NOW WHAT?? DON'T LEAVE ANYONE HANGING
The Importance of Swift Rescue After a Fall
The recent accident and subsequent rescue of the two window washers who got trapped halfway up the World Trade Center has (hopefully) gotten everyone thinking more about rescue plans and procedures. Fortunately that episode had a very happy ending. The fire department acted quickly and the men were uninjured as they awaited rescue.
This incident serves as a reminder that having fall protection in place is really only half of the needed preparation. There also needs to be a rescue plan, and equipment in place so that responders can act with sureness and swiftness in the case of a fall.
In this case, the workers were very lucky in that the platform, though it failed, did not fall away from them and allowed them to stay supported while they waited for rescue. If the platform had fallen and left them hanging by their harnesses, the situation would have become much more dire.
Even if a worker is not injured in the initial fall, the need for swift recovery is of utmost importance because of the secondary problem of suspension trauma.
Suspension trauma is induced when a person is held motionless in an upright position. It’s the reason why someone faints if they stand still with locked legs for a period of time. Under normal circumstances, blood from a person’s legs is re-circulated by the muscles pressing on the leg’s blood vessels and moving the blood back up to the heart. In essence, the muscle action works as a pump, assisting the heart in moving the blood. If the legs are held motionless (and the muscles therefore are not doing their job as a pump), gravity keeps the blood pooling in the legs. The longer this goes on, more blood is delivered to the legs but not pumped back out again. The veins in the leg can expand a great deal, allowing for the accumulation of a large percentage of the body’s blood supply—thus the brain and vital organs begin to be deprived of oxygen due to less blood being circulated through them.
This is the point when a person will start to feel the symptoms of suspension trauma:
- Blurred vision
- Sweating/hot flashes
- Shortness of breath
- Paleness/loss of color
- Numbness in the legs
Once the victim has developed symptoms, it is only a matter of time before they will faint. How long this takes varies widely; studies have shown that it can be anywhere from 10 minutes to 60 minutes, with no way to predict how any given person will react.
The fainting response is believed to be a physiological mechanism: when the brain is deprived of oxygen, it basically hits the “off” switch, causing the person to faint. Under normal circumstances they would then fall down, which would allow the blood pooling in the legs to circulate again, and the oxygen supply would be restored. Usually the faint is short, and the person recovers rapidly.
However, in the case of a person suspended in a harness, when they faint they cannot fall to a horizontal position. The blood pooling in the legs is not released, oxygen deprivation in the brain and vital organs continues, and permanent organ damage and death can result.
Once the victim has fainted, death can occur within minutes. If there is no way to get a suspended worker down within 10 minutes, it is critical to raise their legs so that they are hanging in a “sitting position,” with knees raised higher than the waist if possible. An uninjured worker may be able to do this on his own with the use of straps or a self-rescue ladder. If he cannot do it, or does not have the means built into the fall protection system, rescuers should make it a priority to get to him and raise his legs while awaiting full rescue; this can buy some time by helping the blood flow back into the body.
Rescue Plan Needed
Armed with this knowledge, you can see the importance of a quick rescue. Having a plan makes the rescue of a fallen worker a “pre-planned event,” rather than something that happens on the fly once the fall has already happened. While it is impossible to plan for every scenario, having a checklist in place that defines responsibilities and procedures can go a long way toward facilitating a quick rescue—the goal should be 6 minutes or less.
In a best-case scenario, rescue drills should be conducted so that everyone is trained in responding and learns the correct way to get a fallen worker to the ground as quickly as possible.
Why Can’t We Just Call 911?
For some companies, calling 911 is the rescue plan. While that should definitely be included on the list of steps to take, there are a few problems with relying on outside help to retrieve a fallen worker.
Firstly, the response time is likely to be too long. There are many factors that play into how long quickly the fire department or rescue squad gets to your location. If a worker is hanging from a harness, the safety zone for how long they can remain there without permanent damage or death ends at 10 minutes. Unless your location is right next to the fire station, it’s unlikely that they could respond that fast.
Secondly, not all rescue personnel have been well trained in high rescue, and may take longer to construct and implement a plan. Additionally, not all rescue personnel are trained to recognize suspension trauma, and may not realize the need for urgency.
Creating a rescue plan is the first step. Define where each of your fall hazard areas are and note the fall protection system in place there. Then for each area, create a checklist: 1. Who is in charge in the case of a fallen worker? 2. Who calls 911? 3. What equipment will be used for the rescue, and who will operate it? 4. Will the worker be lowered to the ground, or raised to the previous working level? 5. If the worker has been injured as a result of the fall, or is unconscious due to suspension trauma (and therefore cannot assist with their own rescue), what will the procedure be? 6. All personnel involved should be trained in recognizing the symptoms of suspension trauma.
After the Rescue
Once someone has been lowered and released, there is still a possibility of complications from being suspended. Though there are varying schools of thought and incomplete research, there seems to be a potential for further trauma if the pooled blood is released back into the system in one big rush; in other words, if the victim is laid down horizontally. Depending on how long they were suspended, the oxygen-poor blood can become full of toxins. If this flows to the heart and kidneys in a rush, there is a possibility of heart or kidney failure. This is known as reflow syndrome.
The method for preventing reflow syndrome is to keep the rescued victim sitting up if at all possible, with knees bent to about chin level. They should be kept in this position for at least 30 minutes, even if they feel like they have recovered. Anyone who has been suspended for 10 minutes or more should also be given oxygen and monitored by professional medical personnel to be sure no other problems arise. Fall protection is a vital part of any work area where employees have to be at heights. A rescue plan is of equal importance, to be sure that a fallen employee won’t come to further harm after the fall protection system has done its job.
Sources / Additional Reading: http://dynamicrescue.com/blog/docs/Suspension-trauma.pdf http://www.emergencymedicalsupplies.co.uk/SuspensionTrauma.htm https://www.osha.gov/dts/shib/shib032404.html#Footnote http://ehstoday.com/ppe/fall-protection/ehs_imp_37626 http://www.jems.com/article/patient-care/dangerous-suspension-understan http://www.hse.gov.uk/research/rrpdf/rr708.pdf