Suspension Trauma & Orthostatic Intolerance

Date: October 03, 2017

Guest Safety Column from CareWorksComp

By Jim Saulters, CareWorksComp’s Safety Consultant

According to the Occupational and Health Administration (OSHA), Orthostatic intolerance is defined as “the development of symptoms such as light-headedness, palpitations, tremulousness, poor concentration, fatigue, nausea, dizziness, headache, sweating, weakness and occasionally fainting during upright standing”.  While in a sedentary position, blood can accumulate in the veins, which is commonly called “venous pooling,” and cause orthostatic intolerance.

Orthostatic intolerance also may be experienced by workers using fall arrest systems.  Following a fall, a worker may remain suspended in a harness.  The sustained immobility may lead to a state of unconsciousness.  Depending on the length of time the suspended worker is unconscious/immobile and the level of venous pooling, the resulting orthostatic intolerance may lead to death.  OSHA’s research indicates that suspension in a fall arrest device can result in unconsciousness and even death, in less than 30 minutes.  While not common, such fatalities often are referred to as “harness induced pathology” or “suspension trauma.”

To reduce the risk associated with prolonged suspension in fall arrest systems, employers should implement plans to prevent prolonged suspension in fall protection devices.  The plan should include procedures for:  preventing prolonged suspension, identifying orthostatic intolerance signs and symptoms, and performing rescue and treatment as quickly as possible.

OSHA recommends the following general practices/considerations:

  • Rescue suspended workers as quickly as possible;
  • Be aware that suspended workers are at risk of orthostatic intolerance and suspension trauma;
  • Be aware of signs and symptoms of orthostatic intolerance;
  • Be aware that orthostatic intolerance is potentially life threatening. Suspended workers with head injuries or who are unconscious are particularly at risk; and,
  • Be aware of factors that can increase the risk of suspension trauma.

OSHA requires employers provide “prompt rescue of employees in the event of a fall or shall assure that employees are able to rescue themselves.”  This should include identifying rescue procedures that address the potential for orthostatic intolerance and suspension trauma. 

Rescue procedures should include the following contingency based actions:

  • If self-rescue is impossible, or if rescue cannot be performed promptly, the worker should be trained to “pump” his/her legs frequently to activate the muscles and reduce the risk of venous pooling. Footholds can be used to alleviate pressure, delay symptoms, and provide support for “muscle pumping”;
  • Continuous monitoring of the suspended worker for signs and symptoms of orthostatic intolerance and suspension trauma;
  • Ensuring that a worker receives standard trauma resuscitation once rescued;
  • If the worker is unconscious, keeping the worker’s air passages open and obtain first aid; and
  • Monitoring the worker after rescue, and ensuring that the worker is evaluated by a health-care professional. The worker should be hospitalized when appropriate.  Possible delayed effects, such as kidney failure, which is not unusual in these cases, are difficult to assess on the scene.

For more information about suspension trauma and orthostatic intolerance, please contact CareWorksComp’s Safety Consultant, at (866) 780-NFIB (6342) or email him at [email protected].

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