Coalition presents national research revealing cyanide risk versus preparedness gap
Las Vegas, Nev. — Recognizing that limited awareness of sources of cyanide poisoning pose a risk to the health and safety of communities across the county, leading fire, medical and industry organizations announced today the formation of the Cyanide Poisoning Treatment Coalition (CPTC), a national non-profit organization seeking to foster a rational approach to the diagnosis and treatment of cyanide poisoning through increased research, advocacy and education. The Coalition has also launched an educational Website, www.cyanidepoisoning.org, to provide information on cyanide poisoning and Coalition membership and sponsorship opportunities.
The Coalition will host its first educational exhibit for attendees of the annual Fire-Rescue Med Conference on April 24 and 25. The conference, sponsored by the International Association of Fire Chiefs - EMS Section, is being held at the Orleans Hotel and Casino in Las Vegas and will also feature the first CPTC-endorsed educational program on diagnosing and treating cyanide: “Cyanide Detection and Treatment - Instructor Course” presented by National Association of EMS Educators (Saturday, April 22, 12:30 pm - 4:30 pm).
Studies have shown that smoke inhalation is the primary cause of death in 60 to 80 percent1 of the almost 4,000 fire deaths and more than 20,000 injuries in the Unites States every year.2 Firefighters, children and the elderly are at especially high risk of fire-related injury or death. Many residential fires are started by the ignition of common household objects, such as mattresses and other bedding materials, which are highly likely to contain the natural and synthetic materials that release hydrogen cyanide when they burn.3
Recently, cyanide played a part in three fires in Providence, Rhode Island which sent several firefighters to the hospital with cyanide poisoning. While the fires are still under investigation, it is believed the source of the cyanide was from items releasing the gas while burning in the homes and businesses. The Providence Fire Department has formed a task force to conduct a review of the facts that led to the exposure and to take appropriate steps to ensure firefighters are adequately protected in the future.
“The recent incidents in Rhode Island show that one of the most common ways the general public may be affected by cyanide poisoning is through smoke inhalation from structure fires,” said Donald Walsh, EMT-P, Ph.D, President of the Board of the Cyanide Poisoning Treatment Coalition and Assistant Deputy Fire Commissioner of the Chicago Fire Department. “The U.S. fire-related death rate continues to rank as one of the highest in developing countries despite our targeted efforts to reduce the toll. We need to look at cyanide poisoning risk factors very closely in the U.S. - they are overlooked, and in some cases, instances of poisoning are not recognized or treated,” said Dr. Walsh.
Organizations with Participating Representatives American College of Emergency Physicians American College of Occupational and Environmental Medicine Academy of Certified Hazardous Materials Managers International Association of Fire Chiefs, EMS Section National Association of EMS Educators National Association of Emergency Medical Technicians National Association of EMS Physicians National Association of State EMS Officials
Gauging Awareness of Cyanide: Exposure Risk and Treatment Preparedness RTI National Survey on Cyanide Risk and Preparedness Conducted by RTI (Research Triangle Institute) International, this survey polled Advanced Life Support (ALS) emergency medical service (EMS) providers from 832 fire departments and 507 ALS providers around the country. Findings included:
* Only 35 percent polled believed they were likely or very likely to be exposed to cyanide as a result of a fire in their service area in spite of information from the Agency for Toxic Substances and Disease Registry (ATSDR) of the U.S. Department of Health and Human Services, indicating that a majority of the estimated 1.838 billion pounds of cyanide produced in the U.S. in 2004 was used to produce plastics, acrylics, adhesives and laminates used in building construction, interior decoration or furnishings and in transportation vehicle interiors.
* The survey also found 79 percent of ALS providers indicate no Cyanide Antidote Kits are stocked on their “standard” ALS vehicles. Antidotal therapy is essential to reversing poisoning unless only mild exposure has occurred.
Rocky Mountain Poison and Drug Center Survey Results on Hospital Preparedness In a study conducted by the Rocky Mountain Poison and Drug Center, hospitals were evaluated for preparedness to treat cyanide poisoning and data results were presented at the 2005 North American Congress of Clinical Toxicology. Findings included:
* Results showed a significant difference in treatment capacities (as gauged by quantities of antidotes stocked) between various regions - with metropolitan areas in the Northeast having almost twice the capacity to treat people with cyanide poisoning as metropolitan areas in other regions.
* The study also found that some hospital stocking guidelines only recommend keeping a supply of one Cyanide Antidote Kit on hand - a supply not typically considered adequate for managing multiple victims as in terrorist attacks, large structural fires or other disaster-related events.
“The general lack of knowledge about cyanide poisoning and insufficient antidote stocking levels are alarming and are two essential areas in which the CPTC plans to focus educational efforts,” said Dr. Walsh. “In the coming months, the CPTC plans to develop and implement a variety of educational programs and tools to assist fire service and emergency response managers and emergency medical providers, including doctors, nurses and first responders, to help improve emergency preparedness, early recognition and response to incidents of cyanide poisoning.”
About the Cyanide Poisoning Treatment Coalition
The Cyanide Poisoning Treatment Coalition is a 501(c)(3) non-profit made up of organizations and individuals whose members have direct involvement with the identification and treatment of cyanide exposure. Currently, there are few resources that raise awareness and educate professionals about the potential danger of cyanide exposure. Through joint strategic initiatives to focus the required attention and resources on the issues, the members of the CPTC aim to increase
awareness surrounding the dangers of cyanide exposure. For more information on cyanide poisoning, how to obtain a CPTC membership application or become a sponsor, please visit the Coalition website at www.cyanidepoisoning.org.
CPTC Board of Directors
President
Donald Walsh, PhD, EMT-P, International Emergency Medicine Disaster
Specialists and Assistant Deputy Fire Commissioner of the Chicago Fire
Department, Chicago Illinois Vice President
David Cone, MD, Associate Professor and Chief, Division of EMS, Yale
University School of Medicine, New Haven, Connecticut
Secretary/Treasurer
Bruce Evans, MPA, Captain, Operations Division, Henderson Fire Department,
Henderson, Nevada
Director
Daniel O’Brien, MD, FACEP, FAAEM, Medical Director, Kentucky Emergency
Medical System
Director
Jonathan Borak, MD, DABT, Associate Clinical Professor of Medicine,
Epidemiology and Public Health, Yale University and Director, Yale
Interdisciplinary Risk Assessment Forum
Director
Dennis Rubin, Fire Chief, City of Atlanta
Director
Keith Wesley, MD, FACEP, Medical Director, Chippewa (WI) Fire District and
Bayfield-Ashland (WI) County EMS
The Cyanide Poisoning Treatment Coalition was founded through an unrestricted educational grant from EMD Pharmaceuticals and is currently seeking additional sponsors. Please visit our website for more information or to become a sponsor.
About Cyanide: Toxicity and Prevalence
Cyanide is a chemical that exists in several compounds and physical forms. The gaseous form, hydrogen cyanide, is present in vehicle exhaust and tobacco smoke, and is produced during structure fires when products containing carbon and nitrogen, such as wool, paper, cotton, silk and plastics, pyrolize or incompletely burn. Inhaling smoke from one of these common building fires is likely the most common source of cyanide poisoning. Liquid forms of cyanide are one of the very few soluble compounds of gold, and thus are used in electroplating, gold mining, metallurgy and jewelry for chemical gilding, buffing, and extraction of gold.
Once a person has come into contact with cyanide, it is absorbed and released into the bloodstream and enters the body cells where the cyanide disrupts the body’s ability to utilize oxygen properly, even in the presence of normal oxygen levels. Unable to use oxygen, the body’s cells begin to produce toxic byproducts, such as lactic acid, that ultimately kill the cells. Cyanide poisoning is most harmful to vital organs, such as the heart and the brain, which are dependent on oxygen to function properly; therefore, the first symptoms of cyanide poisoning appear at the neurological and cardiovascular levels. At
moderate to high concentrations of cyanide exposure, victims can become incapacitated within seconds, and without treatment death can occur within minutes.
References
1 Teofilo L. Lee-Chiong Jr.,MD “Smoke Inhalation Injury” Postgraduate Medicine, Vol. 105, No. 2, February 1999.
2 USFA website: http://www.usfa.fema.gov/statistics/national/
3 U.S. Fire Administration Topical Fire Research Series: Mattress and Bedding Fires in Residential Structures; Vol. 2, Issue 17 (March 2002).