What happens to Haitian earthquake victims whose limbs were crushed?

Answers to your questions about the news.
Jan. 21 2010 3:52 PM

Life or Limb

What happens when your leg gets trapped under a building?

Collapsed buildings in Haiti. Click image to expand.
Collapsed buildings in Haiti

Doctors have swarmed to Haiti from around the world to tend to the victims of last week's earthquake, including many whose arms or legs were pinned under steel beams or slabs of concrete. Can you die from a crushed limb?

Yes. If your arm or leg were compressed for less than four hours—two hours if you're elderly or have poor circulation—there is a good chance that doctors will be able to save both your life and your limb. If you manage to survive with a compressed limb for more than eight hours—because you don't have an open fracture and haven't succumbed to fatal blood loss—then you'll almost certainly need an amputation, but the rest of you should be OK. In between those two time frames, emergency doctors face a difficult decision. They can try to save your arm or leg, but the toxins released from its damaged tissues might enter your bloodstream, putting you in grave danger of organ failure.

This all plays out in a chain reaction of systemic effects which doctors call "crush syndrome." During the first phase of crush syndrome, the limb is still trapped under concrete or another material, and thus cut off from blood flow in either direction. As a result, muscle tissue begins to die, and the collapsing cells release proteins, potassium, and lactic acid. These chemicals, which circulate through the body at much lower concentrations under normal circumstances, accumulate in the affected area. (Dead muscles also tend to harden. If the compressed limb exhibits a wooden quality similar to rigor mortis, it's likely to be amputated.)


When the concrete is lifted and circulation is restored, fluid rushes into the affected area to dilute the released electrolytes so their local concentration matches that of the rest of the body. Under normal circumstances, bodily fluids circulate through two spaces—the blood vessels and the insides of cells. But after a crushing injury—or any condition that depletes protein stores like liver failure or malnutrition—the fluid becomes sequestered in an extravascular space. (The process is known as "third spacing.") For some earthquake victims, several gallons of fluid might become sequestered in a swollen, damaged limb in the days following their rescue, resulting in dramatically increased pressure in the affected area and decreased blood pressure in the rest of the body. To prevent hypotension, which can quickly starve vital organs, rescuers often administer fluids to a crush victim through an IV drip even before freeing them. (All of this extra fluid can cause more problems. The blood can become diluted, resulting in anemia.)

While fluids flow into the injured limb, the proteins and potassium flow out into the rest of the body, posing an even greater risk to the victim. Once it gets into the bloodstream, this debris from expired muscle tissue can clog up the kidneys. Typically, one-half of those pulled from collapsed buildings experience some degree of kidney failure, and one-half of those survivors require dialysis. The increased potassium concentration can cause the heart to beat irregularly or stop altogether. Lactic acid—also from the damaged muscle tissue—decreases blood pH, exacerbating the risk of cardiac problems.

The lingering effects of crush syndrome can be deadly even days or weeks after rescue. A study of 18 patients admitted to the intensive-care unit following the 1999 Marmara earthquake in Turkey found that eight did not survive their hospital stay. Doctors in Haiti face a particularly challenging situation. Crush syndrome can be managed if electrolyte levels can be closely monitored. But medical centers were destroyed in the earthquake, modern equipment is scarce, and electricity is hard to come by. As a result, amputation–either in the field or in an operating room—is often the safest option.

Got a question about today's news? Ask the Explainer.

Explainer thanks Jim Holliman of Uniformed Services University of the Health Sciences and Jerry Mothershead of the American College of Emergency Physicians.

Become a fan of the Explainer on Facebook.



The Democrats’ War at Home

How can the president’s party defend itself from the president’s foreign policy blunders?

An Iranian Woman Was Sentenced to Death for Killing Her Alleged Rapist. Can Activists Save Her?

Piper Kerman on Why She Dressed Like a Hitchcock Heroine for Her Prison Sentencing

Windows 8 Was So Bad That Microsoft Will Skip Straight to Windows 10

We Need to Talk: A Terrible Name for a Good Women’s Sports Show


Cringing. Ducking. Mumbling.

How GOP candidates react whenever someone brings up reproductive rights or gay marriage.


How Even an Old Hipster Can Age Gracefully

On their new albums, Leonard Cohen, Robert Plant, and Loudon Wainwright III show three ways.

The U.S. Has a New Problem in Syria: The Moderate Rebels Feel Like We’ve Betrayed Them

Homeland Is Good Again! For Now, at Least.

Oct. 1 2014 11:48 AM An Up-Close Look at the U.S.–Mexico Border
  News & Politics
The World
Oct. 1 2014 12:20 PM Don’t Expect Hong Kong’s Protests to Spread to the Mainland
Oct. 1 2014 2:16 PM Wall Street Tackles Chat Services, Shies Away From Diversity Issues 
The Eye
Oct. 1 2014 1:04 PM An Architectural Crusade Against the Tyranny of Straight Lines
  Double X
The XX Factor
Oct. 1 2014 2:08 PM We Need to Talk: Terrible Name, Good Show
  Slate Plus
Political Gabfest
Oct. 1 2014 1:53 PM Slate Superfest East How to get your tickets before anyone else.
Brow Beat
Oct. 1 2014 2:24 PM The New Interstellar Trailer Is the Most Exciting Yet
Future Tense
Oct. 1 2014 2:26 PM The Apple Graveyard Leave a flower for a dead Apple product.
  Health & Science
Oct. 1 2014 2:36 PM Climate Science Is Settled Enough The Wall Street Journal’s fresh face of climate inaction.
Sports Nut
Sept. 30 2014 5:54 PM Goodbye, Tough Guy It’s time for Michigan to fire its toughness-obsessed coach, Brady Hoke.