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The Guardian Fall Team Blog

You’ve fallen. In the blink of an eye you went from welding a beam to hanging 20’ above the ground in your safety harness. Your co-workers are scrambling to rescue you, and as you look down at the spinning earth below, you are grateful to be alive and that the danger is over. But is it? Maybe - maybe not.

Out of the woods… or are you?

It’s easy to think of the arrest of a fall as the “beginning of the end” when it comes to dangers posed by falling, and that the subsequent rescue is in fact the end of the danger, but that’s not always the case. While you are dangling in your safety harness awaiting your (hopefully expedient) rescue, a potentially life-threatening process may have begun, unseen below the straps of your harness and tool belt.

How your body reacts to the fall – 'Orthostatic Intolerance' (aka Suspension Trauma)

Lower extremity blood flow is in part reliant on the squeezing action of muscles (during walking for example) to return to the heart and lungs to be refreshed with oxygen. During long periods of standing, sitting, or immobility, venous pooling can occur, whereby blood (because it is not being pumped back to the heart) engorges the veins of the lower legs, creating in essence a reservoir of oxygen-depleted blood.

In extreme cases, the body tries to overcome this stagnation by temporarily increasing heart rate to the point the sufferer may experience heart palpitations, sweating, or dizziness.

If the situation is not remedied, the body then lowers heart rate dramatically (to reduce arterial pressure) which, due to lack of blood pressure, can cause fainting. Together, these symptoms describe a condition called 'orthostatic intolerance', and for anyone working at height, it’s worth knowing more about.

Are only fall victims at risk from orthostatic intolerance?

Orthostatic Intolerance (also referred to as 'Suspension Trauma') isn’t new, nor is it restricted to safety workers donning full-body harnesses. In fact, if you have ever stood up quickly from a kneeling or squatting position and felt light-headed, you have experienced orthostatic intolerance.

In those cases the effects are mild, and after the brief “woozy” period (the wooziness is due to lack of oxygen to your brain), proper blood pressure is restored and you feel fine. Office workers who sit at a desk during much of their day are advised to take frequent breaks and go for short walks to refresh lower extremity blood and prevent venous pooling. If you have ever been on a long flight (I could tell a horror story or two about my 11-hour flight from Frankfurt to San Francisco…), you probably remember the flight attendant suggesting you occasionally flex your leg muscles and rock your toes back and forth. Even these small movements increase circulation and help prevent the symptoms of orthostatic intolerance when you launch from your seat to grab your overhead bag when the plane finally makes it to the gate.

How dangerous is orthostatic intolerance?

At the risk of being called a fear monger, it’s important to know that orthostatic intolerance can kill you. It’s not often, but there are reported cases of workers being suspended in their harness for less than 30 minutes (some less than 15), only to suffer an extreme case of suspension trauma that resulted in death. In some cases, death occurred after the worker reached the safety of solid ground...

How did this happen?

Remember above when I mentioned the unoxygenated blood that pools in your legs when you are suspended? When a worker is relieved of the static, hanging condition and blood is able to flow freely, the large quantity of oxygen-depleted blood hitting the heart can actually cause a heart-attack. Of course there are many factors that contribute to this possibility, including a worker’s weight and overall health, but the point is that prolonged suspension can kill you.

That is why OSHA requires employers have a rescue plan in place at all times, and when a fall occurs, the worker is rescued as quickly as possible. It’s also why knowing the symptoms of suspension trauma is important; you are the first link in the chain to get your co-workers to safety, and to prevent a potentially life-threatening situation from getting worse.

What can workers do?

Workers can protect themselves from orthostatic intolerance in several ways. Having a rescue plan in place and taking quick action is the most effective means of preventing orthostatic intolerance; the quicker a worker is rescued, the less time there is for it to occur. Also, ensure that full-body harnesses are adjusted properly and are not overly constrictive or loose.

Trauma relief straps are another important equipment option, as they allow a fallen worker to relieve the pressure on their legs caused by their harness and assume a standing position. If straps are not available, pumping and flexing the legs will help to circulate blood and prevent venous pooling. Once a worker has been rescued, be sure to get them to a medical professional for evaluation. Since orthostatic intolerance affects each worker differently, having a check-up to ensure the worker has not suffered delayed effects of orthostatic intolerance is a worthwhile investment in their safety as well.

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