||Crush syndrome results from
prolonged pressure on limbs causing disintegration of muscle tissue (rhabdomyolysis) and
release of myoglobin, potassium, and phosphate into the circulation (34). Systemic
effects include hypovolemic shock, hyperkalemia, renal failure, and fatal cardiac
arrhythmias. Patients with crush syndrome may develop kidney failure and require dialysis (35).
Following the 1988 earthquake in Armenia, more than 1,000 victims trapped in collapsed
buildings developed crush syndrome as a result of limb compression; 323 developed
secondary acute renal failure requiring renal dialysis (36). Amputations and
chronic sequelae of orthopedic and neurologic injuries, especially spinal cord injuries,
can be expected (37). For example, a rate of 1.5 cases of paraplegia/1,000 injured
was observed after the Guatemalan earthquake (38), and more than 2,200 people
became paraplegics as a result of injuries sustained in the 1976 Tangshan quake (6).
Following the Tangshan earthquake, all these chronically disabled people required
extensive treatment and rehabilitation in long-term-care facilities. This care
significantly taxed the health care system in the region for years to come.