By Robert Bohrer
Scenario: Your engine company is dispatched to a 911 call at a rest stop off the interstate for an unresponsive person in a car. Dispatch advises that the caller did not try to remove the victim from the vehicle. While en route, you and your crew start thinking of possible reasons why the person might be unresponsive and how to deal with this call.
On arrival at the scene, you notice a vehicle at the far corner of the rest stop where no other vehicles are parked. Your driver stops the fire engine a distance away from the vehicle, and the person who called 911 walks over to you. He is a security guard and says, “I was on routine patrol and I noticed this car by itself way over here. As I approached, a pungent, rotten egg smell hit me, and that’s when I noticed a person slumped over. I backed away and called 911.” As you examine the scene, you notice pieces of paper taped to various windows of the car. You retrieve binoculars from the glove box and peer through them to get a better look at what is written on the pieces of paper taped to the windows. You read the following: HYDROGEN SULFIDE SUICIDE POISON GAS DO NOT OPEN. You immediately have your crew cordon off the area and request a hazmat response.
Chemical suicide, also known as “detergent suicide,” seems to be gaining popularity as a newer method for ending one’s life with the use of household chemicals. The genesis for this form of suicide can be traced back to Japan where, for a three-month span in 2008, 208 men, women, and children ended their lives by mixing common household chemicals together. However, there are unofficial reports of more than 2,000 people killing themselves in this suicide wave. These individuals used instructions from Web sites explaining which chemicals to mix to make a deadly vapor cloud of hydrogen sulfide (H2S).
The Centers for Disease Control and Prevention (CDC) conducted its own study from 2008 to 2010 and found 72 cases of chemical suicides in various states around the U.S. The problem with this form of suicide is that it not only potentially kills the victim, but it puts police, fire, and emergency medical services (EMS) at risk of inhaling the fumes and becoming victims, too. About 80 percent of first responders for these 72 documented cases were overcome by the toxic fumes and, therefore became victims. Keep in mind that these suicidal individuals usually are in a confined space, whether it is in a vehicle, a closet, a small bathroom, or even a college dorm room. Sometimes, the suicidal individual will put up signs or biohazard symbols alerting the first responders to the presence of deadly vapors, but we have to consider that not all chemical suicides will have these signs to alert first responders. Exercising situational awareness and not being complacent will not only help first responders but it will also allow for an incident action plan to fall in to place at these particular incidents.
Warnings Signs of a Chemical Suicide Scene
Often, when first responders arrive on the scene of a chemical suicide, the area that would be considered the “hot zone” will possibly have indicators of toxic fumes being present. Some of the indicators are a smell of rotten eggs or sewer gas, tape applied to the cracks on the windows and doors to prevent the fumes from escaping, actual signage explaining the presence of toxic fumes, and chemical containers located inside the vehicle (photos 1-3).
(1) Photos by author.
Also consider where the vehicle is parked. For example, is the vehicle parked at an isolated place away from other vehicles and individuals? Also, it is important to remember that chemical suicides don’t always have to be in a vehicle; they can also be in a building. When responding to these types of calls, we must remember that wherever chemical suicides take place, it is considered a hazmat scene, and if the patient is salvageable, then that patient needs to be properly decontaminated before being placed in an ambulance and taken to the hospital.
Remember that these are hazmat patients, and if they are still alive, properly removing their clothes and decontaminating them will remove about 90 percent of the contaminant. Also keep in mind that the patient compartment of the ambulance needs to be properly set up to receive a hazmat patient. If you are part of a fire/EMS system, then the ambulance from the fire station that provides hazmat response should have the proper coverings and equipment to outfit the patient compartment for hazmat patient treatment and transport. However, if you are part of a fire department that is separate from EMS, then the fire-based hazmat team will need to help the ambulance crew set up the patient compartment to receive the hazmat patient.
Hydrogen Sulfide Chemical Information
- UN Number: 1053.
- National Fire Protection Association 704, Standard System for the Identification of the Hazards of Materials for Emergency Response: Placard: Health 4—Extreme, Flammability 4—Extreme, Instability 0—Minimal, Special Hazards—NA.
- Molecular Formula: H2S.
- Molecular Weight: 34.08 (heavier than air).
- IDLH: 100 ppm (very deadly).
- Vapor Density: 1.189.
- Boiling point: -76°F (-60.33°C).
- Melting point: -115.6°F (-85.49°C).
- Soluble in: Water.
- Classification: Sulfide, Sulfur compounds.
H2S is also known as “sewer gas,” “swamp gas,” “stink damp,” and “sour damp,” but it is also a colorless gas known for its pungent rotten egg odor at low concentrations. It is extremely flammable, highly toxic, found in confined spaces, and it is the second common cause of inhalation death [carbon monoxide (CO) being the top cause of inhalation death]. H2S works very much like hydrogen cyanide does, and it binds to iron in the mitochondria of the cell preventing the uptake of oxygen (O2). Another issue to keep in mind is that H2S desensitizes the olfactory (smell) sense, and as a rescuer you might think the gas has dissipated because you can’t smell it anymore. However, in reality, the gas hasn’t left, and you are walking further into the vapor cloud further exposing yourself.
Effects on the Body
<40 for <15 minutes
Eye and mucous membrane irritation.
Pulmonary membrane irritation.
Cough, dyspnea, cyanosis, and confusion.
****At 700 ppm, 2-3 breaths can cause immediate death.****
Warning Signs and Questions When Approaching Vehicles
- Smell of rotten eggs or sewer gas?
- Is patient unconscious and unresponsive?
- Tape over the vents and/or around the windows?
- Suicide note?
- Posted notes warning rescuers?
- Cooler, pail, or bucket in the vehicle containing chemicals?
- Empty chemical containers inside or outside the vehicle?
Warning Signs When Approaching Buildings
- Smell of rotten eggs or sewer gas in the area that gets increasingly stronger as the vehicle or building is approached.
- Signs posted on doors or windows.
- Other people from inside the building complaining of breathing problems.
Some locations where chemical suicides may take place include closets, bathrooms, and even college dorm rooms. Always maintain scene and rescuer safety when responding to these types of emergencies, especially when called out for welfare checks. You must don and wear personal protective equipment (PPE) including respiratory protection prior to entering a scene where H2S is present. Remember, the highest level of respiratory protection is wearing a self-contained breathing apparatus (SCBA) and making sure personnel are properly trained and Occupational Safety and Health Administration 29 CFR 1910.134-compliant.
Another consideration for rescuers regarding H2S is the fact that it is heavier than air; so, if the vehicle or building are opened up for ventilation, just remember that the vapor will not immediately dissipate. The toxic fumes will stay in or around the vehicle or building for a little while after ventilation has begun. Make sure to maintain scene and rescuer safety even after ventialtion of the fumes has been initiated. Remember, if the patient is declared deceased where they are found, then it becomes a crime scene, so maintain the integrity of the scene for the law enforcement investigation.
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Treatment of Patient Once Removed from Vehicle or Building
**Follow local and state protocols when treating hazmat patients. The information below is only a guide, and is not to take the place of standing medical protocols for your department.**
Once the patient has been removed from the hot zone, perform the following:
- Assess airway/breathing/circulation.
- Rescuers in proper PPE should provide a patient assessment and remove the patient’s clothing and double bag it.
- Check for respiratory effort and rate and assist with ventilations as needed. One-hundred percent O2 is recommended.
- Check for pulse and, if present, place the patient on the electrocardiogram monitor and evaluate the rhythm.
- Attempt venous access.
- Attach pulse oximeter.
- Attempt to do as much as possible for the patient while en route to the appropriate hospital.
Some medications that you can administer to help treat H2S exposure follow:
- Amyl nitrite by inhalation for 15-30 seconds every minute until an IV is established.
- Administer sodium nitrite IV push at 300mg for 2-4 minutes.
These medications will help in forming sulfmethemoglobin; this removes sulfide from the cells. Also, follow your department’s medical protocols for other symptoms the patient is experiencing.
H2S Response Review
- Secure and size-up any scene that involves an unresponsive person or persons in a confined space.
- Request further information from the 911 dispatcher about any details the caller might have given about the victim such as any unusual smells (i.e., rotten eggs, sewer gas, chemicals, and so on), any suicide or warning notes on windows or doors, if the victim has a history of suicidal attempts, and so on.
- Request wind speed and direction from the 911 dispatcher. This will aid rescuers in maintaining a safe distance from the scene. This will also aid in any decisions for an evacuation of citizens in the vicinity of the call.
- The air must be tested by qualified personnel using H2S detector tubes or a four- or five-multigas meter. Also, the air needs to be evaluated for the potential of fire or explosion. Unless rescuers have intrinsically safe radios, then radios will have to be turned off in or around the hot and warm zones.
- If the victim may be sleeping, then attempt to wake him up by activating a siren, an air horn, or any other means possible that does not put rescuers in harm’s way.
- If you cannot wake the victim, then rescuers will need to perform a recon evaluation of the scene while using the proper PPE and respiratory protection. Assess the scene for a chemical mixing container(s) and household chemicals present in the vehicle or building.
- If the victim has used chemicals to commit suicide, the rescuers should be aware that not all chemical suicides will have warnings or a suicide note(s) taped to the window(s) to warn first responders of the deadly fumes (photo 4).
- If victim is still alive, rescuers should keep in mind that he is a hazmat victim and he could off-gas the chemical from his clothes and breath. Thorough decontamination of the patient is required prior to transport to the hospital.
Once the call has been completed, the rescuers must establish an area to conduct thorough decontamination of themselves. Just like any hazmat decontamination, the most contaminated areas on the body are the hands and feet. So, make every effort to thoroughly decontaminate the whole body, but spend more time on cleaning the hands and feet.
Also look out for corridors established in the area when setting up and actually conducting decontamination. You don’t want to spend time decontaminating someone only to have them walk through the runoff or come in contact with contaminated equipment. That is completely counterproductive, and it will hold up everyone else that is in line needing decon.
Chemical Suicide Incidents in Florida
February 6, 2010—Sarasota County: Sarasota County Sheriff’s deputies found one person dead in a parked car at an apartment complex. The victim had placed a note on the window to warn anyone of the presence of deadly chemicals. Because this was a hazmat call, the residents of the apartment complex were evacuated.
February 13, 2013—St. Petersburg: A 23-year-old used household chemicals to create H2S. A police officer was affected by the gas and had to be treated in the hospital.
March 1, 2013—Orange County: A male was passed out in a vehicle in a wooded area near the Orange and Osceola County lines. The vehicle had a warning sign taped to the window, so first responders were aware that deadly chemicals had been used. No rescuers were injured during this call.
August 7, 2013—Okaloosa County: A 24-year-old was found in a vehicle that was parked at a church. The vehicle had warning signs taped to the windows.
October 1, 2010—St. Lucie County: A victim was found slumped over at a rest area off I-95 by a state trooper. There were signs posted on the vehicle warning of poisonous gas and not to open the vehicle. The smell of rotten eggs and concentration of toxic gas was so great that a state trooper had to be hospitalized.
April 2, 2015—Orange County: Police investigated a possible chemical suicide.
Chemical Suicide Incidents Nationwide
At the time of this article was written, the Florida counties (photo 5) and states marked in yellow (photo 6) indicate where chemical suicides have been reported. Keep in mind that there have already been more chemical suicides reported in other Florida counties and states, but the details on those incidents were not fully known when this article was originally written.
March 26, 2013—Sterling Heights, MI: One victim and no injuries to first responders.
January 13, 2014—Clark County, OH: One victim and no injuries to first responders.
September 3, 2014—Anne Arundel, MD: One victim and 20 displaced residents in apartment complex.
October 27, 2014—Hillsborough, CA: One police officer injured.
June 3, 2015—Town of Newburgh, NY: Five police officers injured.
June 11, 2015—Lowell, MA: At least six first responders hospitalized.
The information provided in this article is to help first responders understand the fact that chemical suicides are becoming a growing threat. The sad fact is these types of emergencies are only going to get more widespread and possibly evolve into something much worse. We understand that helping someone with a medical emergency is our job, but to effectively help someone, we have to protect ourselves first and that includes a chemical suicide call. That is why it is imperative to maintain scene safety and try and get as much information from the 911 dispatcher or from on-scene observations. Do not get complacent while on scene, and if there is any suspicion of a possible chemical suicide, please take all the necessary precautions for yourself and everybody else around you. Now, keep in mind the information contained in this article is not to take the place of your department’s current medical protocols or operating guidelines, but rather supplement your knowledge on this particular subject.
Robert Bohrer is 15-year fire service veteran in South Florida and currently serves at his department as a driver engineer. He has an associate’s degree in Emergency Medical Services from Palm Beach State College and is also an instructor at the college. He is a State of Florida certified fire instructor II, live fire training instructor, and a hazmat technician. He also is the owner of a hazmat training company that travels all over the state and country offering hazmat and advanced fire training.