Page 49 - JSOM Summer 2022

Last, it is highly likely that a medic will be responding to a sit- 3. Demirkiran O, Dikmen Y, Utku T, et al. Crush syndrome patients
uation where more than one casualty may be crushed. Obtain- after the Marmara earthquake. Emerg Med J. 2003;20(3):247–250.
ing appropriate information as early as possible is important 4. Via AG, Oliva F, Spoliti M, et al. Acute compartment syndrome.
Muscles Ligaments Tendons J. 2015;5(1):18–22.
to ensure the proper amount of medical and rescue equipment 5. Crush syndrome management protocol. Ranger Medic Handbook.
is requested and made accessible during this process. This will 2019:67.
impact performance and patient outcomes. 6. Crush syndrome protocol. Advanced Tactical Paramedic Protocols
Handbook. J Spec Oper Med. 2016;10:55–56.
7. Walters T, Powell D, Penny A, et al. Crush syndrome – prolonged
Conclusion field care (CPG ID:58). Joint Trauma Service clinical practice guide-
The initial case study places a Special Forces team in Iraq, line. 28 December 2016. https://jts.amedd.army.mil/assets/docs
where they were called on to respond and help an injured /cpgs/Crush_Syndrome_PFC_28_Dec_2016_ID58.pdf. Accessed 18
November 2020.
sniper who suffered crush injuries due to the structural col- 8. Travis A, Martone G. Search and rescue operation continues in Haiti
lapse of a damaged building. This scenario illustrates the very [transcript]. Talk of the Nation - NPR. 18 January 2010. https://
real possibility for Special Operations medics of having to www.npr.org/templates/story/story.php?storyId=122701542. Ac-
treat patients who are at risk of developing crush syndrome. cessed 18 November 2020.
9. Schogol J. Special Forces helping rescue Nepal earthquake survi-
vors. Air Force Times. 26 April 2015. https://www.airforcetimes
In response to the earthquake in Haiti in 2010, a four-person .com/news/pentagon-congress/2015/04/26/special-forces-helping
Air Force Pararescue team was attached to a search and rescue -rescue-nepal-earthquake-survivors/. Accessed 19 November 2020.
team out of Fairfax County, Virginia, and rescued at least 13
people from collapsed structures. Additionally, 26 US Special
8
Forces Soldiers assisted the Nepalese military with locating and
9
rescuing survivors of the Nepal earthquake in April 2015. It is
not known if these service members treated any patients expe-
riencing crush syndrome, but the likelihood of such casualties
experiencing crush syndrome from this mechanism of injury is
appreciated. Crush syndrome is a potentially lethal sequela of
crush injuries. After the 1999 Marmara earthquake in Turkey,
18 patients who were transferred to the Istanbul University
Hospital experienced crush syndrome. Seven of these patients
did not survive the injuries caused by the manifestation of this
3
syndrome. This underscores the significance of crush injuries
that can be encountered on the full spectrum of operations,
both combat and non-combat in nature. To ensure mission
success, understanding the physiology of crush injuries and
crush syndrome and being prepared to treat these patients
are paramount. Early coordination for supplies or capabilities
needed to rescue and treat patients at risk of developing crush
syndrome, and quick evacuation to a critical care facility, will
ensure the greatest chance of survival for these patients. 3

Disclosures
The authors have no conflicts to disclose.

Funding
The authors received no funding for this effort.

Disclaimer
Opinions or assertions contained herein are the private views
of the authors and are not to be construed as official or as re-
flecting the views of the United States Department of Defense,
Department of National Defence (Canada), or their affiliated
Services.

References
1. Parrish A, Tagore A, Ariyaprakai N, et al. Managing the toxic
chemical release that occurs during a crush injury. JEMS. 22 Octo-
ber 2018. https://www.jems.com/2018/10/22/managing-the-toxic
-chemical-release-that-occurs-during-a-crush-injury/. Accessed 18
November 2020.
2. Wade G, Talbot M, Shero J, et al. Acute extremity compartment
syndrome (CS) and the role of fasciotomy in extremity war wounds
(CPG ID:17). Joint Trauma Service clinical practice guideline.
25 July 2016. https://jts.amedd.army.mil/assets/docs/cpgs/Acute_
Extremity_Compartment_Syndrome_and_Role_of_Fasciotomy_
(CS)_in_Extremity_War_Wounds_25_Jul_2016_ID17.pdf. Accessed
18 November 2020.
Austere Crush Injury Management | 47