Dealing With Crushing Injuries

Dealing with Crushing Injuries

What is a Crushing Injury?

Crush injuries occur when a part of the body, such as a hand, arm, leg, foot or trunk is squashed.

Often there is little visible damage on the outside. But this belies the fact that the damage that has occurred on the inside. This can make dealing with crushing injuries can be problematical.

Crush injuries are common on farms and in forestry, where hands are particularly at risk. The most serious agricultural and forestry cases occur when heavy machinery is used. With casualties becoming trapped under them or in-between moving parts.

Forestry workers are also at risk from heavy timber in movement, or collapsing timber stacks.

Crush injuries can happen:

  • In tractor rollovers
  • While using or moving heavy equipment
  • When moving large hay or wool bales, or timber
  • While dealing with large animals in yards or small spaces
  • During logging or cutting firewood

Crush injuries are also common following natural disasters, when buildings collapse, and in road accidents.

crush point warning sign

Crush Injury Syndrome

For crush injury syndrome to occur, it must affect a large area, such as the entire arm or thigh. Blood circulation to the area has to have been obstructed.

Moreover, the force or pressure applied must be present for some time before Crush Injury Syndrome can occur. In a crushing incident where the crushing pressure is not released immediately, the severed body part may progress into crush injury syndrome. This may occur if the casualty themselves, or just their affected body part is trapped.

Not all crush injuries actually progress into Crush Injury Syndrome however. For example, a crushed finger is very painful, but not a large enough part of the body to cause Crush Injury Syndrome.

Crush Injury Syndrome is a potentially life-threatening condition.

In this condition, toxins produced by the breakdown of cells in the body are trapped by the compressive pressure. Removing the pressure can cause the sudden release of toxins into the circulatory system. This can potentially overwhelm the kidneys.

In addition, releasing the compressing pressure or force can cause fluid to leak into the injured area, resulting in Hypovolaemic Shock.

Crush Injury Syndrome – History

Seigo Minami, a Japanese physician, first reported Crush Injury Syndrome in 1923. He studied the pathology of three soldiers who died in World War I from insufficiency of the kidney.

The syndrome was later described by Eric Bywaters in patients during the 1941 London Blitz.

The mechanism is believed to be the release into the bloodstream of muscle breakdown products—notably myoglobin, potassium and phosphorus. The most devastating systemic effects can occur when the crushing pressure is suddenly released, without proper preparation of the patient.

Crush Injury Treatment

Standard Urban First Aid Protocol for Crushing Injury

For crushing less than 15 minutes:

  • Release the compressive force, or object, as quickly as you can.
  • Dial 999.
  • Control any bleeding.
  • Treat for shock.

For crushing more than 15 minutes:

  • DO NOT release the compressive force or object.
  • Dial 999.
  • Monitor and reassure patient.

Crushing injury treatment needs quick action. 15 minutes can pass in the blink of an eye when a situation is stressful. If the compressive object can be moved, do it quickly.

Remote First Aid for Crushing Injury

  • If help is not immediately available. Consider removal of the crushing object, but apply a tourniquet above the injury site prior to lifting the object. This will help to prevent the sudden release of toxins into the circulatory system.
  • Dial 999 or alert emergencies services as soon as possible.
  • Monitor and reassure patient.

Where Can You Find Out More

We have a series of First Aid blogs relating to the forestry and agricultural environment that might interest you.

As the preferred first aid provider for Forest Enterprise Scotland, we regularly deliver Emergency First Aid at Work Courses +F courses. That include content on treating crushing injuries and are suitable for forestry and agricultural environments.

About The Author

Tom Durham

Tom has 10 years of experience as a first aid trainer / assessor and over 20 years experience of outdoor sports instruction and coaching internationally. Prior to becoming a founder of the First Aid Training Co-operative, Tom grew a successful business delivering predominantly outdoor / remote first aid courses across Scotland, using his experience to help others in the outdoor industry improve their skills. Tom is a graduate of the Rural Leadership Programme and also runs a mountain bike trail design consultancy. He continues to work internationally, dividing his time between Scotland and the Italian Alps.