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Rescue Can Bring Quake Victims New Danger
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"When they are under the rubble they are relatively safe. When the pressure is taken away and the blood goes into the muscle, that is when the trouble starts," Vanholder said.
The most immediate threat is potassium, the ion that is in high concentration inside muscle cells and is essential to their ability to contract. Too much potassium in the bloodstream can cause the heart to beat erratically and ultimately stop; it is an ingredient in the lethal intravenous cocktail used to execute prisoners.
The other major toxin is myoglobin, a protein that binds oxygen in muscles so they can work at peak efficiency. Once released into the blood, it is filtered by the kidney, where it accumulates, blocks microscopic tubules and damages the organ, sometimes permanently.
Giving a victim intravenous fluid dilutes these substances and helps flush them from the body. Various other steps can help protect the heart from the toxic effects of potassium. If the injury is severe enough, dialysis is necessary.
With dialysis, the kidneys often heal and return to normal function, although on average a person needs at least two weeks of the therapy, which can lead to other life-threatening complications, such as infection and bleeding.
Even with ideal care, about 15 percent to 20 percent of people with kidney damage from crush syndrome die, according to data collected by Turkish physicians who have done extensive research on treating earthquake victims.
Crush syndrome is less common in infants and the elderly, presumably because they have less muscle than young adults.
"The feeling is adult males are more prone to develop the syndrome because they have a bigger mass of muscle. They are the ones we really want to treat early," said Itamar Ashkenazi, an Israeli surgeon who has written about the field care of rubble-trapped disaster victims.
The Renal Disaster Relief Task Force goes out with a team from Médecins Sans Frontières (also known as Doctors Without Borders), which provides the logistics. It keeps 20 dialysis machines in the organization's Brussels warehouse. Frequently, however, the task force doesn't bring in machinery but helps organize treatment with equipment already in the country.
The biggest response so far was for the 1999 earthquake in Marmara, Turkey. It consisted of about 50 people in a half-dozen teams that included physicians, nurses and dialysis technicians. The team that went to China on Thursday had two Belgians and two Chinese from Hong Kong.
