Avoid Suspension Trauma with a Comprehensive Fall Protection Program

Avoid Suspension Trauma with a Comprehensive Fall Protection Program

Fall protection and awareness of suspension trauma are essential for ensuring workplace safety, as proper equipment use and effective rescue plans can prevent injuries and save lives.

It’s an unfortunate fact that falls have been a leading cause of injury and death in the workplace, in construction and in general industries. Falls don’t just occur in the workplace though. Even if workers are off the clock and at home, each year roughly 500,000 Americans visit the emergency room after falling off or getting injured from a ladder. In the workplace, employers are legally required by the federal Occupational Safety and Health Administration (OSHA) to provide fall protection for employees who will work over four feet off the ground, or to their next lower level. 

Fall protection equipment can be any device, apparatus, or other personal protective equipment (PPE) that aims to protect workers from falling off their walking working surface or the consequences of falling. Equipment like guardrails actively prevents people from falling. Furthermore, fall arrest equipment refers to the specific equipment that does not necessarily prevent a worker from falling but can successfully suspend the worker before hitting the ground below if manufacturer instructions are followed. These pieces of equipment could include—but are not limited to—body harnesses, lanyards or self-retracting lifelines (SRLs). However, once a worker’s fall is successfully arrested with their fall arrest equipment, one hazard is replaced by another. Remaining upright for too long and developing symptoms like low blood pressure is referred to as orthostatic intolerance. It plays a significant factor in developing suspension trauma, but its effects can be mitigated if workers are trained to recognize the signs and symptoms.

What is Suspension Trauma? 

Suspension trauma is a life-threatening condition that occurs when the body responds to being in an upright position for a prolonged time with sweating, dizziness, nausea, heart palpitations or loss of consciousness among other symptoms. While fall protection equipment aims to prevent the almost certain debilitating or fatal results of falling from heights, the body still assumes some of the forces incurred from the fall. Shock-absorbing elements in lanyards or SRLs shoulder most of the burden, but the remaining shock suffered is distributed around the victim’s body and can cause a decrease in heart rate, blood pressure and cardiac output. This is a tricky hazard to mitigate because the effects of orthostatic intolerance will vary between workers, and it’s often difficult to determine the rate or intensity at which suspension trauma occurs.

The Effects of Suspension Trauma 

The body’s upright position while being suspended in a fall arrest harness can block airways and restrict blood flow around the body, creating poor circulation. Typically, the leg straps constrict blood from naturally traveling between the upper and lower halves of the body. Blood can start collecting in the leg muscles and will become increasingly toxic. If this occurs for too long, that toxic blood can enter the body’s main bloodstream once the harness is removed. This can damage the organs to the point of fatality if enough progresses. 

Restricted blood flow also greatly increases the chances of developing a blood clot, which has been fatal for some fall victims as the effects appeared sometime after the victim was rescued. Additionally, the heart is put under increased pressure during suspension trauma. Blood pressure can decrease, and the victim could fall into shock at this point. If blood flow diminishes to a certain extent, it can affect brain activity and the victim can lose consciousness.

Prevent Suspension Trauma 

If someone falls, 9-1-1 should be called immediately. However, this should not be expected to be the main means of rescuing a fallen worker. OSHA requires that employers prepare and implement fall protection rescue plans for workers who must don fall arrest equipment. The rescue plan should be put into effect as emergency personnel are responding. They must aim to rescue the worker as quickly as possible. It can take as little as a few minutes for the effects of orthostatic intolerance to begin and suspension trauma to set in. Depending on the general health of the individual, the victim could lose consciousness, go into cardiac arrest or die. Due to the panic and stress of the situation, fall victims often have difficulty accurately communicating the state of their well-being to first responders. Best practices suggest that an organization’s rescue plan includes someone dedicated to staying in constant communication with the victim. Emergency medical personnel will benefit from knowing more details about the fall victim and the fall incident so that they can provide proper treatments and hopefully prevent further permanent damage from occurring.

Proper donning procedure and ensuring the proper fit of a body harness is one of the most effective methods of preventing suspension trauma. In order for the connecting device and harness to absorb the most shock possible from the fall, a harness must be properly adjusted to fit each user. Proper leg strap tightness is a significant contributing factor to the severity of suspension trauma. The common rule of thumb for proper tension of leg straps is referred to as “flat hand, not fat hand.” If the user can fit their clenched fist (or, fat hand) under the leg straps, they should tighten the straps until they can only fit their extended palm (or, flat hand) underneath the leg straps. If the flat hand cannot fit under the straps, loosen until it can. Leg straps that are too tight can cause further injury during the fall. Leg straps should remain stationary on the leg while the worker walks around while wearing the harness. Any that slip up and down during normal walking movements should be checked for proper tightness. If a user falls in a harness that is too loose, they could potentially be ejected from the harness during the fall. At the very least, their body will jostle while the fall is being arrested and greater fall forces felt by the user can be anticipated. The more fall forces passed onto the body and not absorbed by the fall protection equipment, the greater the risk of injury. It’s also important to note that fall protection equipment must be removed from service after successfully arresting a fall and should not be used again.

Reduce the Effects of Suspension Trauma 

Rescue training is another effective method of preventing suspension trauma after a fall. Besides learning to recognize the signs and symptoms of orthostatic intolerance that can lead to suspension trauma, employees should be trained in self-mitigation methods as well. All body harnesses compliant with the ANSI Z359 standard are equipped with a sub-pelvic strap that can assist with promoting body movement while a victim awaits rescue. The sub-pelvic strap sits directly underneath the buttocks and, if the user is conscious after their fall, can slide down the legs to orient the body in a more “seated” position. This position helps promote circulation and can help delay orthostatic intolerance. Users can also practice vigorously moving their legs up and down to promote blood flow and increase circulation. 

 In recent years, manufacturers have strongly encouraged the addition of suspension trauma straps to body harnesses. Many manufacturers include harness options with trauma straps already integrated into the harness before purchase, but some users prefer to add them to their harness after purchase. While use slightly varies between manufacturers, these suspension trauma straps can be deployed to create a loop underneath the fall victim’s dangling feet. Once properly tensioned, the user can press their feet against the straps to encourage movement, improve circulation and increase blood flow. If used properly, these straps can effectively delay the effects of orthostatic intolerance and reduce the long-term effects of suspension trauma.


Suspension trauma will vary for each fall victim, but its effects can be potentially lessened if effective actions are taken during fall rescue procedures. Still, mitigating hazards is a reactionary measure while attempting to eliminate hazards can proactively protect workers from suffering suspension trauma. The goal should always be to prevent the incident from occurring altogether, instead of planning to remedy issues only as they happen. 

Increased awareness and training can greatly benefit an organization’s fall protection program. Fostering a safety culture leads to a world with no falls, not just fewer. That vision starts with the initial design of a building’s architecture and requires partnership and cooperation from all levels of an organization. A more robust safety culture can help prevent injuries and save lives.

This article originally appeared in the June 2024 issue of Occupational Health & Safety.

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