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什麼是懸吊創傷(suspensiontrauma)?

Postedon2010年11月03yadmin

因為參與了到院前救護相關的工作，使得自以為看過很多種創傷的我有機會認識到更多稀奇古

怪的傷害，今天介紹一個蠻特別的傷害：Suspensiontrauma。

現今很多工作都需要在高空作業，想當然耳，他們大多都有安全裝置固定在身上防止突然墜

落。大部分的時候如果不小心墜落了，他們也會有辦法抓到附近的支撐點，或是由同伴直接拉

起救援，但是萬一遇到困難，使得墜落者就這樣半吊在空中呢？由於現代的安全護具通常都會

有繩索跨過雙大腿內側以提供支撐，因此若墜落者就這樣以頭上腳下的垂直姿勢半吊著，自己

的體重就會壓在這兩條繩索上，使得靜脈回流受阻，血液堆積在雙下肢，心臟輸出因此降低，

大多數病患會在30分鐘左右陷入昏迷。

治療的方法是什麼呢？其實就是儘快把患者救下來，平躺，然後開始ABC評估與治療。

網路上有文章說不可以平躺，建議要先保持L坐姿或W型坐姿，甚至讓護具還維持一點

壓力避免大量血液衝回右心。但2009英國政府的HealthandSaftyExecutive做了一個EBM

查詢，發現其實平躺施救並沒有關係，甚至認為沒有好好平躺會讓腦部的循環無法恢復，繼而帶

來更嚴重的傷害。該篇文章對於EBM愛好者來說相當精采，是五大步驟精

采示範，請勿錯過。

順帶一提，Wikipedia附了一個連結說有生理學家認為suspensiontrauma是古代西方十字架刑

罰致死的機轉之一。

以上附的圖片是由一家廠商提供(跟我沒有利益關係)，主要是廣告那一條繩子(TraumaStrap)，可

以讓作業人員不小心被懸吊在半空中的時候可以用力採住，先減少護具對胯下血管的壓力，又可以讓

雙腳的肌肉用力，促進靜脈血液回流。

Strap

SuspensionTrauma

Suspensiontrauma(Syn."orthostaticshockwhilesuspended"化also

knownasharnesshangsyndrome(HHS),ororthostaticincompetenee

isaneffectwhichoccurswhenthehumanbodyishelduprightwithout

ersonisstrappedintoa

harnessortiedtoanuprightobjecttheywilleventuallysuffertheCentral

IschaemicRespon(commonlyknownasfainting).Ifonefaintsbut

remainsvertical,onerisksdeathduetoone'sbrainnotreceivingthe

atriskofsuspensiontraumaincludepeople

usingindustrialharnessfailarrestsystems,abilingsystems,c

onfinedspacesystems),peopleusingharnessforsporting

purposcaving,climbing,parachutingetc),stuntperformers,circus

performers,andsoon.

MedicalSuspensionShockisalesswelldocumentedformofSuspe

nsiontraumaaffectinghealthcarepatientsintheraputicbathsand

hospitalbeds,safetyats,supportandsuspensionframes,slings,and

swings,whichpreventfalling(recumbination)despitefainting.

(PhlebotomyTodayFeb.2012)

Ina2006articleontheCrucifixionofJesus,PhillipBishopand

physiologistBrianChurchsuggestthatsuspensiontraumaisacau

ofdeathincrucifixion

Prevention

Preventionofsuspensiontraumaispreferabletodealingwithitscon

icrecommendationsforindividualsdoingtechnical

ropeworkaretoavoidexhaustingthemlvessomuchthattheyendup

withouttheenergytokeepmoving,andmakingsureeveryoneina

groupistrainedinsingleroperescuetechniques,especiallythesingle

ropepickoff,aratherdifficulttechnicalmaneuverthatmustbe

oneisstranded

inaharness,butisnotunconsciousorinjured,andhassomethingto

kickagainstorstandon(suchasarockledgeorcavingleg-loops)itis

helpfulforthemtoutheirlegmusclesbypushingagainstiteveryso

often,ersonisstra

ndedinmid-airorixhausted,thenkeepingthelegsmovingcanbe

nehand,exercisingthe

legmuscleswillkeepthebloodreturningtothetorso,butontheother

hand,asthemovementsbecomeweakerthelegmuscleswillcontinue

todemandbloodyettheywillbecomemuchlesffectiveatreturningit

tothebody,andthemomentthevictimceasmovingtheirlegs,the

bloodwillimmediatelystarttopool."Pedalinganimaginarybicycle"

shouldonlybeudasalast-ditchefforttoprolongconsciousness,

becauassoonasthe"pedaling"stops,

itisimpossibletorescuesomeoneimmediately,thenitisnecessaryto

raitheirlegstoasittingposition,whichcanbedonewithaloopof

riggingtapebehindthekneesorspecializedequipmentfromarescue

kit.

Whenrescuingavictimitisparamounttoletthebloodflowtothebrain

ndedvictimismorelikelytobeinjuredbynotraising

geinABCmanagementshouldbe

undertakenbadontheabovetheoreticalriskofsuspensiontrauma.

TheBritishHealthandSafetyExecutive(HSE)hasdoneanextensive

reviewofthistopic2009⑶whichcontradictsitarlierstatement

2002.

1.人SeddonP.:Harnesssuspension::HealthandSafetyExecutive-

CONTRACTRESEARCHREPORT451/2002,page3,hieronline

2.人CatholicMedicalAssociation,LinacreQuarterly,August2006.[1]