Springdale, AR: Station one received a 911 call for an unconscious/unresponsive male at a local poultry production plant. We sent a typical response of an engine and a medic unit. They arrived on scene and found a male patient down and unresponsive. They started to treat the call like a typical cardiac event. They hooked the monitor to the patient and realized that his SPCO2 was over 40. Due to the training we have provided our people on the subject of CO and HCN exposure, they recognized this may be one of those cases. They placed the patient on the cot and moved him to the squad. Still following ALS protocols for a suspected cardiac incident, the patient was placed on high flow O2 and baseline vitals were obtained. The patient started to come around and stated he had a taste of sour almonds in his mouth. This of course is another sign of possible HCN poisoning and the captain picked up on it. The engine captain sent his firefighter to the engine to get the 4 gas meter and zero it out.
Our meters on the engine companies are equipped with O2, LEL, CO and HCN. The medic crew initiated transport and the firefighter returned with the meter. They found no indications of any problems in the immediate area. They entered the boiler room where the patient was said to working and immediately the meter started alarming. The CO was 383 ppm and the HCN was 65ppm. The engine captain again recognized this information needed to be passed along to the medic crew and remembered that HCN’s IDLH is 50 ppm. He called them on the radio and advised this was a HCN incident. The engine captain had the building evacuated and the maintenance personnel turned on the vent fans. The toxic environment was ventilated quickly and the plant personnel were able to enter the boiler room to find the problem and fix it.
The medic crew, based on the meter reading and the signs and symptoms of the patient, advised the ER doctor of their findings. The medic advised the doctor that the patient needed the Cyanokit. The doctor wanted to verify the information so he asked the medic a few quick questions, one of which was: What was going to happen if he administered the kit? That is when I received a phone call in the middle of the night. The medic asked what would happen if the kit was given. I told him the kit converts the HCN to a B-12 vitamin that the body will expel. The patient may turn red or urinate red for a little while, but there should be no major side effects.
I found out the next morning that they administered the Cyanokit at the ER. The doctor agreed that the kit was warranted due to the signs and symptoms, but most importantly due to the meter readings. It is imperative that crews recognize the signs and symptoms, but it is more important that they can back it up with real numbers from meters. Doctors across the nation don’t always recognize HCN exposure because it is and can be confused with CO poisoning.
This is the second time this year we have utilized the Cyanokit. The first time was in the field and the doctor at the ER didn’t understand why we gave it. Once the information was passed along, he agreed the decision. The same doctor was on duty the second time and there was no confusion about the administration.
Now, we have a Cyanokit on every one of our medic units and the local ER has 6 in stock. Due to our close relationship with the local medical community, they recognized early the need for the kits and actually purchased them before we did.
Captain Todd Andrews
Springdale Fire Department