Comments about technological history, system fractures, and human resilience from James R. Chiles, the author of Inviting Disaster: Lessons from the Edge of Technology (HarperBusiness 2001; paperback 2002) and The God Machine: From Boomerangs to Black Hawks, the Story of the Helicopter (Random House, 2007, paperback 2008)

Friday, September 24, 2010

Crush Syndrome: A Mystery in Early Collapse Rescues

Following is information that the editor couldn't fit in my article on heavy rescue, published last year in Invention&Technology.

From the earliest days of building collapses, rescuers knew time was of the essence, but important details were elusive. One mystery: During the Blitz of London (September 1940 through May 1941), rescue parties took enormous risks to remove survivors from heavy rubble who, after extrication, appeared to be in good spirits and good shape. After receiving effusive thanks, the rescuers packed them off to the hospital. End of story?

No - within a day or so, the rescuers heard that the victims had died under care at the hospital. It was heartbreaking. A medical team at Hammersmith Hospital had two such cases in a single day in 1940. This coincidence raised the salience of the issue and triggered a wave of calls to other hospitals. More cases turned up. What was going on? Autopsies and experimental therapies followed.

By early 1941 the answer emerged: in a manner of speaking, the people were dying because they had been released from entombment. Massive wreckage had lain across muscle tissue for many hours, blocking circulation. In a typical situation, tissue of the large leg muscles began dying as the rescuers worked through the wreckage by hand, excavating a tunnel by pulling out bricks and sawing timbers. When help arrived and the crushing pressure came off, blood began flowing to and from the damaged tissue. This carried a wave of toxic byproducts through the circulatory system.

Kidneys went off line and survivors who looked quite healthy died of heart failure. Those with pelvic injuries were particularly at risk. Maddeningly, the British researchers discovered that a German physician by the name of Von Colmers (I couldn't find his first name -- does anyone know?) had figured out the problem while assisting at the Messina earthquake of 1908.

(People interested in the history of disaster response may find the case of Messina worth a look, because the big earthquake and tsunami triggered one of the first major international relief efforts. The King and Queen of Italy took such a strong interest in the recovery that they jumped into the work, hands-on. During an aftershock, Queen Elena came rather close to being trapped in a hospital collapse.)

After World War I German doctors published more journal papers on handling crush injuries, but the information never drew attention in England ... until the Blitz.

Today, heavy rescue crews know to expect cases of “crush syndrome.” Before any beams and timbers are lifted they begin medical treatment via intravenous fluids, which may mean an EMT crawling through a void with a medical kit. Those of us with a fear of confined spaces can be very grateful there are men and women with the courage to volunteer for such work.

Another lifesaver is an intravenous kit designed specifically for use on survivors so entrapped that nothing but one wrist is visible, and immobilization aids that allow a survivor to be sledded through a twisty tunnel while protecting the spine from further injury.

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