In the first days after an earthquake, numerous wounded people suffered from so-called ‘crush syndrome’, that can lead to an acute kidney insufficiency. The following is an excerpt from an article on MSF’s response to the Indonesia earthquake in November 2009.
A 7.0 magnitude earthquake rocked Port-au-Prince, Haiti, on January 12th 2010. Victims were treated at an MSF surgery outside the building of the Carrefour hospital. © Julie Remy
Marie-Noëlle Rodrigue, an MSF emergency operations manager said:
“In the case of Indonesia, we know that the country has good capacity to respond to the emergency.
"But our experience after earthquakes shows that international medical teams have an added-value in terms of specialised medical care, specifically orthopaedic surgery or nephrologists care.
"We have the capacity to set up an inflatable hospital quickly, with two operation theatres and dozens of beds for patient hospitalisation. It’s the same kind of structure we used in Manshera, in Pakistan in 2005.”
What is crush syndrome?
Crush syndrome (also known as traumatic rhabdomyolysis or Bywaters' syndrome) is a serious medical condition characterised by major shock and renal failure following a crushing injury to skeletal muscle.
Cases commonly occur in catastrophes such as earthquakes, where victims have been trapped under fallen masonry.
Muscle tissues that have been damaged by severe internal injury may release massive quantities of toxins into the bloodstream after the release of the crushing pressure.
These toxins are the products of the breakdown of the muscle fibres – myoglobin, potassium and phosphorus. It is not certain exactly how these toxins affect the kidneys, but left untreated, crush syndrome can be fatal.
Treatment of crush syndrome?
Severe crushing injuries and life-threatening complications are major causes of death after major disasters like earthquakes.
Treatment of crush syndrome should ideally begin as soon as the patient is released from the crushing force. Experience in previous earthquakes has shown that prompt treatment and close monitoring of the severe complications are of great importance in saving patients' lives.
Dialysis is a vital part of effective treatment of crush syndrome. Nephrologists – doctors who are experts in kidney disease – monitor the patient’s blood to check that all the toxins have been removed.
Orthopaedic surgeons are also vital to ensure that physical injuries to limbs are treated and, where necessary, amputations are carried out before infection spreads.
Any patient who has been buried under rubble for any length of time will be dehydrated. Adequate rehydration reduces the risk of acute renal failures in crush syndrome.