Suspension Trauma: Symptoms and Treatment

Whenever workers need to use fall protection systems to work at height, it is CRUCIAL that a rescue plan is in place. Safety managers need to ensure that the facility either has equipment that can be used for rescue purposes or that local fire and ambulance companies are aware that they may need to perform a rescue at elevation. Prompt worker rescue is imperative after a fall has been arrested on a fall protection system because of suspension trauma. The dangerous effects of suspension trauma can occur in minutes and even if a prompt rescue does occur, it is very important that every person who is interacting with the equipment understands the symptoms and the appropriate way to treat a worker for suspension trauma after they have been retrieved from a fall protection system.

The symptoms of suspension trauma can be broken down into several different phases. After a worker’s fall has been arrested and all of their body weight is being suspended in the harness, the early signs of suspension trauma can begin to appear in a matter of minutes. In order to monitor the worker’s status during the rescue process, keep an eye out for the following signs and symptoms associated with suspension trauma.

Initially, the worker may develop cold, clammy skin. The worker’s vital signs will present shallow, rapid breathing which will coincide with a rapid, but weak pulse. If these symptoms begin to happen for a worker, they may complain that they are feeling lightheaded.

If the worker continues to dangle in the harness after they are starting to feel lightheaded, the worker may experience a sudden plummet in their blood pressure and pulse strength. This drop will cause an immediate loss of consciousness. And once the worker has lost consciousness, prompt rescue is imperative in order to increase the worker’s chances for survival. For best results, an unconscious worker needs to be rescued within 5 minutes. If a worker is unconscious and their brain is not receiving enough oxygen, they will have a higher chance of experiencing brain damage after five minutes without oxygen. After 10 minutes, the brain is likely to suffer severe damage in addition to organ system failure. At this point, the worker is at very high risk of death by suffocation. 

After a worker has been rescued, there are very specific post-rescue care instructions that need to be followed. Once blood is able to flow freely throughout the worker’s body again, the worker is at risk of suffering from Reflow Syndrome. Reflow Syndrome is, “The return of pooled, hypoxic blood with metabolic byproducts from the extremities to the heart.” Basically, if blood cannot circulate throughout the body, it begins to accumulate carbon dioxide and other bodily waste products that can be dangerous for the human body to process in large amounts. When blood is full of carbon dioxide and other metabolic waste, the heart and other organs are at risk for failure.

So, the million-dollar question: how do we protect someone’s body from their own blood?

The answer: Positioning.

Once a worker is back on the ground after a fall has been arrested on a fall protection system, a worker should be placed in the “W” position. The “W” position is where a worker sits upright on the ground with their back/chest straight and their legs bent so that their knees are in line with the bottom of their chin.  For added stability, make sure that the worker’s feet stay flat on the ground. In this position, a KED board can still be used if there are any potential spinal injuries and a worker needs stabilization before transport.

Once the worker is in this position, they will need to stay in that position for at least 30 minutes. Try to leave the worker in this position until their symptoms begin to subside. The time in the “W” position will allow the pooled blood from the legs to be slowly re-introduced back into the body. By slowing the rate at which the pooled blood reaches different organs, you are giving the body more of an opportunity to filter the pooled blood and maintain internal homeostasis.

DO NOT ALLOW A WORKER TO LAY FLAT OR STAND UPRIGHT IMMEDIATELY AFTER A RESCUE WHERE SUSPENSION TRAUMA IS A POSSIBILITY. If a worker’s body is in a straight line, all of the toxic blood can rush right back into the body and cause organ failure and/or brain damage due to a lack of oxygen and the presence of waste materials.   

Even though elevated rescues might seem like an unusual circumstance for safety managers and first responders, it is a good idea to address how to approach these situations. As always, training anyone who may be involved with this situation is very important. This is a unique topic that is not always discussed among safety professionals. Spread the word about how to respond to a worker who is suffering from suspension trauma. Remember, you could help save someone’s life by passing along this information. 

Quick List of Suspension Trauma Symptoms:

  • Feeling faint or light-headed
  • Breathlessness
  • Profuse sweating
  • Very pale
  • Feeling very hot, quickly
  • Nausea
  • Increased heart rate or significantly decreased heart rate
  • Exceptionally low blood pressure
  • Dizziness
  • Grey out or loss of vision
  • Numbness in legs

Quick Reference for Suspension Trauma Treatment:

  1. Loosen Harness Leg Straps**
  2. Place worker in the “W” position (refer to section above)
  3. Use KED board for stabilization if back injury is suspected
  4. Leave worker in “W” position for at least 30 MINUTES and until they are stable
  5. Medical teams will decide when to begin transporting the worker to the hospital

**NOTE: If you remove the used harness from the worker’s body, DO NOT put the harness back into service in the workplace AND save it in case OSHA requests to see the harness at a later date.

Quick List of Health Factors that Influence Suspension Trauma:

  • Ability/inability to move legs
  • Pain
  • Injuries
  • Fatigue
  • Dehydration
  • Hypothermia
  • Shock
  • Cardiovascular disease
  • Respiratory disease
  • Blood loss
  • Stress/Panic
  • Smoking/drinking
  • Other illness


1. Suspension Trauma/Orthostatic Intolerance. Retrieved from:
2. Robertson, David. Orthostatic Intolerance. Vanderbilt University, Nashville, Tennessee.
3. New York Medical College. Orthostatic Intolerance. Vahalla, New York.
4. Seddon, Paul. Harness Suspension: Review and evaluation of existing information. Health and Safety Executive. Research Report 451/2002. 104 pp.
5. Sheehan, Alan. Suspension Trauma. Training handout.
6. Weems, Bill and Bishop, Phil. Will Your Safety Harness Kill You? Occupational Health & Safety. 72(3): 86-88, 90, March, 2003.
7. National Association of Emergency Medical Technicians (NAEMT). Provider Textbook section in: PHTLS Basic and Advanced Prehospital Trauma Life Support Fifth Edition St. Louis, MO: Mosby; 2003: Section 1.

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Hannah Addison

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Hannah was formerly a Marketing Copywriter for Rigid Lifelines, a division of Spanco. She graduated from Kutztown University with a B.A. in Professional Writing.