Hydrogen Cyanide - What Every Emergency Responder Needs to Know

By Captain Rick Rochford
Jacksonville Fire Rescue Department

Let me ask you a question. How often after a fire do you hear a firefighter complain of headaches, dizziness, or achiness? How often do you see a fellow firefighter stagger around incoherently after they leave the structure and not think twice about it? These symptoms are typical after a long, strenuous physical activity such as fighting a fire. Recent research indicates, however, that these symptoms could indicate cyanide poisoning which occurs in firefighters more often than previously recognized.

On February 20, 2003, a fire erupted at the Station Night Club in West Warrick, R.I., as the band Great White performed. Pyrotechnics on stage ignited the substandard sound proofing material. A total of 460 patrons were in attendance. One hundred people were killed and an additional 200 were injured. Investigative reports and testing from the National Institute of Standards and Technology (NIST) showed that upon ignition of the pyrotechnics the building was uninhabitable within 90 seconds due to the high concentrations of carbon monoxide and hydrogen cyanide.

In March of 2006, a firefighter in Providence, R.I., was diagnosed with cyanide poisoning after responding to a building fire. Over a period of 16 hours, seven more firefighters were diagnosed with cyanide poisoning, including one who suffered a heart attack while working the pump panel in the front of the residential structure. It was only through a series of coincidences that emergency room physicians checked that last firefighter for cyanide poisoning.

Incidents like the ones mentioned above are happening on a daily basis without any indication that these toxic substances are affecting firefighters. Annually, there are an estimated 20,000 residential structure fires that are caused by mattresses, pillows and bedding materials all of which are likely to contain synthetic materials that release hydrogen cyanide when they burn or smolder. When ignited, these same materials cause a fire to burn two to three times hotter and faster than natural products allowing fires to reach flashover much more quickly.

Cyanide has a half-life of one hour in the body which means that if a firefighter absorbs 100 mg/dl through the body it would take approximately eight hours for the toxic substance to metabolize out of their system. What happens if they respond to more fires during their shift or if the firefighter does not decontaminate after the fire? Where is this substance going to go? Is this substance going to continue to have harmful effects on their body?

The primary concerns regarding cyanide are its ability to cause fatal health issues and the inability or unavailability of assessing the problem. Research has shown that cyanide poisoning may occur up to eight days after exposure. The National Institute of Occupational Safety and Health (NIOSH) has recognized that electrocardiogram changes can be observed two to three weeks after a fire-related cyanide exposure. Collectively, this information raises grave concerns in light of the hundreds of firefighters that suffer heart attacks at fire scenes every year.

During a fire, cyanide poisoning affects a victim by cellular asphyxiation. As the victim inhales hydrogen cyanide it creates lactic acid within the tissues and muscles which inhibits the victim's ability to exit the structure on his or her own. As a result, the victim breathes in carbon monoxide and becomes unresponsive. Once found, they may be treated medically for carbon monoxide instead of hydrogen cyanide poisoning. The medical treatment for carbon monoxide inhalation can revive the patient, however, without a cyanide antidote kit, the lasting effects of hydrogen cyanide poisoning can create enduring medical complications.

Cyanide is a toxin with the potential to cause rapid death. It is clear that the number of firefighters and patients affected by cyanide each year has been under-recognized and under-treated in this country. Familiarization with this byproduct of combustion must be addressed by the fire and medical communities, as well as the general public, to prevent unnecessary exposure to this toxic substance. Hospital physicians must be educated on the increased likelihood of firefighters presenting with cyanide induced cardiac events and must be aware that Carboxyhemoglobin and cyanide levels should be drawn as soon as possible given the short half-life of cyanide in the blood.

Present day firefighters are no longer fighting the combustible fires that their forefathers fought. They are fighting highly volatile chemical fires that are burning two to three times hotter due to the introduction of plastic and synthetic furnishings. They are fighting fires that have an increased chance of producing flashovers and extremely toxic levels of poisonous substances such as hydrogen cyanide and carbon monoxide.

In light of these facts, firefighters at all levels need to be re-educated about fire behavior. They need to learn how to predict and anticipate both the behavior of a fire and the type of smoke that it will generate. Firefighters also need to learn the proper protective equipment to be worn during the fire, after it is extinguished, and during salvage and investigation. Armed with this information, they can reduce job-related injuries and line-of-duty deaths.

Wouldn't it be nice, for a change, to have a once-yearly celebration at the National Fire Academy because there are no line-of-duty deaths?

» Hydrogen Cyanide: New Generation Concerns Resulting in Firefighting Tactics and Medicine

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