Suspension Trauma Tucson Expo 2011

1. Suspension TraumaTucson Expo 2011 Captain Ian Cassidy Northwest Fire District Special Operations Response Teams

2. Objectives • Expand your understanding of physiological terms. • Define suspension trauma and understand the basic physiology. • Realize the urgency of expedient rescue. • Discuss ways to minimize risk of suspension trauma. • Discover ways to prolong symptoms until rescue can be achieved. • Be able to implement the steps needed, post rescue, of a victim with suspected suspension trauma. • Understand your role in a rescue and the importance of training for the event.

3. Terminology • Pathology- study of illness or disease, and how it affects the body. • Suspension- hanging in a harness or other support which maintains the attitude of the body. • Trauma- serious wound or abnormal condition • Orthostasis- maintaining an upright and motionless position. • Venous pooling- accumulation of blood in the veins due to gravity (typically in legs).

4. Terminology • Syncope- fainting. • Tachycardia- increased heart rate >100 beats per minute (bpm). • Hypo/Hypertension- A decrease or increase in blood pressure.

5. Suspension Trauma • “Harness Induced Pathology” • “Orthostatic Incompetence” or “Orthostatic Intolerance” • Was first seen in crucifixion • Occurs when in a vertical position where the body remains motionless. • Venous pooling in legs • One way valves • Lack of a pump

6. Suspension Trauma • Reduces amount of circulating blood volume. • Not enough good (oxygenated) blood to go around. • Uncirculated blood becomes acidotic (poison) • Syncope • Body is tricked, cannot produce a horizontal position. • Can caused renal (kidney) failure as well.

7. Suspension Trauma • Tolerance to suspension varies. • Shock from the event • Injuries sustained (if any) • Harness comfort level (proper wearing/fit) • Psychological state • Health (diet, exercise etc.) • Most studies show syncopal episodes taking place between 5-35 minutes

8. Suspension Trauma • Studies show differences in tolerance are also based on harness type: • Class I: Body Belt: Syncope within 0.35-4.76 min. • Class II: Chest Harness: 0.62-13.13 min. • Class III: Full Body Harness: 5.08-30.12 min. • Suspension from the back was also the most tolerated connection point.

10. Rescue • Follow your emergency response plan! • Dial 911 or have a designee do it right away. • Gather all pertinent victim information for incoming Fire units. • Self rescue, employer rescue or professional rescue = Hospital transport

11. Professional Rescue • What do we need/want to know? • Age • Is patient conscious • Known medical history • Time of fall • Nature of fall (syncope? slip/trip? Etc.) • Known hazards (Electrical, mechanical etc.) • Is area secure • Is there a rescue in progress

12. Rescue • Each employer should maintain emergency contact forms on site and available for fire department personnel should an incident occur. • Saves time • Allows for more efficient patient profile • Helps employer notify workers family • Reduces stress during high risk situations.

13. Rescue • Contact form should contain: • Name, address, phone numbers • At least two emergency contacts with multiple contact numbers. • Pertinent medical informationto include medications. • Any other information that the employee is willing to share.

14. Avoidance • Properly fitted harness for each employee. • Each employee must set their harness up prior to an incident occurring. (Train) • Adequate hydration. • Make good decisions with regards to workers in elevated positions. • Purchase anti-suspension trauma devices.

15. Avoidance After the fall: • Encourage victim to flex their legs every few minutes. • Use of anti-suspension trauma device • If trained and comfortable, invert for short periods of time. • Move legs constantly in an extension/ flexion type movement.

16. Management • Recognition, sings and symptoms: • Light headedness • Nausea • Difficulty breathing • Hot flushes • Increased heart rate and blood pressure • Loss or dimming of vision • Syncope

17. Management • Even if signs and symptoms are not present management should include: • Removing the patient from the suspended state. • Keeping the patient in a seated position for a minimum of 20 minutes. • Return the patient to a horizontal position over a period of about 20-40 minutes. (SLOW!)

18. Management • Treat all other manageable injuries using first aid skills. • If suspected spinal injuries are present hold patients head as still as possible in an in-line position until professionals arrive.

19. Your Role • Collect information prior to Fire Department arrival. • Make sure the RP (Responsible Party) is accessible when they arrive. • The RP should not be directly involved with the rescue. • Make sure the area is secure, all work in the area is stopped.

20. Your Role • If employer rescue is on-going make sure only trained personnel are involved. • More rescuers can mean more injuries/victims. • Know the rescue plan and be able to explain it to the fire department crews. • Address any hazards that may slow rescue operations when Fire Department arrives. (Secure power etc.)

21. Training • Training is essential. Do not expect your people to perform under stress if they have not practiced in a controlled environment. • Standard rescue practice for technical rescue teams is 20 hours per month after they complete 200 hours of initial training.

22. Training “Amateurs train until they get it right, professionals train until they can’t get it wrong.”

23. Any Questions? Thank You!