Harness Induced Pathology

Harness Induced Pathology is a silent killer in High Angle Rope Rescue, it can also be known as Harness hanging syndrome, Suspension Trauma, Suspension Induced Shock, and Etc. Whatever the title may be, it still poses a problem for rescuers and patients. We will be covering the problems associated, sign/symptoms, and recovery of Harness Induced Pathology.

Harness Induced Pathology occurs when a rescuer or victim is suspended in their harnesses for long periods of time. When the harness is under tension around the body it can constrict around the major arteries and blood vessels thorough out the body, thus not allowing the proper blood flow to the heart, brain, and muscle tissues. When the proper blood flow is interrupted it can cause hypoxia to the brain, causing the rescuer/victim to become unconscious, and in some cases even death. Another problem associated with Harness Induced Pathology is the pooling of blood in extremities. When the harness constricts around the body it can act as a tourniquet cutting off the much needed oxygen to vital organs.  During normal bodily functions, the legs do not pool larger amounts of blood due to the large amounts of muscle tissue surrounding the arteries, thus allowing the heart to pump normally while the leg muscle provides assistants in allowing the blood the travel "uphill". When this process is interrupted by constricting of the harnesses around the legs, the muscle and blood vessels in the legs tend to relax. This can cause the heart to drop in blood pressure when the constriction or tourniquet is released, thus not allowing enough blood to reach the brain. One other problem with pooling blood is septicemia. When blood pools for longs periods of time it can build harmful toxicants. When these toxicants are released, they travel to vital organs causing shock and even cardiac arrest at times. If rescuers understand the sign and symptoms, they can treat and even prevent this from happening to themselves and victims.


Signs and Symptoms

Faintness, nausea, hot flushes, sweats, breathlessness, feeling of panic or uneasy, change in pulse rate (suddenly slowing or becoming rapid), cramping of muscles, and or sudden fatigue


Preventing Harness Induced Pathology:


  • Take adequate fluids
  • Keep warm but avoid excess sweating and heat exhaustion
  • Recover before a long assents  or other vigorous exertion
  • Do not push yourself to the point of exhaustion  
  • Avoid prolonged stationary suspension in a harness – take turns at the job, consider a boson’s chair or alternative belay position.
  • If it is necessary to hang in your harness, change position as necessary to keep comfortable and try to regularly tense your calves to maintain circulation
  • Always wear a chest harness so that you can lean back without risk of turning inverted or falling from your harness if consciousness is reduced or lost for any reason
  • When wearing a class two or three harness, make sure your waist strap is tight, but do not over tighten the thigh and buttocks straps. Leave room for adjustment during rescue of training operations
  • If you feel at all faint or unwell at any time, let others know, tense your legs repetitively and try to lower your head and raise your legs.

Treating Harness Induced Pathology:

  • Stabilize the patient as well as possible before a lift
  • Ensure cold patients are adequately insulated with dry and waterproof clothing or a plastic bag and blankets or hypothermia bag if in a stretcher – do not forget to insulate the head.
  • Rehydrate if possible – oral water or sports drinks if conscious, IV fluids if medical or paramedic assistance enables this.
  • If exhausted, provide some easily digestible energy source – glucose sweets etc.
  • Treat any cold or exhausted person as a patient and ensure they are closely monitored and, if possible, hoisted horizontally in a stretcher rather than allowed to climb or be hoisted in a harness only.
  • If a horizontal stretcher hoist is not feasible, consider an under knees strap to hold the patient more horizontally.
  • When vertical hoist is unavoidable, minimize hanging time
  • Accompany patients during raises and lowers wherever possible
  • Monitor vital signs
  • Ask conscious patients to do leg contractions to assist circulation
  • Get the patient horizontal as soon as possible, consistent with safety for rescuers
  • If collapse occurs mid hoist and intervention is not possible on the rope, complete hoist or lower patient rapidly – whichever will get the patient to a stable position with at least one rescuer to provide care.


If unable to provide IV therapy from height, wait until to victim is a few feet from the ground, give appropriate fluids and treatment before the patients harness releases tension from the victim’s body. Remember, when working from rope always try and reposition ones self to avoid Harness Induced Pathology.

Information on this article is from Fire and Rescue Concepts Tower Rescue Program and some reference material of DR. Ian Millar, MFESB Medical Officer

DISCLAIMER: This post is for informational purposes only. If Departments wish more training on Rope Access or Tower Rescue Training contact us at estroud@fireandrescueconcepts.com


  • Jarod Howard says:

    Awesome information. I’m going to have to add that to our training course. I’ve had students rescue me and I’ve hung there for about 20 minutes in my harness while they stumble trying to untangle the equipment (rookies).

  • Harry Fair says:

    This can be a problem in caving (spelunking) incidents with hypothermia as a complicating factor.

    Thanks for making a great, yet brief, exposition of the problem which is not widely enough known.

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