Burn Injury Resource Center

In Clear Spring, Maryland a few weeks back, an electrical malfunction in a stereo speaker caused a fire that sent a woman to the hospital to be treated for smoke inhalation. The woman was taken to Meritus Medical Center east of Hagerstown.

Authorities said the fire started at 5:46 a.m., when a stereo speaker on a living room shelf in the two-story home caught fire. The fire caused several hundred dollars in damages to the home and its contents. But even with so little damage, the fire required 15 firefighters from the towns of Clear Spring, Halfway, Maugansville, and Williamsport to hose down the house for five minutes to bring the fire under control.

Most importantly, a smoke alarm alerted the occupants of the fire. Without smoke detectors, the fire could have filled the house with hydrogen cyanide-laden smoke so quickly that the occupants would not have gotten out alive--and all because of a stereo speaker malfunction. Remember this story, so that you will make sure to check the batteries in the smoke alarms in your house.

In another story that was very close to being tragic, the New York Fire department saved the life of two adults and a baby after responding to an apartment fire in Brooklyn on Thanksgiving. The New York Daily News captured an amazing photo of Firefighter Andrew Hartshorne carrying the baby from the wreckage of the fire. Firefighter Neil Malone then gave the infant mouth-to-mouth resuscitation, furiously pumping the eight-month-old baby's chest and forcing air into his mouth, while praying the limp little boy would take a breath on his own. After five agonizing minutes where the firefighters were starting to give up hope, the baby finally coughed and began breathing on his own.

"I knew I was working against the clock -- every second is crucial," said Malone. "The baby was unresponsive, he had no pulse. It was about five minutes and thirty seconds that the baby was left without air. It didn't look good. But it's like a song to your ears when you hear that baby get its breath on its own."

The child's pulse returned, but he remained in critical condition the day after the Thanksgiving blaze. "The smoke has affected his lungs. He's still in danger," said the baby's father. The baby was heavily sedated and receiving intensive care at New York-Presbyterian/Weill Cornell Medical Center.

The child also suffered burns on much of his body, in addition to requiring an oxygen mask and breathing tube. The possibility of brain damage exists, but doctors will not know if any damage occurred for several days. "We are praying there was no oxygen deprivation" that causes brain injury, one family member said.

Fire Department investigators believe the fast-moving fire was ignited by a cigarette that touched a mattress. The fire tore through the third floor of the building, forcing one man to leap from a window to a second-floor ledge. The flames then blocked the brownstone's exits, trapping the terrified family inside.

"It was an inferno," Malone recalled. "I've seen a lot of fires in my 28 years [with the FDNY] but I've never seen this scope of devastation." Firefighters fought their way through the flames to get the adults out, and then find the baby on the floor. "The baby was covered in soot," said Malone. "To find him in all of that debris is just amazing."

"I'm not a hero, I'm just doing my job," Malone said when asked about it. "It was the best Thanksgiving I ever had."

If you or someone you know does suffer a severe burn injury or a smoke inhalation injury, you should call Kramer & Pollack LLP in Mineola, New York so that the personal injury attorneys in that firm can determine whether another party has legal liability for injuries suffered, and if the injured party has a solid legal case.

On October 6, 2011, the Fire Smoke Coalition launched the first Smoke Inhalation Treatment Database for use by EMTs, first responders and medical professionals throughout the world.

In the United States, residential fires are the third leading cause of fatal injury and the fifth most common cause of unintentional injury death, yet the majority of fire-related fatalities are NOT caused by severe burns--they are cause by smoke inhalation.

Despite the amount of fires in the U.S. decreasing each year, the amount of civilians dying in fires is actually increasing. For example, in 2009, 1,348,500 fires were attended by public fire departments, a decrease of 7.1 percent from the year before; however, 3,010 civilian fire deaths occurred, which is an increase of 9.3 percent.

In fire smoke, hydrogen cyanide can be up to 35 times more toxic than carbon monoxide, an underappreciated risk that can cause severe injury or death within minutes. In a review of major fires over a 19-year period, cyanide was found at toxic or lethal levels in the blood of approximately 33 percent to 87 percent of fatalities.

While many fire department medical directors and physicians have altered treatment protocols to consider cyanide as a deadly poison in smoke inhalation patients, thousands still have not. Until cyanide is presumed to be responsible along with carbon monoxide, especially in victims removed from closed-space structure fires, people will continue to die of what is actually a complicated illness. It cannot be assumed that carbon monoxide is the only poison requiring treatment, or that it is the sole cause of death.

The Coalition is requesting all medical providers and physicians to enter data following treatment to smoke inhalation victims. Information collected will be available to all medical professionals, day or night, and will hopefully provide insight into "new" treatment practices that include consideration of an antidote for cyanide poisoning associated with smoke inhalation--more than just hyperbaric chamber therapy that forces high amounts of oxygen into a patient to cleanse the lungs of carbon monoxide. There are only two FDA approved cyanide antidotes in the United States--the Cyanokit®, also known as Hydroxocobalamin, is one of them.

In April, the Congressional Fire Services Institute (CFSI) passed a resolution noting that there is mounting proof, obtained through atmospheric monitoring on fire grounds throughout the U.S., that hydrogen cyanide (HCN) is a predominant toxicant found in fire smoke. The resolution calls for educating the fire service about the dangers of smoke inhalation--including those of HCN--through support of a national education program, the development of HCN poisoning treatment protocols for all local and state emergency medical services (EMS), and efforts by the Centers for Disease Control and Prevention (CDC) to establish a national database of smoke inhalation injuries, medical complications and deaths linked to HCN.

If you or someone you know suffers a burn injury or a smoke inhalation injury, you should call Kramer & Pollack LLP in Mineola, NY so that the personal injury attorneys in that firm can determine whether another party has legal liability for injuries suffered, and if the injured party has a solid legal case.

Paramedics in the Buffalo suburb of Tonawanda, NY have a new tool to help them save victims of smoke inhalation.

In late August, the paramedics announced that their ambulances will now carry supplies of the drug Cyanokit, which works to help those suffering from smoke inhalation by counteracting the chemicals in toxic gases and smoke. Other ambulance units around the country will likely do the same thing over time.

Paramedics are calling it a life-saving treatment. "It's to benefit the citizens of our town and the firefighters who put their lives on the line, should anyone be overcome by smoke and the toxic effects of cyanide that's in smoke," said one paramedic.

The drug has been used in France since 1996 and has recently been FDA approved.

Cyanokit (hydroxocobalamin) is a form of vitamin B-12. It is used as an antidote to cyanide poisoning. Cyanokit works by helping cells in the body convert cyanide to a form that can be removed from the body through urination.

Cyanokit is given as an injection through a needle placed into a vein, most often in an emergency situation. The medicine must be given slowly through an IV infusion, and can take about 15 minutes to complete.

Cyanokit is usually given only once. However, you may receive a second dose if needed.
Cyanide poisoning can occur if a person is exposed to smoke from a house or industrial fire, if they swallow or breathe in cyanide, or if they get cyanide on the skin.

Cyanokit is usually given in an emergency, so you may not have time to tell your caregivers about any drugs you take or medical conditions you have. However, you will need follow-up medical care after receiving this medication. Tell your doctor if you have high blood pressure, heart disease, or congestive heart failure.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

You may develop an acne-like skin rash from 1 week to as late as 4 weeks after you were treated with Cyanokit. This rash should go away without treatment. Call your doctor if you have a rash that does not clear up on its own.

This medication can cause you to have unusual results with certain medical tests. Tell any doctor who treats you that you have recently received a Cyanokit injection.

On May 19, the Fire Smoke Coalition sent out a press release saying that it "applauds the Congressional Fire Services Institute's (CFSI) National Advisory Council (NAC) passage of A Resolution to Address a New Epidemic: Smoke Inhalation at its April board meeting." CFSI is a leading non-partisan policy institute designed to educate members of Congress on the needs of our nation's fire and emergency services.

In its resolution, CFSI notes that there is mounting proof, obtained through atmospheric monitoring on fire grounds throughout the U.S., that hydrogen cyanide (HCN) is a predominant toxicant found in fire smoke. The resolution calls for educating the fire service about the dangers of smoke inhalation--including those of HCN--through support of a national education program, the development of HCN poisoning treatment protocols for all local and state emergency medical services (EMS), and efforts by the Centers for Disease Control and Prevention (CDC) to establish a national database of smoke inhalation injuries, medical complications and deaths linked to HCN.

To learn even more about the Fire Smoke Coalition and about HCN poisoning, click on this link.

"It's encouraging to see that both fire smoke and hydrogen cyanide poisoning are being recognized by CFSI for the serious and prevalent illnesses they are," said Rob Schnepp, assistant chief of Special Operations for the Alameda County (CA) Fire Department. "As we learn more about the dangers of fire smoke, and pass that information along to firefighters and civilians around the world, we are confident we can reduce the number of people injured and killed by smoke."

In the United States, residential fires are the third leading cause of fatal injury and the fifth most common cause of unintentional injury death, yet the majority of fire-related fatalities are not caused by burns, but by smoke inhalation. Despite the amount of fires in the U.S. decreasing each year, the amount of civilians dying in fires is actually increasing. For example, in 2009, 1,348,500 fires were attended by public fire departments, a decrease of 7.1 percent from the year before; however, 3,010 civilian fire deaths occurred, which is an increase of 9.3 percent.

In fire smoke, hydrogen cyanide can be up to 35 times more toxic than carbon monoxide, an underappreciated risk that can cause severe injury or death within minutes. In a review of major fires over a 19-year period, cyanide was found at toxic-to-lethal levels in the blood of approximately 33 percent to 87 percent of fatalities.

The Fire Smoke Coalition will begin working with various government agencies and medical associations in an effort to reduce the number of smoke inhalation deaths by elevating awareness surrounding hydrogen cyanide as the most deadly toxicant in fire smoke, which is treatable if detected.

"As a country, if we can accept that 30,654 human beings died during a 10-year period, we've become complacent about the illness," said Shawn Longerich, executive director of the Coalition. "That's unacceptable. This resolution raises the bar for all of us to do more and we can by embracing new medical treatment protocols that include consideration for hydrogen cyanide poisoning in fire smoke."

Cyanide is a toxic chemical substance that is found in a gas or a salt form. The gaseous form is colorless with a bitter almonds odor. Cyanide can be ingested by mouth, inhaled or absorbed by the skin.

Cyanide is used in the synthesis of some plastic items; it can be used in cleaning metal as well as in other industrial or laboratory settings. Cyanide is also naturally present in some pits and seeds of fruits such as apricots and almonds but it's in a small amount. Nitroprusside is a drug that may lead to cyanide toxicity if it's given in an improper dose. During a house fire, cyanide gas is produced due to the combustion of common household materials. Inhalation of cyanide leads to cyanide poisoning. Cyanide can be used in chemical warfare and poisoning.

Cyanide simply works by decreasing the oxygen content of the blood by causing a chemical change that prevent oxygen from getting into the hemoglobin of the red blood cell and this will lead to tissue hypoxia.

Signs and symptoms of cyanide poisoning:

• Headache.
• Dizziness.
• Faintness.
• Flushing.
• Nausea.
• Vomiting.
• Bitter almond smell
• Rapid breathing.
• Rapid heart rate (tachycardia).
• Abdominal pain.
• Weakness.
• Fainting.
• Confusion.

Poisoning with large amount of cyanide may lead to:

• Convulsions.
• Paralysis.
• Coma (loss of consciousness).
• Shock.
• Cardiac arrhythmia.
• Respiratory arrest (stop breathing).
• Cardiovascular collapse.
• Death

.

Diagnosis:

Diagnosis will depend on the history of exposure to cyanide and the symptoms of the patient if they are present.

Treatment:

• Seek medical attention as soon as possible.
• The success of the treatment depends on the time between the exposure and treatment and on the concentration of the exposure.
• Move away from the area where cyanide gas is present to an area with fresh air.
• Don't induce vomiting if cyanide has been swollen.
• The antidote for cyanide is the administration of amylnitrate followed by the administration of sodium thiosulfate. A new approved antidote is Hydroxocobalamin.
• Treatment in the hospital will depend on the condition of the patient including airway management, oxygen supplementation, cardiopulmonary resuscitation, intravenous fluids and other medications depending on the situation.
• In cases where poisoning was due to Nitroprusside (antihypertensive drug) in a hospital then the drug should be discontinued.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.