Suspension trauma

Tom and all:
Here's an interesting experience that occurred recently that's on point with this Suspension Trauma also called Harness Hang Syndrome(HHS) and a few tips from an expert.
Recently, at the SERA, Southeastern regional, conference of the NSS(Nat'l Speleological Society) in which cavers meet to compare, compete and explore, there was a live expedition in a cave in which there was an emergency rescue on rope of two fairly experienced cavers.
The first caver got stuck ascending on the rope, for some reason(I don't remember exactly why) and when his friend tried to ascend up behind him to help, he jammed his top ascender underneath him in order to get closer and he also became immobilized. The cave was difficult and took rescue workers several hours to get to the two victims.
After hours on the rope they both began to experience HHS and one had even become unconcious upon his extraction.
Very, very fortunately, there was a doctor present who was specifically trained and familiar with HHS and its effect on the blood and circulatory system, such that any other doctor may not have known exactly what to do. It's treatment is unique even for Doctor's so we may have to let even them know if this happens to you.
Here's why, this particular doctor instructed them not to remove the harnesses until after a certain type of injection was given and had time to work in the circulatory system, because he explained that the blood becomes very acidic and pools in the lower extremities and if the harnesses would have been released without this medicine being administered first, the acidic pooled blood would have slammed against theirs hearts and killed them. Very fortunately they lived.
This story came from Bruce Smith, author of On Rope, when I was in one of his classes back in June, to illustrate the point that Rescue personnel must know and be trained specially and specifically for climbers. And that climbers should be aware to keep moving in some way no matter what while one rope.
Bruce Smith shared several points for us climbers:
1) Never climb w/o a way of communicating for help.
2) Never Never Never remove the harness of a victim who has been suspended for any length of time immobilized.
3) Keep moving in your harness if stuck.
4) Carry a prussik loop or foot loop in order to stand up periodically to keep the blood flowing.
5) Never jam your ascender under an object or always leave space under any object while ascending in order to be able to changeover and descend if needed.
Just wanted to share this real life episode with you guys.
 
P.S. Forgot to mention, like the article Tom posted stated at the end, most emergency services, paramedics and even hospital doctors will not know of this and we must communicate what we know of this syndrome to them. We may be the only link to saving the victim's life.
 
Besides keeping the harness on the article goes into the procedures for positioning the victim. Be sure to read the article, I'm tempted to give the bullet points here but that wouldn't be the best way to learn them for yourself.
 
Being in both fields mentioned. Paramedics and ER's ar very familiar with this problem. As a 13 year paramedic, we have extensive medical directives on dealing with all stages of this and most will see it immediately. Nothing really different from someone being pinned in a vehicle! The big problem I see is that emergency services don't understand out climbing systems and out friciton knot usage for climbing. Our Urban search and rescue team recently had a drill on rescue of tree workers. Unfortunately I couldn't get in ion it!
 
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Nothing really different from someone being pinned in a vehicle!

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That is interesting. I take it you are saying that a release of toxins when circulation is restored is a problem with pinned victims just like it is with suspesion trama victims.
 
Yes, and i think the sudden amplitude/impact of the sudden blood pressure change on release of device or just pressure release has an overwhelming force of it's own too.

My first factory job took a guy that lived down the road like that. He got pinned between the coupling of a pair of RR boxcars that serviced us. Small town, they went and got his wife from the local bank to say goodbye before they seperated the cars, causing the poor SoB to hemmor-rage; game over.
 
Thanks Arborcare1 for your great service as first responders are the true heroes in America!
Could you expand on your statement that HHS is "nothing different than someone being pinned in a vehicle". --This brings up many questions. Such as what Treeco mentioned and for example, wouldn't the conditions(time immobilized, body position, etc.) and the location of the body limb being pinned(which body part) have to be almost exactly the same as HHS in order for the treatment to be the same? Are you saying that pinned victims have to be treated while still in the trapped vehicle before the pinning is released so as not to poison or slam the heart with toxins and excessive pressure?
Thanks again for your input.
 
I'' try to explain. They syndrome was first seen wide spread in Vietnam when the medical device called the mast trousers were used. Those are the inflatable pants used on multitrauma patients. Initially the squish all the blood from the lower extremities to the heart and brain to sustain life. Generally you cannot life with a low bllod volume so you increase it to the vital areas mechanically. Well the problem was that when they removed them, the soldiers died on the table. Several reasons, generally no replacement of blood volume to make up for the release of pressure. Secondly, COMPARTMENT SYNDROME. Your cells make energey by using many compounds including oxygen and sugars (krebs citric acid cycle). When you are pinned, or circulation is restricted(by a saddle) you have anerobic energy production. (without air) The byproduct is mainly Lactic Acid and other cardiotoxic(bad for heart) compounds. The sudden surge in these compounds throughout the circulation is devastating on the heart and all the stuff that makes the cells function like they should. Treatment is Sodium Bicarbinate to counter the lactic acidosis, Insulin to increase the uptake of sugar for energy, albuterol to effect the potassium and open the lungs up to breathe and some iv sugar. Generally these people have a poor outcome.

This can also happen within a muscle. All muscled are covered with facia(skin) Any hunter has spent time scraping this off deer meat to keep it from being chewy. This is a container for the muscle. When there is swelling within the muscle(significant bleeding) this exerts pressure and prevents circulation thus compartment syndrome. OR treatment is to cut open the facia to relieve the pressure.

Lots of stuff to this. Hopefully I explained better than I spelled.

I have been a firefighter/paramedic for 13 years. I got into the tree buisness and love it! I just can't learn enough!!! Started my own buis after working for a complete hack. He taught me how to climb with just 1 flip line. I just never got used to being 80 ft up and disconnecting to reposition. Scary isn't it? I then traveled to take some classes from the Amazing Chisolm brothers traveling tree education and acrobatic company. Now I'm hooked. Still a little shaky at 80ft but loving it! can't wait to be ISA certified!

Thanks to all of you for posting your great knowledge and pics. I love to look at your jobs. Gived great insight!
Thank you!
 
arborcare.... we all start in this bus from different avenues...true arborists have the desire to better themselves. this is what seperates us from the hacks...THE DESIRE TO LEARN AND DO IT RIGHT Im glad you found this exciting career. Enjoy
 
Yes you did travel quite a few times to Rutgers. I'm glad that you are feeling the way you do and all is well. Keep loving your job. You spend so much time there!

Thanks for the info in your last post. It was very interesting!
 
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