Health impact when a building or structure falls

From physical injuries, cuts, bruises, burns and fractures to inhaling powdered concrete, glass and other construction dust, or getting this dust in the eyes, there are many health implications of being in a building collapse.

A conference paper on the 1995 Hanshin-Awaji Earthquake in Japan, on bodily harm done when structures and buildings collapsed because of the earthquake, showed the following causes of death:

• Compression or suffocation
• Trauma, including bone fracture
• Burns
• Nasal obstruction, nasal compression, and upper airway obstruction
• The paper also found that injuries to the chest or abdomen (thoracic compression) could prove lethal

To be sure, this was just one disaster that was studied in detail. The kind of building materials used, and the manner of injury can vary widely in a structural collapse. Injuries can also vary, depending on where they occur and how they were sustained. Here’s a broad overview of the type of health problems that can arise after a structure collapses:

Crush injury is an injury caused by constant high pressure on one part of the body. This type of injury is uncommon outside of situations like a building collapse or a road accident.

Falling rubble may also lead to the following problems:

• Trauma: Blunt force trauma can cause a number of problems, from concussion (in case of an injury to the head) to fractures.
• Amputation: Falling rubble and materials can cause deep lacerations (cuts), in severe cases, even amputation of limbs. (This is different from cases where amputation has to be performed as a medical necessity to rescue or save the patient.)
• Organ damage: If rubble or materials fall on someone, then depending on the site of the injury, the amount of force and the duration for which the pressure is suffered, it could cause long-term damage to the organ.
• Other problems: At the site of a building collapse, there may be dust and aerosolised particles that can cause damage to the eyes and respiratory tract. Bruising and cuts are common injuries in a building collapse. Nerve injuries may also occur in a building collapse—these injuries may have long-term, even life-long, health implications. (Read more: Paralysis symptoms, causes, diagnosis, management and treatment)

Crush injuries where a skeletal muscle is badly crushed under rubble and remains under continued pressure anywhere from 15 minutes to several hours can cause shock and kidney failure—both complications associated with crush syndrome.

(Skeletal muscles are typically attached to our bones via tendons, and they are involved in voluntary movements such as walking.)

Crush syndrome occurs when crush injuries lead to bodily damage on a systemic level. Here is what happens in crush syndrome:

• The skeletal muscle that is under crushing pressure and oxygen deprivation starts to breakdown (rhabdomyolysis) and die (necrosis). This can cause acute tubular necrosis (the death of cells lining the tubes of the kidney) and eventually acute kidney failure.
• Muscle breaks down into a protein called myolysis, and minerals like potassium and phosphorus. Now, if the thing crushing the body is removed suddenly, it can release these substances into the blood as blood and oxygen start circulating again (reperfusion) and lead to acute kidney failure.
• Research shows that death by crush syndrome can happen in one of the following ways:
  • If the crush injury is to the head, the person may succumb due to severe head injury
  • Hyperkalemia or excess potassium which in turn can cause irregular heartbeat and cardiac arrest. Hyperkalemia is also a risk factor for chronic kidney disease
  • Hypovolemic shock or shock due to low blood volume (hypovolemia)
  • Renal failure
  • Coagulopathy or a blood disorder in which the patient cannot properly make clots to reduce bleeding
  • Haemorrhage or excessive internal or external bleeding
  • Sepsis or infection that can cause multiorgan damage and failure
  • Injury to the abdominal region can damage the organs and/or cause asphyxia. In some cases, crush syndrome may also result in acute respiratory distress syndrome (ARDS), a life-threatening condition in which fluid builds up in the tiny air sacs (alveoli) of the lungs, leading to severe breathing difficulties.

If building material such as iron sariya (rods used to reinforce structures) or broken window glass goes through a part of the body, it may cause impaling. This may lead to problems like:

• Excessive bleeding
• If the material goes through an internal organ like the lungs or liver, it could require emergency surgery

Rescue workers and first responders like the fire brigade are trained in how to evacuate a person with such an injury. For example, if someone has been impaled on an iron sariya, the sariya is not removed at the site. Instead, the patient is taken to a hospital, where an emergency ward doctor may remove the sariya or leave it in, depending on their analysis of what would be best for the patient.

Buildings are ideally made to last. They have a structural integrity that is reinforced in many different ways by architects and builders. Unfortunately, a weakness in one part of the building may trigger further damage (secondary fall risk) as other structures collapse around it. Rescue workers and bystanders need to be cautious, as these may cause further damage to health and life.

Asphyxiation or suffocation can occur in case the rubble or dust obstructs breathing. This is a serious health concern as it can lead to confusion, loss of consciousness and death within minutes.

Where rescue personnel are able to secure the person before death, asphyxiation can lead to other health problems in the long run. For example, in cases where the brain is deprived of oxygen for a prolonged period, it can lead to brain hypoxia which in turn can cause brain damage and other problems like loss of motor function.

You might have seen a number of materials at a construction site: sand, concrete, glass, brick, PVC pipes, etc. When a structure fails—during construction or afterwards—some of these materials can break apart. Depending on whether they break down into pieces or fine dust, they may cause inhalation of harmful substances, including particle dust and chemicals. These substances can enter the airways and cause long-term damage to the respiratory system.

Burns are a major concern when a building collapses—from an electrical short-circuit to flammable chemicals in homes and offices, there are many fire hazards that rescue workers from the National Disaster Response Force, first-responders like the police and bystanders who want to help need to consider.

Though rescue workers typically disconnect electrical and gas connections before entering a building that has collapsed, exposed electrical wiring and gas leakage do pose a risk.

The first 24-48 hours after an incident are crucial. Death in the first 24 hours mostly occurs by shock or airway obstruction and breathing problems. Death thereafter is often due to sepsis and multi-organ failure.

Typical injuries in a structure collapse include fractures, trauma, lacerations (cuts or open wounds), head injury, hypothermia (low body temperature), dehydration, and crush injury/crush syndrome. Victims may also inhale toxic fumes or dust, leading to further problems.

Treatment options may differ widely based on the nature of the person’s injuries, the situation (whether it is safe for rescue workers and medical staff to go in or better to remove everyone inside the collapsed structure before offering medical assistance) and the help available at the time. That said, here are some broad things that rescue workers and medical practitioners often do to save lives in case of a structure collapse:

• During rescue efforts, it is obviously important to remove anything that obstructs breathing first. To restore breathing, NDRF rescue workers may have equipment such as nebulizer, manual suction unit, oxygen concentrator, bag valve mask and pulse oximeter.
• It’s also important to take in the situation and understand if removing rubble or piece of construction material could cause significant bleeding—in these cases, a medical practitioner or trained rescue worker should ideally be on hand to tourniquet a wound to stop the bleeding.
• They may also need to splinter broken bones—depending on the soundness of the structure, this may be done before or after shifting the patient to a safe area.
• Concussion and head injuries require immediate hospitalization. A stiff neck collar (cervical collar) is often used to immobilize the head and neck, to avoid further damage to the head, neck and spine.
• Sometimes, on-site amputations are necessary to rescue a person from the collapsed structure or save them. This, too, needs to be done by a trained medical worker.
• Though it may seem counter-intuitive, it is a bad idea to relieve heavy pressure in case someone has been pinned down by rubble for over 15 minutes—medical staff should ideally be on hand as the pressure is relieved slowly. In case they suspect crush syndrome, the patient may be given fluid therapy with salts like sodium bicarb to make their urine more alkaline.

Rescue workers must always wear protective gear, including helmets, dust masks, earplugs, safety glasses, heavy-duty gloves, steel toe boots, and coveralls. 

Rescue work and what is known as confined space (medical) care require lots of training and skill to save lives. For example, for airway management in building collapse victims, rescue experts may use “suction, bag valve mask, oral airways, laryngoscope, nasotracheal tubes, and endotracheal tubes (to restore normal breathing).... If there is a concern of dust inhalation, then albuterol or ipratropium may be useful.” In case of suspected crush syndrome, doctors or trained rescue staff may need to start an intravenous drip—or where that is not possible, start an intraosseous line—to give the age-appropriate amount of saline. This requires a level of commitment to lifelong training saving lives that is truly commendable.

This article is a brief overview of the potential injuries—especially fatal injuries—that may occur when a building or structure collapses.