Fainting and Collapse in Attics and Crawlspaces
Why this matters
Attics and crawlspaces are where techs collapse, for reasons that have little to do with the person and a lot to do with the space: heat well above anything outdoors, stale or poisoned air, cramped positions, live wiring and a single narrow way in and out. When a coworker stops answering from up there, the instinct is to go straight in after them. Sometimes that is right. Sometimes the thing that dropped the first person is waiting for the second, and most deaths in small spaces are rescuers. The first question is never "how do I get to them." It is "what is the air, and what is the heat."
This card covers why people collapse in these spaces, how to answer those two questions in under a minute, and how to get help to someone who cannot get themselves out. The rescuer's own boundary is owned by its own card; see related: Rescuing Without Becoming the Second Victim. It is lay first aid in line with American Red Cross and American Heart Association guidance, not training; a hands-on course is what makes a responder.
Why people go down in these spaces
| Cause | What points to it |
|---|---|
| Heat (heat exhaustion, heat stroke) | Summer afternoon attic, long time up there, heavy sweating or hot dry skin, confusion |
| Dehydration | Long day, little water, cramps, dizziness on standing or climbing |
| Low blood sugar | Skipped meal, a coworker with diabetes, shaking and confusion before collapse |
| Carbon monoxide | A fuel-burning appliance in or near the space running, a disconnected or damaged flue, headache or nausea before collapse |
| Low oxygen or toxic gas | A crawlspace with a sewage leak, standing water, recent pesticide or fumigant use, fresh spray foam, a closed-up space with an odor |
| Electrical contact | Working near wiring, a cut cable, metal ducts or pipes, a person lying across a conductor |
| Fainting (a brief drop in blood flow to the brain) | Standing up fast after kneeling, pain, heat; comes round within about a minute |
| A heart or medical event | No obvious cause, chest pain or shortness of breath before |
Several of these stack: a dehydrated tech who skipped lunch in a 130 F attic is three causes at once.
The two questions, before you go in
The air. Ask these out loud, from the access point, and take any yes as a reason not to enter:
- Is there a gas, oil or propane appliance in or near this space, and is it running?
- Is there an odor of sewage, rotten eggs, solvent, chemicals or anything unusual?
- Has anyone else nearby, a homeowner, a pet, felt unwell?
- Has anything been sprayed, foamed, fumigated or treated in here recently?
- Is the space closed up with no ventilation, below grade, or with standing water?
Smell is never an all-clear. Hydrogen sulfide from sewage deadens the sense of smell at dangerous levels, and carbon monoxide has no odor at all. A space that smelled bad and now does not is a reason to leave. A personal CO monitor on the tech's belt, if the shop issues them, answers the CO part in seconds: read it from the hatch.
The electricity. If the person was working on or near wiring, do not touch them, the ductwork or the metal they are lying on until the power is off. If you cannot tell which circuit, turn off the main breaker at the panel.
The heat. In a summer attic, you can do only a few minutes of work before you start to fail too. Know that before you climb, plan to come back to the hatch on a timer, and bring cooling with you.
If the air question has any yes and you cannot fix it from outside the space (shut a gas appliance off at a switch or valve outside the space, open vents from outside), you do not go in. You call 911, tell them why, and wait at the access point talking to the person.
Getting help to a person who cannot get out
Call 911 early and describe the space. Paramedics bring a stretcher; a fire crew brings people, ropes and the equipment to bring someone out of an attic or a crawlspace. They decide what to send from what you say. Tell them:
- that the person is in an attic or a crawlspace and cannot get out on their own;
- how it is reached (a pull-down ladder in a garage, a hatch in a closet ceiling, a crawlspace door on the north side of the house) and roughly how far in the person is;
- whether they are conscious and breathing;
- and anything about the air, the heat or electricity that you have already found.
The call itself, and how to get responders to the right door, is owned by its own card; see related: Calling 911 From a Job Site So They Find You.
Do not try to carry an unconscious adult down a pull-down ladder or drag one out of a crawlspace alone. It is slow, it injures the rescuer and it can injure the patient, especially if they fell or hit their head. Bring care to them and let the fire crew do the extraction.
What you can do at their side, once the air and electrical questions are clear:
- Check breathing. If they are breathing but unresponsive, roll them onto their side to keep the airway open. If they are not breathing normally, the dispatcher will coach CPR; on joists in an attic it is very hard to do well, which is one more reason to tell 911 the person is not breathing in a place you cannot work.
- For heat, cool them where they lie: wet towels or cold packs on the neck, armpits and groin, water poured over the skin, a box fan set at the hatch blowing in. Heat stroke is an emergency where cooling cannot wait for transport. See related: Heat Illness Prevention (OSHA NEP).
- If they are awake and can swallow, give water, and if they have diabetes or skipped a meal, juice. See related: Low Blood Sugar and Diabetic Emergencies at Work.
- Light the space and the path, open the doors responders will use, and send someone to the curb to wave them in.
A worked case: the July attic
A two-person crew is running a bath fan duct in a garage attic in July. The lead is in the attic, about 20 feet from the pull-down ladder, kneeling on the joists. The helper is in the garage. It is about 3:00 pm and the helper's pocket thermometer, set on the top step of the ladder earlier, read 132 F.
3:04. The lead stops answering the helper's questions. The helper climbs until his head and shoulders are through the hatch and sees the lead slumped forward on the joists, not moving.
3:04, the air. The helper runs the questions aloud. There is no fuel-burning appliance in this attic; the house is heated by an electric heat pump with its air handler in the hall closet. No odor. The homeowner, inside the house, is fine. Nothing has been sprayed. The attic has ridge and soffit vents. Every answer is no.
3:05, the electricity. The lead was working near the bath fan's cable. The helper cannot see whether he is touching it, and calls to the homeowner to switch off the main breaker in the garage panel. She does.
3:05, the call. The helper calls 911 on speaker: an unconscious man in a garage attic, reached by a pull-down ladder, about 20 feet in on the joists, attic about 130 F, no gas appliances, power is off. The dispatcher sends an engine as well as an ambulance.
3:06, the heat. With the air and electrical questions answered, the helper climbs in with a gallon of water and two shop towels. He is in a 132 F attic himself, so he tells the homeowner to call his name every two minutes and plans to come back to the hatch at 3:10 whatever happens.
3:07. The lead is breathing and sweating heavily and does not answer. The helper rolls him onto his side on the joists, soaks both towels and lays one on his neck and one on his chest, and pours water over his arms. The homeowner sets a box fan at the hatch pointed in.
3:10. The lead mumbles and does not know where he is. Confusion with heat points to heat stroke, not simple fainting. He is not alert enough to drink, so the helper gives him nothing by mouth and keeps wetting him down. The helper climbs back to the hatch, as planned, to cool off for a minute, then returns.
3:13. The engine arrives. The homeowner meets them at the driveway and walks them to the garage. The fire crew takes over and brings the lead down in a basket on a rope system. He is taken to the emergency department.
What the case turns on. The helper went into the space only after three checks came back clear: the air, the power and his own time limit. Every action after that was cooling and airway, and none of it was an attempt to carry the lead down a ladder.
What changes the answer: the crawlspace
Two weeks later the same shop sends a plumber into a crawlspace to trace a leak at a sewer line. The gas water heater sits in the crawlspace near the access door. Fifteen minutes in, he stops answering.
The air question now has two yeses: a sewer leak, which can release hydrogen sulfide, and a gas appliance running inside the same space. His helper does not go in. She calls 911 and says a man is unresponsive about 15 feet into a crawlspace with a sewage leak and a gas water heater, and that nobody is going in. From the outside, she props the crawlspace door open and keeps calling his name. The fire crew arrives with air monitors and breathing apparatus and makes the entry.
The helper did less than the attic helper and was right to. The space that took the first person was still capable of taking the second, and that answer does not change with how close the patient is to the door.
How to verify you got this right
Before the next summer, walk one attic job and one crawlspace job with a newer tech and ask them to run the air and heat questions out loud from the access point, then say what they would tell 911 about the space. Check that they asked about fuel-burning appliances, odor, other people affected and recent treatment, that they did not use smell as the answer, and that they described the access path in a sentence a fire crew could act on. Do not call 911 for the drill.
References
- American Red Cross and American Heart Association Guidelines for First Aid, fainting and heat-related emergencies
- NIOSH, hydrogen sulfide and carbon monoxide hazards in enclosed spaces
- OSHA heat illness guidance and the National Emphasis Program on heat
- See related: Rescuing Without Becoming the Second Victim
- See related: Inhalation Exposure First Response