History

· Entrapped and crushed under

heavy load > 30 minutes

· Extremity / body crushed

· Building collapse, trench

collapse, industrial accident,

pinned under heavy equipment

Signs and Symptoms

· Hypotension

· Hypothermia

· Abnormal ECG findings

· Pain

· Anxiety

Pearls

· Recommended exam: Neurological. Mental Status. Musculoskeletal.

· Scene safety is of paramount importance as typical scenes pose hazards to rescuers. Call for appropriate resources.

· Avoid Ringers Lactate IV Solution due to potassium and potential worsening hyperkalemia.

· Crush injury is very painful. Contact Medical Control if additional pain medication needed.

· ECG changes with Hyperkalemia include those in protocol but may also be a bizarre, wide complex rhythm.

· Patients may become hypothermic even in warm environments.

Differential· Entrapment without crush syndrome

· Entrapment without significant crush

· Altered mental status

Crush

Syndrome

Airway Protocols

as indicated

IV Procedure

12 Lead ECG Procedure

Cardiac Monitor

Abnormal ECG

Hemodynamically

unstable

Exit to

Appropriate Protocol

B

P

II

YES

Peaked T Waves

QRS 0.12 sec or greater

QT 0.46 sec or greater

Loss of P wave

Asystole

PEA

VF / VT

P

PP

Exit to

Appropriate Protocol

Notify Destination or

Contact Medical Control

Monitor and Reassess

Monitor for fluid overload

NO

I

NO

YES YES

Hypotension /

Entrapped > 1

hour

P

Crush Syndrome Trauma

Protocol T2

Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS2012