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Disasters: What causes death after rescue?

February 15, 2023

They survived the earthquakes in Turkey or Syria, waited days under the rubble for help, were rescued — and died shortly after. What causes post-rescue death?

People standing atop rubble in Syria
Aid and rescue crews have not been able to reach many of the worst-struck areas in Syria and Turkey, pushing people to dig in the rubble to try to locate their loved ones on their own.Image: Mahmoud Hassano/REUTERS

After the massive earthquakes in Syria and Turkey, Zeynep spent over 100 hours under the rubble of a collapsed house before rescue workers were finally able to free her.

"The woman is doing well given the circumstances," a February 10 press release from the aid organization ISAR Germany (International Search And Rescue), which was involved in the rescue, said.

Shortly after being freed, however, Zeynep died.

"She was still laughing on the way to the hospital," said emergency doctor Bastian Herbst, one of the ISAR doctors who helped rescue Zeynep from the rubble and transport her to help.

There could be 120,000 reasons why the woman died, said Herbst. Perhaps she had internal injuries that rescuers couldn't detect immediately. Or maybe Zeynep died the so-called "rescue" death.

Destroyed home in Turkey
People in Turkey and Syria are living on the streets, too worried about the possibility of aftershocks and further destruction to enter their homes.Image: Francisco Seco/AP Photo/picture alliance

Death by cold blood

"Rescue death has various causes," said Herbst.

One of them is hypothermia. The icy temperatures in the earthquake area work to constrict the blood vessels of people trapped under the rubble. This constriction ensures that as little valuable body heat as possible is lost to the environment through the skin or extremities. The temperature of the blood drops in these parts of the body, while the warm blood in the core of the body ensures the functioning of the vital organs.

Zeynep's recovery was complicated. "We had to move her a lot to be able to free her," said Herbst. Through this movement, the emergency doctor said Zeynep's blood vessels could have widened, allowing cold blood to flow to the core of her body. This could have caused cardiac arrhythmias and her subsequent death.

Search crews atop rubble
UN death counts estimate some 50,000 people killed in the Turkey-Syria earthquake and its aftershocksImage: Chris McGrath/Getty Images

Kidney damage and ventricular fibrillation

Or she could have experienced kidney damage and heart arrhythmia.

Although she was able to move her feet, "her legs were buried under stones and rubble," Herbst said. It is possible the tissue in her legs was damaged, causing her body to release myoglobin, a protein responsible for transporting oxygen within muscle cells when tissue is injured.

Once victims are freed and blood can suddenly flow unhindered again, the body can become flooded with myoglobin, which can lead to kidney failure and an associated increase in potassium levels. Too much potassium in the body can in turn lead to ventricular fibrillation (a type of irregular heart rhythm prohibiting the heart from pumping blood to the rest of the body) which is particularly dangerous for people with previous heart conditions.

Less stress leads to death

"We know it from shipwrecked people: The moment they see the rescue team, they won't allow themselves to drown," said Herbst, adding that stress hormones can keep organ functions maintained. When these hormones subside after rescue, the circulatory system can collapse.

Zeynep lost her husband and children in the earthquake.

"Perhaps she became aware of this, and it robbed her of her will to live," said Bastian Herbst. "We don't know."

Quake survivor pulled from the rubble dies in hospital

This article was translated from German. 

DW journalist Julia Vergin
Julia Vergin Senior editor and team lead for Science online