Barriers delaying treatment in cases at risk of crush syndrome in major disasters: Kahramanmaraş earthquake experience

Abstract

Background Crush syndrome is a life-threatening condition in disasters, particularly earthquakes. Early fluid therapy is criti cal to reduce morbidity and mortality, yet disaster settings often hinder timely intervention. Methods This qualitative phenomenological study explored the experiences of 20 emergency medical service personnel involved during the acute phase of the February 6, 2023 Kahramanmaraş earthquakes. Data were collected through in-depth interviews, transcribed verbatim, and analyzed using MAXQDA 2020. Results Three primary treatment initiation points were identified: during extrication, after rescue at the scene, and inside the ambulance. Five key barriers to timely crush syndrome intervention emerged: (1) crowd density, (2) media interference, (3) inadequate search and rescue training, (4) lack of scene safety, and (5) resource shortages. These factors significantly delayed early fluid therapy for high-risk patients. Conclusions Although emergency medical service personnel recognize the urgency of early crush syndrome treatment, oper ational barriers impede timely care. Integrating health-care professionals into search and rescue teams, improving inter-agency coordination, and ensuring scene safety are essential strategies for enabling earlier intervention. These findings highlight the need for targeted disaster preparedness policies addressing crush syndrome-specific response requirements.