Toolbox Talk – Crush Syndrome

We are focusing on an important and potentially life-threatening condition that can arise during rescue operations and building collapses: crush syndrome. Understanding this condition, its symptoms, and the associated hazards is crucial for ensuring our safety and the safety of those we aim to rescue. In this toolbox talk, we will cover what crush syndrome is, how to recognise its signs, and the necessary precautions to take when dealing with collapsed structures. Let’s dive in and equip ourselves with the knowledge needed to handle these challenging situations effectively.

What is Crush Syndrome?

Crush syndrome, also known as traumatic rhabdomyolysis, is a severe medical condition that can occur following a crush injury, common in victims of building collapses, earthquakes, mine disasters, explosions, terrorist attacks, local wars, and other major accidents. The complications that arise from such injuries lead to the development of crush syndrome.

According to the Diseases Database, crush syndrome is described as: “Severe systemic manifestation of trauma and ischemia involving soft tissues, principally skeletal muscle, due to prolonged severe crushing. It leads to increased permeability of the cell membrane and to the release of potassium, enzymes, and myoglobin from within cells. Ischemic renal dysfunction secondary to hypotension and diminished renal perfusion results in acute tubular necrosis and uremia.”

Who is Affected by Crush Syndrome? (Epidemiology)

Crush syndrome is most commonly observed in scenarios involving:

• Building collapses
• Earthquakes
• Wars
• Explosions causing building collapses
• Industrial accidents (e.g., mining)
• Road traffic accidents

The incidence of crush syndrome ranges from 2% to 15% in all trauma patients and can be as high as 30% in earthquake victims.

Symptoms of Crush Syndrome Key clinical features include:

• Crushing injury to a large mass of skeletal muscle.
• Sensory and motor disturbances in compressed limbs, which may become tense, swollen, and pulseless.
• Myoglobinuria and/or hemoglobinuria, which can make urine appear tea-colored early on.
• Oliguria with profound hypovolemic shock.
• Nausea, vomiting, confusion, and agitation due to disturbed body chemistry; elevated levels of urea, creatinine, uric acid, potassium, phosphate, and creatine kinase; possible hypocalcemia.

Hazards When Entering a Collapsed Structure

Rescue workers and emergency responders face numerous hazards when entering a collapsed structure. These hazards must be considered to ensure safety:

1. Water System Breaks
   • Flooding of basement areas.
2. Sanitary Sewer System Breaks
   • Exposure to pathogens.
3. Electrical Hazards
   • Exposed and energized wiring.
4. Airborne Contaminants
   • Smoke, dust (asbestos, silica), and bloodborne pathogens.
5. Hazardous Materials
   • Ammonia, battery acid, leaking fuel.
6. Natural Gas Leaks
   • Creation of flammable and toxic environments.
7. Structural Instability
   • Risk of further collapse.
8. Oxygen Deficiency
   • Confined spaces may lack sufficient oxygen.
9. Slip, Trip, and Fall Hazards
   • Holes, protruding rebar.
10. Falling Objects
    • Risk of being struck.
11. Fire Hazards
    • Proximity to flammable materials.
12. Heavy Machinery
    • Risk from cranes and other equipment.
13. Sharp Objects
    • Glass, debris.
14. Secondary Explosive Devices
    • Potential remnants left by terrorists.
15. Secondary Collapse
    • Risk from aftershocks, vibrations, explosions.
16. Residual Contamination
    • Chemical, biological, radiological.
17. Unfamiliar Surroundings
    • Difficulty navigating.
18. Adverse Weather Conditions
    • Impact on rescue operations.
19. Noise Hazards
    • Generators, heavy machinery.

Understanding the complexities and dangers of crush syndrome, particularly in the context of building collapses, and the associated hazards of rescue operations in collapsed structures is crucial. Safety protocols and awareness can significantly reduce risks and ensure effective emergency responses. Stay vigilant and prioritize safety in all rescue efforts.

Download the full Toolbox Talk document on the Crush Syndrome below: