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After the Fall — Preventing Suspension Trauma

Learn how to prevent suspension trauma while waiting for rescue after a fall

Often, employers believe their job is complete if they can keep their workers safe from an impact injury during a fall event. Unfortunately, timely rescue and post-fall suspension trauma are often, according to OSHA case studies, ignored when employers are building a fall protection plan. To the employee waiting for rescue after a fall-related event, suspension trauma is a real and very serious threat.

What is Suspension Trauma?

Suspension trauma, also referred to as orthostatic intolerance, is a natural human reaction to being upright and immobile and can be caused by a situation when a person is forced to stay upright without standing. The use of a personal fall arrest system during a fall event can be the cause of this situation.

During a fall event, several things occur that can lead to suspension trauma. Because the worker is suspended in an upright position with his/her legs hanging, blood begins to accumulate in the legs. This is commonly called venous pooling (the accumulation of too much blood in the veins) which reduces the flow of oxygenated blood to the heart and brain.

Additionally, in a post-fall suspension event, the leg straps on a worker’s safety harness can exert pressure on veins in the legs, compressing them and further reducing blood flow back to the heart.


Fall Protection Equipment
Fall Protection Equipment
Fall Protection Kits
Fall Protection Kits

When venous pooling happens to someone in a standing position, he or she loses consciousness, faints and falls to the ground in a horizontal position resulting in the head (brain), heart and legs on the same level and normalized blood flow. Unfortunately, during a fall event, the harness keeps the worker upright. The worker faints but cannot collapse and circulation isn’t restored.

Under the most ideal circumstances, when a rescue plan is in place, suspension trauma should always be treated as an emergency situation because, according to the Emergency Medicine Journal, it can become fatal in less than 30 minutes.

Suspension Trauma Warning Signs

It is important to know the warning signs associated with suspension trauma. They include: faintness, breathlessness, sweating, paleness, hot flashes, increased heart rate, nausea, dizziness, unusually low heart rate, unusually low blood pressure and loss of vision.

Taking Steps to Reduce the Potential for Suspension Trauma

One of the ways to slow the progression of suspension trauma is to stand up. When standing, the leg muscles must contract to provide support and maintain balance and these actions also put pressure on the veins. This pressure, along with a series of one-way valves in the veins, helps blood get to the heart and reduces the amount of blood pooling in the legs.

How Does a Worker Stand While Hanging in a Harness?

A worker can stand in a harness by employing suspension trauma relief straps. Suspension trauma relief straps typically come packaged in two pouches that attach to each side of a harness. During a fall event, the worker can deploy the trauma relief straps - creating a loop that the worker can put his feet into and press against to simulate standing up. 


Figure 1: Suspension trauma relief straps

This allows the leg muscles to contract and can relieve pressure from the leg straps to help improve circulation.

Preparedness is Key

Too often, a worker is saved by his personal fall arrest system, only to succumb to suspension trauma while waiting for rescue. Everyone who works at heights should be fully trained in fall prevention and protection procedures. Those procedures should also include provisions for rescue in the event a fall does occur.

Rescue Procedures

Under 29 Code of Federal Regulations (CFR) 1926.502 (d) (Construction standard), the Occupational Safety and Health Administration (OSHA) requires that employers provide for "prompt rescue of employees in the event of a fall or shall assure that employees are able to rescue themselves." The rescue procedure should address the potential of suspension trauma and how the rescued worker will be handled to avoid any post-rescue injuries.

Rescue procedures should include:

  • Employee training on how to "pump" his/her legs frequently to activate the muscles and reduce the risk of venous pooling as well as how to use footholds to alleviate pressure, delay symptoms and provide support for "muscle pumping."
  • Continuous monitoring of the suspended worker for signs and symptoms of suspension trauma.
  • Ensuring that a worker receives standard trauma resuscitation once rescued.
  • If the worker is unconscious, keeping the worker's air passages open and obtaining first aid.
  • Monitoring the worker after rescue and ensuring the worker is evaluated by a health-care professional. The worker should be hospitalized if appropriate. Possible delayed effects, such as kidney failure, which is not unusual in these cases, are difficult to assess on the scene.

OSHA does not have a similar rule for general industry. Following the practices established for construction is suggested.


When personal protective equipment (PPE) is used in the workplace OSHA requires the employer to train each employee on:

  • When PPE is necessary
  • What PPE is necessary
  • How to properly don, doff, adjust and wear
  • The limitations
  • Proper care, maintenance, useful life and disposal

OSHA does not have a similar rule for general industry. Following the practices established for construction is suggested.

OSHA specifies suspension trauma should be included as a topic of discussion for any worker required to wear fall arrest PPE and those who may perform rescue activities. Specific suspension trauma issues to address should be:

  • How it can occur
  • Factors that may increase worker’s risk
  • How to recognize signs and symptoms
  • Appropriate rescue procedures and methods to diminish risk while suspended

For more information on fall protection equipment and the associated standards, check out these Grainger articles:

Fall Protection Equipment
Construction Fall Protection, Subpart M 
ANSI Z359: A New Lift to Fall Protection Standards


Bill Weems and Phil Bishop, Will Your Safety Harness Kill You? Occupational Health & Safety, March, 2003. 
Dr. Caroline Lee and Dr. Keith M Porter, Suspension Trauma. Emergency Medicine Journal, April 2007. 
OSHA, Suspension Trauma/Orthostatic Intolerance, Safety and Health Information Bulletin (SHIB) 03-24-2004, 2011

(Rev. 9/2015)

Find even more information you can use to help make informed decisions about the regulatory issues you face in your workplace every day. View all Quick Tips Technical Resources at www.grainger.com/quicktips.

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DISCLAIMER:The information contained in this publication is intended for general information purposes only and is based on information available as of the initial date of publication. No representation is made that the information or references are complete or remain current. This publication is not a substitute for review of the current applicable government regulations and standards specific to your location and business activity, and should not be construed as legal advice or opinion. Readers with specific questions should refer to the applicable standards or consult with an attorney.

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