Alpine Rescue & Mountain Emergency Medicine

ICAR MED REC 0036 2021

Suspension Syndrome






Suspension Syndrome


Rauch, Simon; Strapazzon, Giacomo; Brugger, Hermann; Pasquier, Mathieu; Mortimer, Roger; Skaiaa, Sven Christjar;  Lechner, Raimund; Paal, Peter

Responsible person

Rauch, Simon

Originally based on


Date of publication


Valid Until



Suspension syndrome (also called suspension trauma or harness hang syncope) describes a potentially life-threatening event induced by passive hanging on a rope or in a harness system in a vertical or near-vertical position.
Although numerous cases are reported, the exact incidence of the suspension syndrome is not known. Since the first case series of the suspension syndrome was presented in 1972 its pathophysiology has been debated controversially. A widespread hypothesis assumes blood pooling in the lower limbs, prompting a reduction in cardiac preload and subsequently a decrease in cardiac output and tissue perfusion, eventually leading to loss of consciousness and cardiac arrest. However, no study has proved this hypothesis.
The immediate aid by first responders is still debated and some recommendations advisen against placing a casualty in a supine position afer being rescued from suspension, hypothesizing
an acute right ventricular volume overload due to the blood returning from the legs. This hypothesis has never been proven and is based on ‘expert opinion’ only.
Recently, an experimental study brought new insight into the pathophysiology of the suspension syndrome and gave reason to release this recommendation.

Update 20.05.2021

Letter to the Editor
Response  to  Drew,  R .  (2020).  Suspension  Trauma:   The   silent   killer.  
Canadian   Journal of Emergency Nursing. https://doi.org/10.29173/cjen18 (IHR) 

We  read  ‘Suspension  Trauma.  The  silent  killer  by  Richard  Drew’  on  suspension  trauma   with   concern.
Here you can read the Letter to the Editor by ICAR MedCom Members:


ICAR MED REC 0036 2021
MED REC 0036 2021 Suspension Syndrome
MED REC 0036 2021 Suspension Syndrome.pdf (168.22KB)
ICAR MED REC 0036 2021
MED REC 0036 2021 Suspension Syndrome
MED REC 0036 2021 Suspension Syndrome.pdf (168.22KB)

Important Notice

'These recommendations are based on an unanimous consensus opinion of ICAR Medcom. Unusually we are publishing these before a definitive peer reviewed article will be published. We feel this deviation from our normal practice is important for the safety of patients'