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New Information on True Causes of Death from Smoke Inhalation: Hydrogen Cyanide Poisoning

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.