Suspension Syndrome
Objective: Get a suspended patient down promptly. If the patient is peri-arrest, place them supine and start standard life support. Do not keep them sitting for 30 minutes after rescue.
Why this matters
People collapse while hanging nearly upright in a harness or on a rope. The mechanism is still debated. What is not debated is that they need to come down. Do not keep an unconscious patient sitting because of an old rescue custom.
First, make the scene safe and get the patient down. If the patient is peri-arrest, place them supine and start standard life support. Check for a fall, hypothermia, and injury from a long hang. Do not keep them sitting for 30 minutes after rescue. The International Commission for Alpine Rescue medical commission, ICAR MedCom, said that in its 2023 review. That upright hold does not have evidence behind it.
- Make the scene safe first. A second fall helps no one.
- Get the patient down promptly. If they are unconscious or peri-arrest, lay them flat and run the usual airway, breathing, and circulation sequence.
- Look for a fall, hypothermia, and muscle injury from a long hang. Do not stop at the harness story.
- We are getting the patient down. We are not leaving them on the rope to stabilize.
- The patient is unconscious. I will place them supine, open the airway, give oxygen, and monitor.
- I will not keep a lifeless patient sitting for 30 minutes.
Clinical sequence
- Make the site safe. Rescue is a technical problem if you are not the rope team. Call the people who can lower the patient without dropping them.
- Once the patient is down, assess responsiveness and breathing. Peri-arrest or arrest gets standard CPR and defibrillation for a shockable rhythm. Lay the patient supine to do that.
- If the patient is awake and dizzy, lay them flat unless a specific injury makes that impossible, and be ready for a faint. Give oxygen if they are hypoxic.
- Expose and look for harness injuries, pelvic or femur fractures, and hypothermia. A long hang can mean rhabdomyolysis later. Rhabdomyolysis is muscle breakdown. You will not diagnose that enzyme in the field. Tell the hospital how long the patient hung.
- Transport. Do not clear a suspended patient because they woke up when you laid them down.
Teaching points
- Suspension syndrome is the better name. Suspension trauma implies an injury that may not be there. Trauma may still be present. Look for it.
- Moving the leg muscles while waiting for rescue is prevention, and only for a conscious person who can do it. It is not a treatment for someone who is already unconscious.
- Australian and New Zealand first-aid guidance agrees. Rescue the person, lay them down, and do not follow the old rule to keep them sitting.
Common errors
- Keeping an unconscious patient upright after the rope is off.
- Delaying CPR to debate the physiology.
- Missing a fall injury because the story was only the harness.
Practice
One-minute check
A worker is lowered, unresponsive, with a slow pulse. Say the position you will use, and say the 30-minute rule you will not follow.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- Rauch S, et al. Suspension syndrome: a scoping review and recommendations from ICAR MedCom. Scand J Trauma Resusc Emerg Med. 2023;31:95. doi:10.1186/s13049-023-01164-z. Peri-arrest patients are placed supine and given standard life support.
- ANZCOR Guideline 9.1.5: rescue promptly and place the person lying down. The recommendation to keep patients sitting for 30 minutes is not supported and may be harmful.
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.