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pelled to provide outstanding
hospitals and medical care in this
area so that the population feels
safe and remains.
"Besides, the distances in Is-
rael are so short that we can get
to any casualty site readily and
see the casualties early. There's
probably no other place in the
world where a medical facility is
so close to all the front lines in a
country and can easily test the
theory of early intervention."
It is now 55 years after the
classic description was developed
of what was then termed the
crush syndrome. It described in-
juries suffered by civilians dur-
ing the German bombing blitz of
London in 1940-1941.
running marathons might have
experienced the same thing"
ez
plains Dr. Better. "Although it
doesn't happen with everyone
the degeneration of the muscles'
of these soldiers released the
myoglobin into the urine. Al.
though it's not known why as yet,
these soldiers required more flu-
id intake than the rest of the
troops."
The medical profession, as well
as national armies, are now well
aware that after extensive mus-
cle damage only early, aggressive
intravenous volume replacement
will prevent irreversible shock.
During rescues from a collapsed
building or wrecked auto, saline
solution is infused as soon as one
of the trapped person's limbs has
been freed. It may be another45
Feeding
to 90 minutes before the entire
body is carefully freed and the in-
fluids
jured person is taken to a hos-
pital.
before
The rescue team at the Tech-
nion Crush Syndrome Center,
excavation.
the only academic center in Is-
rael specializing in rescuing and
Dr. Better has slides and pho- treating victims of mass disas.
tos of those years. They show vic- ters, consists of civil engineers to
tims being dragged out of the help clear the rubble and physi.
rubble by their shoulders or legs. cians across disciplines areas.
More than 40,000 civilians died.
"When we hear of a disaster,
Since that time, medical re- we generally call and offer our
search has learned what happens services because at Technion
when muscle tissue is injured we're prepared for disasters with
and why the results can be so fa- large quantities of intravenous
tal.
fluid bags and related equipment
When fallen cement, steel gird- for rapid transport to the site of
ers or anything heavy lies on the a rescue operation," Dr. Better
body and has the victim immo- says.
bilized, the pressure from the
He served in the Israel Army
weight of the debris causes the during the 1948, 1956 and 1967
membranes around the muscles wars and for 10 years was a re-
to stretch. Within an hour or so, serve regimental medical officer
that pressure produces holes in in the Paratroop Brigade. He is
the membrane. It is through now associated with the Section
these holes that the body's fluids for Salvage Rescue of the Home-
leak into the muscles and the front Command.
muscles swell to a frightening
"In disasters that occur in re-
size. If left untreated, the limbs mote areas, we're prepared to air-
become hard and must often be drop medical and paramedical
amputated if the victim survives. personnel and equipment," says
Eventually, the trapped vic- Dr. Better. "Our goal has always
tim's body is left without fluids been to make ourselves available
so that there is no circulation. As to disasters, wherever they hap
a result, the victim goes into pen. The procedure was usedaf-
shock.
ter the bombing of the Jewish
At the same time, two of the community center in Buenos
substances that were in the mus- Aires and after SCUD missile at-
cle begin to leak out through the tacks during the Gulf War. The
holes. Potassium is one and, Israeli, Swiss and NATO military
when it's no longer available, the have all adopted the procedure.
victim's blood pressure rises
Dr. Better founded the
rapidly.
nephrology transplant service at
i
Myoglobin is the second, and the Rambam Hospital in Haifa,
begins leaking into the body as oversaw the first cadaver kidney
the muscles degenerate. When transplant in Israel and estab-
myoglobin reaches the kidney, it lished similar services in Cyprus
is lethal.
and on the West Bank. C:1
Dr. Better's response is to re-
plenish the body's fluids as quick-
ly as possible.
The normal deadline for local
Trained as a kidney specialist,
news and publicity items is
in the 1970s Dr. Better noticed
noon Thursday, eight days
that some of the elite troops in
prior to issue date. The dead-
the Israeli Army had traces of
line for out-of-town obituar-
myoglobin in their urine after
ies is 10 a.m. Tuesday, three
strenuous marches.
days prior to issue date.
"Some of you who train for
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