Management of Crush Victims in Mass Disasters

Abstract

SummaryCrush syndrome is the second most common cause of death after earthquakes (the first most common is direct trauma). Many logistic problems with the treatment of patients with crush syndrome are due to chaotic disaster circumstances; consequently, medical and logistic recommendations on the treatment of crush victims are needed. In a joint initiative of the Renal Disaster Relief Task Force of the International Society of Nephrology and European Renal Best Practice, a work group of nephrologists, intensivists, surgeons, and logisticians with disaster experience or experts in guideline preparation collaborated to provide comprehensive information and recommendations on the management of crush casualties considering their occurrence with "epidemic" dimensions after mass disasters. The result is the monograph "Recommendations for the Management of Crush Victims in Mass Disasters", which may help provide effective health care to disaster victims with renal problems. This article discusses medical and logistic principles of the treatment of crush victims, both at the disaster field and on admission to hospitals, and guidance is described. The importance of early fluid administration even before extrication of the victims and avoidance of potassium-containing solutions during the treatment of crush victims is underlined. Also, the logistic problems in treating crush casualties are emphasized. The most important aspects of the recently published recommendations are highlighted.

A contrast study of the traumatic condition between the wounded in 5.12 Wenchuan earthquake and 4.25 Nepal earthquake

“…3,4 Limb fracture is the most common injury in two earthquakes but its occurrence is higher in 4.25 Nepal earthquake. On the contrary, chest trauma and multiple trauma have a lower incidence.…”

Combined administration of anisodamine and neostigmine rescued acute lethal crush syndrome through α7nAChR-dependent JAK2-STAT3 signaling

“…CS is characterized by hyperkalemia, metabolic acidosis, hypovolemic shock, myoglobinuria, and acute kidney failure12. Currently, recommended treatment for CS involves early fluid replacement using physiological saline, basification of urine using bicarbonate, diuresis using mannitol and correction of hyperkalemia using calcium gluconate and glucose-insulin infusion34. Acute kidney failure is the most fatal outcome for CS patients, since it may lead to refractory hyperkalemia, acidosis, and uremia.…”

Comparison of Injury Epidemiology Between the Wenchuan and Lushan Earthquakes in Sichuan, China

“…In contrast, patients who were struck or buried tended to have multiple injuries and to suffer one or more conditions associated with burial that increase mortality, including serious infection, myoglobinemia, malnutrition, and disturbance of the internal environment. [19][20][21] On the other hand, severely injured patients might progress to MOF or death if they do not receive effective treatments in time. 22 In the more violent Wenchuan earthquake, delay in receiving emergency treatments and transferring patients to medical establishments may have contributed to the higher rate of MOF and mortality.…”