Rescue a casualty at height

• Situational awareness: Work at height
• Hierarchy of control: Work at height
• Safe system of work: Work at height
• Use of secondary systems

First aid management

The Health and Safety Executive (HSE) has clarified guidance on the first aid management of a person falling into suspension in a harness, who may develop suspension intolerance. For further information refer to the Health and Safety Executive (HSE) research report, Evidence-based review of the current guidance on first aid measures for suspension trauma.

The key recommendations in the report are:

• No change should be made to the standard first aid guidance for the post-recovery of a semi-conscious or unconscious person in a horizontal position, even if the subject of prior harness suspension
• No change should be made to the standard UK first aid guidance of ABC management
• A casualty who is experiencing pre-syncopal symptoms or who is unconscious while suspended in a harness should be rescued as soon as is safely possible
• If the rescuer is unable to immediately release a conscious casualty from a suspended position, the elevation of the casualty’s legs by the casualty or rescuer where safely possible may prolong tolerance of suspension; however, this should not hinder rescue efforts as the incident evolves
• The actual amount of time that a person may be suspended before symptoms start to have an adverse effect will vary, as there are many contributing factors. Such as the individual’s medical fitness, injuries, the harness fit or adjustment, the attachment point used and whether the person is completely immobile. Normal ABC first aid protocols should always be prioritised for an unresponsive person. For someone unconscious in a harness, a potentially compromised airway and restricted breathing would be a major concern.
• First responders to a person in harness suspension should be able to recognise the symptoms of pre-syncope and act as soon as possible

Initial responding personnel should assess the condition of the casualty and may be able to stabilise them, for example by maintaining an airway.

Rescue

When considering the rescue options for a casualty at height, factors such as the length of time they have been suspended, the nature and mechanics of any potential injuries sustained and their current medical condition should inform what actions will be taken, what equipment will be used and how quickly a rescue needs to be carried out.

A casualty at height may have suffered injuries that require specialist equipment, such as basket stretchers or spinal immobilisation. Depending on the medical condition of the casualty, medical care, such as spinal or airway management, may be required throughout the rescue.

It may be necessary for personnel to take immediate life-saving actions. A casualty that is in suspension and unconscious will require urgent rescue or treatment. If personnel are unable to rescue a casualty who is showing signs of suspension intolerance, they should try to raise the casualty’s legs, or reduce the weight of the casualty in the harness; these actions may prolong the tolerance of suspension. However, carrying out these actions may delay or hinder the rescue activity, which may have a greater impact on the condition of the casualty.

It may be appropriate to extricate casualties to a place of safety via a safe route or existing means of egress, such as an internal stairway, which would not require any additional safety equipment. If time and circumstances permit, the use of an aerial appliance may be appropriate. Specific considerations for such use include:

• Availability
• Access
• Overhead hazards
• Underground hazards
• Increased rescue loads
• Time constraints
• Operating requirements

In situations where these options cannot be used, the use of rope-based systems may be appropriate. Rope systems, equipment and PPE for casualty rescue should incorporate the most appropriate and safest method that conforms to regulations.

If the condition or injuries of a casualty do not allow for the use of a casualty harness during their rescue, they may need to be packaged and removed using a stretcher. For further information about the use of stretchers, refer to Use casualty transport equipment.

The use of emergency responders accompanying the stretcher in a rope rescue is an advanced technique; this type of stretcher use should be restricted to specialist teams.