Firefighters Cyanide Antidote Kit Info
 
 
As of 12/12/08 the Charlottesville Albemarle (Virginia) Rescue Squad (C.A.R.S.) now has in-service two cyanide antidote kits - "Cyan-o-kit" is the trade name.  The two kits are located in the C.A.R.S. Duty Officer's response vehicle (in this vehicle only at this time).  Each kit contains a 5 gram dose of the antidote.  The 5 gram dose is split between two vials (2.5 grams each).  The vials contain the powdered concentrate (red in color) which is made into solution by adding 100 cc's of IV fluid (supplied in their carrying case).  Attached is the guideline for administration - drafted in conjunction with C.A.R.S. OMD, C.A.R.S. staff, and Blue Ridge Poison Control toxicologists. 
 
** Note in the guideline that Blue Ridge Poison Control serves as primary medical command for the administration.** 
 
Patients are screened in the field (as described in the guideline) for possible treatment - while the antidote (unlike its predecessors) has next to no known harmful side effects - the main side effect is a marked reddening of the skin (looks like a bad sunburn, goes away in a week or two). 
 
In a nut shell, the antidote converts the harmful cyanide into vitamin B12, which is then excreted in the urine (turns that red as well).  The kits are in excess of $800/ea at this time.   
 
WHAT DOES THIS MEAN TO SUPPRESSION STAFF?
 
Cyanide is one of a host of potentially harmful/lethal gases found in fire smoke.  In more "modern" construction, and with more "modern furnishings" (synthetic materials) - higher cyanide concentrations are more prevalent.  The attached guideline outlines some common signs and symptoms - but there is no good way to definitively know if/how high the concentrations are and which if any fire victims may have been dosed.  Observational findings with the patients (as described in the guideline) and presumptive indicators on scene (type of materials involved in the fire) are what we have to go on. 
 
So, PLEASE LET COMMAND/RESCUE PERSONNEL ON SCENE KNOW WHEN YOU SUSPECT -
 
- the victims of smoke inhalation were found in/removed from/self evacuated from a confined smoke filled area (house, trailer, business, etc.), where the victims were exposed to and inhaled smoke from a fire involving burning/smoldering suspect materials (plastics, rubber compounds, foam, silks, chemicals, etc.) 
 
The kits are not intended for every inhalation injury patient, so your input on the suspected contents of the fire and potential for exposure are invaluable in determining the need for administration.  Also don't forget about the antidote kit if one of our members should go down and be removed without functioning respiratory protection in place.
 
** Keep in mind there are also pure cyanide sources in the community as well.  Not too many years back someone on campus intentionally drank a cyanide slurry, committing suicide.  Be on the look for exposures to various chemicals by all routes both on campus and in the community at large.**
 
*** It could happen anywhere City or County, but when you are out in the County especially Crozet/Scottsville area keep in mind if you suspect an exposure CARS is the only agency carrying the kit at this time.***  Of course UVA hospital has a fair number of the kits in-house, so make sure you still voice your suspicions to the transporting agency.  
 
Also attached is a decision tree that goes with the Carbon Monoxide oximeter (there are two of these meters in the field - (1) on E7, and (1) in the C.A.R.S. Duty Officer's vehicle) - during the winter months/heating season it tends to prove useful in ruling out CO exposure in those folks feeling "flu-like" but whom may have been exposed to CO - each engine should be able to meter for indoor concentrations with your three gas meter if you suspect exposure - and the two CO oximeter units are available if needed as well.  Also good for evaluating members in rehab as well.  The chart is also useful for triaging multiple patients with exposure - built with START triage colors.