- 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)
19 comments:
This article was very informational to me and very shocking at the same time. I had no idea of what Crush Syndrome was and that it even existed. As I think of all the Haitian people that are still trapped under their homes and other buildings I can't help but wonder how many of these individuals have developed Crush Syndrome as a result of the earthquake. Also, due to the fact that the muscles swell and there are possibilities of organs releasing toxic fluids it saddens me to think that more people will die as a result of this. I agree with Dr.Hansmann that there are not many workers at the moment in Haiti that are familiar with Crush Syndrome and the Haitians will suffer because of it. I would suggest that the government try to find workers and doctors that are educated on Crush Syndrome so as to assist the people in Haiti in the best manner possible.
Amy G.
This article on Haiti is very tragic. I can't even imagine what the people and their families are going through. The crush syndrome is very shocking to me because I have never heard of it and didn't know what it could do to people until Dr. Hansmann posted this interesting article. I would have thought that the government would react immediately into getting these people some help with professional doctors from anywhere in the U.S. Yes I know that they are lacking equipment and facilities, but they could at least send these people somewhere else so they could get the treatment that they need. I can’t even imagine the pain that the people are going through who have the crush syndrome if it causes the muscles to swell. All we can do at this time is pray for the people who are suffering in Haiti. There are many organizations out there that we could donate to. One person can make a difference.
Jennifer Valerio
This article dealing with the earthquake in Haiti was quite informative. I, having no prior knowledge of Crush Syndrome, was shocked to hear of the complications that people are afflicted with. It saddens me to think of those people who have lost loved ones, their homes and everything they own. As if that wasn’t bad enough, to add Crush Syndrome and all the injuries brought on by the earthquake into the equation is very distressing. I think it is extremely important for those who are volunteering their services to have as much knowledge about Crush Syndrome as possible. Learning all they can about the syndrome will help deal with the cases they come across and hopefully reduce the mortality rate. People like you and me can do our part by donating to the Red Cross and other relief funds. Hopefully our monetary donations will go towards the IV triages that are needed for the immediate support of those that are still trapped under the rubble. Any little bit can help.
Victoria Lopez
It is interesting to be reading this information as my husband was in a trench collapse March 10, 2009 at his worksite. He was buried with dirt up to two feet above his head. I had read about Crush syndrome in order to ensure that I knew what to expect and what to ask as we went to the doctors after his accident. Besides the physical problems which are already difficult enough to deal with, there will also be the post traumatic stress due to the trauma. This situation will take years to work through and hopefully people like ourselves as well as others will educate ourselves in order to be available when we are needed hear or abroad.
Sylvia S.
The earthquake in Haiti is a horrendous tragedy. Aside from the casualties, the lives of many survivors will never be as they once were. I agree with Sylvia S. that PTSD will also be a pressing issue among survivors. It will take a long time before Haiti recovers. Natural disasters, such as this one, remind me of the uncertainty of life. Tragedy can strike at any time, and a natural disaster can occur anywhere.
I wanted to add that I just finished watching an episode of the Dr.s that featured sufferers of Crush Syndrome in Haiti. It was heartbreaking to watch the victims of the earthquake and even more so to find out that sometimes there was not much that could be done because of lacking medical supplies.
My heart and prayers go out to the Haitian community. It is always devastating to hear tragedies that occur to third world places. The media has been doing it's best to capture the reality of the the horrible aftermath that has struck Haiti through real life footage. It is through viewing it on television and hearing some of the stories from Haitians, that you realize the actuality of their nightmares. About a week ago I turned on my television and heard the story of a young boy who rescued some of his relatives who were stuck under structures for hours. I cannot imagine the shock and pain that his relatives had to undergo. After reading this article I now understand the severity of what most of the people from Haiti will be experiencing after being crushed under homes/infrastructures. Global awareness of the Crush Syndrome is vital when dealing with the medical attention needed after earthquakes. It pains me to know that some of the simple technology/equipment that we take for granted here in the US is unfortunately not readily available to those of other parts of the world. Hopefully those that can go and serve the Haitian community are able to help some of the people that were able to survive and provide the IV triages necessary for immediate care. Although many of the Haitians will be needing long term care for such things as kidney failure/damage and psychological counseling, which for them can be hard to come by, it is a blessing to see the many people that have reached out to Haiti. Whether it be from simple small donations or doctors and health care providers lending their time and skills, every bit of it is surely helping. Compassion is truly visible. It was very interesting to learn about Crush Syndrome, especially when we can all relate it to the recent Haiti Earthquake.
Well this is an educational and somewhat disturbing article. I say educational because I did not know that Crush Syndrome even existed until I heard about it here. I do not think the western doctors should have too much trouble learning about this syndrome. They would be doing hands on and on the job training where most people seem to learn quicker. It is disturbing to imagine going through this from start till now being victim or rescuer and knowing that 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 damage to facilities and lack of equipment. I do find it interesting that the muscles release toxins when one is crushed. I question if this is the body’s response to intense body damage? Is our body programmed to “self destruct” when it senses there is too much damage?
Well this is an educational and somewhat disturbing article. I say educational because I did not know that Crush Syndrome even existed until I heard about it here. I do not think the western doctors should have too much trouble learning about this syndrome. They would be doing hands on and on the job training where most people seem to learn quicker. It is disturbing to imagine going through this from start till now being victim or rescuer and knowing that 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 damage to facilities and lack of equipment. I do find it interesting that the muscles release toxins when one is crushed. I question if this is the body’s response to intense body damage? Is our body programmed to “self destruct” when it senses there is too much damage?
James D.
I remember watching the news coverage about the earthquake in Haiti. The reporters tried their best to explain to describe the devastation that had occurred. However, I did not hear them mention Crush Syndrome.
It’s shocking to read that this can occur in as little in one hour. Then, the mortality rate is 50% for those that do have this.
I found an article, that reported that Doctors Without Borders found a dialysis center at a General Hospital. The doctors were able to restart the machine and start treating patients.
They formed an outreach team to inform other doctors about the treatment and to prepare for expected increase in patients needing treatment. I sad to think that over the past couple of weeks, news about the Haitian people has lessened. Hopefully, we will get more updates about the progress that doctors are making soon.
http://www.doctorswithoutborders.org/news/article.cfm?id=4229&cat=voice-from-the-field&ref=home-sidebar-right
B. Ramirez
I was astonished to hear that such conditions could be experienced from earthquake survivors. It isn't easy to read and hear about how everyone in the haitian community is having so much difficulty trying to regain some sort of their lives back and how even with so much effort that is being done by so many countries, their emotoinal and psychological states have all been very much effective. Crush Syndrome is so mush beyond what I had thought people were experiencing because i wasn't aware of what excatly it was, a shock caused to earthquake or war victims that have had some sort of construction fallen on top of them, for which many have renal failer. I can sincerly say that this is very interesting and at the same time very sad because of what you hear and see about these individuals.
http://en.wikipedia.org/wiki/Crush_syndrome
Until reading this blog I had no knowledge of the Crush Syndrome. I find it saddening to think that for those who survived the actual earthquake and after shocks in Haiti, they have another obstacle to overcome. Even more shocking is that many doctors and other medical professionals from America who have rushed to help the injured and aid in the extraction of survivors from the destruction have no experience in dealing with the Crush Syndrome. Due to the urgency of the situation I find it hard to believe that the medical professionals helping the victims in Haiti had time to research this syndrome and the ways to diagnose and treat it. Hopefully the expected numbers of victims with the Crush Syndrome far exceed the actual amount of those afflicted with it. Haiti needs time and bodies to help rebuild itself and move forward.
This article opened my eyes to the realistic situation of the Haiti Earthquake and has given me a "name" for what I've seen in many children and adults. The media coverage as well as the images presented to the world are very dramatic. It becomes even more "disturbing" to be aware of how much the Haitians have been affected. The country's present situation along with the lack of resources has contributed to the Crush Syndrome. Not only have these factors been an influenced but the citizen's shock of what has happened to them impacted their response in helping each other.
It is sad to think that the best choice for the many injured is limb amputation. It is the best of two evils. It only makes me think, what will become of them? Not only do they need to deal with the lack of organization in receiving the basic living needs; but now they have to deal with the consequences of having a limb amputation. Consequences such as physical, emotional, social, and psychological. What will be their life expectation? It is important for those involved in helping to rebuild Haiti to also take into consideration all the individuals who have been affected by the Crush Syndrome.
A.Huerta
Haiti has already endured a massive amount of suffering, the aftermath of the quake has left a nearly unimaginable volume of sheer aesthetical cleanup, if that alone was the only challenge faced by the Haitian people it would still be no small feat; however, aesthetical cleanup is not Haiti’s only issue. The problems there run deep, compiling even another complication on top of it all must be overwhelming to those involved. Crush Syndrome not only has a high mortality rate if not treated carefully, but it is also drastically worse if not treated at the initial extraction of the trapped individual, taking into account that nearly all of the work in Haiti is being done by non professional volunteers. It is likely that most of the trapped victims will not have received treatment for crush syndrome at extraction this will likely lead to many tragic kidney failures if quick decisive action is not taken by medical teams. With the drastic short supply of medical supplies and facilities it is nearly certain that many Crush Syndrome victims will not have immediate access to dialysis, all of these complications will certainly leave Haiti in serious turmoil for some painful time to come.
-sukania mendez
This was such an informative piece but had such sadness to it. I have heard of the Crush Syndrome when September 11th happened. CNN ran a segment and they described what it was. What happened in Haiti is so troubling and they have little to no resources available. There are an estimated 300,000 people they are saying have died as a result of the devastating earthquake. It makes me wonder how many were from Crush Syndrome and I pray we get medical professionals there fast. I have been watching the news and every country needs to do there part in helping out.
Claudia Lucio
This article has made me aware of new syndrome that I had never heard. The article was very informative and detail. It explains the syndrome very well also gave information as far as how to treat it. It is very sad to hear that as a result of the earthquake this syndrome has come. I also feel for those that need to have dialysis done because it is not a go thing to go thru, for that there is no cure only a transplant but in order to get one it has to be available and there is no a lot of those around. I know how said is to have someone that has to have dialysis done because my father is going thru that and I see how living with dialysis is hard. I can just think of the persons with this new problem in their life and coping with it is hard but far worse is that there not enough places to practice their medication, supplies, and even persons to help around. It has been such a huge tragic thing.
I've never heard of Crush Syndrome and it sounds like something very devastating and painful. I can't imagine being not only crushed and surviving through that, however all of the agony that comes afterward. Living in Haiti is difficult enough from what we hear on T.V. due to poverty and lack of resources, much more difficult now having to deal with a disability that they may never be able to survive or live with. This shows how we should continue helping the people of Haiti and being aware of what they are going through.
-Anna L. Ocanas
Great informative article! It was davastating knowing or hearing the news of the happenings and the aftermath of this nature's disaster. I deffenitly did not know about the Crush Syndrome until now. Most people, especially in those countries, are not aware of the results when a tragic like this happens. Those people need lots of medical attention and it's ashame that proper medical attention is not provided for them. People with crush syndrome are hard to be treated since medical attention is not given and as a result there will be more people dying from this. As time has passed by, it seems to be forgotten about them!
Can't say I've ever heard of Crushed Syndrome, but within certain circumstances, such as natural disasters it may become a chilling reality. I can just imagine the vast number of individuals that suffered these symptoms during the Haiti Earthquake devestation and the inability to seek necessary preventative treatment in time before further complications advanced. Im sure there are many psychological problems that accompany their experiences of the traumatic earthquake and Crush Syndrome. This serves as a wake up call for the preparation of North American medical and medical related professionals.
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