Who does this guideline apply to?

This guideline applies to adults, adolescents and children.

Who is the audience for this guideline?

This guideline is for bystanders, first aiders and first aid providers.

Summary of Recommendations

The Australian and New Zealand Committee on Resuscitation (ANZCOR) makes the following recommendations [all Good Practice Statements]:

1. Remove all crushing forces as soon as possible if safe to do so.
2. Control external bleeding.
3. Do not routinely apply arterial tourniquets before the removal of the crushing force unless there is actual or suspected life-threatening bleeding.
4. All persons who have been subjected to crush injury, including from their own body weight, should be taken to hospital for immediate treatment.

Crush injuries may result from a variety of situations, including vehicle entrapment, falling debris, industrial accidents or by prolonged pressure to a part of the body due to a person’s own body weight in an immobile person.^1-5 Crush syndrome refers to the multiple problems that may subsequently develop, most commonly as a result of crush injuries to the limbs, particularly the legs^1. Crush syndrome results from disruption of the body’s chemistry and can result in kidney, heart and other problems. The likelihood of developing acute crush syndrome is directly related to the compression time, therefore crushed persons should be released as quickly as possible, irrespective of how long they have been trapped.^{1, 2}

Crush injury should be suspected whenever there is a crushing force.  A crush injury should be suspected whenever a part of the body is crushed or compressed or when you are unable to fully see or examine a part of the body.

Crush injury can also result from prolonged pressure to a part of the body due to the person’s own body weight when immobile and may show few signs or symptoms.

Persons with crush injuries may show signs and symptoms of bleeding (Refer to ANZCOR Guideline 9.1.1, ANZCOR Guideline Shock 9.2.3 and ANZCOR Guideline First Aid Management of Hypothermia and Cold-Related Injuries 9.3.3).

A person with a crush injury may not complain of pain, and there may be no external signs of injury. All persons who have been subjected to crush injury, including from their own body weight, should be taken to hospital for immediate investigation.^2-4

If the person is unresponsive and not breathing normally, follow ANZCOR Basic Life Support Flowchart (Guideline 8).

1. Ensure your safety and the safety of others [Good Practice Statement].
2. Send for an ambulance [Good Practice Statement].
3. If it is safe to do so and physically possible, remove all crushing forces from the person as soon as possible¹ [Good Practice Statement].
4. Control any external bleeding^{5, 6} (Refer to ANZCOR Guideline 9.1.1) [Good Practice Statement].
5. Treat other injuries [Good Practice Statement].
6. Prevent or treat hypothermia (Refer to ANZCOR Guideline 9.3.3) [Good Practice Statement].
7. Reassure and constantly re-check the person’s condition for any deterioration [Good Practice Statement].
8. If the person is unconscious and breathing normally, follow ANZCOR Guideline 3 [Good Practice Statement].

There is insufficient evidence to recommend the routine use of tourniquets prior to the release of a crushing force to delay the onset of reperfusion injury.  We acknowledge the work of Schwartz et al in 2015⁷ but are waiting for higher certainty of evidence but note difficulty in conducting this research. 

Bleeding may be significant following the release of a crushing force. 

ANZCOR recommends the application of tourniquet(s) where there is actual or anticipated life-threatening bleeding from a limb, before or immediately following the removal of the crushing force (Refer to ANZCOR Guideline 9.1.1), on the proviso that this should not delay release of the crushed person [Good Practice Statement].

• ANZCOR Guideline 8 - Cardiopulmonary Resuscitation
• ANZCOR Guideline 9.1.1 - Principles for the control of bleeding for first aiders
• ANZCOR Guideline 9.2.3 - Shock
• ANZCOR Guideline 9.3.3 - Hypothermia: First Aid and Management

1. Greaves I, Porter K, Smith JE. Consensus statement on the early management of crush injury and prevention of crush syndrome. J R Army Med Corps. 2003;149(4):255-9.
2. Aoki N, Demsar J, Zupan B, Mozina M, Pretto EA, Oda J, et al. Predictive model for estimating risk of crush syndrome: a data mining approach. J Trauma. 2007;62(4):940-5.
3. Brown A, Nicholls R. Crush Syndrome: A report of 2 cases and a review of the literature. Brit J Surg. 1977;62(4):397-402.
4. Burns K, Cone DC, Portereiko JV. Complex extrication and crush injury. Prehosp Emerg Care. 2010;14(2):240-4.
5. Jagodzinski NA, Weerasinghe C, Porter K. Crush injuries and crush syndrome - A review. Part 1: The systemic injury. Trauma. 2010;12(2):69-88.
6. Hatamizadeh P, I N, Vanholder R, Rashid-Farokhi F. Epidemiological aspects of the Bam Earthquakes in Iran: the Nephrological Perspective. M J Kid Dis. 2006;47(3):428-38.
7. Schwartz DS, Weisner Z, Badar J. Immediate Lower Extremity Tourniquet Application to Delay Onset of Reperfusion Injury after Prolonged Crush Injury. Prehosp Emerg Care. 2015;19(4):544-

When citing the ANZCOR Guidelines we recommend:

ANZCOR, 2025, Guideline 9.1.7 - First Aid Management of Crush Injury, accessed 16 July 2025, https://www.anzcor.org/home/first-aid-management-of-injuries/guideline-9-1-7-first-aid-management-of-crush-injury