Prehospital management of earthquake crush injuries: A collective review
1The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, United Arab Emirates
2Department of Critical Care and the Intensive Care Unit, Burjeel Royal Hospital, Al-Ain, United Arab Emirates
3Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, United Arab Emirates
Keywords: Acute kidney injury, crush syndrome, disaster, earthquake, injury, management, mass casualty, medical response, rhabdomyolysis, trauma
Earthquakes are natural disasters which can destroy the rural and urban infrastructure causing a high toll of injuries and death without advanced notice. We aim to review the prehospital medical management of earthquake crush injuries in the field. PubMed was searched using general terms including rhabdomyolysis, crush injury, and earthquake in English language without time restriction. Selected articles were critically evaluated by three experts in disaster medicine, emergency medicine, and critical care. The medical response to earthquakes includes: (1) search and rescue; (2) triage and initial stabilization; (3) definitive care; and (4) evacuation. Long term, continuous pressure on muscles causes crush injury. Ischemia–reperfusion injury following the relieving of muscle compression may cause metabolic changes and rhabdomyolysis depending on the time of extrication. Sodium and water enter the cell causing cell swelling and hypovolemia, while potassium and myoglobin are released into the circulation. This may cause sudden cardiac arrest, acute extremity compartment syndrome, and acute kidney injury. Recognizing these conditions and treating them timely and properly in the field will save many patients. Majority of emergency physicians who have worked in the field of the recent Kahramanmaraş 2023, Turkey, earthquakes, have acknowledged their lack of knowledge and experience in managing earthquake crush injuries. We hope that this collective review will cover the essential knowledge needed for properly managing seriously crushed injured patients in the earthquake field.
How to cite this article: Abu-Zidan FM, Idris K, Cevik AA. Prehospital management of earthquake crush injuries: A collective review. Turk J Emerg Med 2023;23:199-210.
All authors have contributed to the idea. Fikri Abu‑Zidan supervised the project, did the literature search, retrieved the literature, critically read and wrote the disaster medicine and acute care surgical section of the article, drew Figure 4, organized the structure of the manuscript, and repeatedly edited the manuscript. Kamal Idris critically read and wrote the section on the pathophysiology of the crush syndrome, rhabdomyolysis, and acute kidney injury. Arif Cevik Alper critically read and wrote the section on the prehospital care of earthquake‑injured patients, drew Figure 5, and assisted in drawing Figure 4. All authors approved the last version of the manuscript.