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From: iayork@panix.com (Ian A. York)
Newsgroups: alt.folklore.urban
Subject: Re: squished man (warning: contains icky stuff)
Date: 7 Mar 1996 10:47:25 -0500

In article <4hljii$t2l@saltmine.radix.net>, Ted Frank <moe@Radix.Net> wrote: >
>A paramedic whose wedding I recently attended told the concept to me in
>1990; he was retelling the story of someone hit by a commuter rail train.
>(I don't think he was present for the accident.) The reasoning he gave
>had something to do with the smashed internal organs falling apart once
>the crushing item left; it didn't seem implausible to me at the time

>Where's Ian Nork when you need him?

Ah, Dr. Frank, you were wise to consult with me. If you would be so kind as to assist, we shall begin by surgically dissecting the story. Scalpel, please ...

The story has these parts, as I understand it: 1. The person is fine while he's under pressure. 2. He'll die immediately, or very rapidly, once the pressure is off. 3. There's no medical intervention that can help him. 4. This is not a rare one-off, it's the typical result of crushing

Thank you, Dr. Frank. Now if you would hold the lamp while I play the cold, sterilizing light of pure logic upon the pieces ...

Crushed organs, and loss of some organ function, are unlikely to be the culprit. Organ function is either going to blow at once (e.g. heart) or else won't cause the instant death that's implied. Blood loss is more likely, and you can construct imaginary scenarios in which the pressure prevents massive blood loss which then occurs once the pressure is off; but these would be extremely unusual. If you can reach somebody, then the paramedics should be able to establish an IV access that will help, and there are other things that can be done (see below for a cite). In other words, the massive blood loss theory contradicts points 3. and 4.

Yes. Yes, I see. Now, Dr, Frank, I believe we will inject some facts into the discussion.

There is one factor that might come close to fitting the facts, and I suspect that this is the germ of the story. When limbs (etc) are blocked off the general circulation, they build up lactic acid and other metabolic wastes. On restoration of circulation, these wastes re-enter the system and can cause general badness. However, this is a predictable event, and with medical intervention death is far from inevitable.

And finally, Doctor, we should apply a tincture of reference to the affected surfaces.

My extensive medical library includes the book "Emergency Doctor" (no exclamation mark, damn it) by Edward Ziegler in cooperation with Lewis R. Goldfrank, M.D. (Ballantine Books, New York 1987, ISBN0-345-35664-0). Goldfrank was (is?) the dirctor of Emergency Medical Services at Bellevue Hospital in New York, and the book's about the emergency wards there. The book opens describing a case of a woman who had a crane fall on her - New Yorkers may remember this. The woman (Mrs. Gerney) had her legs crushed beneath the crane:

"Both of her legs were pinned at a point ten inches above the knees between an edge of the giant machine and the crumbled sidewalk. As the crane came to rest, her right leg seemed to be almost severed, her left severely crushed."

As with the UL versions, she was perfectly lucid:

"'She was surprisingly calm, a lovely woman with an air of detachment that was tremendously impressive.

'"Hello, doctor," she responded, and it was clear that she was in complete command of her faculties and was evidently in a mood of calm resignation.' [ ... ]

'While we were waiting for the large crane I went back down and talked with her while one of the paramedics started giving her the typed and cross-matched blood [ ... ]

Here's the critical part:

'Her pulse and respiration looked surprisingly good. My gravest concern now was turning to the moment when we got her free of the weight. Lactic acid builds up - a natural breakdown product of the body's own glucose metabolism with limited oxygen - in the compromised part of the lower extremities. This toxin when liberated to the systemic blood supply could cause complications, such as severe acidosis and shock. We planned to enclose her extremities in medical anti-shock trousers (MAST) as soon as she was free, to support her mangled legs and to minimize both bleeding and the lactic acid problem.'"

To make a long story short, the woman did not die when the pressure was released.

I haven't found anything in Medline about this, but narrowing down the search (I'm not going to look through everything that has the word "trauma" or "crushing" in it) is too difficult. But I'd call this legend generally false, though with a chewy truthful center (releasing pressure can cause problems) and possibly, though not certainly, with an actual episode where releasing pressure did cause death.

I'll send you the bill, Dr. Frank. It was a pleasure and a privilege to assist you in the operation that bears your name.

Ian