Haiti Earthquake- Crush Syndrome Likely Cause of Significant Disability

Haitian earthquake survivors are now experiencing increased rates of Crush Syndrome, a sometimes deadly result of earthquake-induced injuries.

• 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)

New SSA Campaign for Extra Help with Drug Costs

On 08 January, Michael J. Astrue, Commissioner of Social Security, and Chubby Checker, Grammy Award winner, announced a new campaign about a “twist” in the law that makes it easier to qualify for Extra Help with Medicare prescription drug costs.

Commissioner Astrue said, “The changes in the Medicare law that take effect this month will allow hundreds of thousands of Americans who are struggling to pay their prescription drug costs to get Extra Help during these tough economic times.” Rock and roll legend Checker’s promotion says, “Listen up, America! For 50 years, people of all ages and backgrounds have danced the Twist. “Now it’s important everyone learn about this new twist in the law…”

The Extra Help program provides assistance to more than 9 million seniors and people with disabilities, helping them save an average of about $4,000 a year on Medicare prescription drug plan costs.

To qualify , people must meet certain resource and income limits, but the new Medicare law eases those requirements in two ways: (1) It eliminates the cash value of life insurance from counting as a resource; (2) It eliminates the assistance people receive from others to pay for household expenses, such as food, rent, mortgage or utilities, from counting as income.

To learn more about the Extra Help program and to view the promotion featuring Chubby Checker, go to http://www.ssa.gov/prescriptionhelp/ OR http://www.socialsecurity.gov/extrahelp

EEOC Jurisdiction for GINA Title II

WASHINGTON, DC-- The recent US Equal Employment Opportunity Commission press release, “Historic Genetic Information Nondiscrimination Act Takes Effect”, explains the EEOC’s enforcement role and responsibilities under Title II of the Genetic Information Nondiscrimination Act (GINA), marking the first legislative expansion of EEOC jurisdiction since the Americans with Disabilities Act (ADA) was passed in 1990.

GINA has critical implications for people with genetically-determined disabilities and people with family histories of genetic conditions. In particular, according to the EEOC, "an employer may never use genetic information to make an employment decision because genetic information doesn't tell the employer anything about someone's current ability to work."

The US EEOC website has a number of other disability-related features and information, too. For information on “Pandemic Preparedness (H1N1) in the Workplace and the Americans with Disabilities Act, please visit: http://www.eeoc.gov/facts/pandemic_flu.html. For full text of The Americans with Disabilities Act Amendments Act of 2008 and the EEOC Notice of Proposed Rule Making, visit: http://www.eeoc.gov/laws/statutes/adaaa_info.cfm. And, of particular interest to families and friends of people with significant disabilities who have care giving responsibilities, “Employer Best Practices for Workers with Caregiving Responsibilities”, at http://www.eeoc.gov/policy/docs/caregiver-best-practices.html provides general and area-specific guidance and recommendations for employers.