This information is for guidance only, as I am not medically qualified. I welcome comments or feedback from medical professionals.
Bondage is probably the most risky area of BDSM, but also the most popular, especially with newcomers. Accidents do happen, as in any activity. It is a question of using common sense and minimising the chances of a mishap. As part of this, it is a good idea to be familiar with basic First Aid and resuscitation.
Japanese bondage, in its original form, was designed not only to restrain, but also to torture and kill. Do not underestimate the effects of even relatively simple bondage, particularly over time. Since suspending a person massively increases the risks, it should not be attempted without the personal guidance of an experienced practitioner. It is certainly beyond the scope of this discussion as it is not for beginners.
Do not rely on what you see on the net as a guide to what is safe bondage practice. They are likely to be of experienced bondage models in positions only held for the few seconds it takes to shoot the picture and are staged by an entire crew. Some of it is definitely not safe. Also, with the use of photo-editing software, the impossible can easily be faked.
Always keep a safe tool to hand capable of quickly cutting your strongest rope, e.g. EMT shears or bandage scissors, without cutting your partner. If you use chains, you'll need bolt cutters. If you need them, you are likely to need them quickly. For example, it is all too easy for a candle or cigarette to get forgotten in the heat of the moment and start a fire. Could you get the bondage off in time?
Any of the problems in this section could occur, and with no means of escape, the consequences could become very much more serious.
Monitor your partner very carefully. Communication is essential. Check to see if there is any unwelcome discomfort, whether a knot or rope could be adjusted for better effect. A knot digging in or a rope chaffing can adversely affect the whole experience. Eye contact will tell you volumes. Observe breathing. A fall in temperature of a limb can indicate loss of circulation but in reality it is very hard to make an accurate comparative assessment. This should not be relied on.
Make sure you have unambiguous safe-words. A safe-word can be any pre-arranged signal or word to end or change the pace of the session. This is vital when "No" or other pleas to stop could be just part of the game. For example, colours are popular choices, e.g. red = stop immediately, orange = I'm approaching my limits and green = go on. Safe-words are sacred and must always be obeyed instantly. Don't even joke about ignoring them. If you have any doubt that the person tying you will not respect them, walk away. A good dominant should be aware enough to pre-empt their use.
The 'double squeeze' technique is a sensible safeguard, i.e. the dom gives two squeezes of the hand to the sub; if all is OK, the sub returns them. Failure to respond should set the alarm bells ringing.
Falling & fainting
The most obvious hazard to both falling and fainting are impact injuries through striking the floor or other objects. It is your responsibility to minimise this risk. This can be done by ensuring that you have a good hold on your sub, especially when standing or moving around. If standing, it is a useful precaution to rig a safety rope to a secure overhead point and attached to a safe part of the bondage, e.g. a chest harness. Remember that, if their hands are tied, it is harder to maintain balance and impossible to protect themselves in the event of a fall.
In order to minimise the risk of fainting, you should make sure that your sub has eaten fairly recently and does not become dehydrated. Energy drinks, water and snacks are good to have handy. Alcohol and drugs (legal or otherwise) should be avoided as they increase the likelihood of accidents.
However, bondage carries additional risks. Be very careful what you tie to fixed or heavy objects. For example, the consequences of tying piercings in this way and a fall could be very unpleasant - what could happen to genitals doesn't even bear thinking about.
Tight bondage and hands above the head positions tend to figure in many fainting incidents.
Fainting or a fall can easily result in Dislocation and Strangulation., as ropes can be pulled out of position or result in unexpected stresses.
At the risk of stating the obvious, make sure that any fixing or suspension points are very secure. For overhead points, you can be reasonably sure that floor joists are strong enough. However, your fixings should be of suitable specification and properly mounted. Miss a joist and you will almost certainly bring the ceiling down - guaranteed to kill your passion, at the very least. Wall mounted points will either need to be screwed into brickwork with Rawplugs or directly into the battens in a cavity wall. If in doubt, get qualified help.
Strangulation, choking & breathing difficulties
To minimise the risk of strangulation, never place a rope over the front of the neck or around the neck. Nooses are definitely out. The only safe configuration is halter neck style, so any pressure is on the back of the neck. You should also be aware of ropes, which may slip and end up around the neck. The risks are multiplied with suspension or if your sub falls or faints.
A bound submissive cannot remove a gag. It is your responsibility, so you need to be observant and not leave your sub unattended. Never use anything that could be swallowed, become lodged in the throat or obstruct the airways.
Breathing difficulties can also be caused by constriction, e.g. of the rib cage. Don't tie too tight. Remember that as you add wraps of rope or cinch the bindings, the tightness will increase. Problems can also be caused by certain positions, which make breathing difficult. This is known as positional asphyxia. If the position means that a greater effort required when either inhaling or exhaling, the muscles would eventually become too tired to work. This is largely how crucifixion kills. The degree of stress to which the sub is subjected can also increase breathing rates, creating a vicious circle. Never underestimate the effect of being bound in a fixed position can have over time.
Obviously, any health problems affecting breathing, e.g. asthma or obesity, are likely to increase susceptibility.
In particular, suspension needs to be treated with extreme care as it can turn normally comfortable ties into crushing constriction.
At best, lack of circulation causes 'Pins and needles' and numbness. At worst, body parts are damaged or even die without a blood supply.
Restricting circulation should be avoided by keeping a little slack in the ropes. The 'one finger rule' is that you should be able to slip a finger under the bondage. Keep an eye out for ropes tightening during play or as you build up the bondage. Insist that your sub should not to try to be a hero and inform you immediately of any tingling, unpleasant pain or loss of sensation.
Avoid placing knots on blood vessels, e.g. on inside of wrists. Also, tie above, not on joints. The thicker the rope and the more turns, the lower the risk. Anything less that 6mm (1/4') should be avoided for general use.
Hands usually suffer first. So as not to end your scene prematurely and for safety, it is a very good idea to do your bondage so that the hands can be easily released without having to untie everything else.
Limb temperature can be used as an indicator. Note how warm your subs hands and feet are at the start of the scene, if they become noticeably colder, it is possible that circulation has been restricted. However, it can often be difficult to make effective comparisons. Another test is to squeeze a finger or toe and see how quickly the colour returns to the nail. The slower the return, the worse the circulation.
Nerve damage can be painless and thus occur without any warning. It is often permanent.
The first method of minimising damage is to stick to the 'one finger rule'. The second is to avoid tying over bony areas.
Obviously, physical force should be used with care. Moving a bound sub around can put unexpected strains on limbs.
Falling creates, probably, the biggest hazard; not only from contact with the ground, but also where limbs are attached to a static object. Hoists, pulleys etc. should be used with care, the extra mechanical 'muscle' they provide could easily result in dislocations.
The dom should always be aware of the risk of the sub falling. Having the arms tied will hamper the sub's balance. Loose or surplus rope can cause a tripping hazard. It is not a bad idea to attach a safety rope to part of the body harness to a secure overhead point, especially if the bondage restricts the feet from maintaining balance.
Prolonged or stressful positions can result in cramp, especially if you do not drink enough. Pulling back against the cramp can help. For example, a leg cramp can usually be relieved by pulling your toes towards you and straightening the leg.
When you are pulling a rope through a binding, the end can whip around with surprising ferocity. This can be particularly nasty around the face, eyes or other sensitive areas. So, slow down when the end of the rope approaches and guard any sensitive areas with your hand.
Where not to tie
I make no apology for reiterating that you should never place a rope across the throat or in a way that it could obstruct circulation or breathing. Passing the rope over the back of the neck is the only safe method.
Bindings should not be placed on joints, except the hips. This can lead to loss of circulation or nerve damage. Take care to place arm or leg bindings above the bony area of the joint. Leave plenty of slack as cinching will often tighten the binding more than you expect. Use the 'one finger' rule.
Never tie any part of the body or piercing, which could be pulled off or otherwise damaged in the event of a fall or fainting, to a fixed or heavy object. Any kind of slipknot should be avoided.
Common sense should apply. In my opinion, those with conditions such as heart, breathing problems, blackouts, e.g. low blood pressure, or fits should avoid bondage. Bondage can be very stressful. One should also be aware of injuries or anything, which may be exacerbated.
Copyright Bruce Argue t/a Esinem, 2004. www.esinem.com, firstname.lastname@example.org