After the Fall: Will your rescue program leave workers hanging?

When workers are suspended in mid-air after a fall, their lives hang in the balance – even if they survived the fall without a scratch. Seconds count. Does your company have a plan for prompt rescue?

In March 2004, OSHA issued a safety and health bulletin outlining the dangers of prolonged, upright suspension. The bulletin warned of the risk of "orthostatic intolerance" and "suspension trauma," which refer to some of the potential health hazards – death being the chief one – experienced by workers who are suspended upright by fall arrest equipment after a fall.

"Unless the worker is rescued promptly using established safe procedures, venous pooling and orthostatic intolerance could result in serious or fatal injury, as the brain, kidneys and other organs are deprived of oxygen," the bulletin states.

Injuries suffered during the fall, or the shock resulting from the experience of the fall, "can increase the onset and severity" of venous pooling and orthostatic intolerance, as can physical and environmental factors such as fatigue, dehydration, hypothermia, cardiovascular disease, respiratory disease and blood loss, according to the 2004 OSHA bulletin.

While experts credit employers for making strides in their commitment to fall safety in recent years, they suspect it still may have come as a shock to some that their workers face considerable danger after a fall. Fall protection experts such as Paul A. Satti, technical director of the Construction Safety Council, believe many companies are lacking a "thought-out or thorough rescue plan."

Mike Wright, president of New Carlisle, Ohio-based Safety Through Engineering, agrees.

"In general, whether it's construction or general industry, employers aren't prepared for rescue at all," Wright said. "They probably would say they are."

"Commonly, companies just follow the OSHA standard, which says they have to prepare the worker for self-rescue or rescue them in a prompt, timely manner," said Michael Dunn, president of Fort Allen, La.-based Emergency Response Training Inc. However, "very rarely do we find that companies train their employees in self-rescue for fall protection."

Despite a growing awareness of the dangers of suspension trauma, Wright still sees a sharp contrast between OSHA's vision of post-fall rescue detailed in the preamble to 29 CFR 1926 Subpart M – fall protection for construction – and what's happening on the job site.

"In the United States, we think of the word 'rescue' as 9-1-1, house on fire, break in the door, break all the rules and do whatever you can to get the person out," Wright said. "We think of an unplanned event."

OSHA's 1926 Subpart M, however, envisions post-fall rescue as something much more structured and methodical – a "pre-planned event," Wright explains.

Even so, experts say many companies are happy enough if their fall arrest systems keep their workers from hitting the ground. Bob Apel, product group manager for Pittsburgh-based safety equipment manufacturer MSA, explains there's been a "natural evolution" in the field of fall protection, and employers have taken a "crawl-before-they-can-walk" approach. In other words, many employers first try to master the basics of fall protection before moving on to the subject of rescue.

The problem is, many have yet to move on to the subject of rescue.

"Having a rescue plan is just as important as having a fall protection plan," Apel said. "You really should not have one without the other. Just putting together a fall protection program without rescue is only doing half the job."

There's a growing body of evidence suggesting that simply calling the local fire department does not constitute an effective rescue plan, according to Randall Wingfield, president and owner of Bainbridge Island, Wa.-based Gravitec Systems Inc. USA and chairman of the American National Standards Institute (ANSI) Z359.1 committee, which is promulgating a "family of standards" that will add to the existing ANSI fall protection standard and will include a new section on developing a fall protection program.

Rescuing a suspended worker presents unique logistical challenges – such as high elevations and access-impeding obstructions – that can flummox emergency personnel, and Wingfield says he's aware of instances in which rescue personnel failed in their efforts to save a suspended worker who had survived the fall.

"Just because a truck has sirens and it's painted a bright color doesn't mean that all rescue personnel are trained in high-angle rescue," Wingfield said.

The onus, Wingfield believes, is on the employer to ensure that the suspended worker is rescued quickly. That means "ensuring that for anyone who works at heights, there's a rescue plan."

How Prompt is Prompt?

Just how long a worker can remain suspended upright and motionless before suffering health consequences is a matter of some debate. In 29 CFR 1926.502, OSHA requires employers to "provide for prompt rescue of employees in the event of a fall," and the agency's 2004 bulletin points to research that indicates that "suspension in a fall arrest device can result in unconsciousness, followed by death, in less than 30 minutes."

Dunn points to the results of an Air Force study in which volunteers suspended in harnesses experienced adverse health effects in as little as 12 to 15 minutes.

"The volunteers passed out, their vital signs went south and they had to be medically rescued," Dunn said.

Andrew Sulowski, P.Eng., M.Sc., founder of Toronto-based Sulowski Fall Protection and a board member of the International Society for Fall Protection, advises that rescues generally should be completed "in 15 minutes max," with one proviso.

"They should be done as quickly as possible but 100 percent safe for the rescue crew," Sulowski said.

The Construction Safety Council's Satti believes OSHA's confined space standard for exposure to atmospheric hazards that could cause oxygen deficiency provides some guidance.

"Anything more than 4, 5, 6 minutes and you're risking irreversible health effects," Satti said. "I would say to have somebody suspended no more than 3 to 5 minutes would be a responsible time for rescue."

But Satti also acknowledges that the 3- to 5-minute window is "a tough time to meet" for employers without a rescue plan in place.

"You'll take 3 to 5 minutes just looking at the guy trying to plan what to do," Satti said.

The revised ANSI Z359.1 standard for fall protection in general industry, expected to be published in 2006, suggests that 6 minutes "may be an appropriate time to look at," according to Wingfield.

Still, Wingfield acknowledges that even the Z359.1 committee is struggling with defining the parameters of prompt rescue.

"Most of us in the business of rescue feel that it's less important to talk about the time and more important to talk about what's appropriate for the particular circumstance," Wingfield said. "I think there's a certain vagueness [in the definition of 'prompt rescue'] for a reason, because every scenario is different. There are so many variables to consider: Is the person conscious or unconscious? What's the body-holding device? Is the person suspended or is his body being supported by something in addition to the harness? It's up to employers, who have the responsibility of caring for the worker at heights, to identify the hazards and respond to them accordingly."

Don't Leave Home Without One

If the responsibility lies with the employer to have a post-fall rescue system in place, what are the critical components of rescuing a suspended worker?

As obvious as it sounds, experts agree that the most important aspect of effective post-fall rescue is this: Have a plan.

The lack of any form of a pre-conceived post-fall rescue plan not only puts the fall victim at risk but also puts rescuers in harm's way.

"Whenever you have unplanned attempts to rescue, second or third injuries or fatalities are not uncommon," Satti noted.

Whether the plan calls for self-rescue, buddy rescue, a team approach or a dedicated in-house rescue team, Wingfield stresses that simply having a written post-fall rescue plan takes some of the stress and chaos out of an already stressful situation, increasing the chances of a successful rescue.

Rescue plans, Wingfield adds, don't have to be complex.

"It might be as simple as figuring out, 'Where's the articulated lift?' Or 'Where's the ladder?'" Wingfield said.

The revised Z359.1 fall protection standard will offer more specific guidance on designing a post-fall rescue plan, among other aspects of creating a comprehensive fall protection program.

"I'm pretty confident it is the best standard in the world right now on how to create and maintain a fall protection program in general industry," said Wright, a Z359.1 committee member.

A fall protection standard being developed for construction – ANSI A10 – will address rescue procedures for construction sites, according to Michael McCann, safety director for CPWR – Center for Construction Research and Training, the research and training arm of the AFL-CIO's Building and Construction Trades Department. McCann is a member of the ANSI A10 committee.

As a starting point, though, OSHA's 2004 bulletin encourages employers to implement a rescue plan that includes procedures for:

• Preventing prolonged suspension;
• Identifying orthostatic intolerance signs and symptoms; and
• Performing rescue and treatment as quickly as possible.

The agency cautions that "some authorities advise against moving the rescued worker to a horizontal position too quickly," which "is likely to cause a large volume of de-oxygenated blood to move to the heart, if the worker has been suspended for an extended period." This can lead to cardiac arrest.

In a rescue situation, OSHA recommends continuous monitoring of the suspended worker for signs and symptoms of orthostatic intolerance and suspension trauma. The possible signs and symptoms of orthostatic intolerance include faintness, nausea, breathlessness, dizziness, sweating, unusually low heart rate or unusually low blood pressure, paleness, hot flahes, "graying" or loss of vision or increased heart rate.

If rescue can't be performed in a prompt manner, and self-rescue isn't an option, Dunn recommends having suspended workers keep their legs moving to "keep the blood pumping," reducing the risk of venous pooling.

"That can help lengthen the time he has to hang there until rescue shows up," Dunn said.

Wingfield notes that more and more fall arrest equipment is being designed to maximize the worker's health and safety during suspension. For example, some harnesses now come with additional leg loops to stand on while the worker is suspended in mid-air, providing "some additional relief from the harness," and fall arrest systems in general now are designed to be more conducive to leg movement during suspension, Wingfield says.

Other products specifically designed for rescue include four-in-one pulley systems that give the rescuer a "four-to-one mechanical advantage," according to MSA's Apel.

"If you have a worker who weighs 200 pounds, rather than lifting 200 pounds, you're only lifting 50 pounds to make the rescue much easier," Apel said.

With that said, employers need to understand that buying rescue equipment isn't "as simple as a one-size-fits-all rescue kit," according to Apel. Employers need to do their homework to make sure their rescue equipment is compatible with their logistical demands.

The best way for employers to appraise their equipment demands, Apel concludes, is "to talk to the manufacturers."

"They're the experts and they can help you do that," he said.

The major safety equipment manufacturers also offer fall protection and post-fall rescue training, so "there's no need in today's market to crawl before you can walk. You can start off running, with a full fall protection program that includes rescue."

Rescue training courses also are available from safety consultants, rescue training companies and not-for-profit organizations such as the Construction Safety Council.

Practice Can Save Lives

Perhaps just as important as having a rescue plan in place is practicing the plan before a real-life fall occurs.

"Look at how often emergency personnel and firefighters practice and conduct drills," Satti said. "They never stop improving upon their readiness."

Unfortunately, Satti says, he doesn't see many construction companies "taking a mannequin and dropping it, and then taking a scissors lift, boom lift or some kind of self-retracting system to [simulate] a rescue.

"Contractors should go through the physical motions of practicing a rescue," Satti said. "When they do that, they identify what works and what doesn't work."

Satti notes that safety picnics, safety days or other annual safety events typically held by larger construction firms are ideal for simulating post-fall rescue situations. Such events pose a "great opportunity" for employers to raise fall protection awareness, show workers the company is serious about fall safety and have some fun at the same time, Satti explains.

Simulating post-fall rescue scenarios is an integral part of what Wrights calls "pre-planning" – making rescue situations a planned event rather than a chaotic event. Part of that pre-planning process also entails thinking about potential safe places for rescue, whether a worker would be lowered or raised to safety and other aspects of "workplace geometry and how that's going to affect rescue," according to Apel.

The workplace geometry includes considerations such as what kind of obstructions are in the worker's fall path and whether a worker would have a clear path in the event of fall – which Wright believes are determinations that should be made by an OSHA-defined "competent person," ideally a foreman or job superintendent – during a job safety analysis before a construction project begins.

Most fall protection experts will tell you that the best rescue strategy is to take every possible precaution to prevent workers from falling in the first place. But the reality is that falls happen, even on the work sites of the most safety-conscious employers, and a rescue plan is an essential component of a company's overall fall protection program.

"If you're not going to give your employees the skills to perform rescue," Satti asserted, "then you might as well not even put them in the harness at all.