Handling falls from suspension
Falls from suspension are rare, but they certainly happen. The first suspension performance I ever saw was a self-suspension where the performer dropped themself. In my area (SF Bay), several drops have received quite a bit of scrutiny. As a rigger/DM/bondage bottom/event or venue owner/producer, do you know what to do in this situation? Panic and adrenalin tend to rule the moment, and most people want to do precisely the wrong things in the immediate aftermath of a fall (untie them! walk around to see if everything is working!). I’m discussing this from a medical perspective, not getting into legal/ethical/community implications.
If someone falls from suspension…
At an event/venue where medical staff is available, immediately call medical staff if there is any fall from suspension. Dangers include broken bones, skull fractures, spinal cord injury, concussion, bleeding in the brain, facial fractures, etc.
Take a first aid/CPR class! This quick guide is intended to supplement and review that content, not replace it.
If you have no medical training, here are some simple guidelines on what to do:
Do not move the person who fell.
Check for responsiveness (see if they are awake) by loudly saying, “Are you OK?” If they do not respond, you could consider gently patting their shoulder, without moving them. If they are not responding or are confused, call 911 (*or your local emergency number, see note below).
Check for breathing. If they are unresponsive and not breathing (or not breathing normally, such as only gasping), start CPR (with chest compressions) if you know how while someone else calls 911. The 911 operator can also give you instructions.
If an AED is available, get it and follow the instructions on the unit. They are intended for layperson use and will not shock someone who doesn’t need it!
Just because someone is talking and can move all extremities doesn’t mean they couldn’t have a severe injury. Keeping someone lying still could save their life (or keep them from being paralyzed). When in ANY doubt, call 911. Some injuries are very time sensitive.
Do not move the person who fell or cut/untie the rope unless the rope is impairing the person’s breathing/circulation or causing other serious harm. When EMS arrives, they can cut the rope. They are trained to move victims safely, and you are not.
Encourage the person who fell to stay still. Provide support and reassurance. If other basic first aid is needed (like pressure to stop spurting blood), provide this while keeping them still. Don’t straighten or move anything.
The following merit an immediate 911 call:
A fall from over 3 feet in the air
A fall straight onto the head
Any signs of spinal injury (which include the immediate onset of neck pain, numbness, paralysis, incontinence, and severe pain). Remember that if the person who fell is in subspace or confused, you can’t accurately assess for this – call 911.
Any loss of consciousness (blackout) or confusion
… if you doubt, call! Don’t hesitate to call 911*. The paramedics have seen it all; you can’t scare them. Their primary objective is the health of their patient.
If you have medical training:
If the person is not responsive, check for pulse and breathing. If CPR is needed, provide inline stabilization of the neck. Remember to use a jaw thrust rather than a chin lift when giving rescue breaths.
Every fall is different, and a lot of factors go into determining whether someone needs emergency care (a 911 call). Those factors may include the height of the fall, angle of impact, point of impact, the person’s overall health, etc. If there are no apparent signs of severe issues like the ones listed above, perform a secondary survey to determine what other care might be needed.
If they landed face down, it might be reasonable to provide inline stabilization and log roll them onto their side (recovery position) or back (if CPR is needed). Do this with help and only if you are adequately trained.
If you determine it is necessary to cut the rope, provide inline stabilization. Support the limbs after cutting the rope to ensure no sudden movements (which can cause further injury). Consider that in many cases, you will not need to cut the rope or will not need to cut all of the rope. Moving injured limbs may cause further pain and trauma both to the limb itself and potentially to the spine as well.
If there is any suspicion of spinal cord injury (high-risk mechanism or signs/symptoms), call 911 and provide inline stabilization of the neck until EMS arrives. This algorithm is a review/reminder of factors EMS consider when deciding whether to clear c-spine in the field.
Keep in mind that someone with altered mental status (for example, in subspace!) is impossible to adequately evaluate for spinal injury without radiological studies.
*Anywhere it says “call 911” in this article, read “call 911 or your local emergency number.” Note that when you’re calling from a cell phone, you may or may not be routed to the correct call center. Know your local emergency number (for San Francisco, it is 415-553-8090). In much of Europe, the number is 112.
*This article has been proofread and contributed to by two kinky MDs-Dr_Who and MietteRouge. It is intended as a quick (rather than exhaustive) guide and was explicitly made as brief as possible.
You are more than welcome to reproduce this article in your organization. Please do not change the content and give attribution as above.
Disclaimer: Nothing in this article is a substitute for using your judgment, consulting with a medical professional on the scene, and calling 911. I am simply offering some thoughts and discussion on this subject. Please don’t sue me.
As a postscript, because it has been requested several times, here are some notes about handling a fall from suspension from a self-suspender or bottom’s perspective:
It is challenging for the person who fell to have to take control of the situation. They have a possible injury, adrenalin rush, and coming out of rope/subspace to contend with. Thus IMHO, it’s much better if others (the top, DM, medical staff, a spotter, etc.) can manage the situation. As a rope bottom, it’s reasonable to ask a potential suspension top questions about their suspension qualifications, including “what would you do if I fell” – and decide from there whether this is a safe person to put you up in the air. I am all about empowered and educated bottoms. This is a situation where it certainly is best if the bottom doesn’t have to be educated. For self-suspension, having a spotter who knows the procedure to follow in case of falls is extremely important.
A bottom or self-suspender who finds themselves in a position of having fallen and being the one who knows what to do should instruct everyone around not to move them (because panicking riggers tend to want to move a person who fell and untie them immediately, or if they’re slightly smarter cut the rope). If they are in a venue where there may be medical staff or just someone with some medical training, request that a qualified person be found/brought to the scene. They should remember that it will be almost impossible to accurately evaluate themselves for injury immediately after an event like a fall. For example, I was in a significant car accident years ago. When EMS arrived, I was wandering around the scene babbling incoherently, and until someone pointed out that my leg was bleeding (I had a pretty good gash), I didn’t even notice it. Depending on the type of fall (factors I outlined above), the person who fell will likely want to request that 911 be called.
