Avert a "second disaster" in Nepal by managing crush injury and preventing kidney failure
The George Institute for Global Health has called upon doctors and other disaster relief professionals working at the site of Nepal earthquake to follow the field guide produced by the Renal Disaster Relief Task Force of the International Society of Nephrology to ensure that crush injury survivors do not suffer from complications arising due to muscle injury leading to kidney failure.
“Natural disasters can result in kidney injury, secondary to crush injury to muscles in victims trapped under rubble in collapsed buildings. Destruction of existing dialysis facilities leaves already dialysis-dependent patients without access to their dialysis units or medical care,” says Dr. Vivekanand Jha of the George Institute for Global Health and Secretary of the Indian Society of Nephrology and member of the Disaster Relief Task Force. “Muscle injury due to trauma, excessive immobilization and lack of blood supply cause rapid and excessive release of a toxic muscle protein called myoglobin from cells that may result in acute kidney shutdown. If not managed appropriately and in a timely manner, this can result in death”.
“This complication is entirely preventable. The guide, which can be used by doctors and field workers, describes simple preventive measure that can be started soon after identification of victims trapped under the rubble, and continue after extrication. This is the time of maximum risk as the potentially toxic molecules are released from the crushed tissue and enter the circulation’’ Dr. Jha points out.
Because of chaos and lack of knowledge, crush injury is not always recognized by rescuers and health-care professionals, so that the narrow time window is missed when administration of fluids may limit the degree of injury to kidney. Once kidney failure develops, patients need dialysis, which is often not available in resource-constrained settings. Even existing dialysis facilities are disrupted because of damage to infrastructure. The Renal Disaster Relief Task Force works closely with Medicines Sans Frontieres to co-ordinate relief efforts and support the relief teams with expertise and materials where needed.
Experience from previous major earthquakes around the world shows that many rescued victims subsequently died of crush-related acute kidney failure. These guidelines were produced after major earthquakes in Turkey and Pakistan and are designed to support field workers. They have been shared widely with physicians and nephrologists in the quake hit areas of Nepal including the Nepal Society of Nephrology, and have been made available at
“It is important that medical units in and around disaster-prone areas should develop their own detailed disaster preparedness plans to cope with sudden influxes of victims of crush injury,’’ said Dr. Jha. Mass disasters and subsequent “renal disasters” will continue to be major cause of death in the future. National and international disaster preparedness and logical planning can be helpful to decrease post-disaster chaos and provide efficient health care.