
• While awaiting the ambulance stay with them monitor their condition and reassure them.
• If they go unconscious, place them in the recovery position, maintain their airway and monitor their airway, breathing and circulation. Give oxygen if available.
• If their breathing deteriorates while unconscious, commence CPR.

If unconscious:

• Remove their harness and place them in the recovery position, maintain their airway and monitor their airway, breathing and circulation. Give oxygen if available.
• If their breathing deteriorates while unconscious, commence CPR.

Please note that a person suspended “head down” needs the same urgent rescue as a “head up” suspension.

The Health and Safety (First Aid) Regulations (Northern Ireland) 1982 set out the essential aspects of first aid that employers have to address. Guidance to help employers understand and comply with this legislation is contained in the Approved Code of Practice and Guidance.

Goody Training Solutions strongly recommends that all employers download a copy of the ACOP to help them assess the level of first aid cover they require, in terms of personnel, equipment and facilities.

If, after assessing their company’s needs, an employer decides that they need first aiders as defined in the ACOP, then these first aiders should undergo a 24 hour (4 day) First Aid at Work training course with an HSENI approved training provider. (Goody Training Solutions is an HSENI-approved First Aid at Work training provider.)

First Aid at Work certification lasts for three years from the date of the course assessment. To maintain certification the first aider should attend a 12 hour (2 day) requalification course within the three months before the original certification expires. If this is not possible, HSENI will allow an extension of the certificate up to a maximum of 28 days. If the requalification course is not completed within this time, the first aider must attend another 24 hour initial course.

In addition to the full First Aid at Work courses, there is a recommendation that organisations consider training for Appointed Persons. From the Approved Code of Practice and Guidance:

Even in organisations with comparatively low health and safety risks where first aiders are considered unnecessary, there is always a possibility of accident or sudden illness. It is important, therefore, that someone is always available to take immediate action, such as calling an ambulance. Employers must, in the absence of first-aiders, appoint a person for this purpose, though appointed persons are not necessary where there is an adequate number of first-aiders.

It should be remembered that appointed persons are not first-aiders and so should not attempt to give first-aid for which they have not been trained. However, as the appointed person is required to take charge of the situation as well as look after the first-aid equipment and, ideally, should know how to use it, training in emergency first-aid is recommended for appointed persons.

Emergency First Aid/Appointed Person training is a one day (six hour) course.
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