First aid for crash syndrom

Authors: Rednenko V.V., Poplavets E.V.

Editor: Rednenko V.V.

Equipment for the practical skill:

• foldable splint for a leg
• soft pads
• dummy with the possibility of immobilization of the leg (or a standardized patient)

Clinical situation:      

• As a result of a natural catastrophe, the building collapsed. You found the victim with feet covered by the rubble of a building. There is a danger of collapsing the remains of the building. You have made a decision to urgently evacuate the victim to a safe place before the ambulance arrives.
• Provide first aid to the victim before evacuation.

Order of the skill performance:

• Perform a primary examination
  • of the scene of a accident
  • of the victim
• Call an ambulance (rescue service)
• Specify the time of compression
  • compression is less than two hours
  • compression is more than two hours
  • compression time unknown
• Time of compression is less than two hours
  • Free the limbs from under the crushing weight
  • Apply a bandage for the injured limbs
  • Immobilize the limbs
• Time of compression is more than two hours or compression time unknown
  • Apply a haemostatic tourniquet at the compression boundary of the injured limb
  • Free the limbs from under the crushing weight
  • Remove clothes from the injured limb
    
  • Evaluate the viability of the limb (color, integrity of tissues):
    • the limb is viable; 
    • the limb is not viable: incomplete separetion, crushing, signs of severe anaerobic infection (unpleasant smell, dark color of damaged tissues, swelling, necrosis of soft tissues)
  • Time of compression is more than two hours or compression time unknown and The limb is viable
    • Apply a tight bandage on the compressed part of the limb from distal part to proximal one
    • Immobilize the limb
    • Remove the haemostatic tourniquet
  • Time of compression is more than two hours or compression time unknown and The limb is not viable
    • Apply a bandage for the injured limb
    • Immobilize the limb
    • Do not remove the tourniquet!