Summary Statement Explains the dangers of staying in a safety harness after a fall and discusses procedures to avoid injury or death from this situation.

March 2003

Workers and emergency response personnel must be trained to recognize the risks of suspension trauma.

Workers should never be permitted to work alone in a harness. Rope/cable tenders must make certain the harness user is conscious at all times. Time in suspension should be limited to under five minutes. Longer suspensions must have foothold straps or means for putting weight on the legs. Harnesses should be selected for specific applications and must consider: compliance (convenience), potential arrest injury, and suspension trauma. Tie-off lanyards should be anchored as high and tight as work permits.

Workers should be trained to try to move their legs in the harness and try to push against any footholds. Workers hanging in a harness should be trained to try to get their legs as high as possible and their heads as close to horizontal as possible (this is nearly impossible with many commercial harnesses in use today). It the worker is suspended upright, emergency measures must be taken to remove the worker from suspension or move the fallen worker into a horizontal posture, or at least to a sitting position.

The victim should not be suspended in a vertical (upright) posture with the legs dangling straight. Victims should be kept as nearly horizontal as possible, or at least in a sitting position. Rescuers should be trained that victims who are suspended vertically before rescue are in a potentially fatal situation. Rescuers must be aware that post-rescue death may occur if victims are moved to a horizontal position too rapidly.

It may be advantageous in some circumstances to locate the lanyard or tie-off attachment of the harness as near to the body's center of gravity as possible to reduce the whiplash and other trauma when a fall is arrested. This also facilitates moving legs upward and head downward while suspended. Front (stomach or chest) rather than rear (back) harness lanyard attachment points will aid uninjured workers in self-rescue. This is crucial if workers are not closely supervised. Any time a worker must spend time hanging in a harness, a harness with a seat rather than straps alone should be used to help position the upper legs horizontally. A gradual arrest device should be employed to lessen deceleration injuries. 5) Workers should get supervised (because this is dangerous) experience at hanging in the harness they will be using. [OHS endbug]

I was surprisingly comfortable with my legs dangling relaxed beneath me, and my arms outstretched in a posture that must have resembled a crucifixion. I had no feeling of stress and mused as to why this was considered dangerous. I felt I could stay in this position for a long time. Three minutes later, maybe less, I wondered why I suddenly felt so hot. The next thing I knew, they were reviving me from unconsciousness. I had just experienced what could be deadly for your workers who use safety harnesses. Fortunately for me, my suspension trauma occurred in the safe environment of the research ward of University of Texas Medical Branch Hospital at Galveston, Texas, where I was the first subject in a NASA experiment studying orthostatic intolerance in astronauts. Your workers won't be so lucky.Wide ranges of situations require safety harnesses of various types. Workers requiring fall protection, workers entering many confined spaces, mountain climbers, deer hunters in elevated stands, and cave explorers all try to protect themselves through the use of safety harnesses, belts, and seats. What is little known however, is that these harnesses can also kill. Harnesses can become deadly whenever a worker is suspended for duration over five minutes in an upright posture, with the legs relaxed straight beneath the body. This can occur in many different situations in industry. A carpenter working alone is caught in mid-fall by his safety harness, only to die 15 minutes later from suspension trauma. An electrical worker is lowered into a shaft after testing for toxic gases. He is lowered on a cable and is positioned at the right level to repair a junction box. After five minutes he is unconscious--but his buddies tending the line don't realize it, and 15 minutes later a dead body is hauled out. The cause of this problem is called "suspension trauma." Fall protection researchers have recognized this phenomenon for decades. Despite this, data have not been collected on the extent of the problem; most users of fall protection equipment, rescue personnel, and safety and health professionals remain unaware of the hazard.Suspension trauma death is caused by orthostatic incompetence (also called orthostatic intolerance). Orthostatic incompetence can occur any time a person is required to stand quietly for prolonged periods and may be worsened by heat and dehydration. It is most commonly encountered in military parades where soldiers must stand at attention for prolonged periods. Supervisors can prevent it by training soldiers to keep their knees slightly bent so the leg muscles are engaged in maintaining posture. What happens in orthostatic incompetence is that the legs are immobile with a worker in an upright posture. Gravity pulls blood into the lower legs, which have a very large storage capacity. Enough blood eventually accumulates so that return blood flow to the right chamber of the heart is reduced. The heart can only pump the blood available, so the heart's output begins to fall. The heart speeds up to maintain sufficient blood flow to the brain, but if the blood supply to the heart is restricted enough, beating faster is ineffective, and the body abruptly slows the heart. In most instances this solves the problem by causing the worker to faint, which typically results in slumping to the ground where the legs, the heart, and the brain are on the same level. Blood is now returned to the heart and the worker typically recovers quickly. In a harness, however, the worker can't fall into a horizontal posture, so the reduced heart rate causes the brain's blood supply to fall below the critical level. Orthostatic incompetence doesn't occur to us very often because it requires that the legs remain relaxed, straight, and below heart level. If the leg muscles are contracting in order to maintain balance and support the body, the muscles press against the leg veins. This compression, together with well-placed one-way valves, helps pump blood back to the heart. If the upper-legs are horizontal, as when we sit quietly, the vertical pumping distance is greatly reduced, so there are no problems. In suspension trauma, several unfortunate things occur that aggravate the problem. First, the worker is suspended in an upright posture with legs dangling. Second, the safety harness straps exert pressure on leg veins, compressing them and reducing blood flow back to the heart. Third, the harness keeps the worker in an upright position, regardless of loss of consciousness, which is what kills workers.There are four phases of fall protection: Before the fall, at fall arrest, suspension, and post-fall rescue. Each phase presents unique safety challenges. Suspension trauma can be influenced by all aspects of the fall, so they are all important. As with many aspects of safety, increasing the safety in one phase can compromise the safety of the others. Whatever training workers have received will determine how they respond to different phases. Here is a brief discussion of each aspect of fall protection.The key issue of fall protection before the fall is compliance. If a harness is too uncomfortable, too inconvenient, or interferes too much with task completion, workers may not use the equipment or may modify it (illegally) to make it more tolerable. A second major point is the length of the attachment lanyard, or, how far can a worker fall before his fall is arrested? The longer the fall, the greater the stress on the body will be when the fall is arrested. The shorter the lanyard, the more often it will have to be repositioned when workers are mobile. A moveable safe anchor is one solution, but this situation is only occasionally available.The whole concept of fall protection is that workers who fall will be stopped by the tethering system. The longer the attachment lanyard, the greater the acceleration time during the fall and the greater the stress on the body at arrest. Unfortunately, the posture of the falling worker is unpredictable. Depending on the harness attachment point and the position of the worker's body at arrest, different harness attachments offer different advantages. An attachment near the shoulders means that any drag from the lanyard will serve to position the worker's body in an upright position so the forces are distributed from head to foot. The head is somewhat protected if the legs and body precede it in the fall, but this offers some disadvantages after the fall arrest is completed.Many safety professionals naturally assume that, once a fall has been arrested, the fall protection system has successfully completed its job. Unfortunately, this isthe case. A worker suspended in an upright position with the legs dangling in a harness of any type is subject to suspension trauma.Fall victims can slow the onset of suspension trauma by pushing down vigorously with the legs, by positioning their body in a horizontal or slight leg-high position, or by standing up. Harness design and fall injuries may prevent these actions, however.Rescue must come rapidly to minimize the dangers of suspension trauma. The circumstances together with the lanyard attachment point will determine the possibilities of self-rescue. In situations where self-rescue is not likely to be possible, workers must be supervised at all times. Regardless of whether a worker can self-rescue or must rely upon others, time is of the essence because a worker may lose consciousness in only a few minutes. If a worker is suspended long enough to lose consciousness, rescue personnel must be careful in handling such a person or the rescued worker may die anyway. This post-rescue death is apparently caused by the heart's inability to tolerate the abrupt increase in blood flow to the right heart after removal from the harness. Current recommended procedures are to take from 30 to 40 minutes to move the victim from kneeling to a sitting to a supine position.An arrest harness attachment on the front of the body facilitates self-rescue after a fall. However, a front attachment means the arresting lanyard may be in the way for many work tasks. An attachment point near the center of gravity (CG) makes post-fall body positioning much easier and increases the likelihood that a fallen worker will not be suspended in an upright vertical position.Yet a front near-CG attachment point can greatly increase the bending stress on the spine at the instant of arrest, raising the possibility that the arrest itself results in serious injury. The most protective harnesses for suspension can be the least comfortable.Safety harnesses save many lives and injuries. However, continual vigilance is needed to train and supervise workers to ensure harnesses are used safely. All phases of fall protection need to be examined for each particular application. Workers and emergency response personnel must be trained to recognize the risks of suspension trauma.Seddon, Paul.Health and Safety Executive. Research Report 451/2002. 104 pp.Pull quotes: All personnel should be trained that suspension in an upright condition for longer than five minutes can be fatal.