Crush Injury Syndrome often occurs in victims pinned under heavy collapsed objects. Collapses may occur in natural disasters such as earthquakes, hurricanes, or tornados; or may occur in industrial settings such as mining or construction. These victims may survive the initial trauma, often appearing alert and stable, then suddenly deteriorate or die once the entrapment is removed. It is felt that this is due to the build up of certain toxins in the crushed tissue that are released and travel to the heart and other vital organs once the victim is freed. This can be reduced or prevented by administering advanced medical treatment to the victim prior to release of the load, while the victim is still “in the rubble”.

Crush Injury Syndrome has been recognized in the medical literature for years including studies published on the earthquakes in Kobe Japan, the former Soviet Armenia, and a major building collapse in Tyre Lebanon. Despite this, the management of Crush Injury Syndrome is rarely discussed in the Paramedic and medical school curriculum. All members of the Special Medical Response Team have been thoroughly trained in the management of Crush Injury Syndrome including medications and techniques beyond the traditional scope of Paramedic practice. Dust impaction syndrome and hypothermia are other unique problems of the collapse environment that our team is trained to recognize and treat. In addition, providing care to collapse victims requires close integration with local rescue teams. Because of this, many members of the Special Medical Response team have undergone additional technical rescue training including confined space training as defined by OSHA regulation 1910.146.