Will your safety harness kill you?

Bill Weems and Phil Bishop
Workers and emergency response personnel must be trained to recognise the risks of suspension trauma.

I was surprisingly comfortable with my legs dangling relaxed beneath me and my arms outstretched in a posture that must have resembled a crucifixion. I had no feeling of stress and mused as to why this was considered dangerous. I felt I could stay in this position for a long time. Three minutes later, maybe less, I wondered why I suddenly felt so hot. The next thing I knew, they were reviving me from unconsciousness.

I had just experienced what could be deadly for your workers who use safety harnesses. Fortunately for me, my suspension trauma occurred in the safe environment of the research ward of the University of Texas Medical Branch Hospital at Galveston, Texas, where I was the first subject in a NASA experiment studying orthostatic intolerance in astronauts. Your workers won't be so lucky.

Harness-induced death
Wide ranges of situations require safety harnesses of various types. Workers requiring fall protection, workers entering many confined spaces, mountain climbers and cave explorers all try to protect themselves through the use of safety harnesses, belts, and seats. What is little known, however, is that these harnesses can also kill.

Harnesses can become deadly whenever a worker is suspended for durations over five minutes in an upright posture, with the legs relaxed straight beneath the body. This can occur in many different situations in industry. A carpenter working alone is caught in mid-fall by his safety harness, only to die 15 minutes later from suspension trauma. An electrical worker is lowered into a shaft after testing for toxic gases. He is lowered on a cable and is positioned at the right level to repair a junction box. After five minutes he is unconscious — but his work mates tending the line don't realise it, and 15 minutes later a dead body is hauled out.

The cause of this problem is called "˜suspension trauma'. Fall protection researchers have recognised this phenomenon for decades. Despite this, data has not been collected on the extent of the problem; most users of fall protection equipment, rescue personnel, and safety and health professionals remain unaware of the hazard.

Suspension trauma
Suspension trauma death is caused by orthostatic incompetence (also called orthostatic intolerance). Orthostatic incompetence can occur any time a person is required to stand quietly for prolonged periods and may be worsened by heat and dehydration. It is most commonly encountered in military parades where soldiers must stand at attention for prolonged periods. Supervisors can prevent it by training soldiers to keep their knees slightly bent so the leg muscles are engaged in maintaining posture.

What happens in orthostatic incompetence is that the legs are immobile with a worker in an upright posture. Gravity pulls blood into the lower legs, which have a very large storage capacity. Enough blood eventually accumulates so that return blood flow to the right chamber of the heart is reduced. The heart can only pump the blood available, so the heart's output begins to fall. The heart speeds up to maintain sufficient blood flow to the brain, but if the blood supply to the heart is restricted enough, breathing faster is ineffective, and the body abruptly slows the heart.

In most instances this solves the problem by causing the worker to faint, which typically results in slumping to the ground where the legs, the heart, and the brain are on the same level. Blood is now returned to the heart and the worker typically recovers quickly. In a harness, however, the worker can't fall into a horizontal posture, so the reduced heart rate causes the brain's blood supply to fall below the critical level.

Orthostatic incompetence doesn't occur very often because it requires that the legs remain relaxed, straight, and below heart level. If the leg muscles are contracting in order to maintain balance and support the body, the muscles press against the leg veins. This compression, together with well-placed one-way valves, helps pump blood back to the heart. If the upper-legs are horizontal, as when we sit quietly, the vertical pumping distance is greatly reduced, so there are no problems.

In suspension trauma, several unfortunate things occur that aggravate the problem. First, the worker is suspended in an upright posture with legs dangling. Second, the safety harness straps exert pressure on leg veins, compressing them and reducing blood flow back to the heart. Third, the harness keeps the worker in an upright position, regardless of loss of consciousness, which is what kills workers.

Phases of fall protection
There are four phases of fall protection: before the fall, at fall arrest, suspension, and post-fall rescue. Each phase presents unique safety challenges. Suspension trauma can be influenced by all aspects of the fall, so they are all important.

As with many aspects of safety, increasing the safety in one phase can compromise the safety of the others. Whatever training workers have received will determine how they respond to different phases.

Before the fall
The key issue of fall protection before the fall is compliance. If a harness is too uncomfortable, too inconvenient, or interferes too much with task completion, workers may not use the equipment or may modify it (illegally) to make it more tolerable.

A second major point is the length of the attachment lanyard or, how far can a worker fall before his fall is arrested? The longer the fall, the greater the stress on the body when the fall is arrested. The shorter the lanyard, the more often it will have to be repositioned when workers are mobile. A moveable safe anchor is one solution, but this situation is only occasionally available.

Fall arrest
The whole concept of fall protection is that workers who fall will be stopped by a tethering system. The longer the attachment lanyard, the greater the acceleration time during the fall and the greater the stress on the body at arrest. Unfortunately, the posture of the falling worker is unpredictable.

Depending on the harness attachment point and the position of the worker's body at arrest, different harness attachments offer different advantages. An attachment near the shoulders means that any drag from the lanyard will serve to position the worker's body in an upright position so the forces are distributed from head to foot. The head is somewhat protected if the legs and body precede it in the fall, but this offers some disadvantages after the fall arrest is completed.

Suspension
Many safety professionals naturally assume that once a fall has been arrested, the fall protection system has successfully completed its job. Unfortunately, this is not the case. A worker suspended in an upright position with the legs dangling in a harness of any type is subject to suspension trauma.

Fall victims can slow the onset of suspension trauma by pushing down vigorously with the legs, by positioning their body in a horizontal or slight leg-high position, or by standing up. Harness design and fall injuries may prevent these actions.

Rescue
Rescue must come rapidly to minimise the dangers of suspension trauma. The circumstances together with the lanyard attachment point will determine the possibilities of self-rescue. In situations where self-rescue is not likely to be possible, workers must be supervised at all times. Regardless of whether a worker can self-rescue or must rely on others; time is of the essence because a worker may lose consciousness in only a few minutes.

If a worker is suspended long enough to lose consciousness, rescue personnel must be careful in handling such a person or the rescued worker may die anyway. This post-rescue death is apparently caused by the heart's inability to tolerate the abrupt increase in blood flow to the right heart after removal from the harness. Current recommended procedures are to take from 30 to 40 minutes to move the victim from kneeling to sitting to a supine position.

Interference among phases
An arrest harness attachment on the front of the body facilitates self-rescue after a fall. However, a front attachment means the arresting lanyard may be in the way for many work tasks. An attachment point near the center of gravity (CG) makes post-fall body positioning much easier and increases the likelihood that a fallen worker will not be suspended in an upright vertical position.

Yet a front near-CG attachment point can greatly increase the bending stress on the spine at the instant of arrest, raising the possibility that the arrest itself results in serious injury. The most protective harnesses for suspension can be the least comfortable.

Recommendations
Safety harnesses save many lives and injuries. However, continual vigilance is needed to train and supervise workers to ensure harnesses are used safely. All phases of fall protection need to be examined for each particular application.

Workers and emergency response personnel must be trained to recognise the risks of suspension trauma.

Bill Weems and Phil Bishop are at the University of Alabama, in Tuscaloosa, Ala. Dr Weems is an industrial hygienist. He directs Safe State, the OSHA consultation agency for small business in Alabama. Dr Bishop is an agronomist. He teaches and conducts research in the physiology of human performance.