Cyanide Poisoning Poses Threat to Health, Safety of Emergency Personnel

Medical professionals and emergency personnel are not prepared to respond to the significant health and safety issues that cyanide poisoning poses to communities across the country, according to a study by RTI International.

The study, presented at the American Public Health Association annual meeting in Boston, was funded by EMD Pharmaceuticals, the U.S. affiliate of Merck KGaA, Darmstadt, Germany and included survey responses from more than 500 emergency medical services (EMS) providers and advanced life support (ALS) providers across the country.

"We found that cyanide poisoning risk factors are often overlooked by emergency planners," said Joe Eyerman, Ph.D., director of the RTI Health Security Program and principal investigator for the study. "By better understanding the prevalence of cyanide and severe risks associated with cyanide toxicity, emergency responders can prepare for the health hazards associated with exposure."

Cyanide is produced during fires when products containing carbon and nitrogen – such as wool, paper, cotton, silk and plastics – burn. Cyanide disrupts the body's ability to use oxygen properly, which ultimately kills cells, causing harm to vital organs, such as the heart and the brain. People can be exposed to cyanide as a result of fire smoke, terrorist acts or industrial accidents.

Studies have shown that smoke inhalation is the primary cause of death in 60 percent to 80 percent of the almost 4,000 fire deaths and more than 20,000 injuries in the Unites States each year.

The researchers found that 79 percent of ALS providers do not stock cyanide antidote kits as a standard item on ALS vehicles, yet antidotal therapy is essential to reversing cyanide poisoning unless only mild exposure has occurred.

The report also showed that only 35 percent of emergency personnel participants believed they were likely or very likely to be exposed to cyanide as a result of a fire in their service area, despite the fact that, according to the Agency for Toxic Substances and Disease Registry, the majority of cyanide produced in the United States is found in products used in building construction, interior decorations or furnishings.

"The results of our research emphasize a need to improve emergency awareness of the risks associated with cyanide exposure as well as enhance preparedness across the country for dealing with cyanide poisoning," said Scott Wetterhall, M.D., M.P.H., senior program director of Health Security and Systems Research at RTI.

The authors recommended that policymakers develop an outreach program and educational materials that communicate basic cyanide awareness facts and standard pre-hospital treatment practices. They also suggest that first responders and policymakers create guidelines for stocking antidotes and devise deployment strategies for dealing with cyanide poisoning.

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