General terms

Suspension trauma

The term suspension trauma is used to describe the injuries caused through being suspended motionless in a safety harness. However, further injuries are also to be expected as a result of a fall.

What causes suspension trauma?

The energy released when a fall is arrested is relayed through the accident victim’s safety harness (or similar), pelvis and then into his/her body. A high energy impulse is generated through the leg straps, compressing the tissue in the pelvic and thigh area. This state is maintained whilst the victim remains motionless in a suspended position - leading to circulatory problems in the legs.

The internal arteries are situated deep down so that the transport of oxygen-rich blood through the victim’s legs is not usually affected. However, the veins, which are chiefly located near the surface and which transport the blood when it is low on oxygen back to the heart, are compressed - stopping or severely restricting the blood flow.

If the blood is allowed to flow freely away from the heart but is extremely restricted on its way back, it is easy to imagine what effect this will have after only a short period of time. The blood will accumulate in the victim’s legs and will no longer be available to the rest of the body. The resulting lack of blood will then lead to an oxygen deficiency. Important organs, such as the brain or heart, will quickly suffer damage as a result of this lack of oxygen - leading to a life-threatening situation. Blood congestion also causes other harmful effects but we will not be discussing these in any more detail in this entry.

Suspension trauma does not occur suddenly - it develops. The longer the victim is suspended in his/her harness, the higher the probability of circulatory problems. There are many factors that promote such circulatory problems - and others that may counteract the effects of suspension trauma. It is not possible to make a general statement about the timeframe when considering suspension trauma.

Suspension trauma is favoured by:

  • A stress reaction as a result of the accident
  • Unconsciousness
  • Other injuries (additional blood loss)
  • Preexisting conditions (cardiovascular, vascular, ...)
  • Excess weight
  • Incorrect use of the PPE equipment
  • A delay in getting the rescue operation under way

Suspension trauma can be counteracted by:

  • Keeping calm
  • Moving one’s legs
  • Taking the weight off through the use of a foot sling, or similar
  • Supporting oneself by holding onto a structure
  • Being able to rescue oneself without any extra help
  • Being physically fit / healthy
  • Being quickly rescued by one’s colleagues

What measures need to be introduced?


After a fall, the top priority is to rescue the victim quickly. The first effective measure against suspension trauma is a rapid and experienced reaction on the part of the victim’s colleagues onsite. The required measures are described in the rescue concept. Dialing the emergency number (112 in Germany) is a matter of course in such a situation but on no account should the rescue operation wait for the fire brigade to arrive.

First aid

After the victim has been rescued, first aid must be administered. First aid measures always depend on the victim’s condition. Care must be taken to maintain vital functions.

If the victim shows no sign of reaction whatsoever (unconsciousness) and is not breathing, you need to start artificial resuscitation immediately. You must not stop this artificial resuscitation until instructed to do so by the emergency services - or if the victim shows obvious signs of being alive.

If the victim is merely unconscious, i.e. he/she is breathing and his/her circulation is not restricted in any way, the victim must be brought into a recovery position. You must continually check that the victim’s breathing is functioning. Should he/she stop breathing, you must begin artificial resuscitation immediately.

If the victim is responsive after the fall and a successful rescue operation, all further measures must be coordinated with him/her. Which measures are necessary and, in particular, how the victim should be positioned, depends on the type of injuries sustained and any other complaints he/she may have. Under no circumstances should the victim carry on working or move unnecessarily. The top priority is to remain calm until the rescue services arrive. Currently, there is a lack of studies confirming the effectiveness of special methods of positioning a victim, such as squatting or crouching. However, if the victim’s other injuries - and the victim him/herself - allows it, there is no objection to a squatting/crouching position.

On no account should life-saving measures be delayed or not carried out.

ABS Safety recommends attending regular first aid courses.