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  1. #21
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    Quote Originally Posted by tree68 View Post

    But you realize that if, in fact, the patient is suffering from cyanide poisoning, your best paramedic, doing a perfect job, is simply wasting his/her time unless they administer a Cyanokit...
    Absolutely, even though we have them we wouldn't know until they got to the ER and had a toxicology report done that cyanide was the underlying problem. We only administer the kits for known exposure. Hopefully in the future we'll be able to test everyone in the field.
    If your going to cry about doing the job you signed up for do us all a favor and quit, there are plenty of dedicated people standing in line for the best job in the world.

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  2. #22
    makes good girls go bad BLSboy's Avatar
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    Quote Originally Posted by Firemedic 61 View Post
    Absolutely, even though we have them we wouldn't know until they got to the ER and had a toxicology report done that cyanide was the underlying problem. We only administer the kits for known exposure. Hopefully in the future we'll be able to test everyone in the field.
    First off, I am NOT attacking you, or your dept. What is the reason for not administering Cyanokits to suspected exposures?

    Indication

    Cyanokit is indicated for the treatment of known or suspected cyanide poisoning.
    Identifying Patients with Cyanide Poisoning

    Cyanide poisoning may result from inhalation, ingestion, or dermal exposure to various cyanide-containing compounds, including smoke from closed-space fires. Sources of cyanide poisoning include hydrogen cyanide and its salts, cyanogenic plants, aliphatic nitriles, and prolonged exposure to sodium nitroprusside.

    The presence and extent of cyanide poisoning are often initially unknown. There is no widely available, rapid, confirmatory cyanide blood test. Treatment decisions must be made on the basis of clinical history and signs and symptoms of cyanide intoxication. If clinical suspicion of cyanide poisoning is high, Cyanokit should be administered without delay.

    Smoke Inhalation

    Not all smoke inhalation victims will have cyanide poisoning and may present with burns, trauma, and exposure to other toxic substances making a diagnosis of cyanide poisoning particularly difficult. Prior to administration of Cyanokit, smoke-inhalation victims should be assessed for the following:

    Exposure to fire or smoke in an enclosed area
    Presence of soot around the mouth, nose or oropharynx
    Altered mental status

    Although hypotension is highly suggestive of cyanide poisoning, it is only present in a small percentage of cyanide-poisoned smoke inhalation victims. Also indicative of cyanide poisoning is a plasma lactate concentration ≥ 10 mmol/L (a value higher than that typically listed in the table of signs and symptoms of isolated cyanide poisoning because carbon monoxide associated with smoke inhalation also contributes to lactic acidemia). If cyanide poisoning is suspected, treatment should not be delayed to obtain a plasma lactate concentration.
    AJ, MICP, FireMedic
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    This message has been made longer, in part from a grant from the You Are a Freaking Moron Foundation.

  3. #23
    makes good girls go bad BLSboy's Avatar
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    Just found this while surfing about. One of the stories happens to be about my former dept.

    Treatment of Choice Emerges for Smoke Inhalation

    Oct 14, 2011 11:33 AM

    By Glenn Bischoff (glenn.bischoff@penton.com)

    In yet another case, two children fell victim to a house fire, and weren’t discovered until the secondary search. “It was amazing that they were alive at all,” Persse said. “They got a lot of smoke.”

    The Cyanokit was administered to both children, who ultimately recovered. While he couldn’t state with certainty that administration of the drug by itself was the difference between life and death in each of these instances, Persse believes that it was an enormous factor.

    “It’s kind of hard to argue that, when you see them go from being completely limp to blinking their eyes and moving their hands and feet within minutes of starting the drug.”

    Just about the only downside to the Cyanokit, in Persse’s mind, is its cost, which has caused the Houston Fire Department to limit its issuance to district-chief cars. “We didn’t put them on the paramedic units because we have way more paramedic units than we have district-chief cars, but there will be a district chief at every working fire and every paramedic has been trained on the Cyanokit,” Persse said. “That’s how we balance the expense problem with the availability challenge.”

    That said, Persse advised that fire departments shouldn’t let the cost issue prevent them from arming themselves with the Cyanokit.

    “I know that there are a lot of fire departments across the nation that are hesitant to use it because of the cost, and that’s a decision they’re going to have to make,” Persse said. “But if it was my family member, I’d want them to get it.”

    Mike McEvoy, EMS coordinator for Saratoga County (N.Y.) Emergency Services, which has been using the Cyanokit to treat firefighters for 2½ years, agreed that cost is an issue, one that is compounded by the fact that the kit has an expiration date. However, McEvoy said that his agency came up with a clever strategy for solving this dilemma.

    “We place them along the Interstate corridor, and so we’re able to get them to any scene within 15 minutes,” he said. “That helps us to turn them over so that we’re replacing them before their expiration date.”

    McEvoy’s agency is so sold on the Cyanokit that it now is administered to anyone who shows “significant evidence” of smoke inhalation, firefighter and civilian alike.

    “When you look at the number of people who die in the United States from structure fires each year, very few of them are burned; most of them die from inhalation injuries,” McEvoy said. “Every time we read about one of those we wonder if the care for that patient included giving them [the Cyanokit], and if not, perhaps that’s the reason the patient did not survive.”

    In Hillsborough County, Fla., in which the city of Tampa is located, four firefighters in the last four years have been treated for hydrogen-cyanide exposure using the Cyanokit. In one instance, the firefighter was overhauling a small structure fire.

    “It was a shed and all of the walls were down, so they didn’t think they needed to be on air packs,” said Robert Marschall, training officer for Hillsborough County Fire Rescue.

    The firefighter was at the center of the structure knocking down a hotspot when the fire “smoldered up,” according to Marschall, who added that the firefighter started to become symptomatic immediately after inhaling the smoke. There were a lot of symptoms.

    “He had periods of shortness of breath, his heart rate went fast and then slow, and he had periods when he was awake and then unconscious,” Marschall said. “He had a headache, he had some weakness and confusion, he was restless and anxious, and he had a metal taste in his mouth.”

    Marschall took a Cyanokit to the hospital, spoke with the emergency-room doctor and convinced him that it was the treatment of choice for hydrogen cyanide exposure through smoke inhalation.

    “He was very receptive and within four hours, our firefighter was ready to go home,” Marschall said.
    AJ, MICP, FireMedic
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    This message has been made longer, in part from a grant from the You Are a Freaking Moron Foundation.

  4. #24
    MembersZone Subscriber tree68's Avatar
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    The cost is a major factor here - some ten times the cost for the same exact item in Europe, which is one reason they are using it as much as they are, and we aren't. This can probably be fixed with a few well-placed kicks in the pants.

    Just as we make certain presumptions about any number of medical conditions (and our treatment is often based on them), methinks we need to start making the presumption that if someone is exposed to smoke and is symptomatic they get the dose. As already noted, this presumption should extend to firefighters who have been recently exposed to smoke.

    The contents of smoke have recently been re-analyzed (it was last done in depth in the 70's, if I was told correctly). I'm not sure where to look for the results, and I forget who it was that did the testing.

    I did hear of a screen that was done that involved all firefighters at one or more fire scenes. Even the chauffeur(s), who never entered the building(s), showed elevated levels of cyanide.

    Granted, that doesn't discount healthy living. There is the very real possibility that cyanide exposure may be the "straw that breaks the camel's back" for someone who's not as healthy as they should be.

    And that's just cyanide. What else is there in that smoke that can hurt us that we haven't accounted for yet?
    Opinions my own. Standard disclaimers apply.

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  5. #25
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    Quote Originally Posted by BLSboy View Post
    First off, I am NOT attacking you, or your dept. What is the reason for not administering Cyanokits to suspected exposures?
    No sweat AJ, we actually do administer to suspected exposures as well, I see I left that out. Also add dilated pupils to the list.
    Last edited by Firemedic 61; 11-13-2011 at 09:14 PM.
    If your going to cry about doing the job you signed up for do us all a favor and quit, there are plenty of dedicated people standing in line for the best job in the world.

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  6. #26
    makes good girls go bad BLSboy's Avatar
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    Quote Originally Posted by Firemedic 61 View Post
    No sweat AJ, we actually do administer to suspected exposures as well, I see I left that out. Also add dilated pupils to the list.
    Gotcha, thanks for clarifying.

    Does every ALS unit carry them, Rescues only, or just selected units?
    AJ, MICP, FireMedic
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    This message has been made longer, in part from a grant from the You Are a Freaking Moron Foundation.

  7. #27
    Forum Member scfire86's Avatar
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    Quote Originally Posted by tree68 View Post
    The cost is a major factor here - some ten times the cost for the same exact item in Europe, which is one reason they are using it as much as they are, and we aren't. This can probably be fixed with a few well-placed kicks in the pants.
    I can only tell you the experience of my former department. Our union pushed for a WeFit program against all the bureaucratic opposition our chief and his risk managers could put in the way. It was finally instituted and within three years the department's workers comp costs had dropped by 50%. There were several co-workers who were in such bad shape physically they made the decision to retire after getting the results of their baseline physicals.

    The physicals were comprised of blood work, vision, hearing, eyesight, cardio capacity and strength measurement.

    They are performed annually. When our chief retired he touted the success of the program as though he had been instrumental in its adoption. When the opposite was just the case.
    Politics is like driving. To go forward select "D", to go backward select "R."

  8. #28
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    Quote Originally Posted by gunnyv View Post
    "What we need to push for are complete NFPA physicals and mandatory physical fitness standards and mandatory rehab as laid out by the NFPA and IAFF."

    I'm all for higher fitness and health standards. But what it boils down to is this-how many of the guys that we work with are we willing to put out of work to get to 0 LODDs?
    And how many small, rural VFDs running on 15 or 20K are year are we willing to bankrupt and force to shutdown due to either/or a lack of funding remaining for operations or lack of remaining manpower?

    I'm all for physicals and standards. The problem is paying for it and dealing with the manpower issues.
    Train to fight the fires you fight.

  9. #29
    Forum Member scfire86's Avatar
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    Quote Originally Posted by LaFireEducator View Post
    And how many small, rural VFDs running on 15 or 20K are year are we willing to bankrupt and force to shutdown due to either/or a lack of funding remaining for operations or lack of remaining manpower?

    I'm all for physicals and standards. The problem is paying for it and dealing with the manpower issues.
    I'm willing to bankrupt all of them if it means that I as a taxpayer depending on those services can be assured those responding won't become an incident while responding to an incident.

    Thank you for asking.
    Politics is like driving. To go forward select "D", to go backward select "R."

  10. #30
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    Quote Originally Posted by tree68 View Post
    There seems to be a growing sentiment that the cause of at least some of our "after the fact" deaths (returns to station, doesn't feel well, collapses, cannot be revived despite efforts of rescuers on scene at the time) may be due to cyanide poisoning, as opposed to "poor lifestyle choices."

    Studies I've heard of (third hand, unfortunately) have shown that even fire personnel working outside the fire building show increased levels of cyanide after an incident.

    In Europe it is now apparently standard practice to give smoke inhalation victims a "Cyanokit" - the antidote for cyanide. Recovery rates have markedly improved, from what I hear.

    While we often do need to improve our lifestyles, we also need to be looking for other reasons for some of these otherwise unexplained deaths.

    There's a lot of crap in that smoke we breathe (and even more of it after the fire is "out").
    It's certainly true that cyanide poisoning may be contributing to some LODDs and that a thorough investigation into the cause of death should be performed on any LODD in which a seemingly healthy person dies.

    However, this doesn't detract from my point regarding the original point of discussion. The bigger issue regarding LODDs annually is not our on scene tactics, it's various medical related circumstances and how we operate our apparatus.

    If we can get a hold of these issues, we should see a much greater drop in LODDs annually than we would see switching to a defensive mindset.

  11. #31
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    Quote Originally Posted by scfire86 View Post
    I'm willing to bankrupt all of them if it means that I as a taxpayer depending on those services can be assured those responding won't become an incident while responding to an incident.

    Thank you for asking.
    WSo just out of curiousity, what do you plan on replacing them with? I mean .... Do you really beleive that no fire protection is better than some fire protection?

    Just asking.

    And by the way, what about all the career and combo departments that have had full-time firefighters go down causing an incident within an incident? Do you plan on shutting them down as well?
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  12. #32
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    Quote Originally Posted by LaFireEducator View Post
    And by the way, what about all the career and combo departments that have had full-time firefighters go down causing an incident within an incident? Do you plan on shutting them down as well?
    Are you really this obtuse?

    Right or wrong, in doing what is being advocated the small, poor, rural volunteer department that you are worried about would "shut down" because they lack sufficient manpower to continue being a fire department.

    If held to the same standard, the career/combo departments would not need to be shut down, they would simply hire more firefighters - whether it be for replacement of career firefighters who no longer meet the fitness standard or additional career firefighters to make up for any volunteers lost.

  13. #33
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    Quote Originally Posted by FireMedic049 View Post
    Are you really this obtuse?

    Right or wrong, in doing what is being advocated the small, poor, rural volunteer department that you are worried about would "shut down" because they lack sufficient manpower to continue being a fire department.

    If held to the same standard, the career/combo departments would not need to be shut down, they would simply hire more firefighters - whether it be for replacement of career firefighters who no longer meet the fitness standard or additional career firefighters to make up for any volunteers lost.
    I'm very well aware of that. The manpower issue is not an issue in career departments as it's a simple fix when they lose bodies that may not past muster .. simply hire new personnel.

    My point ot SC was simple. When volunteer departments lose manpower it's not as simple as going out and hiring replacements. It's more than likely that they would be down the number of members they have lost. There are many rural departments in this area that right now are running with fewer than 15 members, and if NFPA criteria was used for the physicals, would likely lose 3-5personnel, which would make emergency response a very dufficult situation, even if they implemented an automatic mutual aid system (primarily due to distance between departments and the size of the districts).

    On the career side, the question does have to be asked again ..... SC how many career personnel are you willing to see dismissed from thier positions to achieve full complaince with the NFPA standard?
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  14. #34
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    Quote Originally Posted by LaFireEducator View Post
    I'm very well aware of that. The manpower issue is not an issue in career departments as it's a simple fix when they lose bodies that may not past muster .. simply hire new personnel.

    My point ot SC was simple. When volunteer departments lose manpower it's not as simple as going out and hiring replacements. It's more than likely that they would be down the number of members they have lost. There are many rural departments in this area that right now are running with fewer than 15 members, and if NFPA criteria was used for the physicals, would likely lose 3-5personnel, which would make emergency response a very dufficult situation, even if they implemented an automatic mutual aid system (primarily due to distance between departments and the size of the districts).
    If that was your point, then like usual, you did a really poor job of making it.

    On the career side, the question does have to be asked again ..... SC how many career personnel are you willing to see dismissed from thier positions to achieve full complaince with the NFPA standard?
    Actually, this would be the first time for this question. The question in your previous post, at least as written, was about shutting down departments, not dismissing career personnel.

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    Quote Originally Posted by FireMedic049 View Post
    If that was your point, then like usual, you did a really poor job of making it.

    At least I'm consistent.

    Actually, this would be the first time for this question. The question in your previous post, at least as written, was about shutting down departments, not dismissing career personnel.
    That question was actually asked by another poster a few posts up, however, SC hasn't answered it as of yet. I was simply reminding him that the question is still pending
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  16. #36
    MembersZone Subscriber tree68's Avatar
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    Quote Originally Posted by FireMedic049 View Post
    If we can get a hold of these issues, we should see a much greater drop in LODDs annually than we would see switching to a defensive mindset.
    Agreed.

    I would opine that aside from the specific example of going defensive (and despite not saying so specifically, I do think he was referring to lightweight construction), the overall message is that we need to think "outside the box."

    If we continue to do things because we've always done them that way, the outcome isn't going to change.
    Opinions my own. Standard disclaimers apply.

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    Quote Originally Posted by LaFireEducator View Post
    That question was actually asked by another poster a few posts up, however, SC hasn't answered it as of yet. I was simply reminding him that the question is still pending
    I just looked back thru this thread and I don't see any poster other than you discussing the dismissal of career firefighters in regards to NFPA standard compliance. Maybe you can show me that post?

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    Quote Originally Posted by tree68 View Post
    Agreed.

    I would opine that aside from the specific example of going defensive (and despite not saying so specifically, I do think he was referring to lightweight construction), the overall message is that we need to think "outside the box."

    If we continue to do things because we've always done them that way, the outcome isn't going to change.
    I would agree with that message, however I take issue with trying to sell that message as a fix for a problem that doesn't necessarily exist on the level being implied. Tactics do need to change when dealing with lightweight construction, however we aren't exactly dying in droves due to recent tactics in these buildings and saying or implying otherwise is clearly inaccurate.

  19. #39
    Forum Member gunnyv's Avatar
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    Quote Originally Posted by FireMedic049 View Post
    I just looked back thru this thread and I don't see any poster other than you discussing the dismissal of career firefighters in regards to NFPA standard compliance. Maybe you can show me that post?
    God (and all real firemen) forgive me for actually helping LaF make a point, but FireMedic61 responded to my point about this in post #16:

    Quote:
    Originally Posted by gunnyv
    I'm all for higher fitness and health standards. But what it boils down to is this-how many of the guys that we work with are we willing to put out of work to get to 0 LODDs?

    FireMedic 61
    "I don't want to see anyone let go but on the flip side, are you willing to bite it because these guys would rather eat crap and sit in the Lazy-Boy all day? I'm all for helping these guys out, thats part of the brotherhood."

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    Quote Originally Posted by gunnyv View Post
    God (and all real firemen) forgive me for actually helping LaF make a point, but FireMedic61 responded to my point about this in post #16:

    Quote:
    Originally Posted by gunnyv
    I'm all for higher fitness and health standards. But what it boils down to is this-how many of the guys that we work with are we willing to put out of work to get to 0 LODDs?

    FireMedic 61
    "I don't want to see anyone let go but on the flip side, are you willing to bite it because these guys would rather eat crap and sit in the Lazy-Boy all day? I'm all for helping these guys out, thats part of the brotherhood."
    Yeah, I saw those posts, but LA appears to be implying that the question was directed to scfire86 however he hadn't even posted in the thread at that point. So IMO these posts can't be what he was referring to.

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