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4 important considerations for victims of collapsed structures

Rescuers need to anticipate specific medical problems and patient needs as they prepare to encounter patients in a collapsed structure or debris pile


Crush injuries, hypovolemia and hypothermia: First responders should keep these 4 tips in mind for victims of a collapsed structure.

AP Photo/Kathy Willens

We are often given little-to-no warning when our medical skills could be pressed into service for a catastrophe like a tornado, earthquake or construction incident resulting in a structural collapse. When disaster strikes, as they continue to sift through the rubble, should they encounter survivors, first responders should keep the following 4 tips in mind for victims of a collapsed structure.

1. Begin patient care as extrication is planned

Rescuers who encounter survivors must immediately consider respiratory and ocular dust impaction. Being able to provide a victim with water, wipes and a dust mask, if appropriate, can provide an immediate sense of relief and comfort while the formal rescue and extrication is being planned.

Meanwhile, the victim can be prepared for rescue by optimizing their physiologic status as much as possible by receiving IV crystalloid resuscitation, presumptive treatment of hyperkalemia and/or hypoglycemia, and correcting body temperature if at all possible.

2. Coordinate extrication and medical care

Once rescuers are, in fact, ready to free victims trapped in the rubble, it will be critically important for them to coordinate the effort with medical personnel, particularly if victims are thought to also have crush syndrome, so as to optimize the victim’s physiologic status prior to the “lift” of the debris. Without this coordination of care, the victim may suffer a sudden and fatal release of potassium and other cellular debris into the bloodstream when the affected limb is suddenly freed.

3. Expect hypothermia

Many of these victims will be hypothermic, especially if they are trapped in concrete, which tends to act as a heat sink, stealing away much-needed body warmth for survival. In addition, because these victims also have no access to food sources, they can be relatively hypoglycemic as well.

4. Anticipate hypovolemia

Victims who are found days into a rescue effort are bound to be hypovolemic. Lack of access to a water source certainly plays a role in dehydration, but it can also be due to hemorrhage and the rapid shift of extracellular fluid into damaged and crushed tissue that tends to occur when limbs are trapped underneath debris. The crush injury itself also brings its own set of problems, including hyperkalemia from the massive release of this normally intracellular ion, when large muscle groups are compressed or destroyed with its resultant cellular damage and release of its contents into the bloodstream.

These basic tenets of medical care for victims trapped in a rubble pile can be applied not only to major earthquakes, but to other structural collapse scenarios as one may see after a large tornado, hurricane or other event causing structural failure. Take the time to discuss your local disaster medical plan with your agency leadership.

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This article was originally posted April 27, 2015. It has been updated.

David K. Tan, MD, EMT-T, FAEMS, is associate professor and chief of EMS in the division of emergency medicine at Washington University School of Medicine in St. Louis. He is double board-certified in Emergency Medicine and EMS Medicine by the American Board of Emergency Medicine. Dr. Tan remains very active in EMS at the local, state and national levels as an operational medical director for local police, fire and EMS agencies. He is chairman of the Metropolitan St. Louis Emergency Transport Oversight Commission, vice-chairman of the Missouri State Advisory Council on EMS, and president of the National Association of EMS Physicians. Dr. Tan is a member of the EMS1 Editorial Advisory Board. He also provides medical direction to and the EMS1 Academy.