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Hydrogen Cyanide Plays a Large Role in Fire Deaths from Smoke Inhalation

A recent article in the trade publication EMS World discussed how the newer materials being used in home construction are actually making the homes more dangerous in the event of a house fire. And it is not the flames that make fires in new and recently built homes so dangerous, but rather it is the danger of smoke inhalation, which kills many more people in fires than do third degree burns.

With the number of smoke inhalation deaths between 5,000 and 10,000 each year in the U.S., experts looked at possible factors in those numbers being so high. And what they found is that because of lightweight construction materials and the increased use of synthetics in buildings and furnishings, a house fire is likely to reach “flashover” in a shorter period of time in the past. Reduced flashover time means there is a reduced time for firefighters to intervene, and it also means that potential smoke inhalation victims have much less time to escape from the fire. And the levels of toxic gases in the fire smoke also increase dramatically. All that adds up to increased potential for becoming incapacitated from smoke inhalation, and thus more possibility of death.

So it is important to know about the materials that were used to build the house or apartment you live in, so you can figure out how much time you would have to escape in case of a fire.

You see, fire smoke contains particulate matter as well as heated gases such as hydrochloric acid, sulfur dioxide, ammonia and carbon dioxide. It also generates toxins including hydrogen sulfide and hydrogen cyanide.

Recent research from independent studies about smoke inhalation victims may very well change the treatment protocols. More evidence now suggests that victims of smoke inhalation also suffer significantly from cyanide poisoning. Cyanide kills quickly by disabling the blood’s mechanism for carrying oxygen. Cyanide in a fire comes from natural substances such as wool, silk, cotton or paper. Synthetic substances, such as plastics and other polymers, also produce cyanide.

Two studies in different countries were designed to assess the role of cyanide in fire-related mortality. In both studies, blood samples were drawn from smoke inhalation victims as close as possible to the times of exposure to smoke.

In one study, blood was collected by the first-arriving medical squads to residential fires. A total of 109 fire victims were studied – 66 who survived and 43 who died. The data was compared against 114 control individuals – 40 with drug intoxication, 29 with carbon monoxide poisoning and 45 with major trauma. The study showed that in some victims who died, blood levels of cyanide were in the potentially lethal range while blood levels of carbon monoxide were in the non-toxic range.

These results were directly opposite the thinking that smoke inhalation victims die only from carbon monoxide. Instead, the study showed that cyanide and carbon monoxide were both important when determining mortality risk associated with smoke inhalation. Other results of the study showed that cyanide concentrations were directly related to the probability of death, and that cyanide poisoning may have been the leading cause of death in some fire victims, and that cyanide and carbon monoxide may have possibly helped the toxic effects of one another.

The other study collected blood within eight hours from victims exposed to smoke. The study compared 144 smoke inhalation victims who arrived alive over a two-year period at the University of Texas Health Science Center emergency room against 43 smoke inhalation victims who were dead on arrival at the Dallas County Medical Examiner’s Office during the same period.

The study found that the average blood cyanide concentrations in victims arriving alive at the emergency room were lower than concentrations in victims who were dead on arrival. The Dallas County study concluded that elevated cyanide concentrations were more present among smoke inhalation victims. It also concluded that cyanide concentrations were directly related to the probability of death, and cyanide poisoning may have been the leading cause of death over carbon monoxide poisoning.

And in a study using monkeys, researchers found that even sub-lethal concentrations of cyanide in a fire can still cause death because it rapidly brings on unconsciousness, thus preventing escape from the fire and permitting more exposure to fatal concentrations of other toxins.

As a result of these studies, it is easy to conclude that cyanide plays an important role in causing death and incapacitation in fires. Further, medical providers and firefighters should suspect cyanide poisoning in any person exposed to smoke from a fire in a closed space and any other smoke inhalation victims with soot in the mouth, an altered mental status and low blood pressure.

Obviously, the difference between life and death of a smoke inhalation victim is dependent upon the concentration of exposure and the time between exposure and treatment.

The current treatment of smoke inhalation victims is to administer pure oxygen and stabilize vital signs.

Some fire departments and ambulances carry cyanide antidotes kits specifically for smoke inhalation victims, called Cyanokit. By protocol, if a victim has soot in the nose or mouth and suffers an altered level of consciousness, the Cyanokit is used.

If you or someone you know suffers an injury such as third degree burns or smoke inhalation, 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 strong legal case.

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