Secret Firefighter Killers

Joe SherrellEMS Officer

Tulsa Fire Department(918) 596-9808

jsherrell@cityoftulsa.org

Objectives Define Smoke Discuss the contents of fire smoke List the physical properties of CO and CN Describe the effects of CO & CN List the symptoms related to CO & CN

exposure Discuss the assessment method Discuss the treatment for smoke inhalation Understand the use of Cyanokit

RIT has removed the downed firefighter…

SMOKE

Smoke

the gaseous products of burning materials especially of organic originmade visible by the presence of

small particles of carbon

a suspension of particles in a gas

www.merriam-webster.com

Read It – Don’t Breathe ItRead It – Don’t Breathe It

Advantages:Advantages: LocationLocation Intensity Intensity ProgressionProgression EffectivenessEffectiveness Tactical MarkerTactical Marker

Smoke ContentsSmoke Contents•Hydrochloric AcidHydrochloric Acid•Sulfur DioxideSulfur Dioxide•Oxides of NitrogenOxides of Nitrogen•AmmoniaAmmonia•Carbon DioxideCarbon Dioxide•Hydrogen CyanideHydrogen Cyanide•Carbon MonoxideCarbon Monoxide•Hydrogen SulfideHydrogen Sulfide

Smoke = Smoke = PoisonPoison

TOXIC TWINS

Toxic Twins

Carbon Monoxide (CO) Hydrogen Cyanide (HCN)

Carbon Monoxide(CO)

Properties

Colorless Odorless Tasteless Flammable Gas

Where does it come from?

Produced when carbonaceous materials are burned with insufficient oxygen.

Annual Stats Over 2,000 deaths Several hundred thousand

exposed 20-40% suffer health damage

Physiologic Effects 250 times the affinity for

hemoglobin Displaces O2

Leads to Hypoxia

Symptoms

Headache Lethargy/

Fatigue Nausea Dizziness Confusion Dyspnea

Palpitations Convulsions Paralysis LOC Coma Death

Hydrogen Cyanide(HCN)

Properties

Colorless Bitter Almond Odor Gas

Sources in Fire Products

Polyurethane Foam Synthetic Rubber Nylon Asphalt Wool Silk

Physiologic Effects Prohibits the cells from using

oxygen Respiratory Paralysis Cardiac Irregularities

Symptoms – Low Levels

Bitter almond odor

Burning taste Numb Throat Salivation Nausea/Vomiting

Anxiety Confusion Vertigo Ataxia Giddiness

Symptoms – Moderate Levels

Hyperpnea Dyspnea Tachypnea Short Inspiration Prolonged Expiration Tachycardia

Symptoms – High Levels

LOC Coma Protruding

eyeballs Pupils dilated Bradycardia Respiratory

Arrest

Arrhythmias Convulsion Hypotension Incontinence Paralysis Sweating

Toxic Twins

Carbon Monoxide Attacks the blood

Hydrogen Cyanide Attacks the cells

ASSESSMENT

1st Priority

Move to a safe areaRemove GearEmergency Decon

Initial Assessment

ABCsMental StatusEtCO2

CO

Treat Life-ThreatsImmediately

TREATMENT

BLS Airway

Suction Airway Adjunct

Breathing High-flow O2

NRB or BVM

Circulation CPR

ALS

Advanced Airway Establish IV/IO

Large Bore

Treat for CN Poisoning

Confined space with smoke?

Soot around mouth/nose?Altered Mental Status?

Cyanokit Study

69 Patients73% Survived Of the 19 subjects who did not

survive, 13 were presented in cardiac arrest.

Blood Draw

Cyanokit may interfere with lab tests

If time allows, draw 2 vials of blood

Mechanism

Attaches to cyanide ion Allows cells to utilize O2

Excreted in urine

Contraindication

Hx of allergic reaction Safety not established in pediatrics

Safe even without cyanide exposure

Side Effects

Hypertension Red Discoloration

Precaution

Use a separate IV/IO line

Dosing

5g over 15 minutes

Preparation

Glass Bottle Mix 200 cc of NS Don’t Shake

Administration

IV/IO Mix with 200 cc Saline Leave box in place 15 minutes “Power Syringe”

Tulsa Kit

Carried by:

District ChiefsEMS Supervisor (C835)

Assigned Apparatus

Expiration

SecuritySeals

Tulsa Kit Cyanokit

Drug Transfer Spike Vented IV Tubing

NS 100cc (2) Syringe 30cc Stopcock Extension Set Needle Vaccutainer (2)

TRANSPORT

Hyperbaric Oxygen Therapy

Consider if: GCS 13 Pregnancy

Consult OLMC

Facilities OSUMC (Tulsa) Integris Baptist (OKC)

Care Transfer

Describe Scene Cyanokit Use Provide Blood Samples

Summary

•Toxic Twins

•Move to a safe area

•Rapid Assessment

•Oxygenation/Ventilatory Support

•Cyanokit

Questions

References

Bledsoe, Malone, Slattery, Carrison, Evans, Johnson. Cyanide, Carbon Monoxide or Both? A protocol for an Organized Response to the Downed Firefighter or Victim of Toxic Gas Exposure.

Cyanokit Administration Guide

Eckstein, Mark & Manisacalco, Paul. Focus on Smoke Inhalation – The most Common Cause of Acute Cyanide Poisoning. 2006.

Mcevoy, Mike. Cyanokit Setup and Administration. www.firengineering.com

Penney, David G. The Toxic Twins: An advanced Perspective on Cyanide and Carbon Monoxide Poisoning

Shapiro, Arnold. Rescue 911 Episdoe-522.

State of Oklahoma Department of Health EMS Protocols

Smoke Inhalation & Hydrogen Cyanide Poisoning. Journal of Emergency Medical Services. 2004.

Schnepp, Rob. To Hell and Back. The Peoples Burn Foundation

Zemeckis, Robert, 1994. Forrest Gump. Paramount.