ESPELEO RESCATE MÉXICO
Harness Hang Syndrome: Fact and Fiction.-
Joe Ivy
Recently, there has been a lot of information and
misinformation disseminated about Harness Hang Syndrome (HHS)
resulting in the impression that some ascending systems cause HHS
and others do not and that HHS is not of general concern. To
clear up this confusion, we'll cover the history of the testing that has
been done, the results of those tests and the conclusions obtained.
HHS, the rapid loss of consciousness followed by death due to
hanging immobile in a harness, happens in all harnesses and ascending
systems. Someone hanging immobile in a seat harness is a serious medical
emergency that must be dealt with immediately.
In 1978, Maurice Amphoux, a doctor involved in industrial safety
research in France, performed a short series of tests in order to
determine what harnesses would be best for workers to use when working
at height. At the time, it was a standard practice for workers to use
simple waist belts even when a significant fall was possible. Dr.
Amphoux was using a parachute harness for the tests and found, much to
his surprise, that the test subjects lost consciousness after a few
minutes of hanging in the harnesses. One subject lost consciousness in
only 3.5 minutes! He performed some more tests a little later under
better controls and found that the subjects experienced cardiac
arrythmias at the time they lost consciousness. Dr. Amphoux discontinued
the tests because of concern for the safety of the subjects. He then
published his findings, trying to get the word out about HHS. The
French caving community was notified but the news was greeted with
skepticism.
In 1984, the newly-formed Medical Commission of the French Federation of
Speleology (FFS) decided to do some informal HHS testing to see
if Dr. Amphoux was right. The Commission had two subjects hang immobile
in their standard caving vertigear (Frog systems) with no particular
controls. One subject lost consciousness after about 30 minutes and the
other lost consciousness after only 7 minutes! The testers were
horrified and discontinued testing out of fear for the safety of the
subjects. The Commission decided to fall back and come up with some new
protocols for the testing. After seeing what happened, the Commission
began to suspect that some fatalities that had been formerly attributed
to exposure might have actually been caused by HHS.
Two years later, the FFS Medical Commission approached HHS
testing a little more seriously. Utilizing the facilities of the Sport
Physiology Lab at the University Hospital of Besançon, the Commission
had three volunteers in excellent physical condition participate in more
HHS testing. Using the new protocols, the subjects' vital signs
were monitored with EEG, ECG and blood gas sampling equipment. The tests
were also videotaped.
The first subject was positioned as if he had been ascending (with a
Frog system) and simply stopped and became relaxed (as if completely
exhausted) with neck in hyperextension, arms dangling at his sides, legs
extended and feet in the footloop. The subject complained of extreme
discomfort from the neck position just before HHS symptoms set
in. The subject's head was then supported to see if the HHS
symptoms could be alleviated. The symptoms did subside but then
reappeared within a couple of minutes and progressed until the subject
lost consciousness.
The second subject hung in the same position as the first but with his
head supported by a padded stand. HHS symptoms began to appear
anyway. At the onset of the symptoms, the testers had the subject move
his legs some. This caused the symptoms to subside. However, once the
subject became immobile again, the symptoms reappeared rapidly and
progressed until he became unconscious.
The third subject hung with head supported but with legs pulled up, feet
even with his butt as if he had been about to take a step up with his
Frog system. Even with the legs much higher than with the previous two
subjects, HHS symptoms appeared and the subject lost
consciousness. Further, even though this subject was lowered and
released before the symptoms got extreme, he lost consciousness anyway.
More testing was done in 1986 by Jim Brinkley at the Aerospace Medical
Research Lab, Wright-Patterson Air Force Base, Ohio with better controls
that those used by the FFS Medical Commission and the results were the
same. Brinkley used Class III industrial harnesses (very similar to a
parachute harness) and found that HHS occurred very consistently
in all test subjects.
So what are the symptoms of HHS? The FFS testing showed that
HHS symptoms appeared in no more than 10 minutes with healthy
subjects. Brinkley's research showed that 6 minutes was the normal onset
time. Keep in mind that Amphoux's tests had one fellow lose
consciousness in 3.5 minutes. HHS symptoms begin with an overall
feeling of illness (as with a flu bug) followed by excessive sweating,
nausea, dizziness and hot flashes. Testers noticed that the subjects had
obvious brain function impairment with the initial onset of HHS
that worsened very rapidly. As HHS progresses, the symptoms
worsen with difficulty in breathing, increasing heart rate,
progressively worsening cardiac arrythmias, an abrupt increase in blood
pressure followed by unconsciousness. Death would follow within minutes
if the subject were not released quickly.
What causes HHS? No one is entirely sure. First thoughts were
that pressure on the neck from the chest harness shoulder straps might
be a cause but testing ruled that out. Some testers believed that it was
the type of seat harness, but the fact that caving harnesses, parachute
harnesses and Class III industrial harnesses all cause HHS indicates
that this is not true as well. Another theory was pulmonary impairment,
but blood gas testing ruled this out, too. Most of the testers believe
that HHS is caused by blood being trapped in the legs so that the
net result is similar to hypovolemic shock. No blood is actually being
lost, but the amount of blood available in the torso to keep the brain
and vital organs sufficiently perfused with blood is inadequate
nonetheless. There are likely some blood chemistry problems occurring as
well. Until more testing is done with state-of-the-art equipment, no one
will be absolutely certain. However, there are some conclusions we can
make now.
First, hanging immobile in a seat harness is the root cause of HHS.
Any caver who has done much vertical work has hung in his harness for
much longer than 10 minutes and had no problems. But he was not
immobile. As long as you are squirming around, shifting your weight and
keeping busy, HHS is not an issue. The problem occurs when a caver,
perhaps exhausted or cold, tries to ascend a pit and gets hung up
somehow. Most of the French fatalities were inexperienced cavers who had
technical trouble with their gear and were not knowledgeable enough to
correct the problem. Already tired from caving, the cavers struggled
with the gear until completely exhausted, then HHS set in and
they died.
Second, someone hanging immobile in a harness - any harness - is a dire
medical emergency. The FFS testing showed that 10 minutes was the usual
onset time in a healthy subject. If someone is stranded on rope
underground, it's likely that they are tired and cold so you can expect
HHS to set in much more rapidly. Cavers that witnessed two of the
French fatalities said that once the caver on rope stopped struggling,
unconsciousness and death occurred in less than 10 minutes.
Third, preventing HHS is the best course of action. The articles
on the testing done by the FFS were unclear as to how much effort was
needed to revive the test subjects once they lost consciousness or what
their condition was once revived. Certainly, the best thing is to make
certain that it never happens in the first place.
You should never cave alone in a vertical cave. Make certain that
everyone on a vertical caving trip is competent. Everyone should know
how to change from ascent to descent and vice versa. A caver who is
exhausted or badly hypothermic should not be allowed to attempt a climb.
An important note here is that some of the French fatalities occurred in
pits of less than 20 meters depth with one occurring on an 8-meter pit,
so pit depth isn't necessarily an issue. Cavers should not get left
behind in a vertical cave as the group heads for daylight. Finally, most
cavers on a vertical caving trip should know how to do a pickoff (single
rope rescue), if not everyone. If someone in the caving group does get
hung up somehow, do not allow them to struggle for any length of time.
If the stranded caver can't correct the problem on the first try, he
probably won't get it on the second or third. Remember that the FFS
subjects experienced progressively worse brain function impairment as
the HHS symptoms began to set in. This means that not only is the
exhausted caver getting more exhausted, he's also getting more stupid.
Someone should be headed up (or down) the rope to assist the stranded
caver shortly after that first attempt at correction. The would-be
rescuer might be able to simply assist and thus correct the problem. Or
the rescuer may have to pick the stranded caver off and get them back to
the bottom of the pit. Either way, knowing how to do a pickoff should be
mandatory and all the cavers on a trip should be ready to use that
knowledge quickly.