- Two to 15% of earthquake survivors in Haiti are likely to develop Crush Syndrome. Half of those survivors are likely to develop acute kidney failure. About 50% of those individuals will need dialysis.[1]
- Crush Syndrome is unusual in American and European medical practice,[2] and it is unlikely Western medical doctors assisting in Haiti will have extensive experience with the condition.
- Haitian rescue and medical personnel are unlikely to be able to meet the immediate, in-the-field or longer term management needs of survivors with Crush Syndrome due to extensive damage to facilities and lack of equipment.
- Haitian health services need immediate support with IV triage units for trapped survivors and long term support through mobile dialysis units.
Crush injuries and crush syndrome are common following entrapment in a structural collapse. Crush injury is “compression of extremities or other parts of the body that causes muscle swelling and/or neurological disturbances”. Lower extremity injuries account for most crush injuries (74%), with injuries to the upper extremities (10%), and torso (9%) are less typical.[3]
Crush Syndrome includes localized crush injury along with systemic effects, first described in 1941 after study of London aerial bombing survivors.[4] Crushing lasting more than 1 hour and/or sudden release of a crushed body part can cause the syndrome which includes rhabdomyolysis, a condition in which crushed muscles break down and release toxic muscle cell components into the blood resulting in kidney failure, heart rhythm abnormalities, metabolic abnormalities, and other organ dysfunctions.[5] When infections or other medical conditions complicate crush-related kidney failure, the mortality rate is near 55%.
Best practices for crush injuries in the field pre-hospital including providing intravenous fluids (IV) before releasing the crushed body part, especially if entrapment has been longer than 4 hours. Failure to recognize and treat Crush Syndrome is common,[6] especially during rescue efforts by non-medical personnel, and typically increases the death rate.
[1] Centers for Disease Control and Prevention (CDC) http://www.bt.cdc.gov/masscasualties/blastinjury-crush.asp
[2] Ian Greaves, Keith M. Porter, Consensus statement on crush injury and crush syndrome, Accident and Emergency Nursing, Volume 12, Issue 1, January 2004, Pages 47-52, ISSN 0965-2302, DOI: 10.1016/j.aaen.2003.05.001. (http://www.sciencedirect.com/science/article/B6W9C-49NRK2N-1/2/f147366677d0977c277fd6e3e44963ba)
[3] Centers for Disease Control and Prevention (CDC) http://www.bt.cdc.gov/masscasualties/blastinjury-crush.asp
[4] Bywaters and Beall, 1941. E.G.L. Bywaters and D. Beall, Crush injuries with impairment of renal function. BMJ 1 (1941), p. 427.
[5] Robert N. Reddix Jr., Robert A. Probe, Crush syndrome presenting three days after injury, Injury Extra, Volume 35, Issue 10, October 2004, Pages 73-75, ISSN 1572-3461, DOI: 10.1016/j.injury.2004.05.027.
(http://www.sciencedirect.com/science/article/B7CRN-4CT5YWS-1/2/b0213b1dd1f037550884d0482ca99fb9)
[6] A. Hussain, H.C. Kwak, I. Pallister, Crush syndrome: A comprehensive surgical strategy improves outcomes, Injury Extra, Volume 38, Issue 4, April 2007, Pages 111-112, ISSN 1572-3461, DOI: 10.1016/j.injury.2006.12.054. http://www.sciencedirect.com/science/article/B7CRN-4N4JNPB-12/2/1d74c6b122866766cf9b64a89900514e)
