This is a high risk activity and the environment should always be assessed for potential hazards. Helpers will be taking the patient’s full bodyweight, which will increase the likelihood of injury. When the risk to helpers is too great, it may be appropriate to cut the ligature, preserving the knot and allow the patient to fall unhindered to the ground.

• Helpers should hold patient’s thighs and raise them slightly in order to reduce ligature tension
• If the height is too much, then place a table/chair underneath the patient
• One helper should cut ligature from the point of suspension, preserving the knot
• Another helper should support the patient’s head while another helper/s lower the patient to the ground
• Remove ligature from the patient’s neck
• Assess vital signs, and if appropriate call for assistance and commence resuscitation