Crush syndrome occurs when a person's body has been compressed for an extended period of time, usually beyond four hours. It takes more than a crushed extremity to develop crush syndrome, typically it occurs when larger areas of the body become trapped such as the legs, pelvic area or chest cavity.
Damage begins at the cellular level with the weight of the object causing immediate injury. After about an hour, circulation to the area decreases and with it the oxygen supply. This forces the cells to change how they work and anaerobic metabolism occurs, leading to a build up of lactic acid. Minus oxygen, cells lose the ability to hold onto their contents and they begin to leak, causing damage to the surrounding cells.
Cell contents contain potassium along with several other toxic substances that when released suddenly into the body, (when the compression object is moved, for example) can cause renal failure, liver damage, breathing problems and cardiac issues, such as arrhythmia and cardiac arrest.
It is highly crucial then, that as a non-medical professional facing severe entrapment, the urge to move a victim be resisted until emergency professionals are on scene to administer fluids.
Treating a Crush Injury
For less extensive crush injuries and entrapment, there are steps that can be taken to help the victim. Before attempting any type of assistance or rescue, ensure that the area is safe to approach and will remain safe while working. If the helper is injured in the process of giving aid, not only can no longer be rendered, but the emergency resources will now have two patients instead of one.
Having determined that the scene is safe, give care as follows:
- Before rendering any kind of treatment, take protective precautions such as having gloves if available.
- Check the airway first to ensure the patient is breathing. A simple jaw thrust maneuver (shown below) could be enough to make the airway viable.
- Treat any major life-threatening bleeding by applying pressure directly over the bleed with your hand. If medical supplies are not available, use clothing as pressure pads. Once these pads are in place, do not remove them, apply more pressure pads (or clothing) on top of those already in place.
- If a person has been trapped for less than 10 minutes and the compression object can safely be moved, move it and treat any injuries it may have caused.
- Comfort the victim as best as possible and be prepared to treat for shock by covering the patient with a blanket and elevating the legs about 12 inches. do not, however, elevate the legs if a spinal injury is suspected.
- Alert emergency professionals as soon as possible.
Giving comfort during a period of desperation, pain and fear can be a powerful aid by itself and can actually give a patient the fortitude needed to "hold on" until medical help can arrive. Another person's presence is never in vain, whether first aid care can be rendered or not. Simply just being there to hold a hand, could mean the difference between life and death.
NOTE: The jaw-trust technique without head tilt is considered the safest approach to opening the airway of patients with suspected neck injuries because it usually can be done without extending the neck.