After the fall – Suspension Trauma / orthostatic intolerance – the need for a plan to rescue
Leading Edge stresses the importance of thorough planning for rescue
Planning for rescue and emergencies when employees work at height is a legal and moral responsibility for all employers.
Regulation 4(1) of the Work at Height Regulations 2005 obliges employers to ensure all work at height is properly planned, and Regulation 4(2) notes that “planning of work includes planning for emergencies and rescue”.
Often we think of rescue as simply a matter of dialling 999, but calling the local fire brigade does not add up to an effective rescue plan. Response times can be too long and not all brigades have the capability to rescue from height.
Even in the most safety conscious employers’ workplaces accidents happen, so a rescue plan is an essential component of working at height and should be managed via a working at height method statement and risk assessment, and be ingrained through training and practice.
The absence of any form of post-fall rescue plan – relying on employees to improvise the rescue of a colleague – not only puts the victim at risk, but also puts rescuers in harm’s way. Unplanned attempts at rescue often result in secondary and tertiary injuries or deaths.
In intense, stressful and life threatening situations many individuals will suffer an onset of panic after the initial adrenaline rush. A panicked state damages the thought processes and the affected person will be unable to make logical or considered decisions. This puts both the casualty and the rescuer at risk as the panic can interfere with the rescue operation.
In fact, the number of people who are killed or injured as a result of trying to help a colleague or friend who has fallen from height almost exceeds the number of original casualties. This is why adequate operative training is essential not only for those who have fallen from height but also for the operatives attempting the rescue.
Time is short
The reason planned rescue by trained people is so important is that the danger is far from over when the fall arrest equipment does its job. Anyone hanging in a harness is at risk of suspension trauma; as the blood drains from the top half of their body, depriving the brain of oxygen. The critical thing is to get them to the ground as quickly as possible – any more than 10 minutes in suspension and the risk of irreparable damage increases rapidly.
The rescue plan must provide for self-rescue by employees who remain conscious after a fall, where their equipment allows them to get to safety. Workers must be trained and practised in self rescue.
But even where a fallen worker appears to be able to help themselves, the plan must require colleagues to act as though they are incapable, since the situation might change and time is at a premium.
The plan must give clear direction for anyone who witnesses a fall to know who on site at the time is responsible for rescue and to alert them immediately, plus the emergency services where available. This means ensuring every worker has emergency phone numbers to hand and knows the site location to direct third parties.
The plan must set out the hierarchy of rescue options available on site for getting employees to safety – from dedicated rescue equipment, such as additional harnesses, controlled descent devices, winches and hauling devices, to retrieve the fallen worker, plus locations of first aid equipment and any rescue-specific items.
Though speed is of the essence, the plan must make co-workers responsibilities clear and emphasise the importance of not endangering themselves during the rescue.
Death by Rescue
It used to be thought (following industry research) that as the casualty is returned to the level, the fallen worker must not be laid flat because of the risk of stale blood from the legs rushing back through the body poisoning their major organs and causing potentially fatal toxic shock. Operatives were encouraged to put the casualty into a sitting “W” position with their legs bent, unless they are suspected of having a spinal injury.
The HSE following further research has clarified their guidance on the treatment of a casualty following a fall and having been suspended by a harness and may have developed suspension trauma. The HSE recommendation now is:
“Not to place casualty in the “W” position, but to place the casualty in a horizontal position.”
Other Considerations
Other considerations for a plan include how to ensure any wreckage/equipment is set aside to help later investigation, allowing for unusual structural features that might complicate a rescue and ensuring materials are provided in translation where large numbers of migrant workers are on site.
However well thought out, a rescue plan (like a risk assessment) is useless if it is filed away and forgotten. You need to ensure that everyone who could be involved in a rescue: managers; supervisors; and workers are fully trained in the types of situation that might call for a rescue, what their roles are and how to use the equipment you provide.
Rescue operations are carried out under extreme pressure, whatever training your employees have had or are yet to have, will determine how they react.
The training should be kept topped up with regular practice sessions or drills, keeping employees on their toes but also checking that they can act inside the necessary ten-minute window. Just as the plan needs updating with any change of circumstances, personnel or equipment, so does the training.
Being aware of the demands for fast, simple and effective rescue,when working at height Leading Edge Safety have developed a range of products and courses specifically designed for at height rescue allowing typical workers to rescue conscious and unconscious casualties in under ten minutes. For more information and guidance on working at height and rescue from height visit working at height rescue
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