This article was written by Shay and contributed to/edited by two kinky doctors, Dr. Who and Miette Rouge. Who are we/what are our credentials? Bio can be found at the bottom of the article!

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) there have been several drops that 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 exactly the wrong things in the immediate aftermath of a fall (untie them! walk around to see if everything is working!). Note that 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 in there is any fall from suspension. Dangers include broken bones, skull fracture, 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 BOTTOM.
• Check for responsiveness (see if they are awake) by loudly saying “Are you OK?” and gently patting their chest/shoulder, without moving them. If they are not responding or are confused, call 911 immediately. Check for breathing. If they are not breathing (or not breathing normally- only gasping), start CPR (with chest compressions) if you know how while someone else calls 911. The 911 operator can also give you instructions.
• Just because someone is talking and can move all extremities doesn’t mean they couldn’t have a serious injury. When in ANY doubt- call 911. Some injuries are very time sensitive.
• Do not move the bottom or cut/untie the rope unless the rope is clearly 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 bottom 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:

o A fall from over 3 feet in the air
o A fall straight onto the head
o A bottom with any signs of spinal injury (which include immediate onset of neck pain, numbness, paralysis, incontinence, severe pain). Keep in mind that if the bottom is in sub space or confused, you can’t accurately assess for this- call 911.
o Any loss of consciousness (black out) or confusion
o … if you are in doubt, just call! Don’t hesitate to call 911 because you´re embarrassed! 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 chin lift when providing 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 bottom’s overall health, etc. If there are no obvious signs of serious issues like the ones listed above, perform a secondary survey to determine what further care might be needed
• If the bottom landed face down, it may 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 that it is necessary to cut the rope, provide inline stabilization while doing so. Support the limbs after cutting the rope to ensure that there are 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 sub space!) is impossible to adequately evaluate for spinal injury without radiological studies.

By request, some notes about handling a fall from suspension from the bottom’s perspective:
It is very difficult for the person who fell to have to take control of the situation. They have possible injury, adrenalin rush, and coming out of rope/sub space all to contend with. Thus IMHO it’s much better if others (the top, DM, medical staff, etc) can manage the situation. I think 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 a situation where it certainly is best if they don’t have to be **the** educated one.
A bottom who finds themselves in a position of having fallen and being *the one who knows what to do* should instruct everyone around to not move them (because panicking riggers tend to immediately want to move the bottom and untie them, 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 around, request that a qualified person be found/brought to the scene. They should keep in mind that it will be almost impossible for them to accurately evaluate themselves for injury immediately after an event like a fall. For example, years ago I was in a pretty major car accident. When EMS arrived, I was wandering around the scene babbling incoherently, and until someone pointed out to me that my leg was bleeding (I had a pretty good gash that needed stitches), I didn’t even notice it. Depending on the type of fall (factors I outlined above), the bottom will likely want to request that 911 be called.

About the author: This article was written by me (Shay Tiziano)- I’m an ER nurse and ACLS (Advanced Cardiac Life Support) instructor who has spent WAYYY too much time geeking out over BDSM safety. I also got input on the ideas in this post from two kinky MDs (Dr_Who and MietteRouge). I would, however, note that nurses (and doctors!) can and do say idiotic/incorrect things, so using your own judgement no matter how “qualified” the source is always a good thing. This is intended as a quick (rather than exhaustive) guide, was specifically made as succinct as possible.

Disclaimer: Nothing in this article is a substitute for using your judgement, consulting with a medical professional who is on scene, and calling 911. I am simply offering some thoughts and discussion on this subject. Please don’t sue me.

You are more than welcome to reproduce this article for use in your organization. Please do not make any changes to the content and give attribution as above. :-)

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