Cyanide toxicity in smoke inhalation victims

"If commercial flying had as many civilian fatalities as those relating to smoke and fire, there would be a public revolt," said Rob Schnepp, CPTC president and assistant chief of special operations for the Alameda County Fire Department in California. "The numbers aren't going down, and this tells me that we aren't addressing the problem adequately.

 A 2006 NFPA study reveals 87-percent of people who died in fires had toxic blood concentrations of cyanide -- these victims died from breathing the smoke long before the fire killed them and cyanide poisoning can be treated," said Schnepp. Informal data collection performed by the CPTC substantiates the crusade to reduce smoke inhalation deaths. Through June 15, 2009, first responders in the United States treated or transported 933 civilians for smoke inhalation and an additional 455 people died - 135 were children.

The first step to reducing smoke inhalation death is accepting that cyanide poisoning must be considered. "Contents in our homes concoct the perfect recipe for toxic smoke which is drastically different than 10 years ago. Today we have laminates, foam cushions, mattresses, plastics, and acrylics - all which emit hydrogen cyanide during the combustion process. Knowing that, cyanide poisoning should be suspected in any person exposed to smoke in a closed-space fire," said Shawn Longerich, executive director of the CPTC. When all first responders and emergency medical personnel understand how to diagnose cyanide toxicity and utilize suggested treatment protocols and preferred antidotal therapy, there is no question smoke inhalation deaths will substantially decline.

The Society of Academic Emergency Medicine recently awarded Maj. (Dr). Vikhyat Bebarta, Chief of Medical Toxicology and staff emergency physician the Best Basic Science Research Award for a year-long animal model research project comparing the two cyanide antidotes. The end result was the newer antidote caused a more rapid rise in blood pressure and eliminated cyanide from the blood. Research of this magnitude supports a call to action, most especially when thousands of lives can be saved.

To train first responders and emergency medical personnel about cyanide in fire smoke, the Cyanide Poisoning Treatment Coalition will host an educational Smoke Symposium on September 4, 2009 in the Dayton, Ohio area. According to instructor Dr. Donald Walsh, Retired Deputy Chief of the Chicago Fire Department, "professionals will present new pre-hospital care treatments to be considered by first responders and emergency medical personnel. There are new drug treatments on the market today that could drastically change the morbidity and mortality of fire smoke victims." Firefighters and first responders are eligible to attend, free of charge.

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