Today, the Fire Smoke Coalition launched the first Smoke Inhalation Treatment Database for use by first responders and medical professionals throughout the world.
In the United States, residential fires are the third leading cause of fatal injury and the fifth most common cause of unintentional injury death, yet the majority of fire-related fatalities are not caused by burns, but by smoke inhalation. Despite the amount of fires in the U.S. decreasing each year, the amount of civilians dying in fires is actually increasing. For example, in 2009, 1,348,500 fires were attended by public fire departments, a decrease of 7.1 percent from the year before; however, 3,010 civilian fire deaths occurred, which is an increase of 9.3 percent.
In fire smoke, hydrogen cyanide can be up to 35 times more toxic than carbon monoxide,ii an underappreciated risk that can cause severe injury or death within minutes.iii,iv In a review of major fires over a 19-year period, cyanide was found at toxic-to-lethal levels in the blood of approximately 33 percent to 87 percent of fatalities.
While many fire department medical directors and physicians have altered treatment protocols to consider cyanide as a deadly toxicant in smoke inhalation patients, thousands have not. Until cyanide is presumed to be on board, and working concomitantly with carbon monoxide, most especially in victims removed from closed-space structure fires, people will continue to die of what has become a complicated illness. One can no longer assume carbon monoxide is the only toxicant requiring treatment, or it is the sole cause of death. Those days are over.
The Coalition is requesting all medical providers, ALS/BLS and physicians, enter data following treatment to smoke inhalation victims. Information collected will be available to all medical professionals, day or night, and will hopefully provide insight into “new” treatment practices that include consideration of an antidote for cyanide poisoning associated with smoke inhalation. While there are only two FDA approved cyanide antidotes in the United States, the Cyanokit®, also known as Hydroxocobalamin, is not contraindicated in smoke inhalation treatment.
In April, the Congressional Fire Services Institute (CFSI) passed a resolution noting that there is mounting proof, obtained through atmospheric monitoring on fire grounds throughout the U.S., that hydrogen cyanide (HCN) is a predominant toxicant found in fire smoke. The resolution calls for educating the fire service about the dangers of smoke inhalation—including those of HCN—through support of a national education program, the development of HCN poisoning treatment protocols for all local and state emergency medical services (EMS), and efforts by the Centers for Disease Control and Prevention (CDC) to establish a national database of smoke inhalation injuries, medical complications and deaths linked to HCN.
“By approving a resolution on smoke inhalation, our National Advisory Committee recognizes that CFSI should become actively engaged in efforts to increase national awareness on the dangers of smoke inhalation and on initiatives to reduce its risks to both the public and the fire service,” said Bill Webb, executive director of the CFSI. “I commend (Coalition board member, CFSI member and editor of Fire Engineering) Bobby Halton for bringing this resolution forward to the NAC and for providing strong leadership on such an important issue.”
The Smoke Inhalation Treatment Database is the first step toward accomplishing Coalition and CFSI objectives to reduce the number of smoke inhalation deaths. To access the Database, visit www.FireSmoke.org.
