Article on Prolonged Suspension in an Alpine Harness

[Carl Amundson]

A friend sent me a link to an article entitled - Risks and Management of Prolonged Suspension in an Alpine Harness
I thought it would be a good idea to post it here for all the rescue and medical personal to look at:
http://download.journals.elsevierhealth.com/pdfs/journals/1080-6032/PIIS1080603210003200.pdf

[self-deleted_user]

Interesting read. The tl;dr I got from it was "try and stay conscious and keep moving your legs" which I figured as much already.
I wonder though, if the problem is basically going unconscious in a sitting rather than lying down position, wouldn't loosening the chest harness so you can lie back, and then hooking footloops around ankles and tightening up that length to hold feet up basically put you in a lying down position on rope, would that potentially help?

[Ernie Coffman]

The webpage cannot be found is all I got; thus, I tried copying and pasted and still the same 'ole message. Has it gone by the way...or is there something wrong in the link?

[pub]

The link is okay on my end... I can email the pdf to you if you want, it is worth reading

[Ernie Coffman]

Well hot dog, Jerry! I don't know what the heck is wrong here. Let me try, again, and if it doesn't work, I'd appreciate that.

[Ernie Coffman]

I got it that time. Don't know what the deal was, but...I'll go read it now. Thanks much, Jerry!

[pub]

YW Ernie...

It might be worth posting the abstract here:

Suspension trauma is a state of shock induced by passive hanging. Those who survive passive suspension are at risk for rhabdomyolysis. In a wilderness setting, one can see this in cases of persons suspended on rope by their harness. In a conscious person, leg movements work the venous pump to return blood to the central circulation. In the person passively hanging, blood pools in the legs leading to hypoperfusion of vital organs. In the experimental setting, passive hanging has led to unconsciousness in a matter of minutes. Based on a previous series of deaths on rope that included 7 after rescue,
many authors have recommended nonstandard treatment for shock including keeping rescued patients upright or squatting for 30 minutes prior to laying them down. This recommendation assumes that sudden death is a risk from acute volume overload or exposure to waste products in the returning blood. This suggestion is not supported by the original series that demonstrated sudden deaths after rescue nor by modern understandings of physiology. Search and rescue teams and party members assisting a colleague suspended unconscious on rope should follow standard resuscitation measures to restore circulation to vital organs immediately.

[NZcaver]

FYI - Roger is an NCRC instructor and is "cavedoc" here on the forum. Good stuff!

[Tim White]

I am in the process of getting this article up on the Nylon Highway, once there you can view it online without downloading.

Remember that the Nylon Highway and membership into the NSS Vertical Section is now FREE.

http://www.caves.org/section/vertical/

[self-deleted_user]

Oh cool, yay for a cavedoc! =)

But no thoughts on my idea at all? If I understood right the issue seems to be not the pressure on the legs or such necessarily but rather the fact that one is fainted in an upright position instead of laying down perhaps. So what about - assuming self is still conscious when initially getting stuck (or someone else can get to you?) getting them in a lying down position on rope until rescue? I know I'm thinking a frog system as that is what I'm familiar with, but loosening the chest harness should allow the upper body to lie back at least somewhat and then if you were to hook the footloops around the ankles and perhaps tighten that cord some to keep legs raised up. In case it's not making sense (and I'm not sure it's feasable just thinkin' around here) I did a quickie paint drawing haha.

[cavedoc]

But no thoughts on my idea at all?

Actually it's a fine idea. Not sure about the loosened chest harness, but I could make a good argument in its favor. The strap under the legs was demonstrated by Madsen (cited in the article) to make a lift much more tolerable and Turner (also cited) shows something similar based on harnesses more like we would use. In fact she came up with a commerical product that's sold for industrial applications. So if you're suspended and things aren't going right, find some way to turn your footloops into a leg raising tool.

[cavedoc]

I should point out that this article was inspired by a discussion here on cavechat.

viewtopic.php?f=7&t=2816

It was also helped by some great reports in American Caving Accidents. So thankyou editors of ACA and all who have submitted incidents to ACA. Hopefully your work advances science and patient care. And thanks for all on cavechat who ask questions and answer questions. It gets all of us thinking.

[self-deleted_user]

But no thoughts on my idea at all?

Actually it a fine idea. Not sure about the loosened chest harness, but I could make a good argument in its favor. The strap under the legs was demonstrated by Madsen (cited in the article) to make a lift much more tolerable and Turner (also cited) shows something similar based on harnesses more like we would use. In fact she came up with a commerical product that's sold for industrial applications. So if you're suspended and things aren't going right, find some way to turn your footloops into a leg raising tool.

Sweet! My system is really adjustable so I could easily make it to a comfy lying position I think....hmm...I'm going up to Aaron's tomorrow to work on my changeovers and maybe learn how to pass knots (I'm still learning & practicing...being far away from caves means I've had the gear about 4 months now but not a chance to do a vertical trip yet, best I've gotten is cliffwork and at this point I've not been on rope in about 2.5 months so I want to keep up on it a bit better should I ever have a chance for a trip sometime, ever, lol) oh right before my ramble I think I'm gonna see if I can lie down tomorrow and how easy that is to work.

[Carl Amundson]

Here is a link to the article that can be viewed online:
http://wemjournal.org/article/S1080-6032%2810%2900320-0/fulltext

[jbabcock]

I´m pretty sure this has nothing to do with whether you are prone or sitting. I fall asleep sitting up all the time and I haven´t died yet.

My understanding is that the danger is the pressure on your legs from the harness. Blood in your legs cannot return to your body when the harness is pressed against your femoral vein. The blood then becomes toxic with metabolic waste. When the blood does return it interferes with signals in your cardiac tissue causing cardiac arrest. One of the names I have heard for this is compartmental syndrome, which pretty much sums it up. Unless you are willing to cave in a bosun's seat the only solution I know of is to get rescued fast when you become unconscious.

As a side note, this is why tourniquets should only be removed by an emergency room. They do all sorts of in vivo chemistry to detoxify your blood before they remove the tourniquet. It is also why hypothermia victims should not be warmed quickly. The RAF lost a lot of pilots in WWII *after* they pulled them alive from the north sea. They would warm up and just die from a heart attack.

Josh