Multidisciplinary approach to a 93-year-old survivor with crush syndrome: A 124-h rescue operation after the 2024 Noto Peninsula earthquake

Natural disasters, such as earthquakes, pose significant global threats. On January 1, 2024, a devastating 7.6 magnitude earthquake struck Japan's Noto Peninsula, causing widespread destruction and loss of life. The quake resulted in at least 241 deaths, 1536 injuries, and extensive damage to buildings, leading to 34,694 people seeking refuge in shelters.¹ The survival of a 93-year-old woman trapped for over 5 days sheds light on human resilience and medical management during disasters. This letter describes a rare extrication scenario in a disaster setting, focusing on a successful multidisciplinary approach used to manage crush injuries.

On January 6, 2024, amidst the chaos following the earthquake, a critical rescue operation was undertaken in Suzu City to save a 93-year-old woman trapped under debris. A team comprising police, firefighters, and medical personnel, including a doctor and two nurses from a medical non-governmental organization, collaborated on the rescue efforts. The patient, found with her thighs pinned under heavy beams, displayed signs of subsequent crush injury. Her initial medical assessment revealed unstable vital signs with low blood pressure. The administration of 2500 mL of lactated Ringer's solution, 40 mL of sodium bicarbonate, and 10 mL of calcium gluconate, along with the use of hot bags for warming, was instrumental in stabilizing the patient's condition before extrication (Figure 1). The medical team worked in the hot zone (collapsed home confined space) for 15 min. In addition to these medical interventions, we used hot water-filled plastic bags placed against her torso to counteract potential hypothermia. Additionally, continuous verbal reassurance was provided by the rescue team, an essential part of maintaining her consciousness and morale during the entrapment. Decompression occurred 150 min after the initial intervention, and the patient was extracted 240 min after first contact (124 h after onset). Post-extraction, the patient's Glasgow Coma Scale score improved from E3V2M6 to E3V4M6, with sensory disturbances noted in her left lower limb. She was admitted to a nearby tertiary hospital. Laboratory tests showed creatine kinase of 13,475 U/L, potassium of 5.5.mmol/L and creatinine of 1.74 mg/dL confirming crush syndrome and compartment syndrome in the left leg, necessitating a fasciotomy. She was treated with fluid therapy; dialysis was unnecessary. The patient continued her recovery.

Crush syndrome, a significant concern in earthquake disasters, is known to be one of the leading causes of mortality, even after successful rescues.^{2, 3} This was evident in the 2024 Noto Peninsula earthquake, where at least six fatalities were reported due to crush syndrome, underscoring the severity of the condition in post-disaster medical challenges. Comparatively, the 2023 Kahramanmaras earthquake in Turkey also caused a considerable number of crush injuries, 7.7% of the total injuries,⁴ highlighting the global prevalence of this issue in seismic events. However, data related to crush syndrome post-earthquake remains few, emphasizing the need for comprehensive reporting and analysis to better understand the pathological condition and mortality. This is the first reported case of confined space rescue and medicine that was delivered practically and timely in Japan after an earthquake. The proactive management of crush syndrome in the 93-year-old survivor through early fluid therapy and multidisciplinary care contributed to her survival. We believe that such collaborative effort between the rescue, police and medical teams was a decisive factor in the successful outcome of this complex operation at the site of disaster. Our experience enhances our understanding of the challenges and required strategies in disaster medicine.

Dr. Atsunori Nakao is an Editorial Board member of AMS Journal and a co-author of this article. To minimize bias, they were excluded from all editorial decision-making related to the acceptance of this article for publication.

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Informed consent: Yes.

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Animal studies: N/A.