Suspension Trauma and the Rescue Plan

What is suspension trauma?

The fall arrest system has done its job: the worker fell and the full body harness caught them. The job does not end there. In a person hanging motionless in a harness, the pressure of the leg straps and the inactivity of the leg muscles cause blood to pool in the legs, reducing the blood returning to the heart. The result is dizziness, clouding of consciousness and fainting. Known as suspension trauma, this condition can progress, with loss of consciousness, to airway obstruction and death.

The first signs in a suspended worker are:

Dizziness, light-headedness, hot flushes
Pallor, sweating, nausea
Blurred vision, shortness of breath
Numbness and tingling in the legs
Slowed speech, becoming unresponsive

How quickly the condition develops varies from person to person; in some people it can begin within minutes. Injury during the fall, a loosely adjusted harness, cold, heat, fatigue and dehydration speed up the process. For this reason there is no such thing as a safe waiting time: a suspended worker must be rescued as soon as it is safe to do so.

Legislation: where does the rescue plan come from?

The rescue plan is not a separate type of document; it is part of the emergency plan and of the risk assessment for work at height.

Art. 11 of Law No. 6331 on Occupational Health and Safety requires the employer to identify possible emergencies in advance, prepare an emergency plan and appoint a sufficient number of trained people for these tasks.
Annex 4 (A) of the Regulation on OHS in Construction Work gives priority to collective protection for work at height. The more edge protection, platforms and nets reduce the need for harnesses, the more the need for rescue falls too.
The Work Equipment Regulation explicitly addresses rescue for rope access work.

The logic is the same for other jobs done in a harness: if you install a system that arrests a fall, you must also put in place the arrangements to bring down the person it has arrested.

Eight questions to answer before work starts

A rescue plan does not have to be a long document, but it must give written answers, with names, to these questions:

What is the scenario? Suspension after fall arrest, loss of consciousness on a work positioning line, hanging from a platform basket, being stranded on a pole or tower.
What is the method? Access by platform, remote rescue with a raise-and-lower kit, or rope access.
Who will carry out the rescue? At least two trained people on every shift, named.
Where is the equipment? The rescue kit is in the work area, inspected and in a place everyone knows.
Where will the rescuer anchor? A separate anchor point able to carry the load is designated for the rescue.
How will the person be reached? Whether the platform can get onto the site and whether the ground will carry it are checked in advance.
Who will call whom? Radio or phone, who will call 112, which gate the ambulance will be met at.
What happens after the rescue? First aider, referral and incident record.

The answers to these questions should be ticked off on the work at height permit form; a job without answers should not be permitted.

Comparison of rescue methods

Method	When is it suitable?	Equipment needed	Point to watch
Self-rescue	A conscious, uninjured worker close to a platform	Foot loop, suitable descent device	The plan cannot rely on this because of the possibility of panic and injury
Access by platform	If the ground and height suit a platform	Boom or scissor lift, operator	The rescuer is clipped in the basket; they take the person into the basket and only then release the connection
Rescue with a raise-and-lower kit	Direct access to the person is difficult and there is a suitable anchor above	TS EN 1496 rescue lifting device, TS EN 341 descender device	The rescuer does not release the fall arrest lanyard until the load has been transferred to the device
Rescue by rope access	Structures such as facades, towers, chimneys	Rope access equipment	Requires separate expertise and training
Fire brigade	Supplementary support	—	Response time is uncertain; the plan does not rely on this alone

On site, the most practical method is often access by platform. So if a boom lift is used on a construction site or for maintenance work, the rescue scenario should also state which platform will be used and who its operator will be. For platform use, see our article on scissor lifts and boom lifts.

What do the suspended worker and the ground team do?

The suspended worker tries to stay calm, calls for help and keeps moving their legs. If they can push their feet against the structure, they do so. If their harness has a foot loop, they deploy it and stand on it to work their leg muscles. These movements slow the pooling of blood in the legs.

The ground team follows this sequence:

Raises the alarm and starts the rescue plan.
Talks to the suspended person continuously, watching for slowing responses and symptoms.
One person calls 112 and gives the address clearly; one person meets the ambulance at the entrance.
The rescue team brings the person down using the planned method. Rescuers do not neglect their own safety; unprepared climbing leads to a second accident.
First aid is given once the person is down. Even if their symptoms seem to have passed, they are sent for medical assessment.
The harness, energy absorber and connectors that arrested the fall are taken out of use and assessed according to the manufacturer's instructions.
The event is recorded as a workplace accident and reported within the deadline.

Rescue kit and drills

The rescue kit is chosen according to the work area; even so, most kits contain:

A rescue device capable of raising and lowering, and rope of sufficient length
Separate anchor devices and slings for the rescue
Karabiners and connectors
Harnesses and helmets for the rescuers
First aid kit, radio and lighting for night work
Short, illustrated rescue instructions

The kit is inspected by a competent person at the intervals specified by the manufacturer, and the inspection record is kept with the kit. For choosing harnesses and anchors, see our articles on the full body harness and anchor points and lifelines.

The rescue failings we see most often during inspections are:

A kit, but no trained person. The rescue device sits in the store, but nobody on the shift knows how to use it.
A single anchor. No second point has been considered for the rescuer to attach to; the same anchor is overloaded during the rescue.
The platform is on another job. The boom lift planned for the rescue is being used for other work at the far end of the site.
A loose harness. A harness with loosely adjusted leg straps presses on the groin when the wearer is suspended and speeds up the condition; the harness must be adjusted to the wearer every time it is used.

A plan does not become reliable until it has been drilled. Emergency drills are held at least once a year; however, for projects involving a lot of work at height, we recommend a short rescue drill at the start of the work. Use a dummy rather than a live volunteer in the drill and time how long it takes to reach the person. For the drill form and scenario design, see our article on emergency drills. For a plan prepared on the same logic for confined spaces, our article on confined space rescue is a guide.

Bursa Sistemer OSGB adds work at height rescue scenarios to its emergency plan work at construction sites and facilities in Bursa and the surrounding provinces, and checks the rescue questions on work permits as part of its OHS specialist service. For other risks in the construction sector, see our construction page, and to keep track of drill dates, see our OHS calendar tool.

Frequently Asked Questions

How quickly does suspension trauma develop?

It varies from person to person; in some people symptoms can begin within minutes. Injury, a loose harness, cold and fatigue speed up the process. That is why plans are built not around a safe waiting time, but around rescue as quickly as possible.

Is a rescue plan for work at height a legal requirement?

Art. 11 of Law No. 6331 requires emergencies to be identified in advance and a plan to be prepared. For rope access work, Annex II 4.4.1 of the Work Equipment Regulation explicitly requires planning that ensures immediate rescue, and rescue training.

Should we keep the rescued person in a sitting position?

The current approach is to give the rescued person standard first aid; no special sitting position is recommended. If the person is unconscious, breathing is checked and they are treated according to first aid rules. In every case the person is sent for medical assessment.

Can a harness that has arrested a fall be used again?

No; after arresting a fall, the harness, energy absorber and connectors are taken out of use. A competent person decides whether they can be reused according to the manufacturer's instructions; lanyards with energy absorbers are generally single-use.