Emergency Medical Care for Victims with Crush Syndrome at the Pre-Hospital Stage

Abstract

Introduction. Due to combat engagements during war, terrorist attacks, and strikes on civilian infrastructure, a large number of casualties suffer from life-threatening crush syndrome (CS). The survival and preservation of life for CS-victims depend on timely and proper medical assistance. Rescuers-including combat medics, tactical medics, paramedics, emergency responders, and doctors providing first aid to CS-victims - must undergo appropriate training. Therefore, special attention should be paid to modern methods of emergency care for casualties with CS. The aim of the study. To systematize and organize contemporary basic emergency medical care measures for victims with crush syndrome at the scene, during the prehospital stage, and in the early hospital phase. Particular emphasis is placed on the application of infusion-transfusion therapy. Materials and methods. To obtain relevant information regarding modern understandings of the pathological processes occurring in CS-victims and to determine the latest methods for its proper treatment at the prehospital stage, a review of literature from global medical databases was conducted. Sources included PubMed, Scopus, Web of Science, Elsevier, ResearchGate, Cochrane Library, Science Direct, and Free Medical Journals. The study employed historical, bibliosemantic, comparative analysis, and systematic approach methods. Results. The article highlights an issue relevant in both wartime and peacetime - the provision of adequate medical care for casualties with CS, depending on their condition and the tactical situation at all stages of medical evacuation. The focus is placed on proper emergency medical care in accordance with modern guidelines, utilizing protocols such as PDF, CABDE, and MARCH. The study emphasizes that assistance for CS-victims must be organized according to a clear and coordinated algorithm corresponding to evacuation zones - at the scene, in red, yellow, and green zones, as well as during transportation and hospitalization. The proper application of modern infusion-transfusion therapy methods is crucial during emergency care for CS-victims at the prehospital stage, especially during combat operations. In cases of CS complicated by critical bleeding, hemorrhagic, hypovolemic, or traumatic shock, the use of plasma substitutes, donor blood, and its components is essential. Special attention is given to massive blood transfusions and the use of fresh whole blood for treating CS victims at the prehospital stage. Conclusions. The study systematizes and organizes contemporary basic principles of emergency medical care for victims with crush syndrome, with particular emphasis on infusion-transfusion therapy methods. The information presented in the article is essential for a broad range of medical professionals, including anesthesiologists, surgeons, therapists, pediatricians, general practitioners, family medicine doctors, and medical personnel working in emergency services and blood service institutions. All the specialists mentioned above may assume the role of military medics during wartime and must acquire relevant knowledge in tactical medicine to provide adequate medical assistance to casualties with crush syndrome at all stages of medical evacuation, especially at the scene, during the prehospital phase, and in the early hospital period. Implementing these measures can significantly reduce mortality from injuries and complications associated with crush syndrome. The informative materials outlined in this article align with continuing medical education programs and training curricula for medical students, interns, and master's students in higher medical education institutions. The study’s findings should be incorporated into tactical medicine training programs for both military and civilian medical personnel. Furthermore, the results can be used to educate civilians on the basic principles of tactical medicine related to assisting victims with crush syndrome before medical professionals arrive, thus significantly contributing to the training of personnel for military and civilian healthcare services.

Keywords

• crush syndrome, prolonged compression syndrome, emergency care, infusion-transfusion therapy, prehospital stage