“Many people can die from relatively minor injuries if not treated soon enough after a disaster,” says Dr Elmin Steyn, head of the trauma units of the City Park and Vincent Pallotti Hospitals.

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Collapsed lungs, severe blood loss, blockage of the airways, fractures, smoke inhalation and the crush syndrome are all treatable injuries that need not be fatal if treatment comes soon enough. The Golden Hour is the 60 minutes when fairly severe injuries can still be treated and lives saved.

Inhaling smoke very dangerous
“In the case of an explosion and a fire, burns and inhalation injuries can kill many people, especially those who already suffer from lung complaints,” says Dr Steyn.

People trapped in a confined space with a fire raging in a building could suffer both fatal burns and fatal inhalation injuries.

In the latter the cells in the lungs swell, water builds up and the victim is unable to breathe and oxygenate his blood through his lungs. This is similar to the symptoms of fatal pneumonia, Dr Steyn explained.

“If warm smoke is inhaled, the mucous membranes and the vocal cords swell and close up, preventing breathing.

Unconscious people can no longer control their breathing and do not have a cough reflex reaction if their airways are blocked by blood, vomit or spit. If they are reached soon enough, their airways can be re-opened by paramedics at the trauma scene. If not, they can die.

Blood loss, airway obstructions most serious
Multiple fractures are often common amongst those that survive the kind of catastrophe experienced in SE Asia. Fractures in themselves will not be fatal, unless the broken bones damage internal organs or lead to a huge loss of blood. Non-life threatening fractures, will, in the Golden Hour, not take precedence over airway obstructions and severe blood loss or third degree burns.

Healthy young people can lose approximately half of the blood in their bodies before they die.

It depends largely on how many different injuries have been sustained and how serious they are. Once again, if someone receives a transfusion within the Golden Hour, blood loss should not lead to death, according to Dr Steyn.

Crush Syndrome
The crush syndrome kills many people when buildings collapse in explosions or earthquakes.

Ostensibly, a sufferer of this syndrome might not have such severe external injuries, but might have such extensive internal bruising and damage to soft tissue that toxins from the damaged areas can get into the bloodstream and cause kidney failure.

It also often happens that minor head wounds that bleed severely or other cuts attract trauma surgeons’ attention and the possibility of ‘crush syndrome’ is forgotten.

Life before limb in a disaster like this?
Trauma surgeons were having to amputate limbs of trapped survivors in the rubble. The principle followed by trauma surgeons is ‘life before limb’.

If one can save someone’s life by amputating a limb in order to free them, one should not hesitate, says Steyn.

Trying to save a severely injured limb can sometimes cost someone’s life, as toxins from the dead tissue in the injured limbs can lead to kidney and lung failure. Often debris from collapsed buildings or wreckage from cars stops bloodflow to the rest of the body, and restoring the bloodflow from this severely injured limb could be fatal.

Often amputation is the only way to save someone’s life. If someone can be removed from the scene of the disaster, the chances are also greater that other injuries can be treated properly, thereby greatly increasing their chances of survival.

Trapped, and shocked
Once trapped in the debris of a building, a person may die as a result of dehydration, the effects of shock or blocked airways. If the temperatures are low, hypothermia could set in, speeding up the very real possibility of death.

During the Golden Hour paramedics can give lifesaving blood transfusions, stop excessive bleeding, open blocked airways and give intravenous fluids to counteract kidney failure in the case of ‘crush syndrome’”, adds Dr Steyn. - (Health24)

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