All You Need to Know About Suspension Trauma
Suspension trauma is an emergency medical shock condition that can also be described as orthostatic shock. The sufferer hangs in an upright position, allowing blood to pool into the legs that hang down. Being placed in a prone position too quickly can result in death.
What is suspension trauma?
According to abbreviationfinder, suspension trauma is usually diagnosed by rescue teams and rescue services and is based on visual diagnostics and vital signs. The diagnosis at the site of the event is absolutely necessary for a favorable course, since the person concerned must not be brought into the lying position too quickly.
Suspension trauma is a shock that can occur as a result of prolonged hanging in a harness system. In a harness, the person concerned is forced to an upright posture. Its extremities usually hang down. This pose can cause blood to pool in the extremities due to gravity. If the affected person is released from their upright position, this release can result in a so-called rescue collapse, since 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 occurrence. Nevertheless, since the discovery, several deaths have been documented, which can probably be attributed solely to this phenomenon. The physician Amphoux first described the hanging trauma in connection with cavers who had suffered an accident and who had only suffered a minor fall and mysteriously died as a result of the fall.
Causes
When a person changes from a lying position to a standing position, around 600 milliliters of blood can pool in the veins of the legs. The arterial blood pressure and the cardiac output decrease briefly 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 in the brain are equipped with self-regulating mechanisms and thus ensure blood flow. But if there is not enough counter-regulation, then the cerebral blood flow is extremely reduced. As a result, dizziness sets in. However, this does not result in an orthostatic shock, since the person concerned sits down or lies down at the first dizziness or a fainting sign. In this way, the orthostatic change is compensated for again.
No equalization can take place in a belt system. The counter-regulatory mechanisms of the organism are overwhelmed and the blood is redistributed. There is a lack of volume, which can even be exacerbated by constrictions caused by the straps.
Symptoms, Ailments & Signs
Symptoms of suspension trauma are, to some extent, individual. Above all, the time at which it occurs over time is determined by the individual constitution of the respective person. As a rule, the first symptoms appear after a minimum of one minute and a maximum of 20 minutes. Those affected turn pale in the face. You start sweating and you feel dizzy. The legs usually become numb after a while.
Other misperceptions also appear at times. Those affected often suffer from swelling nausea, which can increase to the point of vomiting. Shortness of breath and dizziness are added. Disturbances of the perception system can occur. Visual disturbances are the most common.
Sometimes there is also a bloodless bloodletting at the attachment points of the straps. Even necrosis or varicose veins may appear spontaneously at the site of strangulation. The pent-up blood in the extremities may contain toxic substances, such as those found in post-ischemia syndrome.
Diagnosis & course of disease
Suspension trauma is usually diagnosed by rescue teams and rescue services and is based on visual diagnostics and vital signs. The diagnosis at the site of the event is absolutely necessary for a favorable course, since the person concerned must not be brought into the lying position too quickly. Too rapid a rearrangement can lead to cardiac death because the heart muscle is overstrained.
Complications
If a suspension trauma is not treated, the patient usually dies relatively quickly. For this reason, immediate medical treatment of the trauma is necessary to avoid consequential damage and death of the patient. The longer the patient hangs on the belt system, the more complaints and complications usually occur.
There is vomiting and severe nausea, and the affected person continues to suffer from dizziness and gasping. Misperceptions and paralysis occur in various regions of the body and the quality of life decreases sharply. There are also severe visual disturbances, which, however, normalize again with treatment. The general condition of the patient worsens, and after a few minutes, as a rule, the affected person loses consciousness and faints.
Complications can arise if the patient is moved too quickly during treatment. In this case, the heart can be overloaded and cardiac death occurs. In many cases, resuscitation is necessary when the suspension trauma has lasted for a long period of time. It cannot be predicted whether the suspension trauma will cause permanent damage to the patient.
When should you go to the doctor?
If a suspension trauma is suspected, an emergency doctor must be alerted immediately. The trauma represents a medical emergency that requires immediate treatment and subsequent comprehensive evaluation at the hospital. If symptoms such as abnormal sensations, nausea and vomiting or shortness of breath occur a few minutes after an accident, often in connection with external injuries, the emergency services must be called. Visual disturbances, dizziness and pain can also be warning signs that require rapid clarification.
Externally, a hanging trauma can be recognized by the pale complexion and the frequent outbreaks of sweat. If the legs or other limbs also become numb, a doctor should be alerted. First responders must provide first aid until a doctor is available. After a suspension trauma, the affected person has to spend a few days to weeks in the hospital, depending on how severe the injuries are. After discharge from the hospital, regular examinations by the doctor are indicated, as complications can still occur weeks later.
Treatment & Therapy
Rescuing the patient is the first step in treating suspension trauma. The victim should be placed in an upright position for the next 20 minutes. If this principle is ignored, the orthostatic change can have life-threatening consequences. This is especially true when toxic substances have accumulated in the extremities. Further treatment of the suspension trauma depends on the symptoms.
For example, the first responders remove clothing that is too tight. The patient’s breathing and circulation are continuously monitored. If normal breathing stops and the patient loses consciousness, conventional cardiopulmonary resuscitation is done. If there is only a loss of consciousness but breathing remains normal, the person is placed in the recovery position.
When emergency medics reach the scene of the accident, an oxygen supply is initiated. A venous line is placed. In combination with this, a blood sugar determination takes place. When hypoglycemia is present, emergency medical professionals give the patient glucose as a crystalline solution. Sympathomimetics such as adrenaline are sometimes administered intravenously. If the circulation does not stabilize in this way, sufficient volume administration is indicated.
Prevention
Suspension trauma can be prevented to a certain extent by solely using appropriate harness systems and rope loops. In the event of a fall, the person concerned places their legs in these loops to stimulate the muscle pump. However, hanging trauma cannot be ruled out with certainty.
Aftercare
Anyone who has experienced a suspension trauma as a rope access worker can suffer from the typical symptoms again at any time. Because a crash can happen again by accident. In certain professions and in certain leisure activities, there is simply an increased risk. Follow-up care is primarily related to preventive measures aimed at ensuring that the sufferer uses positioning systems with foot slings and work seats that reduce the risk of suspension trauma.
Doctors and insurance companies provide information about suitable fall protection. However, the use of such systems is the responsibility of the patient himself or his employer. Beyond preventing recurrence, aftercare aims to manage consequential damage. These occur primarily when the patient has been in the safety harness for too long or has suffered a shock.
Aftercare is then based on the existing symptoms. Many forms of aftercare are conceivable, from lifelong permanent treatment to short-term therapies. Doctors provide suitable aids and medicines. In addition to a detailed anamnesis, examinations may also include imaging procedures. Sometimes a psychological stress disorder occurs as a result of a suspension trauma. Psychotherapy provides relief and shows the way to a symptom-free everyday life.
You can do that yourself
People who have felt trapped in a harness system for a long time should only change their body position slowly. Blood circulation can be continuously stimulated, for example, by moving fingers or toes. Further movements of the limbs, such as the wrist or ankle, can be gradually initiated by circling or tilting.
Sudden loading of the limbs with body weight should always be avoided in the event of a hanging trauma. Helpers who want to free those affected from the belt system must be informed about the approximate time of the current position and existing complaints. With numbness in the arms or legs, the body lacks the strength to carry its own weight. The muscles have not been sufficiently supplied with oxygen and other nutrients through the vessels, so that they usually need several minutes to be able to function again.
After an accident, those providing assistance should contact a paramedic immediately. This usually has sufficient experience not to trigger excessive demands. The person concerned should avoid overestimating their condition after sitting in a rigid position in the belt system for a long period of time. A good reflection of his physical possibilities reduces danger for him and is helpful for the recovery process. The urge for liberation often prevails and leads to a further risk of accidents.
aminations do not make sense. On the one hand, this is due to the fact that the typical complaints can be easily avoided by avoiding high levels; on the other hand, the disease is permanent and cannot be treated according to current scientific knowledge.
The best way for climbers to avoid acute complications is to climb slowly, gradually adapting to the changing conditions. On the other hand, there are no complaints at all during scheduled follow-up examinations in the rooms of a doctor’s surgery, since there was no increase in altitude. The aftercare does not prove to be effective here either.
Aftercare is also about supporting the patient in everyday life. The doctor can give you tips on how to behave on the next mountain hike. However, the patient is responsible for implementation. If you have severe symptoms, you should start the descent immediately. On longer tours, accommodation in lower plains is preferable. The increase should be slow. It should be borne in mind that the body needs time to adapt to the changed climatic conditions.
You can do that yourself
People who suffer from altitude sickness should always carry an altimeter with them. In many cars it is already firmly integrated into the on-board system and can be called up at any time with current data. Nevertheless, it is advisable to also have a mobile device with you that can be worn on the body and also measures the height in real time. At the first symptoms of altitude sickness, it is necessary to check the current position in which the person concerned is located. A return to a much lower altitude should be initiated as quickly as possible and there the symptoms should be awaited.
Since altitude sickness can quickly turn into a life-threatening condition, unnecessary risks should be avoided. A doctor must be called if symptoms worsen or drowsiness occurs. Staying in higher areas should be well thought out and planned. If possible, avoid it.
Those affected and their close relatives should obtain comprehensive information about the disease, the symptoms and the resulting consequences. Spontaneous mountain tours should be avoided. The organism can often slowly adapt to certain altitudes. Therefore, if it is necessary to stay at certain heights, several days or weeks should be planned in which only gradual ascent takes place.