Crush Syndrome - The Grim Reaper In The Sichuan Quake

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 in the midst of the survivors.

No doubt, the main concern now is to provide the survivors of the quake with adequate food, water, sanitation and other basic needs required. However, if authorities neglected the possible implications of crush syndrome over logistic concerns, it could prove disastrous to the remaining survivors.

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What is crush syndrome all about?

First discovered by the British physician Eric Bywaters during the 1941 London Blitz , the crush syndrome has always played a significant role in increasing the death toll during war, earthquakes and many other occasions where people are found to be buried under heavy rubble.

To put it simply, crush syndrome is a condition caused when an excessive force is applied to a group of muscles for a long time. Toxic proteins are then released due to the overwhelming external pressure on the body, and damage is inflicted as a result.

There are many clinical symptoms associated with crush syndrome, and some of the more severe ones include likely kidney failure, heart attack and blockage of blood vessels since the pressure exerted by the heavy rubble constricts the blood vessels.

Unlike the common cold, where the symptoms displayed are fairly obvious even to the untrained observer, some patients who suffer from crush syndrome do not even know about their condition, and they exhibit common symptoms (high index of suspicion, altered consciousness etc.) Thus, the reason why crush syndrome has always been a silent killer is because not many people, including patients and trained paramedics themselves have even noticed it until it was too late.

On July 28, 1976, the Tangshan earthquake saw a total of 164851 people injured, and crush syndrome occurred in 2% to 5% of the patients. When another earthquake occurred in Armenia in 1988, crush syndrome was found to be the 3rd most frequent injury and the leading cause of death. Thus, this indicates the severity of the crush syndrome on the health of existing survivors.

How should first-aiders respond to crush syndrome?

While waiting for paramedics and disaster relief teams to arrive, first-aiders should first attempt to remove any heavy objects (e.g. Rubble) that are trapping the survivors. Plenty of water should also be given to these survivors to ensure that they have sufficient hydration.

Most importantly, coordinate your rescue attempt carefully, since once you removed the rubble, the toxic proteins will effectively travel even faster within the survivors' blood stream. Timing is of the essence here. Also, maintain the airway of survivors to allow for air circulation, and be prepared to transport him to the nearest medical center (Since the toxic proteins are travelling all over his body now.) once he is freed.

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

A team of doctors from Doctors Without Borders/Médecins Sans Frontières (MSF) have already sent in the necessary equipment needed for kidney dialysis to the affected areas in China to prepare for patients with crush syndrome having kidney failure. Also, three nephrologists (physicians trained in kidney diseases) have also been dispatched to China to reinforce the necessary treatment that needs to be given.

Summary

In conclusion, just a short round-up of all the points mentioned in this article and the inclusion of other miscellaneous tips:

What is crush syndrome all about?

Occurs when excessive force is exerted on a group of muscles for a long time.

Symptoms include:

Possible kidney failure, heart attack blockage of blood vessels. Weak and rapid pulse Pale,cool & clammy skin
How should first-aiders respond to crush syndrome?

Remove rubble Give plenty of water Wait for aid Be prepared to load & go patient once he is freed Maintain airway, breathing & circulation (ABCs)
What's the situation now in China for patients with crush syndrome?

Doctors Without Borders have sent three doctors to affected areas. Equipment needed for possible kidney dialysis have also been sent in.

Crush Syndrome - The Grim Reaper In The Sichuan Quake