Written By: Dr. Jassin Jouria
A 53-year-old male is brought to the Trauma Center after accidentally getting pinned between a forklift and a concrete wall during a construction project. Nearby workers called for an ambulance when they had difficulty getting the man’s lower leg out. He complains of severe localized pain at his calf, and not being able to feel his ankle or foot. With obvious concern for a neurovascular compromise and compartment syndrome, the trauma physician immediately takes the patient to the operating suite for operative exploration.
Crush injuries constitute the major chunk of such workplace injuries. These are most likely to occur in big industrial units with heavy machinery.
These injuries occur when the body is subjected to heavy direct pressure. A high magnitude of pressure is delivered to the body when it gets sandwiched between two heavy objects or two parts of a single object. A crush injury can also happen by the fall of any heavy item on the body or vice versa. The severity can range from mild bruising of the finger to amputated limbs. Hence, these injuries are serious and may lead to amputations, disability, or even death.
Statistics on Crush injuries
According to the bureau of labor statistics, crush injuries account for 16.7% of occupational accidents. In the US, workers bear 50% of the cost of these injuries. It makes a total of $100 billion per annum.
What are the Common Causes of Crush Injuries?
Crushing force on the body by any means can culminate in crush injuries. In industrial settings, crush injuries most often occur by:
- Forklifts: These are transport vehicles that carry heavy loads. Forklifts are a major cause of crush injuries. They can tip over their operator or equipment handlers, trap a person with some solid object, or cause a fall on any body part.
- Big machines with moving parts: The handling of movable parts of heavy machinery is another cause of industrial crush injuries. Moving metallic handles can entrap the body exerting enormous pressure. Punch presses, power shear equipment, and brake presses are examples of such machines.
- Conveyor Belts: These are known for causing the majority of hand injuries in industrial settings. The moving belt catches the limbs between itself and an object. The tightly entrapped part gets crushed severely.
The other notable causes of crush injuries include falling from a height, structural collapse of a building or a machine, and hitting by a moving metallic object.
Effects of Crush Injuries on The Body
Crush injuries are usually serious and need prompt management. They can range from mild finger laceration to whole limb amputation. Entrapment of body parts in mild pressure objects for a shorter duration is usually manageable with symptoms of bruises, lacerations, and mild pain.
However, major crush injuries exerting enormous force can prove devastating. They injure the tissues, muscles, and bones. Due to high pressure from heavy objects, blood supply is compromised resulting in tissue death. A metallic object can itself amputate a body part if hit with extreme force or ischemic can culminate in surgical amputation to save the life.
Big open wounds or lacerations can get infected with longer hospital stays. Symptoms of major crush injuries include damaged muscles and bones, Severe pain, open dirty wounds, compartment syndrome, and amputations.
In severe cases, a person may not survive a heavy crush injury if stuck between two solid objects for a longer duration. If only a peripheral part is involved in an accident, it usually results in amputation. Major effects of these crush injuries can be summarized as:
- Damage to skin, muscles, bones, and nerves
- Head injuries
- Paralysis
- Head trauma
- Amputated limbs
- Bone fractures
- Big open wounds
- Organ death
- Sepsis
- Death
How to Avoid Crush Injuries in the Workplace?
There is always a risk of getting injuries while dealing with machinery. Crush injuries can be decreased to a great deal if certain precautions are strictly adopted. Though, complete avoidance is not possible due to the nature of the work. There are some general guidelines and some specific rules to prevent crush injuries among workers.
Four basic steps are taken to formulate a plan for general health safety in industrial workers:
- Identifying hazards
- Assessment of risks
- Controlling risk
- Reviewing process
Every country has protection guidelines for its industrial workers. These health guidelines aim to protect labor, avoid disabilities and offer financial support in case of injury. In the US, OSHA (occupational safety and health administration) has detailed guidelines in every industry that are aimed to reduce crush injury accidents. Here are a few basic principles to avoid crush injuries in the workplace:
- Wear complete protective gear according to the nature of the job. Good quality gloves, helmets, masks, glasses, and cloth covers are among the necessities.
- Get to know the role of the job and the type of work in detail. Have a clear idea about possible risks.
- Read the manual about the handling of machinery. Do not neglect safety instructions.
- A manager should make sure about the provision of protective wear and proper training of operating machines.
- Do not operate faulty equipment. Check, repair, and maintain it. Fit safety shields on belts and other possible parts.
- Make sure to avoid loose clothes during work hours.
- Avoid shortcuts and careless handling.
When to Seek Medical Attention?
Visit a doctor at the earliest in case of any crush injury. Cases of injuries with only bruising, mild pain, and no loss of mobility can be managed conservatively at the workplace. Anyhow, the majority of cases require proper evaluation by a clinician.
The classic symptoms to rush to the hospital include bleeding, open wound, numbness, swelling, restricted mobility, and severe pain. Initial first aid facility should be utilized if present within industry premises. Trained staff should ensure scene safety. Bleeding should be stopped with pressure dressing at the earliest. In the hospital, management is planned after a physical examination and necessary investigations.
After completing initial lifesaving protocols, surgery is usually required in the majority of crush injuries to stitch the wounds, repair tissues, correct fractures, and amputate the ischemic limb if required.
Meet the Author Dr. Jassin Jouria
Dr. Jassin Jouria is a practicing Emergency Medicine Physician who specializes in resuscitation of critical patients. The majority of his clinical work is at the Decatur County Memorial Hospital Emergency Department in Greensburg, Indiana. Learn More About the Author.
References:
- https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1202
- https://injuryfacts.nsc.org/work/work-overview/top-work-related-injury-causes/data-details/
- https://www.betterhealth.vic.gov.au/health/healthyliving/farm-safety-crush-injuries
- https://www.hg.org/legal-articles/crush-injuries-in-the-workplace-preventing-work-accidents-35113
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