Crush Syndrome − The Silent Grim Reaper of the Sichuan Quake

Yeo Teck Wei, a freelance writer, is WazzupManila’s Singapore based correspondent.

Raising awareness of the hidden killer lurking in the midst of the chaos

Even as the death toll in the Sichuan quake creeps past the 55,000 mark, not many people are aware of a possible killer hiding amidst the survivors.

At the moment, there is no doubt that the main concerns are the provision of adequate food, water, sanitation and other basic needs of the survivors. However, should the authorities fail to consider the possible implications of crush syndrome, things could prove disastrous to the survivors.

What is crush syndrome?

First discovered by the British physician Eric Bywaters during the 1941 London Blitz , crush syndrome has always played a significant role in increasing the death toll in wars, earthquakes and other instances when people becomes buried under heavy rubble.

Simply put, crush syndrome is a condition caused when an excessive force is applied to a group of muscles for a long time. Toxic proteins are released due to the overwhelming external pressure on the body, and serious damage eventually results.

There are many clinical implications associated with crush syndrome; with most severe including kidney failure, heart attack and blockage of blood vessels due to its constriction from the pressure exerted by heavy rubble.

Unlike the common cold, where the symptoms displayed are fairly obvious even to the untrained observer, victims of crush syndrome may not at all exhibit any unusual characteristic. There are even patients afflicted with it who do not have any hint of their actual condition. At most, they only exhibit common symptoms associated with calamities (high index of suspicion, altered consciousness etc.) It has therefore become a silent killer because most people, including patients and trained paramedics do not realize its existence until it has become too late.

On July 28, 1976, the Tangshan earthquake resulted to a total of 164851 people injured and further aggravated by 2~5% because of crush syndrome. When another earthquake occurred in Armenia (1988), crush syndrome was found to be the 3rd most frequent injury and leading cause of death. Such figures indicate how grave a concern crush syndrome is on the health of survivors.

How should first-aiders respond to crush syndrome?

While waiting for paramedics and disaster relief teams to arrive, first-aiders should attempt to remove any heavy object (e.g. Rubble) trapping the survivors. Plenty of water should be given to ensure that the survivors have sufficient hydration and maintain the survivors' airway to allow for air circulation.

Very importantly, rescue attempts should carefully be coordinated to insure that patients are transported to medical facilities immediately after being freed. Let it be noted that once rubbles are removed, toxic proteins travels faster in the survivors’ blood stream. It cannot be over emphasized that timing is very much of the essence in such situations.

What’s the present situation in China for patients with crush syndrome?

A team of doctors from “Doctors Without Borders/Médecins Sans Frontières” have already sent the equipment necessary for kidney dialysis in preparation for crush syndrome patients with having kidney problems. Furthermore, three nephrologists (physicians trained in kidney diseases) have also been dispatched to China to reinforce the necessary treatment that needs to be given.

Summary

Here is a short round-up of all the points mentioned and the inclusion of other miscellaneous tips:

What is crush syndrome all about?

It is a condition that occurs when excessive force is exerted on a group of muscles for a long time.

Symptoms/Implications include:

1. Possible kidney failure,
2. Heart attack
3. Blockage of blood vessels.
4. Weak and rapid pulse
5. Pale, cool & clammy skin

How should first-aiders respond to crush syndrome?

1. Remove rubble
2. Give plenty of water
3. Wait for aid
4. Maintain airway, breathing & circulation (ABCs)
5. Be prepared to load & send patient to the hospital once freed.

What’s the situation now in China for patients with crush syndrome?

1. “Doctors Without Borders” sent three doctors to affected areas.
2. Equipment needed for possible kidney dialysis have also been sent..