Treatment of Choice Emerges for Smoke Inhalation
Oct 14, 2011 11:33 AM
By Glenn Bischoff (email@example.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.