MEDICAL TREATMENT AT COLLAPSE RESCUES
As noted by Carlos Castillo’s account of the successful extrication of the trapped Filipino, Mayo, sophisticated medical care administered prior to extrication is often necessary both to expeditiously free the victim and maximize his chances for survival and a full recovery. In the case of Mayo, the absence of medical capabilities would have meant at least several more hours for extrication, specifically to remove the concrete beam crushing his foot and ankle.
Our brief period of medical care accomplished multiple important goals. We were able to medically evaluate and stabilize the patient. Prior to extrication he received three liters of normal saline IV fluid, one ampule of dextrose, and one ampule of bicarbonate. We then were able to control his pain using morphine in order to complete the evaluation of his trapped leg and eventually release it. Stabilization and evaluation gave us the opportunity to suggest to rescuers the best place to remove a piece of the wood from the beam’s skirt (behind Mayo’s ankle) and the best direction from which to pull so as to extricate the foot and ankle. Their skillful tool operation and gentle but firm pull, combined with our judicious administration of morphine, resulted in Mayo’s expeditious and painless extrication, 55 hours after the earthquake had struck.
After extrication Mayo remained in stable condition despite the severe crush injury to much of his left leg and buttocks area.
His successful rescue contrasted starkly with that of Danny, another Filipino extricated by the Philippine miners during our efforts to reach Mayo. Danny was alert and conversant and assisted with his rescue, but he also had significant crush injuries. Danny was extricated by the miners 52 hours after the initial quake. Because of the miners’ lack of understanding and because of poor crowd control at the scene, we were unable to reach and medically treat Danny prior to his ambulance transport. He was dead less than 10 minutes after extrication, a direct and possibly preventable result of crush syndrome.
This is a very common scenario in structural collapse rescues and emphasizes the importance of providing medical care within confined spaces.
Full preparation for successful structural collapse rescue includes a rescue unit staffed with skilled paramedics who are backed up closely by a knowledgeable emergency physician. The unit must understand the serious potential for crush syndrome, dust inhalation, and other problems frequently encountered in these situations and be prepared to treat them immediately. The evaluation and treatment must begin prior to extrication, particularly when crush syndrome might be involved.
What is crush syndrome and why does it kill? Simply put, this condition develops when muscle tissue is compressed for enough time (usually 4 to 6 hours) that it begins to die. When the trapped area is released, blood rushes into the impaired muscle tissue and the plasma portion leaks into the tissue. This may occur rapidly enough and with enough blood volume that the patient develops shock and dies. Blood returning from the injured area carries multiple toxins that may cause the heart to stop (asystole) or fibrillatc (V-ftb), either of which results in sudden death. A later sequela in survivors is kidney failure caused at least in part by a protein called myoglobin, released into the bloodstream from injured muscle.
Many of these problems can be prevented by timely medical intervention. It should ideally begin when the patient is initially reached by the rescue team. Starting treatment after removal from the rubble may be too late.
