Report from the Special Committee on Crush Syndrome of the Japan Association for Disaster Medicine (JADM): Strengthening Multidisciplinary Collaboration and Response Systems to Improve CS Survival

Introduction: The occurrence of crush syndrome (CS) during large-scale disasters, such as the Hanshin-Awaji earthquake, has demonstrated the critical need for a well-structured response system to improve survival rates. CS often leads to severe complications like acute kidney injury, necessitating immediate and coordinated medical intervention. Proper rescue, rear-area transport, and multidisciplinary hospital treatment must be ensured from the onset of a disaster. Furthermore, a unified response across multiple agencies, including healthcare professionals, emergency services, and international support organizations, is vital to ensure the efficient management of CS cases. Methods: Our Research Group, under the Ministry of Health, Labour, and Welfare, conducted a comprehensive analysis of CS occurrence in past disasters. This included evaluating on-site response protocols, standardizing treatment procedures (such as dialysis), and reviewing surgical interventions. The committee established within the academic society focused on accumulating case data, preserving historical knowledge, understanding international standards, and sharing new findings through educational activities. Research was also conducted on the effectiveness of various treatment modalities, such as early blood purification therapies. Results: Several key issues were identified: the need for a consistent severity classification system for CS patients, the revision of long-distance transport protocols, and a reassessment of the Crush Injury Cocktail. Additionally, the utility of decompressive fasciotomy, amputation, and the timing of early blood purification therapies were evaluated. Based on research, updated guidelines for long-distance transport and comprehensive treatment, incorporating both intensive care and surgical intervention, were proposed. Knowledge sharing was expanded through international collaborations and participation in global working groups. Conclusion: Future efforts will focus on strengthening interagency and international collaborations, along with proactive academic and public education initiatives. Comprehensive investigations of CS cases from recent disasters, such as the Noto and Kumamoto earthquakes, will be conducted to further enhance disaster preparedness and response strategies.