Crush Syndrome Injuries: Key Problem After Quakes

Crush syndrome, the damage to the body caused by prolonged pressure and immobilization, is one of the major medical problems seen after severe earthquakes, and such injuries reportedly have accounted for more than half of the thousands of hospitalizations after the devastating temblor in Soviet Armenia.

Many of the deaths and injuries in quakes occur when people are trapped beneath falling buildings. Injuries to the head, chest and abdomen are frequently fatal, but injuries to the pelvis, legs and arms are “often survivable,” according to Dr. Marshall T. Morgan, chief of the division of emergency medicine at the UCLA Medical Center.

Crush injuries can cause broken bones and severe bleeding. They also commonly cause muscle injury that results in kidney damage.

Protein Released

The immediate crush injury and the subsequent immobilization cause the muscle to release a protein known as myoglobin. In the bloodstream, myoglobin is a toxic pigment that can clog the kidneys and block the flow of urine. It can also damage the kidney cells that cleanse the blood of poisons, such as excess potassium, phosphate and acids. (U.S. doctors report that they often see similar kidney damage after massive drug overdoses, when individuals may lie motionless for hours or days.)

The kidney damage from a crush injury is usually reversible if kidney dialysis machines and expert medical care are available. “Kidney failure in and of itself should no longer be lethal,” said Dr. Alan Wilkinson, director of clinical nephrology at the UCLA Medical Center. “In general, people recover,” he said, if they can receive dialysis and if the “other injuries aren’t so severe that they die from them.”

The amount of kidney damage depends on the extent of the initial injury and the period of time that elapses before medical assistance becomes available.

Earthquake victims who have been trapped for long periods of time are likely to become severely dehydrated and develop higher concentrations of toxic substances in their circulation than those who were rescued quickly. With a large crush injury, dialysis may be necessary within 24 to 48 hours, according to Wilkinson.

Soviet relief officials have requested kidney dialysis machines from foreign donors as well as specialists to help operate them. Thirty dialysis machines are being airlifted from Britain to Armenia, according to the Soviet news agency Tass, as well as 70 self-contained intensive-care system units, including 10 for children.

Patients with crush injuries are particularly vulnerable to infections. They often require treatment with antibiotics and surgery to remove diseased tissue. Sometimes amputations are necessary.