Suspension Trauma: is it something to worry about?

[catbirdseat]

A friend sent me some links on Suspension Trauma. It's totally new to me. This was first recognized as a problem with cavers, passing out and dying in France. My understanding of it is that if suspended in a vertical position without use of the legs, the blood will pool in the legs and you will first faint and then die from lack of blood to the brain.

 

Now, I don't think this is a serious problem for climbers, except for perhaps aid climbers under certain circumstances. In most cases in which prolonged hanging in a harness takes place, climbers will be using their legs to either jug a rope or to rappel. The action of using the leg muscles ensures that blood is returned to the heart and hence to the brain.

 

What happens if a climber takes a fall on lead and is injured so badly he can't proceed? With luck his partner can lower him to a ledge where he can assume a prone position, but there are situations where he might be forced to hang for a prolonged period of time. In this situation, survival might depend on the partner getting to the leader in order to rig a chest harness and leg slings that allow the legs to be raised and the head lowered.

 

Does anyone have any personal experience with this? One example which comes to mind is the accident on Rainier a few years ago in which an avalanche swept a rope team down the mountain until the rope snagged on an outcropping. One person was suspended by the rope and died before he could be reached. It was reported that the cause of death was head trauma and hypothermia, but it also seems reasonable that suspension trauma played a role.

 

Oberon State (Australia)

 

PHCC Info

 

SAR Info pages

 

[scott_harpell]

sport climbers beware!

[EWolfe]

...

[Alpine_Tom]

Years ago, I worked for a winch and hoist manufacturer in Seattle, and learned there that horses were susceptible to this sort of thing (I guess in the old days they used slings to lift horses onto and off of ships, so used to be a regular concern.)

[skyclimb]

Suspension trauma is similar to a "red out" in aviation. SO a black out is where you are pulling positive G's and climbing, so the blood rushed to your head and you pass out. A red out occurs during negative g maneuvers, where all the blood rushes out fo your head and into your lower extremities.

My point beign it is very hard to loose conciousness because the amount of gravitational force that needs to be present is around 7 times that of normal for a red out.

Same thing goes for when you are standing up! Why don't you pass out if you stand up for a lot of hours? 1 gravitational force will not cause the body or brain to loose blood(as long as your are right side up).

I've always wanted to get down on a plane pulling negative g's.

[catbirdseat]

The fact is that you CAN pass out just standing up. Happens all the time in the military on the parade grounds. If the troops are forced to stand at attention without moving for long enough, some will start to pass out. The reason for the command "at ease" is so that the men can fidget enough to avoid passing out.

[murraysovereign]

Even when at attention, if you watch very closely you'll sometimes see they're rocking slightly back and forth from heels to toes and back to heels, just to keep the calf muscles contracting and relaxing to help move the blood back up.

 

The big difference between standing and hanging in a harness, though, is that when hanging, the leg loops act like a tourniquet (tell me you've never noticed this...) - blood can make it down into the legs, but the combination of gravity and constriction from the leg loops is too much for the heart to counteract, so the blood is trapped in the legs.

[snoboy]

I have heard of something similar, but it only as it applies to unconcious hanging patients.

 

There is also something referred to as compartment syndrome, which is defiened as follows:

 

Swelling in a confined space that produces dangerous pressure; may cut off blood flow or damage sensitive tissue.

[MysticNacho]

If you have compartment syndrome, you probably have a lot of other problems that you need to worry about... such as massive internal bleeding. I think it usually happens in the abdomen.

[skyclimb]

catbirdseat said:

The fact is that you CAN pass out just standing up. Happens all the time in the military on the parade grounds. If the troops are forced to stand at attention without moving for long enough, some will start to pass out. The reason for the command "at ease" is so that the men can fidget enough to avoid passing out.

 

yeah, I bet you are standing with your knees locked for hours on end while on the wall.

Better start moving, sounds like you need some blood to your brain.

Compartment syndrom here we come

I feel stupider for having read and followed this thread.

[Crux]

skyclimb said:

Suspension trauma is similar to a "red out" in aviation. SO a black out is where you are pulling positive G's and climbing, so the blood rushed to your head and you pass out. A red out occurs during negative g maneuvers, where all the blood rushes out fo your head and into your lower extremities.

My point beign it is very hard to loose conciousness because the amount of gravitational force that needs to be present is around 7 times that of normal for a red out.

Same thing goes for when you are standing up! Why don't you pass out if you stand up for a lot of hours? 1 gravitational force will not cause the body or brain to loose blood(as long as your are right side up).

I've always wanted to get down on a plane pulling negative g's.

 

SC-- Got those facts a little upside down?

 

Seriously, you surely know that a negative G force is that which is opposite to the usually experienced gravitational force, which is also called a positive G force. And so-called red-out is associated with too much blood flow to the brain, too much flow that may be caused by negative Gs, which will tend to lift the blood to the head.

 

BTW: Excellent documentation has been provided by CBS this time around... Of course, an aware climber, busy climbing, is not at risk of blacking out from lack of blood flow to the brain.

 

However, given an accident or an improper rescue technique, that same climber may be subject to being held in a vertical position for a substantial length of time, as when dangling in a harness or strapped to a litter being rescued. The point of concern is that this situation may prove fatal to the climber.

 

On the more mundane level of concern, any protracted inattention to the brain's requirement for a precise and constant flow of blood, at any time that flow may be accidentally impeded, may cause one to black out and lose consciousness. The case in point is that of military personnel standing at attention. I recently learned in a physiology course that standing with the knees locked is an aggravating factor in this situation. Regardless, it’s a long way for blood to be pumped upward, from the feet to the heart, when a person is standing. If the leg muscles aren’t exercising, then the veins and venous valves can’t do much of their normal part to assist the return blood flow, and blood will tend to pool to an extent where pressure and flow to the brain is reduced. Note that flow to the brain is normally very constant: Any change in flow to the brain will cause immediate effects.

 

Given exposures to high negative G-forces, fighter pilots wear Military Anti-Shock Trousers (MAST); pneumatic devices that limit blood flow to the lower extremities. Correct? Without MAST, extended exposure to positive 4 or 5 G forces will cause enough reduction of blood flow to the brain to cause a blackout: A pilot may maintain consciousness, but will lose vision until those G forces are reduced.

 

Interestingly, deployment of MAST devices is also now apparently a part of procedural drill for some SAR teams, not only for reducing hemorrhaging from extremities, but also when practicing an evacuation that entails keeping a client in a prolonged vertical position...according to documentation linked to in the CBS post

 

[ketch]

Crux your definatley on to something with the MAST. In SAR cases and others were inactivity of the body or brain can be present blood often doesn't make it back. It's common in many planned medical procedures for the patient to be fitted with air or massage leggings after surgery or procedures that "impair" function. A fall or just being stuck hanging in harness would possibly count.

The knee lock problem is similar. Partly due to heat partly due to locking the knees I have had a few members of performing groups like choirs drop on stages that I have run for the same shock like symptoms. Poor folks oughta get in a group that moves a little

[mtn_mouse]

catbirdseat said:

The fact is that you CAN pass out just standing up. Happens all the time in the military on the parade grounds. If the troops are forced to stand at attention without moving for long enough, some will start to pass out. The reason for the command "at ease" is so that the men can fidget enough to avoid passing out.

Nice to see the military is still firmly planted in the 16th century!

[catbirdseat]

So what do you do if you've just fallen and broken a leg and you are just hanging there? If you are in a lot of pain, you will avoid movement, then what? Hopefully, your partner will be able to lower you fairly quickly. What if he is slow in doing so? Should you try to rig up your own chest harness, in case you pass out?

[ketch]

CBS, thats a good question. I suppose rigging some kind of a chest harness would be good. I think that the pressure of the seat harness would make the problem worse.

I don't know maybe the extra pressure from spandex pants is the answer. If we all climb with a double set of spandex and don't forget the clean underwear for when you go to the hospital that mom told you about. Then we be prepared for all events.

[Lambone]

There was a tragic accident on Lower Cathederal Rock in Yosem this summer involving this.

 

The leader fell on a traversing pitch, sustained head trauma (no helmet), but was concious and alive for a while. His belayer (girlfriend) could not get him down with self-rescue techniques (for whatever reason), and it took rescuers several hours to reach the leader. He was pronounced DOA.

 

Now, given he did have serious head trauma...but he also spent many hours just hanging in his harness. I remember reading something about this being the possible cause of death in the accident report...don't remember where...some web-site.

 

I may be sketchy on some of the details, but I just thought this accident was related to the topic here.

[Don_Gonthier]

This type of injury is not related to G-forces, it is called Compartment Syndrome as snoboy said. Here is a link http://www.emedicine.com/emerg/topic739.htm that I hope works. If you read this carefully you will see that damage to the muscle occurs because of a loss of blood flow to the affected area. The isochemic shock occurs later, after the toxins build up and nomal blood flow is resumed. While this particular artical dosen't specifically mention hanging in a harness, it does say the syndrome can be caused by any thing that causes blood pressure to rise in a compartment. This includes hanging in a harness but also remaining in one position for a long period concious or unconcious and crush injuries.

If this occurs for a long time the treatment is a faciectomy, cutting open the facia, the sac that holds the muscles to releave the pressure. If there is any necrosis, dead tissue, this must be cut away. A couple of examples of this are the guy who took all the photos for Stefan Glowasc's book "Rocks Around the World", Uli Wiesmeier. He lost 50 percent of the muscle in his legs after getting compartment syndrome while competing in a paragliding world cup. He was concious the whole time he was hanging, but hung for nearly 24 hours. Another example is that singer Eddie Money from the 80's. He got it from passing out after taking some type of drug and alcohol, he crashed on a couch with his legs crossed and had to have surgery to remove some dead tissue from his leg, now he walks with a cane. Just say no to drugs boys and girls. Another form of compartment syndrome is called chronic compartment syndrome and is very common. It's cause is rapidly increasing training. One symptom is bad muscle cramps and pain that recurs after a certain amount of exersize. This is the one I'd worry about if I were you. The harness hang syndrome is just another reason to get accident victims to some sort of medical attention fast.

[catbirdseat]

Suspension Trauma and Compartment Syndrome are two different manifestations resulting from the same cause- restricted bloodflow. The former as it affects the brain and the latter as it affects the muscles. Obviously, from a survival standpoint both are important, but getting blood to the brain is of the most immediate concern.

[mtn_mouse]

catbirdseat said:

So what do you do if you've just fallen and broken a leg and you are just hanging there? If you are in a lot of pain, you will avoid movement, then what? Hopefully, your partner will be able to lower you fairly quickly. What if he is slow in doing so? Should you try to rig up your own chest harness, in case you pass out?

 

In rescue training we were taught to support an injured climber horizontally while he was still hanging on the rope. From this postion, a stokes litter could be lowered or raised to the injured party, and moved into place right underneath him.

 

We would set up several prussiks and slings, and lay the climber out flat, supporting the ankles, knees, back, and head. The waist was already supported by the harness.

 

If you or someone were going to be hanging for some time, this would allow several support points, and probably great blood circulation, eliminating the "suspension trauma" problem.

[Norsky]

scott_harpell said:

sport climbers beware!

 

Scott, this is so true. I've seen many people bite the big one at Smith while hang-dogging projects. It's all smiles and beta spraying until the poor bastard turns south. You usually find out when the belayer gets sick of holding the climber's weight and asks them to clip into a bolt. Didn't that happen to Scott Franklin?

[Buckaroo]

Harness Hang Syndrome: Fact and Fiction

 

Harness Hang Pathology

[Jude]

Suspension trauma is similar to a "red out" in aviation. SO a black out is where you are pulling positive G's and climbing, so the blood rushed to your head and you pass out. A red out occurs during negative g maneuvers, where all the blood rushes out fo your head and into your lower extremities.

My point beign it is very hard to loose conciousness because the amount of gravitational force that needs to be present is around 7 times that of normal for a red out.

Same thing goes for when you are standing up! Why don't you pass out if you stand up for a lot of hours? 1 gravitational force will not cause the body or brain to loose blood(as long as your are right side up).

I've always wanted to get down on a plane pulling negative g's.

 

I do this for a living. GLOC (G induced loss of consciousness) is caused by insufficient blood pressure to supply blood to the brain. This happens under positive G’s. There can be progressive stages, such as tunnel vision and “Gray out” (loss of vision), depending on the onset rate. We use straining maneuvers and an anti-G suit to prevent blood from pooling in our extremities and to force it to our heads. G's are used to change the flight path of the aircraft, regardless of it's current flight path. It's frequently in a turn.

The “Red Out” Phenomenon is caused by negative G’s. It has been talked about but never really documented the flight physiology people. A typical tactical fighter can generally pull from –3 to + 7-9 G’s. Negative G’s hurt.

Jude

[Jude]

Actually, MAST trousers were based on our G suits.

G suits typically add about 1 G extra tolerance. Most of it comes from our straining maneuvers.

The F-16 has something called "Combat Edge", which is fuller coverage G suit, with chest compression and forced air into the lungs, which simulates some of straining maneuvers and is supposed to be quite effective.

Jude

[Dr_Crash]

Watch out for these hanging belays, guys

 

drC

[JosephH]

When I'm on the end of a rope for almost anytime at all I invert and spend half or more of my time inverted. I tend to pass out easily and this prevents it.