Crush Injury Protocol

Crush injuries can happen at work, at home or outdoors. Such injuries can be caused by heavy machinery, collapsed buildings, vehicle collisions or accidents, falling rocks or landslides. In the event of a crush injury, a paramedic or trained EMT should follow a defined protocol in assisting the individual who is trapped.

When to Enact Protocol

• A protocol of treatment for Crush Syndrome should be followed before the crushed individual can be extracted only in one of the following situations: the person has been trapped for at least two hours by an object--such as machinery, rock or rubble--which is capable of inflicting a crush injury; the patient trapped has a history of heart or renal problems. Crush Syndrome, which is also known as "traumatic rhabdomyolysis," occurs when renal failure and major shock are caused by a crushing injury to an individual's skeletal muscle. Crush Syndrome is common, for example, when patients have been trapped by earthquake debris.

Before Extraction

• Before the extraction process is started, identify and treat any immediate threats to the patient's life. Assess the trapped individual for Crush Syndrome. Control the patient's pain using Fentanyl, or morphine if Fentanyl is unavailable or inappropriate. Monitor cardiac activity and administer oxygen to the patient if this is available and safe for use in the environment. Immediately before extraction efforts begin, start a large bore IV and administer between one and two lites of saline.

During and After Extraction

• During the extrication process, assess whether administration of Albuterol is helpful and appropriate. If the extrication process is prolonged, administer Sodium Bicarbonate. If hyperkalemia is suspected, administer Calcium Chloride over the 5 minutes immediately following extrication.