Crush Syndrome is the unseen enemy that can develop in the body of a trauma survivor, hours to days, after being freed from a collapsed building or pulled from a piece of wreckage. It is due to complications from crushing injuries that can result in restricted oxygen flow, buildup of toxins due to muscle deterioration and elevated potassium levels that compromise the heart. Crush Syndrome is a particularly disheartening development for medical workers because it can turn what appears to be a successful recovery mission into rapid death.

Sadly, first responders who have the opportunity to take preemptive measures to forestall crush syndrome are often unaware and untrained in the protocols to do so.  Crush syndrome has been nicknamed “The Smiling Death” because of how quickly a potentially happy ending can culminate in sadness for loved ones and friends when a trauma victim begins a medical downward spiral which ends in cardiac arrest or organ failure.

Crush syndrome occurs as the direct result of impaired circulation in the body due to pressure or immobilization for an extended period of time. This is often the result of a limb being trapped for an extended period of time, although it can occur simply due to prolonged lack of body movement. When circulation is impaired, the oxygen flow to the body is diminished and dying cells release localized toxins into the blood stream.  Once the individual is freed and/or moved, the oxygen flow resumes, carrying these toxins throughout the body.  Rapid transfer of excessive stores of potassium may also create an electrical disturbance in the heart, sometimes resulting in cardiac arrest.

Rescued individuals who do not receive life-saving treatment to prevent and mitigate the effects of accumulated toxins and/or chemical imbalances due to cell death can suffer almost immediate heart failure, or progressive organ failure within days of the crushing event.  The kidneys are particularly vulnerable to toxic overload and renal failure since released toxins travel almost immediately toward the renal system.

Crush syndrome is quite similar to suspension syndrome which can occur after rock climbers or harnessed workers fall from scaffolding and dangle, suspended, for a period of time.  Blood collects in lower extremities causing toxic levels of ketones and lactic acid to accumulate and then rapidly disperse once the victim is rescued when normal blood and oxygen flow resumes.  Suspension syndrome is most effectively prevented by making certain that a rescued victim is not immediately laid flat, but gradually lowered over thirty minutes to an hour from a supine position.

Emergency services trainer and EMT expert, Jim Sideras, offers a number of life-saving tips for rescue workers to learn and put into practice when working with potential crush syndrome victims. He advocates careful and ongoing evaluation of vital signs, high concentrations of oxygen administration, and the use of various appropriate drugs to help regulate potassium redistribution including saline infusion to help prevent renal failure.

Sideras also recommends routine transfer of all previously trapped victims to a trauma unit for EKG observation and follow-up.  A recent study conducted by Vanderbilt University has shown promising results through the administration of aspirin to trauma victims to help block the flood of toxins that can lead to renal failure.

Crush syndrome is a silent and unsuspecting killer that can claim the lives of rescued victims who may initially appear stable.  Because it can occur rapidly, turning the promise of recovery into death, emergency services workers must be trained to understand the risks associated with freeing trauma victims. The myriad of potential medical problems increase with every hour that passes while a victim remains trapped and potentially crushed in the aftermath of a critical incident. Sadly, the most effective treatment is usually immediate rescue.