Skip to main content

Developed and maintained
by the NFCC


Casualty at height

Hazard Knowledge

Personnel may need to rescue a casualty who is unwell, injured or trapped at height; this could be below ground or above ground. The rescue method will depend on the urgency of the situation; this could be due to:

  • The medical condition and needs of the casualty
  • The type of fall protection equipment the casualty was using, such as:
    • Fall arrest
    • Work positioning
    • Work restraint

Due to the working environment, personnel should be aware of the hazards associated with rescues from height when operating in contexts such as:

It may also be appropriate to refer to the hazard knowledge provided in Casualty in a confined space or complex environment.

Depending on the medical condition of the casualty, medical care, such as spinal or airway management, may be required throughout the rescue. However, the condition of the casualty or the risk of immediate danger to them, may require more rapid life-saving actions. This could be a simple lower or raise using the existing system or need a more technical approach.

Unconscious casualty through suspension intolerance

Suspension intolerance, formerly referred to as suspension trauma, is a condition in which a person suspended in a harness can experience:

  • Pallor
  • Cold sweats
  • Ringing in the ears
  • Dizziness and other symptoms of pre-syncope
  • Loss of consciousness (syncope)
  • Death

Symptoms of pre-syncope include:

  • Light-headedness
  • Nausea
  • Sensations of flushing, tingling or numbness
  • Anxiety
  • Visual disturbance
  • Feeling like they may faint

The condition has been suspected in cases of mountain climbers who fell and were then suspended for several hours. After their rescue, some of these people died many days later, with some medical professionals attributing this to suspension intolerance. There have also been instances of cave explorers becoming trapped on their ropes, who have died either while still on them or shortly after being rescued. The reason for their deaths was again attributed to suspension intolerance.

The condition has been produced in clinical trials, with people suspended in a harness in a generally upright but motionless position. In these trials, where the test subjects were told not to move, most of them experienced many of the effects of suspension intolerance, with some losing consciousness in just a few minutes. A similar situation could occur for somebody working at height who falls into suspension and is not moving, for example, due to exhaustion or injury. Further information can be found in the BSI publication, Code of practice for selection, use and maintenance of personal fall protection systems and equipment for use in the workplace (Appendix D).

A casualty who has fallen into suspension in a harness may develop suspension intolerance, as the blood flow pools in the legs due to gravity and the harness restricts venous return. This will eventually result in reduced cardiac output and a reduction in arterial pressure, leading to pre-syncope and eventually syncope. A casualty in this situation needs to be rescued as soon and as safely as possible. Motionless head up suspension normally leads to pre-syncope within one hour, but can occur in just 15 minutes in a minority of people.