"Fainting" During BDSM Play
Assessment and Treatment of "Fainting" During BDSM Play
Copyright 2003 By Jay Wiseman. All rights reserved.
The big question: Is this a simple vasovagal or is this something much more serious?
"He's OK! He only fainted!"
I confess that hearing the above statement always worries me, particularly when the person uttering it seems relieved or unconcerned. Fainting is an unnatural act, usually of the not-good kind, and it deserves careful evaluation.
A key concept here is that fainting is symptom of an underlying medical condition, not a medical condition in and of itself. Fainting can be a symptom of more than a dozen underlying disorders, some of which are deadly. A short list of causes other than emotional upset that can induce fainting includes stroke, dehydration, epilepsy, strangulation, suffocation, alcohol and/or drug overdose, head injury, internal bleeding, heat stroke, exceptionally high or low blood sugar, and the onset of a sudden, dangerously irregular heartbeat. Therefore, fainting should be viewed as a tip-of-the-iceberg signal that needs further assessment. Don't brush it off as "nothing serious" too quickly.
There are two more key concepts here regarding simple fainting: (1) type of causation and (2) frequency of causation. Fortunately for us, the huge majority of such cases are simple fainting -- a brief loss of consciousness due to non-serious mechanisms, followed by a rapid recovery with no nasty after-effects. Simple fainting is that most pleasant of medical entities, a self-limiting condition that gets better by itself with no need for outside assistance. However, some fainting spells are caused by much more serious conditions, including stroke and heart attack. These are, of course, certainly not self-limiting conditions and they can get much worse unless they receive immediate medical attention.
Thus, it is important for the BDSMer to have some idea of how to distinguish between conditions that are self-limiting and conditions that are not self-limiting. This distinguishing cannot be done with certainty outside of a hospital, and may be difficult to do with certainty even inside a hospital. While it is not possible to draw what some might call "a bright and shining line" between self-limiting conditions and non-self-limiting conditions, there are certain major findings that can help guide the BDSMer's thinking into either the "this probably isn't all that serious" category (sometimes called "little sick" by medics) or the "hmmm, this just might be serious" (sometimes called "big sick" by medics) category. This article will discuss how a BDSMer might sort a fainting victim into either the "little sick" or "big sick" category, and will also discuss some aspects of what to do in either case.
First, let's define our terms.
Fainting is loss of consciousness that is relatively brief in duration -- typically less than one minute. The medical term for a brief loss of consciousness is syncope (pronounced sin-koh-PEE) and it has numerous causes, however all causes have one thing in common; they disrupt the perfusion of the brain. The metabolic demands that the brain must meet to sustain consciousness are very high, so anything that disrupts the perfusion of the brain for longer than a few seconds can cause loss of consciousness.
OK, what is perfusion? Perfusion is the bathing of the body's cells in a solution that supplies nutrients and removes waste products. All cells require perfusion. If perfusion is disrupted to the brain, unconsciousness can occur within seconds. If perfusion is disrupted to the entire body, shock can result, and if shock is not corrected fairly promptly (usually within an hour) death can result.
The four components of perfusion.
Perfusion has four components, and all four components must work together to perfuse the person's body, including their brain, adequately. The four components are:
1. The pump (The heart.)
2. The pipes (The blood vessels.)
3. The fluid (The blood and its contents, particularly sugar and oxygen.)
4. The controls (The brain and nerves.)
Remember: pump, pipes, fluid, and controls. If the perfusion of the brain is disrupted by a disturbance in one (or more) of these components, unconsciousness can result.
As a general rule (and there are exceptions to this general rule, as I'll discuss later on) a "pump problem" is the major "big sick" category of problems that may not be self-limiting and may require outside assistance, perhaps even an ambulance. Therefore, it is particularly important for the BDSMer to spot the person who may have fainted because of a problem with their heart. On the other end of the scale, a "pipe problem" is the major "little sick" category of problems that are likely to be self-limiting and can often be managed without outside assistance. A "fluid problem" or a "control problem" can go either way.
By far the single most common cause of fainting is what's called vasovagal (pronounced vase-oh-VAGUE-all) syncope. This is caused by a problem with the blood vessels (the pipes). In order to maintain adequate perfusion, our brain sends signals via our nerves to our blood vessels that cause the vessels to constrict so that sufficient blood pressure is maintained. In the case of vasovagal syncope, a sudden nasty jolt to the person's nervous system -- often the result of things like sudden pain or fear, bad news, or the sight of blood, causes their blood vessels to relax, particularly the blood vessels in their legs. This same sudden, nasty jolt also causes the vagus nerve to decrease the rate and force of the person's heartbeat. (Thus "vaso" indicates blood vessel involvement and "vagal" indicates vagus nerve involvement, i.e., "vasovagal.") This results in a sudden lowering of their blood pressure in general and, if the person is in a standing position, a particularly sharp lowering of the blood pressure in their brain. When the blood pressure in their brain falls, the perfusion of the brain declines and the person may experience "near-fainting" symptoms such as nausea, dizziness, "cold sweats," and blurry vision, especially at the edges of their vision. If the drop in blood pressure worsens, they may pass out completely.
Cautionary note: A moderate jolt to someone's nervous system can cause "near fainting" symptoms such as dizziness and cold sweats, and a strong jolt to someone's nervous system can cause vasovagal syncope. However, a very strong jolt to someone's nervous system due to sudden severe pain, fear, rage, or sudden exposure to extreme heat or cold can actually cause cardiac arrest. This is especially true of older and/or sicker people. BDSMers who engage in extreme forms of pain play and/or fear play would be well advised to keep this in mind. "Sudden" is somewhat risky. "Severe" is somewhat risky. Mix "sudden" with "severe" -- especially when playing an older or sicker bottom -- and your risk level become exceptionally high.
A CASE SCENARIO
Let's examine how a DM at a play party might respond to a report of a "person who fainted" and consider their thoughts and actions. This DM is very experienced regarding BDSM and is equipped with EMT scissors, gloves made of latex, vinyl, or nitrile, and a small but powerful flashlight. They have recently had a good one-day class in Adult CPR and Basic First Aid. A party attendee tells them that someone in the next room has just fainted. They quickly but not recklessly hurry into the room.
Step One: Look at the overall situation.
As they approach the scene of the fainting, the DM takes a quick look at the overall situation. How many people seem to be involved? How well lit is the area? Does more than one person appear to be injured? Any spilled blood or other possibly infectious fluids? (If such fluids are present, the DM will put on their gloves before going closer.) Any broken equipment? Any other hazards or clues as to what happened? Is the room exceptionally warm or exceptionally cold?
Step Two: Look at the victim
The DM notes the victim's apparent age (young adult, middle-aged adult, or elderly adult), position they are in (standing, sitting, or laying down), any unusual clothing they are wearing (a tight corset can restrict breathing, latex clothing can cause a build-up of body heat), any obvious injuries or bleeding, and if the victim appears to be in distress. The DM further notes if the victim is in a possibly hazardous location or at risk for further injury.
Step Three: Perform a quick first aid assessment.
The DM quickly determines the status of the victim's level of consciousness and their possible need for cervical spine protection if any injury is involved. The DM makes sure that the victim's airway is clear, that they are breathing, that they have a pulse, and that there is no major bleeding. The DM will also assess the victim's "skin signs" for color, temperature, and wetness, and will check the rate and quality of their pulse and breathing. (They will have learned how to perform these assessments in the FA/CPR class that they took.) For the sake of this essay, let's assume that the victim appears to be regaining consciousness but they are still kind of groggy, that they do not appear to be injured, that their airway is clear and that they are breathing regularly and with no distress (this means that they have a pulse) and that there is no immediately obvious bleeding. However, their skin is somewhat pale, cool, and sweaty. Their breathing is "more or less" regular and their pulse is a little fast but otherwise seems OK.
Step Four: Stabilize the victim.
The goal of all emergency care can be summarized in one word: stabilize. In essentially all cases, we are trying to turn an unstable, dangerous situation into a stable, safe situation. Thus, an almost universal question to ask in emergency management is: what is needed to stabilize this situation?
In this particular scenario, let's assume that the bottom is standing there, still distinctly wobbly on their feet, with their hands cuffed over their head and a gag in place. Let's further assume that the equipment involved does not seem to be about to break. What to do?
I would be inclined to first remove the gag, even if the cuffs were digging into the victim's wrists. My reasoning for this is that a gagged "groggy" person is both at increased risk for vomiting and unable to protect their airway if they vomit. Aspiration of vomit into their lungs can occur in an instant and is always life-threatening, whereas injury to wrists from the cuffs, while admittedly serious, is not immediately life-threatening. Thus, my first action would probably be to remove the gag.
Once the gag was removed, I would probably try to relieve the pressure on the bottom's wrists and to get them down onto the floor. If the victim was "coming around" somewhat I would probably try to get them to stand up so that I could release their wrist restraints and then help them lay down. However, if they were still essentially unconscious, I would have a much tougher problem. Please note that if they seem to be rapidly "coming around" it might not be necessary to remove their bondage and lay them down. While I would be cautious and thoughtful about making exceptions, not every bottom who has fainted necessarily needs to have all their bondage immediately removed and to be placed in a horizontal position.
I wrote in "SM 101: A Realistic Introduction" that it can be a bad idea to tie a bottom into a position that would require their cooperation to release them from because if the bottom goes unconscious the situation immediately becomes much more complicated and difficult. Unconscious people become "floppy" and this floppiness, combined with their "dead weight," makes them exceptionally difficult to move. Fortunately, at a play party, there are probably enough people around to safely lower even a large, deeply unconscious bottom to safety. In private, however, it may be a much tougher situation.
In terms of lowering a "groggy" bottom to the ground, I want to make a particular point: I recommend against the use of panic snaps in this situation. I have two reasons for this: First, given that the quality of metal in many panic snaps is not very high, I have received too many reports of some portion of the snap failing or breaking. (If you must use them, buy the good-quality -- and, yes, expensive -- ones called "snap shackles" sold in boating supply stores.) Second, because the release of a panic snap "drops" the weight of the bottom in a sudden way, I have heard of at least two cases in which the top sustained a compression fracture of their lower spine when they tried to hold up a suddenly released bottom. I am increasingly skeptical of the use of panic snaps in any vertical load situation. I am much more in favor of the use of a mechanism that allows a more gradual, controlled lowering such as a worm gear or block-and-tackle. Even rigging up the knot called a Trucker's Hitch to create a simple pulley system can offer a much better alternative to the potentially dangerous, all-at-once release of a panic snap.
Special Alert: In the case of simple fainting, it has been often pointed out that getting the person down onto the ground allows for better re-perfusion of their brain and thus facilitates "waking them up." However, what if, because they are restrained, they pass out and they are unable to lie down? In some cases, they may recover anyway, however in other cases they will not only fail to recover but they may even get worse. It turns out that some people who faint and who are not able to get into a horizontal position may become even more unstable, to the point of developing potentially lethal cardiac arrhythmias within ten to twenty minutes. (This has become especially important to climbers. For more info, please check out the article titled "Harness Induced Pathology" at www.caves.org/grotto/nag/html/harness.html.) For us BDSMers, the take-home message here is that if a person faints while held in upright bondage (or something similar) and doesn't regain consciousness fairly quickly, we need to know that they may get worse, possibly much worse, if they're not placed in a horizontal position. While this is not an utterly frantic "seconds matter" situation, it most definitely is a "minutes matter" situation.
Step Five: Further Assess The Person.
OK, just for the sake of discussion, let's assume that the bottom has had all of their bondage removed and is now laying on the floor. They are still a bit groggy but are awake enough to answer questions. There is no immediate crisis. In many ways, now the DM's work really begins regarding figuring out whether this is a "little sick" situation in which the person is likely to become more stable or a "big sick" situation in which the person is likely to become less stable. Getting answers to the following questions will help.
Assessment is generally in two phases. Phase One is the assessment that takes place immediately. Phase Two takes place after about five minutes. In general, a lot of "little sick" people will look and feel considerably better after about five minutes, while a lot of "big sick" people will still not look or feel much better after about five minutes, any may look or feel even worse.
1. How old is the person?
Fainting in a younger bottom (younger than 40) suggests "little sick." Fainting in an older person (older than 40) suggests "big sick." Fainting in someone over age 50 definitely suggests "big sick."
2. What were they doing when they fainted?
Three factors associated with "little sick" vasovagal fainting are: (a) standing position (b) warm room and (c) painful stimuli. (Hmmm, what kind of person do we BDSMers encounter who receives painful stimuli while standing in a warm room?) Anyone who fainted while walking, sitting, laying down, or during vigorous activity is at definite risk of being "big sick." An older person who faints under such circumstances is at high risk for a pump problem. Strongly suspect "big sick" if the person fainted while walking, sitting, laying down, or doing anything other than standing, especially if the person is over 40.
Note # 1: Moving our leg muscles helps blood return from our legs to our heart. Standing with one's legs locked does not pinch off the blood vessels, but does reduce the amount of help the leg muscles provide to help blood return to the heart. Therefore, not standing with your knees locked and moving your leg muscles "from time to time" will help improve blood return to the heart and reduce your chances of fainting.
Note # 2: While it is widely believed that raising one's hands over one's head increases the odds of someone fainting, with very few exceptions this does not seem to be the case. I can find no credible evidence in the medical literature to support this belief with the exception of a very rare condition called “subclavian steal syndrome” (which occurs in only about 1% of the population). I suspect that it is the motionless of the legs that occurs while the arms are being raised overhead that is the real culprit.
Note # 3: If the person faints immediately after standing up, this is called orthostatic syncope and in and of itself tends to be a "little sick" situation, however it suggests that the underlying health of the person is not so good. They may be on medications that inhibit the rapid changes in their blood pressure necessary to compensate for a quickly standing up. Caution: Be especially alert for signs of dehydration or internal bleeding.
Note # 4: In general, fainting during or immediately after orgasm, even if the person was laying down, tends to not be of special concern. For more info, please see Coming and Fainting: Is It Possible To Pass Out From An Orgasm? (http://www.goaskalice.columbia.edu/2136.html) and "Passing Out at Orgasm" by Spyral Fox (http://members.aol.com/spyralfox/syncope.html).
Note # 5: Fainting that occurs while the person was straining to have a bowel movement, especially in an older person, suggests "big sick." In older people, especially those with heart disease, heavy straining during a bowel movement can sometimes actually cause a cardiac arrest or fatal cerebral hemorrhage. This is why such people are sometimes told "never hold your breath during a bowel movement" by their physicians. This causes a sudden increase in pressure within both the chest and abdominal cavities and is known as a Valsalva (val-SALVE-ah) maneuver. (For you medical-types reading this, the effect is due to stimulation of the aortic sinus bodies, which are similar in function to the carotid sinus bodies.) A Valsalva maneuver is usually harmless in younger people, although it does cause the occasional episode of unconsciousness if they "take a deep breath and hold it" as is seen in the "playground pass-out" games that children play when adults aren't around. However, in very rare and tragic cases, the occasional cardiac arrest does result from a strong Valsalva maneuver performed by a young, healthy person. What this means to the average BDSMer who likes breath control games is that, contrary to popular belief, some people can die from holding their own breath. Some choke-holds cause pressure on nerve bundles in the major arteries in the neck that are known as the carotid sinus bodies, producing effects identical to that of a Valsalva maneuver.
Note # 6: Fainting is occasionally seen during or after a strong episode of coughing or urinating, especially in older adults. This is typically a "little sick" situation if the person quickly recovers and otherwise seems OK.
3. Any injuries or incontinence?
Fainting with no associated injuries suggests "little sick." Fainting with injuries caused before, during, or after the fainting suggest "big sick." A person who was knocked unconscious, even briefly, is automatically in the "big sick" category. Obviously, any bleeding or other injuries should be treated. Fainting associated with tongue-biting and/or incontinence of urine or feces is often seen in fairly severe seizures and suggests "big sick." (Keep in mind that, like fainting, a seizure itself is a symptom of an underlying disorder, not itself a disorder.)
4. Are they known to have any medical conditions?
A person with a known history of heart disease, high blood pressure, diabetes, seizure disorder, and similar conditions is at risk for being "big sick." (Hopefully, they told their play partner about these conditions during pre-play negotiations.) Check for a medic-alert type bracelet or necklace. Some people know that they faint easily. Obviously it would be a good idea to tell a new partner about this before playing.
A note about seizures: As a general rule, a single seizure in a person with a well-established history of seizures may be a "little sick" situation, whereas a seizure in a person with no history of a seizure disorder is probably a "big sick" situation. Also, two or more seizures in a short time, especially if the person does not regain consciousness in the interval between them, is most definitely a "big sick" situation, even if they do have a history of a seizure disorder. At this point, it's probably time to get an ambulance. This could be the dreaded "status epilepticus" condition, and it's a killer.
5. How is their pulse rate?
A textbook normal pulse rate in a adult at rest is 60 to 100 beats per minute. An exceptionally slow pulse rate (below 50 beats per minute) suggests a "big sick" pump problem, especially if the person otherwise seems not OK. An exceptionally rapid pulse rate (above 120 beats per minute) suggests a "big sick" problem due to either a pump problem or a fluid problem (such as dehydration, blood loss, or low blood sugar). An exceptionally slow or rapid heartbeat that lasts longer than five minutes is strongly suggestive of "big sick." An obviously irregular pulse rate suggests a "big sick" pump problem, particularly if the person is also sweaty and otherwise in distress.
Note: A small number of adults, usually older adults, have a chronically and totally irregular pulse caused by a condition called atrial fibrillation. These people will typically know that they have this condition. In and of itself, atrial fibrillation is usually not an emergency unless other "heart-attack-like" symptoms accompany it.
6. How is their skin?
Skin that is exceptionally cold or hot, and/or exceptionally sweaty and dry, and/or exceptionally pale, blue, or flushed, especially if it continues to be so five minutes after the fainting occurs, suggests "big sick." Skin that rapidly returns to normal levels of temperature, color, and moisture suggest "little sick." (Note: in darker-skinned people, check their tongue for changes in color.)
7. How is their brain working?
A person who is confused, disoriented, unconscious, has trouble speaking or walking, has unequal grip strength, or has an uneven face when they try to smile is likely to be "big sick." This is especially true if it persists more than five minutes. Note that dehydration and low blood sugar can cause these conditions, so giving the person a small amount of a sugared drink to swallow, assuming that they are alert enough to do so safely, can be helpful.
Caution: People who have gone unconscious more than once, or who have been unconscious for longer than five minutes, are especially likely to be in the "big sick" category.
8. Did the person show or experience any "warning signs"?
A person about to experience a vasovagal syncope often experiences symptoms such as nausea, dizziness, cold sweats, and blurry vision, sometimes for more than a minute, before they pass out entirely. These conditions are not likely to go away on their own if the person continues playing. Therefore, many faintings can be prevented if the person stops their play for a while and doesn't resume until they feel entirely better. Trying to "tough it out" under these circumstances, hoping the symptoms will go away on their own, can be a genuinely bad idea.
A person with an established seizure disorder may experience an "aura" shortly before they have a seizure. This symptom would tend to indicate "little sick." On the other hand, a person who blacks out very suddenly with no warning signs may have a pump problem or other serious condition.
Caution: "No warning signs" suggests "big sick."
9. How is their breathing?
A "little sick" person will tend to be breathing evenly, without difficulty, and at a normal rate. (Typically 12 to 20 breaths per minute in the average adult at rest.) They will have no unusual odors on their breath. A "big sick" person will often be breathing unevenly, with difficulty, and at an abnormally fast or slow rate. A rate of less than ten breaths per minute or more than 24 breaths per minute is definitely worrisome. An unusual breath odor is also worrisome.
A note regarding hyperventilation: Like fainting and seizures, hyperventilation is a symptom of an underlying disorder, not a disorder itself. (Some medics are taught "all that hyperventilates is not emotional distress.") However, a hyperventilating person can sometimes be successfully treated by mindfully administered re-breathing therapy of a small amount of their own carbon dioxide. However, please keep four important points in mind:
1. No unconscious person is a candidate for re-breathing therapy.
2. Hyperventilation is considerably more likely to be due to a serious medical condition rather than due to emotional distress in someone over age 40, so such people are considerably more likely to need more formal assistance such as medical oxygen instead of re-breathing therapy.
3. If the person will benefit from re-breathing therapy, they will likely do so within the first ten minutes of it, so if re-breathing therapy is not working after fifteen minutes, discontinue it and see further help.
4. No more brown bags! While re-breathing some of their own carbon dioxide can be helpful, always make sure that they always have plenty of access to oxygen. If you must use a brown bag, first tear a really huge hole in the bottom of it. Also, if they can, let them hold the "brown tube" themselves rather than you holding it for them. If they feel the need to remove the bag, let them.
While re-breathing therapy is somewhat controversial (due to cases of disastrously improper use, it is a forbidden technique in some EMS systems), a rational case can be made for the use of "brown tube" therapy, but the age of "brown bag" therapy is most definitely over!
10. What kind of environment are they in?
An exceptionally warm room, particularly if it's "stuffy" due to poor ventilation or crowding, makes fainting due to "little sick" reasons more likely, but if the room is a comfortable temperature and well-ventilated, the chances of the fainting being due to "big sick" reasons is increased. Note that relaxed nudity often requires that the room temperature be at least 75 degrees. (Good playrooms have a thermometer handy somewhere.)
Summary
LITTLE SICK
The more of the below you find, the more likely the person is to be "little sick."
Younger than 40.
Fainted while standing, especially after prolonged standing. Fainted immediately after receiving pain or fright, especially while standing. Fainted during orgasm. Fainted immediately after standing up. Fainted while coughing or urinating.
No injuries or incontinence before, during, or after fainting.
No known medical conditions, especially heart disease, high blood pressure, diabetes, or seizure disorder.
Pulse either is or quickly returns to being regular, strong, and of normal rate. (60 to 100 beats per minute)
Skin either is or quickly returns to normal in terms of temperature, color, and wetness.
Person quickly regains consciousness, orientation, ability to speak clearly, and otherwise normal neurological functioning.
The person experienced warning signs such as nausea, dizziness, blurred vision or an aura prior to fainting.
Breathing either is or quickly returns to being unlabored, regular, and of normal rate (12 to 20 breaths per minute).
The person fainted while in a noticeably hot and/or crowded, poorly ventilated room
(Note: "quickly" means within five minutes.)
BIG SICK
The more of the below you find, the more likely the person is to be "big sick." Two or more findings are especially worrisome, however even a single finding may be more than enough to classify the person as "big sick."
Older than 40
Fainted while walking, sitting, laying down, or during vigorous activity, without apparent cause. Fainted during a bowel movement.
Injuries or incontinence.
Known medical conditions, especially heart disease, high blood pressure, diabetes, seizure disorder.
Pulse is and remains irregular, weak, and/or exceptionally fast or slow
Skin is and remains unusually hot, cold, wet, or dry, or unusually pale, blue, or red.
Person remains groggy, disorientated, or unconscious, or continues to have slurred speech, unequal grip strength, unequal smile, difficulty walking. Repeated episodes of unconsciousness.
The person experienced no warning signs prior to fainting.
Breathing is and remains unusual in terms of being rapid or slow, irregular, or labored
Fainting occurred in a well-ventilated, uncrowded room of comfortable temperature.
(Note: "remains" means longer than five minutes.)
Regarding Further Treatment
If the person falls into the "little sick" category they are likely to get better on their own with little need for further additional assistance. Fainting while playing is often caused or complicated by dehydration and/or low blood sugar, so giving them a sugared drink may be useful. If they feel uncomfortably cold or warm, whatever measures make them feel better should be provided. Interestingly enough, while elevating the legs of a person who has fainted or is in shock is widely taught, new evidence suggests that doing so is not especially helpful. Nowadays, placing an uninjured groggy or unconscious victim on their side in what is known as the recovery position is often preferred. (A very useful aphorism, taught to medics, is "any person who cannot cough on command is presumed unable to handle vomiting in the face-up position.")
Copyright 2003 By Jay Wiseman. All rights reserved.
The big question: Is this a simple vasovagal or is this something much more serious?
"He's OK! He only fainted!"I confess that hearing the above statement always worries me, particularly when the person uttering it seems relieved or unconcerned. Fainting is an unnatural act, usually of the not-good kind, and it deserves careful evaluation.
A key concept here is that fainting is symptom of an underlying medical condition, not a medical condition in and of itself. Fainting can be a symptom of more than a dozen underlying disorders, some of which are deadly. A short list of causes other than emotional upset that can induce fainting includes stroke, dehydration, epilepsy, strangulation, suffocation, alcohol and/or drug overdose, head injury, internal bleeding, heat stroke, exceptionally high or low blood sugar, and the onset of a sudden, dangerously irregular heartbeat. Therefore, fainting should be viewed as a tip-of-the-iceberg signal that needs further assessment. Don't brush it off as "nothing serious" too quickly.
There are two more key concepts here regarding simple fainting: (1) type of causation and (2) frequency of causation. Fortunately for us, the huge majority of such cases are simple fainting -- a brief loss of consciousness due to non-serious mechanisms, followed by a rapid recovery with no nasty after-effects. Simple fainting is that most pleasant of medical entities, a self-limiting condition that gets better by itself with no need for outside assistance. However, some fainting spells are caused by much more serious conditions, including stroke and heart attack. These are, of course, certainly not self-limiting conditions and they can get much worse unless they receive immediate medical attention.
Thus, it is important for the BDSMer to have some idea of how to distinguish between conditions that are self-limiting and conditions that are not self-limiting. This distinguishing cannot be done with certainty outside of a hospital, and may be difficult to do with certainty even inside a hospital. While it is not possible to draw what some might call "a bright and shining line" between self-limiting conditions and non-self-limiting conditions, there are certain major findings that can help guide the BDSMer's thinking into either the "this probably isn't all that serious" category (sometimes called "little sick" by medics) or the "hmmm, this just might be serious" (sometimes called "big sick" by medics) category. This article will discuss how a BDSMer might sort a fainting victim into either the "little sick" or "big sick" category, and will also discuss some aspects of what to do in either case.
First, let's define our terms.
Fainting is loss of consciousness that is relatively brief in duration -- typically less than one minute. The medical term for a brief loss of consciousness is syncope (pronounced sin-koh-PEE) and it has numerous causes, however all causes have one thing in common; they disrupt the perfusion of the brain. The metabolic demands that the brain must meet to sustain consciousness are very high, so anything that disrupts the perfusion of the brain for longer than a few seconds can cause loss of consciousness.
OK, what is perfusion? Perfusion is the bathing of the body's cells in a solution that supplies nutrients and removes waste products. All cells require perfusion. If perfusion is disrupted to the brain, unconsciousness can occur within seconds. If perfusion is disrupted to the entire body, shock can result, and if shock is not corrected fairly promptly (usually within an hour) death can result.
The four components of perfusion.
Perfusion has four components, and all four components must work together to perfuse the person's body, including their brain, adequately. The four components are:
1. The pump (The heart.)
2. The pipes (The blood vessels.)
3. The fluid (The blood and its contents, particularly sugar and oxygen.)
4. The controls (The brain and nerves.)
Remember: pump, pipes, fluid, and controls. If the perfusion of the brain is disrupted by a disturbance in one (or more) of these components, unconsciousness can result.
As a general rule (and there are exceptions to this general rule, as I'll discuss later on) a "pump problem" is the major "big sick" category of problems that may not be self-limiting and may require outside assistance, perhaps even an ambulance. Therefore, it is particularly important for the BDSMer to spot the person who may have fainted because of a problem with their heart. On the other end of the scale, a "pipe problem" is the major "little sick" category of problems that are likely to be self-limiting and can often be managed without outside assistance. A "fluid problem" or a "control problem" can go either way.
By far the single most common cause of fainting is what's called vasovagal (pronounced vase-oh-VAGUE-all) syncope. This is caused by a problem with the blood vessels (the pipes). In order to maintain adequate perfusion, our brain sends signals via our nerves to our blood vessels that cause the vessels to constrict so that sufficient blood pressure is maintained. In the case of vasovagal syncope, a sudden nasty jolt to the person's nervous system -- often the result of things like sudden pain or fear, bad news, or the sight of blood, causes their blood vessels to relax, particularly the blood vessels in their legs. This same sudden, nasty jolt also causes the vagus nerve to decrease the rate and force of the person's heartbeat. (Thus "vaso" indicates blood vessel involvement and "vagal" indicates vagus nerve involvement, i.e., "vasovagal.") This results in a sudden lowering of their blood pressure in general and, if the person is in a standing position, a particularly sharp lowering of the blood pressure in their brain. When the blood pressure in their brain falls, the perfusion of the brain declines and the person may experience "near-fainting" symptoms such as nausea, dizziness, "cold sweats," and blurry vision, especially at the edges of their vision. If the drop in blood pressure worsens, they may pass out completely.
Cautionary note: A moderate jolt to someone's nervous system can cause "near fainting" symptoms such as dizziness and cold sweats, and a strong jolt to someone's nervous system can cause vasovagal syncope. However, a very strong jolt to someone's nervous system due to sudden severe pain, fear, rage, or sudden exposure to extreme heat or cold can actually cause cardiac arrest. This is especially true of older and/or sicker people. BDSMers who engage in extreme forms of pain play and/or fear play would be well advised to keep this in mind. "Sudden" is somewhat risky. "Severe" is somewhat risky. Mix "sudden" with "severe" -- especially when playing an older or sicker bottom -- and your risk level become exceptionally high.A CASE SCENARIO
Let's examine how a DM at a play party might respond to a report of a "person who fainted" and consider their thoughts and actions. This DM is very experienced regarding BDSM and is equipped with EMT scissors, gloves made of latex, vinyl, or nitrile, and a small but powerful flashlight. They have recently had a good one-day class in Adult CPR and Basic First Aid. A party attendee tells them that someone in the next room has just fainted. They quickly but not recklessly hurry into the room.
Step One: Look at the overall situation.
As they approach the scene of the fainting, the DM takes a quick look at the overall situation. How many people seem to be involved? How well lit is the area? Does more than one person appear to be injured? Any spilled blood or other possibly infectious fluids? (If such fluids are present, the DM will put on their gloves before going closer.) Any broken equipment? Any other hazards or clues as to what happened? Is the room exceptionally warm or exceptionally cold?
Step Two: Look at the victim
The DM notes the victim's apparent age (young adult, middle-aged adult, or elderly adult), position they are in (standing, sitting, or laying down), any unusual clothing they are wearing (a tight corset can restrict breathing, latex clothing can cause a build-up of body heat), any obvious injuries or bleeding, and if the victim appears to be in distress. The DM further notes if the victim is in a possibly hazardous location or at risk for further injury.
Step Three: Perform a quick first aid assessment.
The DM quickly determines the status of the victim's level of consciousness and their possible need for cervical spine protection if any injury is involved. The DM makes sure that the victim's airway is clear, that they are breathing, that they have a pulse, and that there is no major bleeding. The DM will also assess the victim's "skin signs" for color, temperature, and wetness, and will check the rate and quality of their pulse and breathing. (They will have learned how to perform these assessments in the FA/CPR class that they took.) For the sake of this essay, let's assume that the victim appears to be regaining consciousness but they are still kind of groggy, that they do not appear to be injured, that their airway is clear and that they are breathing regularly and with no distress (this means that they have a pulse) and that there is no immediately obvious bleeding. However, their skin is somewhat pale, cool, and sweaty. Their breathing is "more or less" regular and their pulse is a little fast but otherwise seems OK.
Step Four: Stabilize the victim.
The goal of all emergency care can be summarized in one word: stabilize. In essentially all cases, we are trying to turn an unstable, dangerous situation into a stable, safe situation. Thus, an almost universal question to ask in emergency management is: what is needed to stabilize this situation?
In this particular scenario, let's assume that the bottom is standing there, still distinctly wobbly on their feet, with their hands cuffed over their head and a gag in place. Let's further assume that the equipment involved does not seem to be about to break. What to do?
I would be inclined to first remove the gag, even if the cuffs were digging into the victim's wrists. My reasoning for this is that a gagged "groggy" person is both at increased risk for vomiting and unable to protect their airway if they vomit. Aspiration of vomit into their lungs can occur in an instant and is always life-threatening, whereas injury to wrists from the cuffs, while admittedly serious, is not immediately life-threatening. Thus, my first action would probably be to remove the gag.
Once the gag was removed, I would probably try to relieve the pressure on the bottom's wrists and to get them down onto the floor. If the victim was "coming around" somewhat I would probably try to get them to stand up so that I could release their wrist restraints and then help them lay down. However, if they were still essentially unconscious, I would have a much tougher problem. Please note that if they seem to be rapidly "coming around" it might not be necessary to remove their bondage and lay them down. While I would be cautious and thoughtful about making exceptions, not every bottom who has fainted necessarily needs to have all their bondage immediately removed and to be placed in a horizontal position.
I wrote in "SM 101: A Realistic Introduction" that it can be a bad idea to tie a bottom into a position that would require their cooperation to release them from because if the bottom goes unconscious the situation immediately becomes much more complicated and difficult. Unconscious people become "floppy" and this floppiness, combined with their "dead weight," makes them exceptionally difficult to move. Fortunately, at a play party, there are probably enough people around to safely lower even a large, deeply unconscious bottom to safety. In private, however, it may be a much tougher situation.
In terms of lowering a "groggy" bottom to the ground, I want to make a particular point: I recommend against the use of panic snaps in this situation. I have two reasons for this: First, given that the quality of metal in many panic snaps is not very high, I have received too many reports of some portion of the snap failing or breaking. (If you must use them, buy the good-quality -- and, yes, expensive -- ones called "snap shackles" sold in boating supply stores.) Second, because the release of a panic snap "drops" the weight of the bottom in a sudden way, I have heard of at least two cases in which the top sustained a compression fracture of their lower spine when they tried to hold up a suddenly released bottom. I am increasingly skeptical of the use of panic snaps in any vertical load situation. I am much more in favor of the use of a mechanism that allows a more gradual, controlled lowering such as a worm gear or block-and-tackle. Even rigging up the knot called a Trucker's Hitch to create a simple pulley system can offer a much better alternative to the potentially dangerous, all-at-once release of a panic snap.
Special Alert: In the case of simple fainting, it has been often pointed out that getting the person down onto the ground allows for better re-perfusion of their brain and thus facilitates "waking them up." However, what if, because they are restrained, they pass out and they are unable to lie down? In some cases, they may recover anyway, however in other cases they will not only fail to recover but they may even get worse. It turns out that some people who faint and who are not able to get into a horizontal position may become even more unstable, to the point of developing potentially lethal cardiac arrhythmias within ten to twenty minutes. (This has become especially important to climbers. For more info, please check out the article titled "Harness Induced Pathology" at www.caves.org/grotto/nag/html/harness.html.) For us BDSMers, the take-home message here is that if a person faints while held in upright bondage (or something similar) and doesn't regain consciousness fairly quickly, we need to know that they may get worse, possibly much worse, if they're not placed in a horizontal position. While this is not an utterly frantic "seconds matter" situation, it most definitely is a "minutes matter" situation.
Step Five: Further Assess The Person.
OK, just for the sake of discussion, let's assume that the bottom has had all of their bondage removed and is now laying on the floor. They are still a bit groggy but are awake enough to answer questions. There is no immediate crisis. In many ways, now the DM's work really begins regarding figuring out whether this is a "little sick" situation in which the person is likely to become more stable or a "big sick" situation in which the person is likely to become less stable. Getting answers to the following questions will help.
Assessment is generally in two phases. Phase One is the assessment that takes place immediately. Phase Two takes place after about five minutes. In general, a lot of "little sick" people will look and feel considerably better after about five minutes, while a lot of "big sick" people will still not look or feel much better after about five minutes, any may look or feel even worse.
1. How old is the person?
Fainting in a younger bottom (younger than 40) suggests "little sick." Fainting in an older person (older than 40) suggests "big sick." Fainting in someone over age 50 definitely suggests "big sick."
2. What were they doing when they fainted?
Three factors associated with "little sick" vasovagal fainting are: (a) standing position (b) warm room and (c) painful stimuli. (Hmmm, what kind of person do we BDSMers encounter who receives painful stimuli while standing in a warm room?) Anyone who fainted while walking, sitting, laying down, or during vigorous activity is at definite risk of being "big sick." An older person who faints under such circumstances is at high risk for a pump problem. Strongly suspect "big sick" if the person fainted while walking, sitting, laying down, or doing anything other than standing, especially if the person is over 40.
Note # 1: Moving our leg muscles helps blood return from our legs to our heart. Standing with one's legs locked does not pinch off the blood vessels, but does reduce the amount of help the leg muscles provide to help blood return to the heart. Therefore, not standing with your knees locked and moving your leg muscles "from time to time" will help improve blood return to the heart and reduce your chances of fainting.
Note # 2: While it is widely believed that raising one's hands over one's head increases the odds of someone fainting, with very few exceptions this does not seem to be the case. I can find no credible evidence in the medical literature to support this belief with the exception of a very rare condition called “subclavian steal syndrome” (which occurs in only about 1% of the population). I suspect that it is the motionless of the legs that occurs while the arms are being raised overhead that is the real culprit.
Note # 3: If the person faints immediately after standing up, this is called orthostatic syncope and in and of itself tends to be a "little sick" situation, however it suggests that the underlying health of the person is not so good. They may be on medications that inhibit the rapid changes in their blood pressure necessary to compensate for a quickly standing up. Caution: Be especially alert for signs of dehydration or internal bleeding.
Note # 4: In general, fainting during or immediately after orgasm, even if the person was laying down, tends to not be of special concern. For more info, please see Coming and Fainting: Is It Possible To Pass Out From An Orgasm? (http://www.goaskalice.columbia.edu/2136.html) and "Passing Out at Orgasm" by Spyral Fox (http://members.aol.com/spyralfox/syncope.html).Note # 5: Fainting that occurs while the person was straining to have a bowel movement, especially in an older person, suggests "big sick." In older people, especially those with heart disease, heavy straining during a bowel movement can sometimes actually cause a cardiac arrest or fatal cerebral hemorrhage. This is why such people are sometimes told "never hold your breath during a bowel movement" by their physicians. This causes a sudden increase in pressure within both the chest and abdominal cavities and is known as a Valsalva (val-SALVE-ah) maneuver. (For you medical-types reading this, the effect is due to stimulation of the aortic sinus bodies, which are similar in function to the carotid sinus bodies.) A Valsalva maneuver is usually harmless in younger people, although it does cause the occasional episode of unconsciousness if they "take a deep breath and hold it" as is seen in the "playground pass-out" games that children play when adults aren't around. However, in very rare and tragic cases, the occasional cardiac arrest does result from a strong Valsalva maneuver performed by a young, healthy person. What this means to the average BDSMer who likes breath control games is that, contrary to popular belief, some people can die from holding their own breath. Some choke-holds cause pressure on nerve bundles in the major arteries in the neck that are known as the carotid sinus bodies, producing effects identical to that of a Valsalva maneuver.
Note # 6: Fainting is occasionally seen during or after a strong episode of coughing or urinating, especially in older adults. This is typically a "little sick" situation if the person quickly recovers and otherwise seems OK.
3. Any injuries or incontinence?
Fainting with no associated injuries suggests "little sick." Fainting with injuries caused before, during, or after the fainting suggest "big sick." A person who was knocked unconscious, even briefly, is automatically in the "big sick" category. Obviously, any bleeding or other injuries should be treated. Fainting associated with tongue-biting and/or incontinence of urine or feces is often seen in fairly severe seizures and suggests "big sick." (Keep in mind that, like fainting, a seizure itself is a symptom of an underlying disorder, not itself a disorder.)
4. Are they known to have any medical conditions?
A person with a known history of heart disease, high blood pressure, diabetes, seizure disorder, and similar conditions is at risk for being "big sick." (Hopefully, they told their play partner about these conditions during pre-play negotiations.) Check for a medic-alert type bracelet or necklace. Some people know that they faint easily. Obviously it would be a good idea to tell a new partner about this before playing.
A note about seizures: As a general rule, a single seizure in a person with a well-established history of seizures may be a "little sick" situation, whereas a seizure in a person with no history of a seizure disorder is probably a "big sick" situation. Also, two or more seizures in a short time, especially if the person does not regain consciousness in the interval between them, is most definitely a "big sick" situation, even if they do have a history of a seizure disorder. At this point, it's probably time to get an ambulance. This could be the dreaded "status epilepticus" condition, and it's a killer.
5. How is their pulse rate?
A textbook normal pulse rate in a adult at rest is 60 to 100 beats per minute. An exceptionally slow pulse rate (below 50 beats per minute) suggests a "big sick" pump problem, especially if the person otherwise seems not OK. An exceptionally rapid pulse rate (above 120 beats per minute) suggests a "big sick" problem due to either a pump problem or a fluid problem (such as dehydration, blood loss, or low blood sugar). An exceptionally slow or rapid heartbeat that lasts longer than five minutes is strongly suggestive of "big sick." An obviously irregular pulse rate suggests a "big sick" pump problem, particularly if the person is also sweaty and otherwise in distress.
Note: A small number of adults, usually older adults, have a chronically and totally irregular pulse caused by a condition called atrial fibrillation. These people will typically know that they have this condition. In and of itself, atrial fibrillation is usually not an emergency unless other "heart-attack-like" symptoms accompany it.
6. How is their skin?
Skin that is exceptionally cold or hot, and/or exceptionally sweaty and dry, and/or exceptionally pale, blue, or flushed, especially if it continues to be so five minutes after the fainting occurs, suggests "big sick." Skin that rapidly returns to normal levels of temperature, color, and moisture suggest "little sick." (Note: in darker-skinned people, check their tongue for changes in color.)
7. How is their brain working?
A person who is confused, disoriented, unconscious, has trouble speaking or walking, has unequal grip strength, or has an uneven face when they try to smile is likely to be "big sick." This is especially true if it persists more than five minutes. Note that dehydration and low blood sugar can cause these conditions, so giving the person a small amount of a sugared drink to swallow, assuming that they are alert enough to do so safely, can be helpful.
Caution: People who have gone unconscious more than once, or who have been unconscious for longer than five minutes, are especially likely to be in the "big sick" category.
8. Did the person show or experience any "warning signs"?
A person about to experience a vasovagal syncope often experiences symptoms such as nausea, dizziness, cold sweats, and blurry vision, sometimes for more than a minute, before they pass out entirely. These conditions are not likely to go away on their own if the person continues playing. Therefore, many faintings can be prevented if the person stops their play for a while and doesn't resume until they feel entirely better. Trying to "tough it out" under these circumstances, hoping the symptoms will go away on their own, can be a genuinely bad idea.
A person with an established seizure disorder may experience an "aura" shortly before they have a seizure. This symptom would tend to indicate "little sick." On the other hand, a person who blacks out very suddenly with no warning signs may have a pump problem or other serious condition.
Caution: "No warning signs" suggests "big sick."
9. How is their breathing?
A "little sick" person will tend to be breathing evenly, without difficulty, and at a normal rate. (Typically 12 to 20 breaths per minute in the average adult at rest.) They will have no unusual odors on their breath. A "big sick" person will often be breathing unevenly, with difficulty, and at an abnormally fast or slow rate. A rate of less than ten breaths per minute or more than 24 breaths per minute is definitely worrisome. An unusual breath odor is also worrisome.
A note regarding hyperventilation: Like fainting and seizures, hyperventilation is a symptom of an underlying disorder, not a disorder itself. (Some medics are taught "all that hyperventilates is not emotional distress.") However, a hyperventilating person can sometimes be successfully treated by mindfully administered re-breathing therapy of a small amount of their own carbon dioxide. However, please keep four important points in mind:
1. No unconscious person is a candidate for re-breathing therapy.
2. Hyperventilation is considerably more likely to be due to a serious medical condition rather than due to emotional distress in someone over age 40, so such people are considerably more likely to need more formal assistance such as medical oxygen instead of re-breathing therapy.
3. If the person will benefit from re-breathing therapy, they will likely do so within the first ten minutes of it, so if re-breathing therapy is not working after fifteen minutes, discontinue it and see further help.
4. No more brown bags! While re-breathing some of their own carbon dioxide can be helpful, always make sure that they always have plenty of access to oxygen. If you must use a brown bag, first tear a really huge hole in the bottom of it. Also, if they can, let them hold the "brown tube" themselves rather than you holding it for them. If they feel the need to remove the bag, let them.
While re-breathing therapy is somewhat controversial (due to cases of disastrously improper use, it is a forbidden technique in some EMS systems), a rational case can be made for the use of "brown tube" therapy, but the age of "brown bag" therapy is most definitely over!
10. What kind of environment are they in?
An exceptionally warm room, particularly if it's "stuffy" due to poor ventilation or crowding, makes fainting due to "little sick" reasons more likely, but if the room is a comfortable temperature and well-ventilated, the chances of the fainting being due to "big sick" reasons is increased. Note that relaxed nudity often requires that the room temperature be at least 75 degrees. (Good playrooms have a thermometer handy somewhere.)
Summary
LITTLE SICK
The more of the below you find, the more likely the person is to be "little sick."
Younger than 40.
Fainted while standing, especially after prolonged standing. Fainted immediately after receiving pain or fright, especially while standing. Fainted during orgasm. Fainted immediately after standing up. Fainted while coughing or urinating.
No injuries or incontinence before, during, or after fainting.
No known medical conditions, especially heart disease, high blood pressure, diabetes, or seizure disorder.
Pulse either is or quickly returns to being regular, strong, and of normal rate. (60 to 100 beats per minute)
Skin either is or quickly returns to normal in terms of temperature, color, and wetness.
Person quickly regains consciousness, orientation, ability to speak clearly, and otherwise normal neurological functioning.
The person experienced warning signs such as nausea, dizziness, blurred vision or an aura prior to fainting.
Breathing either is or quickly returns to being unlabored, regular, and of normal rate (12 to 20 breaths per minute).
The person fainted while in a noticeably hot and/or crowded, poorly ventilated room
(Note: "quickly" means within five minutes.)
BIG SICK
The more of the below you find, the more likely the person is to be "big sick." Two or more findings are especially worrisome, however even a single finding may be more than enough to classify the person as "big sick."
Older than 40
Fainted while walking, sitting, laying down, or during vigorous activity, without apparent cause. Fainted during a bowel movement.
Injuries or incontinence.
Known medical conditions, especially heart disease, high blood pressure, diabetes, seizure disorder.
Pulse is and remains irregular, weak, and/or exceptionally fast or slow
Skin is and remains unusually hot, cold, wet, or dry, or unusually pale, blue, or red.
Person remains groggy, disorientated, or unconscious, or continues to have slurred speech, unequal grip strength, unequal smile, difficulty walking. Repeated episodes of unconsciousness.
The person experienced no warning signs prior to fainting.
Breathing is and remains unusual in terms of being rapid or slow, irregular, or labored
Fainting occurred in a well-ventilated, uncrowded room of comfortable temperature.
(Note: "remains" means longer than five minutes.)
Regarding Further Treatment
If the person falls into the "little sick" category they are likely to get better on their own with little need for further additional assistance. Fainting while playing is often caused or complicated by dehydration and/or low blood sugar, so giving them a sugared drink may be useful. If they feel uncomfortably cold or warm, whatever measures make them feel better should be provided. Interestingly enough, while elevating the legs of a person who has fainted or is in shock is widely taught, new evidence suggests that doing so is not especially helpful. Nowadays, placing an uninjured groggy or unconscious victim on their side in what is known as the recovery position is often preferred. (A very useful aphorism, taught to medics, is "any person who cannot cough on command is presumed unable to handle vomiting in the face-up position.")
A person having trouble breathing due to a medical condition will often do better if they rest in a seated position. Be advised that it is very dangerous to transport people who are suffering from chest pain or other symptoms that suggest a heart attack by private car. Possible heart attack victims should be transported by ambulance if at all possible, even if the hospital is near. A chest pain patient being transported by private car is in a very dangerous, unstable position.Because victims of heart attack or stroke may benefit from "clot-busting" therapy, it is especially important that they be promptly taken to a hospital.
Further treatment will depend on a number of factors. How stable is this person now? Who will be with them? How will they get home? Will they be driving? Candidly, most people who faint will turn out to be "little sick" and will recover entirely from their fainting spell within a very short time. If they look and feel fine, they probably are fine. However, if there is any reasonable doubt, they should be considered "big sick" and measures taken accordingly. If they suffer from repeated or prolonged unconsciousness or repeated seizures, or from chest pain, respiratory distress, or other symptoms of a heart attack, or from a serious injury, it's time to call an ambulance.
Textbook References:
"Algorithmic Diagnosis of Symptoms and Signs" by R. Collins, MD
'Forensic Pathology" (Second Edition) by Bernard Knight, MD
"Guide to Physical Examination and History Taking" (Sixth Edition) by Barbara Bates, MD.
"Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiac Care" by the American Heart Association.
"Healthwise Handbook" (Fourteenth Edition) by Donald Kemper.
"Medical Physiology" (Eighth Edition) by Arthur Guyton, MD.
"Paramedic Emergency Care" (Third Edition) by Bledsoe, Porter, and Shade
"The 60-Second EMT" (Second Edition) by Bosker, Weins, and Sequeira.
Medical Journal Articles Regarding The Non-usefulness of Elevating the Legs:
"Use of the Trendelenburg position by critical care nurses: Trendelenburg survey." Am J Crit Care 1997 May;6(3):172-6. Ostrow CL.
"Trendelenburg position and oxygen transport in hypovolemic adults." Ann Emerg Med 1994 Mar;23(3):564-7. Sing RF, O'Hara D, Sawyer MA, Marino PL
Online References:
http://hometown.aol.com/safescene/ (Jay Wiseman's website on First Aid and CPR.)
http://heartdisease.about.com/cs/syncope/index.htm (This is a really good URL on fainting.)
http://www.intelihealth.com/ (There is a good medical dictionary, with pronunciation guide, under "look it up.")
Coming and Fainting: Is It Possible To Pass Out From An Orgasm? (http://www.goaskalice.columbia.edu/2136.html)
"Passing Out at Orgasm" by Spyral Fox (http://members.aol.com/spyralfox/syncope.html).
"Harness Induced Pathology" at www.caves.org/grotto/nag/html/harness.html
http://gwis2.circ.gwu.edu/~atkins/ (A really good overview of the nervous system and other aspects of physiology put up by David L. Atkins, Professor Emeritus of Biology Department of Biological
Sciences, The George Washington University, Washington, DC 20052.)
Editor's Note: Jay Wiseman is the author of the widely recommended book "SM 101: A Realistic Introduction" and "Jay Wiseman's Erotic Bondage Handbook." He is currently at work on a book regarding BDSM and polyamory. His books are published by Greenery Press (www.greenerypress.com) and are widely available. Jay responded to thousands of emergency calls during his eight years as an ambulance crewman and received the highest Red Cross commendation for lifesaving action. He has been active for more than thirty years in teaching basic, advanced, and wilderness emergency care. Questions, comments, and requests to reprint this essay can be sent to him at jaywiseman@yahoo.com.
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