High Rates of Crush Syndrome Likely

• 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.

BACKGROUND:
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)