The Red Crescent's Triage Framework for Crush Injury Cases at Public Events

Abstract

Mass gatherings (MGs) present a significant risk for crush disasters, where the resulting crush injuries can lead to the lethal Crush Syndrome (CS). Standard trauma triage systems are ill-equipped to identify patients at risk for CS, who may appear stable initially but succumb to systemic complications like hyperkalemic cardiac arrest and acute kidney injury post-extrication. This review examines the evidence-based triage framework developed by the Red Crescent to address this critical gap in prehospital emergency care. A comprehensive literature review was conducted, analyzing peer-reviewed publications, disaster medicine reports, and official guidelines from humanitarian organizations. The development, structure, and application of the Red Crescent's protocol were evaluated with a focus on its pathophysiological rationale and operational practicality. The Red Crescent's framework is a product of a systematic methodology involving evidence synthesis, multi-disciplinary expert consultation, and field validation. It modifies the primary survey by integrating a "Mechanism" (M) component to identify prolonged compression. The secondary survey emphasizes rapid limb assessment for key indicators of compartment syndrome—palpable tenseness and sensory deficit—over late signs like pulselessness. Triage prioritization is directly linked to specific interventions; patients with a significant crush mechanism and signs of neurological compromise or myoglobinuria (detected via point-of-care urine dipstick) are categorized as Immediate (Red) and require aggressive, pre-emptive intravenous fluid resuscitation to prevent CS. The protocol is designed for seamless integration within the broader mass casualty incident response system, leveraging the Red Crescent's extensive volunteer network and logistical capabilities. The Red Crescent's crush injury triage framework represents a critical advancement in disaster medicine. By providing a structured, evidence-based tool for the early identification and prioritization of patients at risk for Crush Syndrome, it empowers responders to prevent predictable, delayed mortality in mass gathering settings. Its widespread adoption and integration into public event medical planning are essential for improving survival outcomes in these complex emergencies.