Suspension Syndrome

Suspension syndrome (formerly called suspension trauma) happens when a person becomes lightheaded, faints or (rarely) has cardiac arrest while hanging motionless in a harness or on a rope. It can also happen shortly after rescue. Suspension syndrome affects people who use ropes or harnesses for work or recreation. It’s rare and often preventable. Fast rescue is critical and can save a life.

Call 911 or your local emergency number if someone around you falls while on a rope and harness. Don’t delay, even if you think you can help the person. It’s impossible to tell if or when suspension syndrome might set in.

“Suspension syndrome” is the most accurate term for this condition. Older names, which healthcare providers don’t use anymore, include:

• Suspension trauma: This implies there’s a traumatic injury. But usually, there’s minimal or no physical trauma. The act of dangling in mid-air is what leads to symptoms.
• Harness hang syndrome: This suggests the harness is to blame when really, it’s not. The problem is the passive hanging, rather than the harness pressing on blood vessels. Trying to remove the harness shouldn’t delay rescue or first aid measures.

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There’s no way to predict when suspension syndrome symptoms may begin. In some people, they start after just a few minutes.

Symptoms of suspension syndrome

Symptoms can begin within minutes or after a longer time — there is no reliable timeline. Symptoms include:

• Dizziness or lightheadedness
• Confusion
• Cold sweats or feeling very warm
• Blurred vision
• Nausea
• Pale skin
• Slow heart rate

Without help, you may faint, meaning you lose consciousness. It’s also rare but possible for your heart to stop beating (cardiac arrest).

Suspension syndrome causes

Experts don’t fully understand what causes suspension syndrome. They know it happens when you’re passively hanging from a rope or harness. This means your feet are dangling in the air and can’t rest on anything solid.

There are many theories for what exactly causes this syndrome. One likely explanation is that your nervous system overreacts. This is called a vasovagal or neurocardiogenic reflex. This reflex causes your heart rate to slow down and your blood pressure to drop, leading to fainting.

Older theories suggested that blood pooling in your leg veins caused too little blood to reach your upper body. But experts now know the link isn’t that simple. While some blood does pool in your legs, the pooling itself likely isn’t the problem. It’s the fact that your nervous system kicks in and triggers changes in response to that.

Risk factors

You may be at risk of suspension syndrome if you have certain jobs or hobbies that require a rope and harness, including:

• Painting or construction work on tall buildings or bridges
• Rock climbing
• Mountaineering
• Caving

How healthcare providers diagnose this condition

Diagnosis happens at the scene when first responders arrive. They’ll talk to you about your symptoms, if you’re able to speak. They’ll provide first aid and take you to a hospital. On the way, they’ll closely monitor your breathing, heart rate, blood pressure and blood oxygen levels.

Once you’re at the hospital, you may need blood tests to check electrolyte levels and kidney and liver function. Providers may also do CT scans or other imaging tests to check for injuries.

How is suspension syndrome treated?

First responders will begin treating you as soon as possible. They’ll remove you from the harness and lay you down flat. This helps enough blood flow to your brain. You may feel your symptoms start to improve. If you’re not breathing or responding, they’ll start CPR. They’ll then take you to a hospital for further evaluation.

At the hospital, you may need medications, IV fluids or other treatments to help your body recover. Healthcare providers will also treat any injuries you might have.

When should I see my healthcare provider?

Healthcare providers at the hospital will explain the follow-up visits you need. You should also tell your usual provider about what happened so they can make a note in your medical record.

What can I expect if I have this condition?

Most people fully recover from suspension syndrome. It’s a scary but temporary experience. If you go into cardiac arrest and need CPR, you may develop complications. Your healthcare provider will explain what you can expect and the care you’ll need.

Very rarely, people die from suspension syndrome.

Can suspension syndrome be prevented?

Yes, there’s a lot you can do to prevent suspension syndrome from happening. Here are some tips:

• Be prepared. Make sure you have the right equipment and training before doing any activities that use a rope or harness. If you work high up, follow all the training and guidelines that your employer provides.
• Go in groups. Do climbing and other activities with others, rather than alone. That way, someone can call for help right away if needed.
• Move your legs. If you’re stuck in mid-air, lift and move your legs as much as possible. This helps keep blood moving in your body and may delay or prevent symptoms. Keep moving your legs as you’re able until help arrives.