A sad headline: Asbestos kills a retired painter and decorator

A RETIRED painter and decorator died due to contact with asbestos, an inquest heard on Thursday.

Mr Peter Taylor, of St Peter's Place, Canterbury, was a retired Painter and Decorator. He died in July 2012 at the Pilgrims Hospice aged 63. The pathologist (Dr George Vittay) told the inquest that Mr Taylor died of pneumonia, caused by mesothelioma.

Verdict: Industrial disease.

There are many deaths each year from exposure to asbestos. People working in the refurbishment industry are most at risk as they may disturb asbestos present in the buildings in which they ply their trade.

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Accidents in Waste Handling

Introduction
The UK produces in the order of 400 millions tonnes of waste each year, of which only about a quarter comes from domestic households.  The handling and processing of this waste is, consequently, a large industry.

HSE statistics reveal that the number of fatal accidents in the waste management sector is over 16 times the national average, while accident rates in this sector are over four times the national average.

Table 1: Typical accident rates in the waste industry (2010/2011) Source HSE statistics

Industry	Accident rates per 100,000 workers
	Fatalities	Major Injury	Over Three-day	All Injuries
Waste	10	438	1954	2447
All Industries	0.6	99	363	462

Causes of accidents

There are several main categories for accidents in the industries associated with waste handling:
•      Manual handling injuries (41 %)
•      Slips, trips and falls (26 %)
•      Struck by objects (16 %)
•      Falls, from vehicles (6 %)
•      Transport related accidents (4 %)
•      Machinery related injuries (3 %)

For manual handling injuries, typical causative factors include:

•      Lifting or performing a movement with too much force
•      Lifting or performing a movement in an awkward position, or
•      Repeating the lift/movement too often

With respect to slips, trips and falls, typical causative factors include:

•      Storing materials or other unnecessary items on walkways and in work areas.
•      Creating and/or using wet, muddy, sloping or otherwise irregular walkways and work surfaces.
•      Constructing and or using improper walkways, stairs or landings or damaging these  surfaces
•      Creating and/or using uneven terrain in and around work areas
•      Working from elevated work surfaces and ladders
•      Using damaged or defective steps to enter vehicles

Workers may be struck by falling objects or, more commonly, by objects that have been thrown.

Machinery related accidents cover a very wide range of machine types and accident types.  Some of these are fatal; while others may lead to serious, severe injuries, including: amputations, crush injuries, severe cuts, etc.  There have been many reported cases (including prosecutions) arising from the use of conveyors.  Workers are injured as a result of poorly guarded conveyor systems, especially in cases where workers are attempting to remove an obstruction from the conveyor while it is still in operation.

Some categories of transport related accident are more common in the waste industry (especially kerbside collections) than elsewhere, such as:

•      Workers having their ankles and feet run over by forward-moving vehicles; either due to standing too close or due to slipping/tripping from kerbs whilst the vehicle is moving past.

•      Workers being injured whilst trying to get onto or off moving vehicles.

•      Reversing vehicles being guided by two ‘banksmen’ and striking one whilst the driver was watching the other for instructions.

•      Banksmen failing to stop reversing vehicles with either verbal or hand signals and either being struck themselves or resulting in others being struck.

•      Workers not expecting vehicles to move, and being struck, such as when the driver was not aware of the worker behind the vehicle.

Avoiding accidents

Many of the steps that may be employed to avoid accidents and injuries are simple, relatively low cost measures.  Avoiding manual handling injuries can be achieved through:

•      Providing appropriate mechanical assistance and equipment (such as carts, trolleys, adjustable work stations for the operators and appropriate tools).

•      Providing this equipment in convenient locations.

•      Training workers in appropriate manual handling techniques and the avoidance of ergonomic risks, etc.

•      Undertaking suitable and sufficient assessments of the risks for the manual handling operations undertaken and introducing suitable measures to avoid and/or control the risks arising.

•      Reviewing the size, shape and weight of materials to be moved, especially those that are handled regularly.

•      Reviewing the design of vehicles, such as (retro) fitting tail gates lifts and scissor lifts, etc.

In line with many other industry sectors, slips and trips can be avoided or controlled by fairly measures, including:

•      Ensuring good standards of housekeeping in work areas – avoid the build up of litter, debris and other general detritus.

•      Ensuring that adequate lighting is provided to all work areas.

•      Ensuring that suitable safety footwear is provided to workers and that it is worn as appropriate.

•      Providing suitable, robust handrails, to steps and stairs, etc.

•      Reviewing the layout and design of the work area.

•      Ensuring that all floors are even and are maintained in good condition (through regular inspection and maintenance).

•      Ensuring that all floors are constructed from suitable materials and (where appropriate) are designed to be non-slippery when wet.

•      Cleaning up spillages promptly and ensuring that suitable materials are available and that suitable procedures are in place).

Falls from heights involving vehicles can be avoided and/or reduced by:

•      Training workers to be aware of the risks of falling from vehicles, even from simple operations such as getting into and out of cabs.

•      Working at the culture endemic in the waste industry of “it won’t happen to me”

•      Reviewing the design and layout of areas where waste materials are loaded and unloaded onto vehicles.

•      Avoiding working from heights (such as elevated surfaces and ladders) by reviewing the activities and modifying the operations and/or the work area as appropriate.

•      Reviewing the design of vehicles, such as (retro) fitting tail-gates lifts and scissor lifts, etc.

Many of the accidents involving machinery can often be avoided by:

•      Ensuring that all machinery is designed (and maintained) to be as safe as is practicable.

•      Ensuring that machine guards are available and are in place at all times.

•      Introducing regular inspections of machinery, looking for defects in the equipment and checking for any defective or missing guard or other safety features (such as interlock systems).

•      Instructing workers in the safe operation of the machinery and, especially, in the actions to be taken when clearing obstructions, etc. 

•      Ensuring that emergency stop controls are operational and are sited in suitable locations.

Many of the transport related accidents can be avoided by greater attention to the task in hand (such as by removing the culture of “it won’t happen to me” that exists within the waste and transport industry) and encouraging workers not to take shortcuts or to adopt sloppy practices.  Further training of both the banksmen and the drivers in accurate communication will also have a beneficial effect in preventing many vehicle related accidents and injuries.

It is relatively simple to prevent workers being struck by thrown objects: prohibit the throwing of objects.  If this is not a reasonably practicable solution, then organise the work area such that workers are not in the line of fire of thrown objects.

Summary

Many people are hurt and killed each year as a result of working in the waste industry.  Many of these accidents can be avoided by implementing a few relatively simple measures:

•      Undertaking suitable and sufficient assessments of the risks arising from operations and implementing (and enforcing the use of) suitable control measures

•      Further training (including risk awareness training as well job specific training).

•      Changing the culture of “it won’t happen to me” to a more positive and proactive culture.

•      Improving and monitoring housekeeping standards.

•      Improving and monitoring the use and condition of machine guards and other safety features.

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Corporate Manslaughter - A Garden Centre is being prosecuted

Another English company has been charged with corporate manslaughter in relation to an incident that occurred two years ago, in which an employee died after a vehicle he was towing came into contact with overhead power lines.

This follows on from two previous prosecutions in England where Cotswold Geotechnical was the first company to be prosecuted and subsequently fined almost £400,000 after the death of an employee when a trench collapsed. Lion Steel became the second company to be successfully prosecuted and was fined £480,000 after an employee fell through a fragile roof. This case highlights that corporate manslaughter can be brought against any company, big or small.

The facts of the case

The Crown Prosecution Service (CPS) has charged a Norfolk garden nursery with corporate manslaughter in relation to the death of an employee two years ago.

The employee died on 15 July 2010 from an electric shock, caused when the metal hydraulic-lift trailer he was towing came into contact with an overhead power line.

The Health & Safety Executive (HSE) investigated the incident on the same day and immediately served the company with two Prohibition Notices, relating to: the operation of vehicles of a certain height from coming into contact with or closely approaching the overhead power lines in the field adjacent to the nursery buildings; and the movement of metal irrigation pipework under the overhead lines without undertaking a suitable risk assessment and implementing a safe system of work.

A month later, a further Prohibition Notice was served to prevent the use of the trailer after the Vehicle and Operator Services Agency (VOSA) found that the brakes didn’t work. An Improvement Notice was also issued to the company to provide information, instruction and training for employees relating to transport and deliveries close to overhead power lines. The firm complied with all the notices.

A spokesperson from the CPS commented on the decision to prosecute the company: 

“I have carefully considered the evidence and have concluded that it is sufficient to charge the company with corporate manslaughter and with failing to discharge a duty imposed by section 2(1) of the HSWA 1974.”

The company has been summonsed to appear at King’s Lynn Magistrates’ Court on 23 November. It is the third company the CPS has charged with corporate manslaughter since the introduction of the Corporate Manslaughter and Corporate Homicide Act in 2008. Earlier this year, a farming company received the largest ever health and safety fine in Northern Ireland following the first corporate manslaughter conviction there.

The company issued a statement, through its solicitors, saying: 

“We have worked closely with the Police, the HSE and other agencies investigating the incident at the nursery. As formal legal proceedings are now underway, it would be inappropriate for us to comment on any aspect of the case at this time. 

“Everyone at the garden centre remains profoundly saddened by the death of the worker, and his family have been, and are constantly, in our thoughts.”

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Contractor's death results in large fine for construction firm

Falls from height remain one of the most common causes of fatalities and major injuries in the construction sector. In the period 2011 to 2012, 49 workers lost their lives on construction sites in the UK, with falls from height being a major cause.  Following the death of a man  after falling through a roof while working on the construction of a shopping centre in North Wales, a building firm has been ordered to pay £450,000 in fines and £98,000 costs after being found found guilty of breaching Section 3(1) of the HSWA 1974.

The Crown Court in Mold (North Wales) heard that Watkin Jones & Son Ltd was the principal contractor during the building of the Menai Centre in Bangor and that Thomas Whitmarsh, (aged 21) was working for a company that was sub-contracted to carry out roofwork at the site.

In December 2009, Thomas Whitmarsh was fitting a rubber membrane to a flat concrete roof when he fell nearly six metres through an unguarded opening in the roof to the floor below, sustaining serious head injuries.  He then spent several months in hospital and was making a gradual recovery. Unfortunately, the brain injury he suffered exposed him to a much higher degree of infection and he later died after contracting acute meningitis. The court heard that there was more than an 80-per-cent chance that the injuries from the fall contributed to his death.



An HSE inspector commented that there had been adequate edge protection around the void, but that this had been removed and not put back in place until after the incident. He went on to comment that: 

“Poor coordination between the principal and the roofing contractors on this particular part of the site led to the edge protection being removed from around the roof opening without alternative safeguards in place.

Falls from height are an alarmingly common cause of death and serious injury in construction. All too often, straightforward practical precautions are not considered and workers are put needlessly at risk. Poor management of risk in this industry is unacceptable and HSE will take strong action when necessary.

This tragic case should remind all contractors that work at height must be managed effectively and adequate safeguards should be in place to prevent falls.”



 By way of mitigation, the firm said it takes health and safety seriously but accepts failings took place in relation to this incident. Following the incident, it modified its procedures to ensure that work is safely handed over to contractors.

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Work at height, rescue and suspension trauma

Introduction and Legislation

Lots of work at height can be, and is, carried out safely. In many other cases, such work is not carried out safely, but people get away with it and come to no harm. However, when things do go wrong with work at height, the consequences are often severe and are sometimes fatal.

The legislative approach to work at height is relatively simple and straightforward and, unsurprisingly, is based on risk assessment. The Work at Height Regulations 2005 are concerned with working safely at heights by:

·         avoiding work at height, where it is reasonably practicable to be do so

·         preventing falls from height, where it is reasonably practicable to be do so

·         mitigating the effects of falls from height, where it is reasonably practicable to be do so

Regulation 4 of the Work at Height Regulations 2005 deals with organisation and planning:  Regulation 4(1) states that: every employer shall ensure that work at height is - 

(a) properly planned;

(b) appropriately supervised; and

(c) carried out in a manner which is so far as is reasonably practicable safe, and that its planning includes the selection of work equipment in accordance with regulation 7

Regulation 4(2) states that: Reference in paragraph (1) to planning of work includes planning for emergencies and rescue.

Avoiding and minimising the risks from work at height

Regulation 6(1) requires the employer to carry out a suitable and sufficient assessment of the risks arising from any work at heights:

“In identifying the measures required by this regulation, every employer shall take account of a risk assessment under regulation 3 of the Management Regulations.”

There will be no need for a specific risk assessment dealing with working at height if this subject has been dealt with fully and satisfactorily in the risk assessments already completed for compliance with Regulation 3 of the Management of Health and Safety at Work Regulations 1999.  For many employers, it will be necessary to revisit these assessments or to complete new “working at height” risk assessments to ensure compliance with the new regulations.

Regulation 6(2) places a duty on the employer to avoid the need for working at a height where it is reasonably practicable to do so:

“Every employer shall ensure that work is not carried out at height where it is reasonably practicable to carry out the work safely otherwise than at height.”

Work must be carried out in a manner such employees are not placed at risks of injury from falling from a height if this is reasonably practicable.  Where reasonably practicable, work should be carried out at ground level rather than at a height.  This applies to maintenance activities as well as to assembly and production activities.

The requirement for prevention of employees working at a height from falling is introduced in Regulation 6(3):

“Where work is carried out at height, every employer shall take suitable and sufficient measures to prevent, so far as is reasonably practicable, any person falling a distance liable to cause personal injury.”

Where work involves access to areas from where a person may fall, access to that area must be prevented in some way.  This may involve several solutions, such as:

• the use of suitable scaffolding systems,
• the use of mobile elevated work platforms and similar equipment,
• the construction of suitable walls or guard-rails (including intermediary guard-rails and toe-boards),
• the use of a harness and anchored lanyard that stops the person reaching the point from which they may fall (such as a 2m lanyard anchored 2.5 m from a fall, i.e. it is too short all allow the person wearing it to reach the edge over which they may fall).

Regulation 6(5) places the employer under a duty to mitigate the effects of falling from a height where it is not reasonably practicable to eliminate the risks of the employee falling.

 “Where the measures taken under paragraph (4) do not eliminate the risk of a fall occurring, every employer shall take—

(a) suitable and sufficient measures, including the provision of work equipment, to minimise—

(i) the distance and consequences; or

(ii) where it is not reasonably practicable to minimise the distance, the consequences, of a fall; and

(b) without prejudice to the generality of paragraph (3), such additional training and instruction or other additional suitable and sufficient measures to prevent, so far as is reasonably practicable, any person falling a distance liable to cause personal injury

There are several ways of mitigating the effects of a fall from a height, these include:

• the use of a suitable fall arrest system,
• the use of suitably positioned and secured safety nets
• the use of rail lock systems on vertical ladders
• the use of suitably sited, specially designed airbags
• etc.

The specific requirements relating to suitable fall arrest systems are outlined in Schedule 5 to the Working at Height Regulations.

Where a risk on a person being injured by a fall exists, the regulations require the use of suitable falls prevention measures and fall mitigation measures.  This is a case of both, not either/or.

Planning for Rescue

Employers involved in work at height operations need to make provision for rescue arrangements it is a requirement of the Work at Height Regulations 2005. Further to this, the casualty needs to be attended to and recovered promptly. This is the employer’s responsibility - not the responsibility of the emergency rescue services.  In the event of a problem developing for a worker working at height, help must be available promptly. As can be seen below (suspension trauma), the survival of an injured person may well depend on the speed of recovery and the level of suitable first aid provision.  As discussed later in this article, being suspended for any length of time may be fatal, owing to the effects of suspension trauma. It follows, therefore that it is important that there is a specific rescue plan in place and that suitable and sufficient resources are provided for each workplace where work at height is carried out. The rescue plan should be regularly reviewed and should be revised as necessary.

As well as physical resources, there should be a provision of trained rescuers on site that are familiar with the procedures, the equipment and the site.

Rescue planning must not be left to the last moment, but should form part of the risk assessment for the work at height. Rescue planning and rescue operations should give consideration to the following issues:

• the safety of the persons carrying out, or assisting with, the rescue
• the anchor points that are to be used for the rescue equipment
• the suitability of the equipment (anchor points, harnesses, attachments and connectors) that has already arrested the fall of the casualty for use during the rescue
• the method that will be used to attach the casualty to the rescue system
• the direction that the casualty needs to be moved to get them to the point of safety, i.e. up, down or sideways
• the first aid needs of the casualty (with respect to injury and also to suspension trauma)
• the possible needs of the casualty following the rescue

Checklist for rescue planning

The following is a simple checklist that employers may work through to ensure that they have considered the important elements of their rescue planning. As with a fire evacuation plan, there is no need to wait for a fire in order to find out if your procedures work – practice opf the procedures (in this case the rescue plan) will identify failings before they can havea serious effect on people.

• How will people be made aware of when someone has fallen?
• How will the suspended worker summon assistance?
• What communication systems will be used between the suspended worker and the rescue team?
• Is there an emergency contact list and other useful information for supervisory staff? 
• Is suitable rescue equipment provided on site and is it readily accessible?
• Have a sufficient number of operatives been trained in the rescue plan and in the use of rescue equipment?
• Has training been kept up to date and does it deal with the rescue equipment provided?
• Have assessments been made of anchor points to which rescue equipment will be attached?
• Has consideration been given to attaching rescue equipment to the suspended worker?
• Have the means of access to the suspended worker been considered?
• Will the rescue arrangements ensure that the suspended worker is recovered in less than five to ten minutes (to prevent suspension trauma)?
• Does the rescue plan take into account an injured (or unconscious) suspended worker?
• Are first aid personnel aware of how to treat casualties with (suspected) suspension trauma?
• Are there suitable arrangements for summoning aid from the emergency services and for liaising with them after arrival on site?
• Have the rescue operatives practiced the removal of suspended casualties using the equipment that you have provided?

Be aware of edges

The potential for a suspended worker (casualty) to be located over an edge must be considered. The rescue will be complicated in instances where edges and obstructions are involved. Recovery that involves working over an edge will:

• increase the effective load in raising operations due to additional friction
• create risks of cutting or abrasion of the anchor line
• put extra shock loading on the anchor line if (sections of) the edge collapse during the rescue
• interfere with the operation of rescue equipment

Rescue equipment that will work with, and will tolerate, the extra issues associated with edges should be selected if edges have the potential to feature in rescue operations.

Four types of rescue

 Although the immediate aim is to recover the suspended worker (or casualty) to the nearest point of safety, there are basically four options for dealing with an emergency rescue that involves an injured or incapacitated worker being recovered to safety. In order of preference these are:

• lowering a remote casualty
• raising a remote casualty
• self evacuation by descent
• rescuing another in descent

The above order is based on the premise that it is preferable that the rescuer is not involved in the descent or the suspension. When rescuing a third party, the first two options are preferable to the forth one. Generally, the first option is preferable to the second one because of the simple expedience that it is more straightforward and physically easier to lower a load than it is to raise one.

General considerations for rescue operations

The rescue system will be under tension and, as such, will be at greater risks of damage from abrasion and cutting. Consider of rescue scenarios (in the form of risk assessments) may indicate the need to use rescue equipment that is capable of coping with these situation, or it may indicate that an additional (backup) safety line may be required. The rescue plan must allow for rescue when the casualty is unconscious.  In order to reduce shock loading and jarring of the suspended worker (casualty) it is important that control is maintained at all times while operating rescue equipment.

The anchor for the rescue equipment should be in a position where the equipment can be operated easily and safely. This may mean that it is appropriate to site the equipment away from the edge to allow for its safety operation. In this situation it may be necessary to use additional equipment to redirect or align the rescue system correctly.  The potential for abrasion and cut-through means that ropes should not be run over edges which also may collapse leading to additional shock-loading of the system). If the system needs to run over an edge, then the rope and edge must be protected from each other and it should be determined that the edge can support the imposed loads.

Raising and lowering operations should be carried out in a controlled manner. The path for raising and lowering should be calculated and checked to ensure that obstacles are not encountered. The potential for some rescue equipment to operate in one direction only must also be considered so that the suspended worker is not moved into a position from which they cannot be recovered.

The general procedure for recovery of the suspended worker should give consideration to the following:

• an assessment of the rescue situation before starting the rescue operation
• arranging for the provision of appropriate medical assistance (such as by summoning the emergency services)
• determination of the appropriate position to carry out the rescue operation from
• determination of the appropriate anchor points for the rescue equipment
• identification of a suitable location (or point of safety) to move the suspended worker (casualty) to
• ensuring that all those involved in the rescue operation are aware of the procedure to be carried out and of their role within this procedure
• ensuring that all relevant employees that have been trained in the rescue procedures are competent to carry out their role
• carrying out the rescue operation in a steady and controlled manner
• ensuring that a suitable means of communication is maintained at all times during the rescue operation
• arranging a suitable process to monitor the suspended worker’s condition at all times during the rescue operation and arranging appropriate first aid and/or medical provision
• reviewing the whole operation in order to determine the lessons that can be learned to make improvements for future rescue operations

Suspension Trauma

One of the reasons why planning for rescue in work at height situations is important is suspension trauma (a special case of orthostatic intolerance and sometimes known as harness hang syndrome).  Orthostatic intolerance is a normal and natural reaction to being upright and immobile.  In such cases, a complex combination of blood pooling in the legs and cardiorespiratory restriction leads to unconsciousness. Orthostatic intolerance can occur in several sets of circumstances, such as:

• being suspended in a harness
• being trapped upright within a confined space
• being secured to a vertical stretcher or litter (such as in mountain rescue)
• many situations where people are forced to remain standing without the ability or room to move

A classic manifestation of acute orthostatic intolerance is a soldier who faints after standing rigidly at attention for an extended period of time.  Suspension trauma presents an immediate threat of death to anyone immobilised in a vertical position.

Causes of suspension trauma

When people stand upright, the heart alone cannot cope with pumping the blood around the body. In particular, it can't draw blood back up, against the force of gravity, from the legs and feet.  To aid the heart, our veins (the blood vessels that return blood to the heart) are very elastic and have a series of (non-return) valves at regular intervals. As people move around, the veins are squeezed by the muscles around them, a process that is important for helping to push blood back up towards the heart.  If people are in an upright position for a while without working their leg muscles, then the blood doesn't get pumped back up from the lower body. Instead it collects in the veins of the lower body (venous pooling), and so reduces the amount of blood available for circulation. This reduces the quantity and the quality of blood available to the brain, which can result in loss of consciousness. This loss of consciousness is an important survival mechanism in these circumstances as when people faint, they fall over.  Once they are lying down, the heart can circulate their blood quite satisfactorily, returning oxygen to the brain with no harm done.

Suspension trauma is the name given to the situation that occurs when people faint but cannot fall over, causing the body to remain upright. This is a serious problem, because if the body stays upright after losing consciousness, then the blood flow is not restored. In such circumstances, the suspended person is at serious risk as the reduced blood flow can lead to serious brain and/or kidney damage, and ultimately to death. If it is allowed to develop unchecked, it can be fatal in a very short time (a matter of minutes).

 Suspension trauma does not take long to develop

In averages cases, it takes somewhere between five and twenty minutes for the first signs of shock to be felt by the casually.  If their legs are held perfectly still (such as if they are unconscious) then the first signs of shock may be apparent after about three minutes.  If they are not rescued, a few minutes after this they the casualty will faint and shortly after this they will die.  If a suspended person is to be rescued, then the rescue must be carried out quickly, preferably within ten minutes of the start of suspension.

By their nature, rescue operations are carried out under extreme pressure.  Consideration should be given to all aspects of the rescue process. Elements to consider would include the type of equipment required, the demands placed upon the rescuer, the training the rescuer will require to carry out the rescue and how the effectiveness of the rescue system as a whole can be maintained  Following a fall and a person being suspended in a harness, it is clear that even if they are uninjured by the fall there is a relatively short time available during which to rescue them.  Following the fall, there is only a short time before the onset of shock and suspension trauma is life threatening.  It is essential, therefore, that the means of rescuing them fallen person has been planned before the event.

Even is the casualty cannot be released form suspension immediately, they can be aided by others if they can be reached safely or if they are still conscious.  If possible, lift their knees into a sitting position using a rope, sling, or other items.  If the casualty is hanging in a harness and is unable to escape, there are some things that they can do to prevent the onset of suspension trauma.  In particular, they cam wiggle their toes and move their legs. This will move the muscles in the legs and will help to squeeze the blood back up towards the heart.  This may be enough to prevent the onset suspension trauma.

First Aid for people with (suspected) suspension trauma

When somebody has been rescued from suspension, do not let them lie down and do not lay them down.  The first action of the first aider on site when the casualty is released from suspension should be to place them in a sitting position with their body upright and their legs flat, or bent at the knees. The exact angle of the knees is not critical, the important issue is that their body is upright, and the legs are no longer dangling. This posture will reduce the pooling effect of gravity, but will keep most of the pooled blood in the legs, preventing reflow and splinting (see below). The casualty should be kept in this position for at least 45 minutes.  The casualty must not be allowed to stand up, exercise, drink or eat. They should be kept calm and relaxed as this will help to reduce the effects of stress on the heart rate. The casualty should be sent to hospital, even if they are not experiencing any ill health.  The first aider must also be mindful of other injuries that have been sustained, such as spinal injuries, choking, etc.

Casualties who have developed suspension trauma may be at risk from reflow syndrome.  This is the name given to the potentially fatal situation caused when the pooled that has blood in the veins in the legs is allowed to flow back into their body.  The blood that has pooled in the veins in the legs will have the nutrients and the oxygen in it used up by the leg muscles.  Once this has been used up the leg muscles will respire anaerobically and the blood will accumulate the toxic breakdown products of this anaerobic metabolism

Another of the problems with treating suspension trauma casualties is overloading or splinting of the heart muscle. Lying the casualty down will cause about 60% of blood volume to return very quickly to the heart and may fill it with blood such that the pumping action is not possible. This overloading of the heart muscle can cause immediate death. During and after rescue, it is important that the casualty is not carried or laid horizontally or allowed to lie down.

Suspension trauma is a potential cause of death in all cases of vertical suspension.  It may result in the death of a person who has fallen and whose fall has been arrested by their fall arrest equipment and who is otherwise unhurt.  In order to prevent fatalities from suspension trauma, employers need to ensure that casualties can be rescued promptly (within ten minutes) and that the first aiders known how to deal with (suspected) suspension trauma cases.

Summary

Plan work at height carefully through a risk assessment based approach and avoid the need for work at height where this is reasonably practicable. In cases where work at height is required, prevent falls from height where reasonable practicable and mitigate the effects of any falls. As part of the planning for work at height work, plans must also be thought through (and practised) on how to conduct a rescue of a worker how falls, but whose fall is arrested and who is left suspended. Speed of the rescue is critical to the survival of the casualty, as is the training of the first aid response to workers who may have suspension trauma.

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