The Crush Syndrome: Awareness Can Save Lives
Two earthquakes of 7.6 and 7.7 magnitudes have hit Turkiye, affecting ten big cities including Kahramanmaraş, Hatay, Gaziantep, Osmaniye, Malatya, Adana, Diyarbakır, Şanlıurfa, Adıyaman and Kilis. With the death count exceeding 36 thousand and estimated injuries exceeding 100 thousand, this devastating catastrophe will be engraved in our minds forever. While we state our get-well-soon wishes to all the people who have been affected by this natural disaster in any way, there are also some lessons that need to be learned from such experiences. Today, I will be giving information about the “Crush Syndrome”, which holds crucial importance in times of earthquakes and has no general knowledge drawn to it.
Cameron Sinclair, a famous architect, once said the phrase that we hear a lot these days: “Earthquakes don't kill people, bad buildings do.” It has been more than two weeks since the occurrence of this catastrophe, yet there is still work being done to get people out of the wrecks of the collapsed buildings, which were clearly not ready for such an earthquake. There have even been saves that may be considered a “miracle”, such as 26-years-old Mehmet Ali Şakiroğlu and 34-years-old Mustada Avcı, who were saved in the 261st hour of the earthquake. Even though many international and domestic crews tried to help the ones under the wrecks, it was not enough, and many victims tried to save others by their own means. This raised the question, “What should we be mindful of when we are rescued, or if we rescue someone, from under a wreck?” Here is where the Crush Syndrome comes into the discussion with the knowledge that could save lives.
Crush syndrome is defined as the systemic manifestations resulting from a crush injury, which can result in organ dysfunction (predominantly an acute kidney injury by multi-organ injury, and dysfunction can also occur) or death (Haines 2021). It happens when one’s body is crushed, in this case under the heavyweights of the collapsed buildings, and stays still for a long time. Some fluids, proteins, and ions like potassium, which exist in a healthy muscle cell, get out of the muscle tissue due to the persistent crushing and get into the circulatory system (Acıbadem 2023). This causes some molecules to exist in a different concentration than they should in the system, affecting the organs starting with the heart and the kidneys by building up in their tissues. Not every case of rescue is one of crush syndrome, it can only be a crush injury. However, it is crucial to take caution because many deaths from the crush syndrome were stated as “normal at rescue, however, soon go into shock” (Rajagopalan 2010).
A person suffering from crush syndrome can display low tension, cardiac insufficiency, respiratory insufficiency, and shock accompanied by an acute kidney injury and cardiac arrhythmia. The person who rescued the individual should display a highly coordinated effort, and the victim should be transported to a higher level of care with dialysis facilities as soon as possible. As Memorial Hospital states, when the victim is rescued and alive, vascular access should be established in the shortest notice to start the fluid treatment, which is isotonic sodium chloride. The amount of the fluid injected differs from victim to victim according to the amount of time it took for them to get rescued, their age, the magnitude of the trauma, the temperature, etc.
It is highly recommended that professionals should make the first treatment. However, upsettingly, as we and the whole world have observed in this disaster, the number of professionals sent to the affected regions was far from enough, meaning that some people may have been rescued with none around. In these cases, a rescue without assistance from a specialized rescue crew can still be mindful until professional intervention. If there is no serum available, then water can be given to the person in small amounts, if necessary, according to their urinal situation and the amount of time that has passed under the wreck. However, the professionals strictly warn people not to give any fluids involving potassium such as any type of juice (Hisar Hospital). The person should be heated and brought to a health professional before intervention with any kind of fluid from the civil people, if possible, for optimal results.
We suggest that everyone further investigates crush injuries and crush syndrome in their research about the earthquakes. As mentioned, this knowledge is essential in times like these. Considering earthquakes are a truth for Turkiye and many other countries worldwide, precautions are critical for any future cases. We, again, want to say that we are deeply sad and mourning for our country and our people and will continue to support with all of our potential, starting with drawing attention to important topics such as this. Get well soon to everyone affected, and we hope for a rapid recovery.
Edited by: Simay Cemre Tülübaş
Çakır, Ülkem. "Crush (Ezilme) Sendromu Nedir? Belirtileri ve Tedavisi." Memorial, 13 Sept. 2023, www.memorial.com.tr/saglik-rehberi/crush-ezilme-sendromu-nedir-belirtileri-ve-tedavisi.
"Crush Sendromu." Acıbadem, 14 Feb. 2023, www.acibadem.com.tr/ilgi-alani/crush-sendromu/.
Haines, Laura N. "Severe crush injury in adults." UpToDate, 31 Aug. 2021, www.uptodate.com/contents/severe-crush-injury-in-adults#:~:text=Crush%20syndrome%20%E2%80%94%20Crush%20syndrome%20is,death%20%5B2%2D5%5D.
"https://hisarhospital.com/enkaz-altindan-sag-kurtarilanlarin-en-sik-karsilastigi-problem-crush-sendromu/." Hisar Hospital, hisarhospital.com/enkaz-altindan-sag-kurtarilanlarin-en-sik-karsilastigi-problem-crush-sendromu/.
Rajagopalan, S. "Crush Injuries and the Crush Syndrome." Med J Armed Forces India, vol. 66, no. 4, Oct. 2010, pp. 317-20. National Library of Medicine, www.ncbi.nlm.nih.gov/pmc/articles/PMC4919827/.