Cyanide Treatment Protocols

By Mike McEvoy
EMS Editor

Finally, the fire service has access to a comprehensive set of treatment protocols for empiric treatment of the leading killer of fire victims: cyanide. Writing in the August 2011 issue of Prehospital Disaster Medicine, Daniel O’Brien and colleagues review and consolidate the published research into a complete set of EMS and Emergency Department protocols for empiric (i.e., based on assessment findings and suspicion rather than clinical tests and laboratory results) treatment of smoke inhalation victims. The protocols incorporate field experience, clinical judgment, and use of the only safe antidote for emergency cyanide treatment of smoke inhalation victims (hydroxocobalamin, carried by many fire and EMS agencies). Watch the upcoming (2012) Fire Engineering EMS Training Minute videos for a demonstration on mixing and administration of the Cyanokit® (hydroxocobalamin) antidote.


O’Brien DJ, Walsh DW, Terriff CM, Hall AH: Empiric management of cyanide toxicity associated with smoke inhalation. Prehosp Disaster Med 2011;26(4):1–9. Available on-line at:

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