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Abstract
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The first known mention of deaths while on rope that had no obvious cause was in 1972 at the second international conference of mountain rescue doctors in Innsbruck, Austria. Trauma could not explain the deaths. Some climbers had died while suspended, and in one worrisome case, the victim died immediately after rescue. Some speakers attempted to explain the deaths and made recommendations for prevention. They recommended against placing a victim supine "abruptly" after rescue, although they did not define "abruptly." The recommendations were buried in obscurity for 3 decades.
Twelve years later, in 1984, the medical commission of the French Federation of Speleology noted a number of cavers who died while on rope. These deaths had previously been attributed to hypothermia, but the time to death seemed too short. The commission studied the phenomenon by putting volunteers on rope and having them hang as if they were unconscious. Syncope sometimes occurred within minutes. The commission concluded that there was more to caver deaths on rope than hypothermia. Suspension is not a single syndrome. There are case reports of an acute phase with syncope or death on rope, sometimes occurring minutes after the victim became passive. There are rare reports of death soon, sometimes only minutes, after rescue. There are also cases of subacute renal failure from rhabdomyolysis after suspension.
In 2002, the Health and Safety Executive (HSE) of England created recommendations to protect workers on rope. They unearthed the 1972 recommendations and suggested that victims who experienced syncope while on rope not be placed lyingflat for at least 30 min after rescue. The HSE also recommended that rescuers not remove the victim's climbing harness. Despite a lack of evidence, these recommendations became standard in the mountaineering, caving, rope access, and search and rescue communities. A single case of death immediately after rescue led to wide- spread speculation on the Internet regarding the cause of death. One theory involved rupture of the heart from blood returning to the central circulation from the periphery.
In 2009, the original HSE recommendations began to be questioned...
The debacle of earlier recommendations for treatment of suspension syndrome is a demonstration of what can happen when recommendations are made without evidence. Expert opinion can be wrong. This episode also demonstrated how those relying on the Internet and other non-peer-reviewed statements can easily incorrect, dangerous information ,,,
Language: en |