222: Is There Enough Evidence to Support the Reversal of Standard Trauma Care for Patients Who Have Been Suspended?

Abstract

The effects of being suspended motionless in an upright position is commonly termed suspension trauma. It has been reported that following rescue some patients are at risk of immediate sudden death from a cardiac arrest when they are laid flat. Although there is little evidence into the causes of this condition a number of authors have written guidelines for the care of these patients and whilst opinions differ, this quote from the UK Health and Safety Executive represents the majority view: “Important! The casuality must never be laid down after being rescued from the suspended position, not even in the recovery position.” This advice is clear, yet it is counter to the conventional approach to trauma care and creates difficulty for transportation and subsequent care if taken literately. It is hypothesised that lying patients down results in a sudden return of pooled blood to the heart resulting in a cardiac arrest, yet this could be explained by other mechanisms which are not related to lying patients down but could result in sudden death, for example, the release of potassium resulting from ischemic areas (e.g. after femoral vessel compression by a safety harness), similar to the mechanism in crush injury. The response of the UK ambulance service as to what guidance to issue to paramedics must be measured. In order to support this decision process a systematic review was undertaken.