Article on Prolonged Suspension in an Alpine Harness

[NZcaver]

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.

After just recertifying my WFR, I see they're back to recommending short term use of tourniquets to stem major bleeding. Rather than accept the limb will be lost or that the tourniquet should only be removed in the emergency room, they say to carefully loosen after 10 minutes and see how effective the clotting is. Then reapply as necessary. Obviously some situations may render a limb beyond repair, but it seems a tourniquet is no longer considered a "last resort."

And for harness hang, I'm not so convinced laying a person prone while on rope will help much. I think Roger's footloop suggestion is a more practical option until they can be moved to solid ground. But I'd be interested to see other data on this.

[self-deleted_user]

Well today up at Aaron's for the heckuvit I tried, I found it most comfy to put the footloops just under my heels where my boots still were (so my feet didn't "fall asleep") and I did have to shorten the length of the rope to keep 'em up (which since my system is adjustible this was easy). It takes some core strength for me anyway to hold my body upright against the rope even with the chest harness helping and so in trying to just go "limp" and relax everything, it kinda made my back feel awkward and curved/bent on a funk angle so I did just loosen it allowing my spine to straighten and actually lie back more and it seemed comfortable enough to chill like that. If I had had neck support to keep my head from falling back I could've fallen asleep.

So for whatever it's worth, if I have to hang out (hehe) for a while and I'm getting tired waiting for rescue or whatever (so hopefully, never!) that's what I'd do if I can, it certainly was quite comfortable for me the only thing not comfy like I said was fully relaxed includes neck, and that is not comfy to be crained back. It definitly felt like my weight was pretty evenly supported in the chest, seat, and footloops and that there wasn't a ton of pressure in any one spot that I could tell.

[Ernie Coffman]

Thanks for bringing up this article, again, Roger, for it's a pretty serious problem as you pointed out in your paper. We've discussed this in our SAR unit and after observing several good points in this discussion, I thought I'd go and see what was on the Internet. Needless to say, there's some interesting stuff out there; and, this link will take you to some commercial sites that are selling straps to help one out of the problem...if they work. http://www.bing.com/search?q=suspension ... =2&sc=8-15

I recall seeing this first discussed and shown at the Bend Convention in 1982, so checked to see what Smith and Padgett had in their On Rope book and on pages 190-191 is, IMHO, a much better strap then the commercial ones. Of course, I didn't check them all out, for most of them were straight up-and-down lengths of nylon webbing. The one that's in Allen and Bruce's book shows a "Y" strap, if you will, and if you visualize it upside down, it makes much more sense; thus, the shorter section would attach to your sit harness and the two longer straps with sewn foot loops would be where you place your feet, so that you can stand and get some of that blood flowing. In the book, they're called "relief straps" and a good name they are. I don't know if CaveDoc pointed out that this happens mainly on long rappells or not, but on shorter raps of a 100'-150', I don't believe one would be in a serious situation. (I'm not trying to start another topic, but just seeing if anyone wanted to add to that.)

Finally, if I find a picture that I have at the last convention in the climbing contest, then this might show Sungura what that position would look like (believe she even tried it out), although that stick drawing would suffice. I wouldn't think it would be very comfortable, though,...and would not ease the problem of prolonged suspension. But the relief straps would. Etrier's might be a second choice, but I believe the one in On Rope is superior for this problem. What say you Roger?

[Ernie Coffman]

This was taken at the Texas Convention in 2009. Some of the other pictures in that folder looked just like the 2010 climbing contest pictures.

[cavedoc]

Etrier's might be a second choice, but I believe the one in On Rope is superior for this problem. What say you Roger?

An etrier is more for monster rappels and really just for comfort. Something that raises the feet is what's important for ST prevention. Your picture looks reasonable. Just raising the upper ascender high enough so the feet follow. Is that more or less what you did Amy?

The commerical products would appear to work with someone in an industrial harness. Not sure if they'd work with an alpine/caving harness. Maybe one of the SPRAT people could comment on that.

[cavedoc]

Hi Josh, welcome to the forum.

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.

Probably true of a lot of people. The risk in ST is passive hanging. Even in sleep we move around. Possibly for this very reason. Big differences between being asleep and unconscious.

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.

Except that a lot of people get the same phenomena without being in a harness. In the two cases I was able to find in which someone died right after rescue, neither was wearing a sit harness. There was no tourniquet effect at all. Given how the straps of a harness don't compress over the femoral vessels, my opinion is that there is no tourniquet effect at all.

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.

That name does get used but is imprecise. In the article I've limited myself to the general term rhabdomyolysis, that is, muscle proteins in the blood stream secondary to muscle destruction. These products can cause kidney failure. Lots of things can cause rhabdomyolysis (or just rhabdo) including compartment syndrome and crush syndrome. All compartment syndrome will include rhabdo but not all rhado is compartment syndrome. Compartment syndrome is swelling inside a bony-fascial compartment of a limb that impedes blood flow and leads to muscle death. It's usually secondary to significant trauma like a gun shot wound. In my search for cases of ST I've not come across one true case of compartment syndrome.

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

Let's leave all of this for another time so we don't get too far off topic.

[self-deleted_user]

Etrier's might be a second choice, but I believe the one in On Rope is superior for this problem. What say you Roger?

An etrier is more for monster rappels and really just for comfort. Something that raises the feet is what's important for ST prevention. Your picture looks reasonable. Just raising the upper ascender high enough so the feet follow. Is that more or less what you did Amy?

Yeah. Sorry I didn't get a photo of it! The difference is that I put the footloops actually underneath though, they weren't on the bottom of my feet but rather the "back" of my feet, so my knees weren't bent and were actually straight. That of course loses a few inches then so my legs weren't horizontal so I just adjusted the length from the ascender - footloops making it shorter to keep my legs horizontal. And the arms hanging down was a bit uncomfy so I tucked them up inside the chest harness (which was lose like that photo) so they didn't fall down.

[LukeM]

So, is there a consensus as to whether raising the feet and lowering the upper body helps to prevent ST? And if so, is this method commonly taught in vertical training? I was certainly never taught anything along those lines.

[self-deleted_user]

Well it seems like the point is this is kinda being discovered based on cavedoc's paper? Yay SCIENCE! and all that! I can't see it *hurting* in any way and certainly can think of ways it would potentially help.

[LukeM]

Well it seems like the point is this is kinda being discovered based on cavedoc's paper? Yay SCIENCE! and all that! I can't see it *hurting* in any way and certainly can think of ways it would potentially help.

I see what you're saying. Now that I look I see that it's said that raising the legs (knees?) helped quite a bit. It would be interesting to know if lowering the torso like you suggested even further increases the amount time someone can spend suspended. Like you said, I can't see it *hurting*. Seems likely to be beneficial too, and if that's the case I'd love to see it be a part of your average beginner's vertical training. It's really simple, at least with a frog setup.

[self-deleted_user]

TBH it just makes common sense to me...I honestly didn't realize it wasn't common practice to at least get legs up. But I do have a medical/science background so maybe I just think differently than a lot of folks. And yeah, it's very easy to do on my frog system at least, and the way mine is made allows for adjustability for the length of basically every bit so that makes it even that much easier.

It would be neat if we could do some sort of testing in a safe lab setting and get some data rather than theory going. I'd volunteer!

[LukeM]

I believe I've seen the technique of resting with your legs straight out while being held up by your footloop described in a caving text (Alpine Caving Techniques? Not at home so I can't check). I don't think it was in the context of preventing ST though. I remember thinking "that seems like a good way to mitigate harness hang syndrome, but they haven't mentioned it so maybe not." I'll have to check when I get home.

[cavedoc]

So, is there a consensus as to whether raising the feet and lowering the upper body helps to prevent ST? And if so, is this method commonly taught in vertical training? I was certainly never taught anything along those lines.

The Turner and Madsen papers would say yes, at least as far as raising the legs. Again, I have no data about lowering the upper body but it makes sense, for what that's worth.

Remember that ST is an issue with prolonged passive hanging. If you're going somewhere on rope it's not an issue. You can be on rope all day w/o a problem. But if you think that things are going to heck and you might not be able to climb up or get back down, then raising the legs is probably a good idea. As far a vertical training goes, spend the energy practicing change overs. If you can get back down the problem is solved. I'd hate to see someone think "Oh, I don't need to know how to change over. I'll just put up my feet." Good vertical technique, frequently practiced is the best prevention.

[LukeM]

The most practical application I can think of is if someone becomes over-tired while climbing and needs to rest for longer than just your standard break. Sure, they could head back down and wait for help, but that's terribly inefficient if the alternative was just taking a long enough break to recover. If your legs are getting tired you don't really want to spend energy using them to keep blood flowing. Granted, their legs may never recover enough strength, in which case maybe they've gained just enough energy from waiting to perform an efficient changeover. OR, they may even be too tired to perform a changeover, in which case, wouldn't it be nice if they knew a standard procedure for preventing ST?

Another possible scenario is waiting for a temporary illness to pass, such as a digestive issue, a migraine, or tachycardia. In a lot of cases you can push through that sort of thing, but battling pain is a big distraction, and it would be nice to know that you can just lean back and put your feet up for a rest (almost) free from the spectre of suspension trauma.

I do agree that teaching change-overs is the number one priority, but I don't see these techniques as requiring much brain power to absorb. They're practically intuitive, as Sungura has said.

[cavedoc]

it would be nice to know that you can just lean back and put your feet up for a rest (almost) free from the spectre of suspension trauma.

Remember that the studies showed improvement, not immunity. And remember too that pretending to hang passively is how they got people to pass out. Not something to do lightly. But the pain and nausea cases are times one just might want to have an alternative. Fainting is a killer.