It’s not JUST Smoke! The Truth about Fire Smoke

Smoke: “An aerosol of solid or liquid particles usually resulting from incomplete combustion.”

Anatomy of Fire Smoke Particulates Irritants Asphyxiants/Toxicants Dust Soot Irritants Hydrochloric acid Sulfur dioxide Oxides of nitrogen Ammonia Asphyxiants/Toxicants Carbon dioxide Hydrogen cyanide Carbon monoxide Hydrogen sulfide Kulig K. N Engl J Med. 1991;325:1801-1802. Lee-Chiong TL. Postgrad Med. 1999;105:55-62. Photo: Cyanide Poisoning Treatment Coalition (2006), Falls Church, VA.

ROUTES OF ENTRY Inhalation Absorption Ingestion Injection

Oxides of Nitrogen - NOx Deep lung irritant – may produce pulmonary edema - Strong irritants, particularly to mucous membranes. - When inhaled will damage tissues in the respiratory tract - Threshold limit value: 5ppm Least amount causing immediate irritation to the throat: 62 ppm Dangerous for short exposure: 117 to 154 ppm Rapidly fatal for short exposure: 240 to 775 ppm

Formaldehyde Formaldehyde Water soluble Heavier than air Flammable Gas at room temp Probable human carcinogen Sources: resins, plastics, preservatives, drying agent, tobacco smoke

Formaldehyde Formaldehyde Acute health effects: Inflammation of lungs and respiratory tract, pulmonary edema. 2-3 ppm: nasal irritation 20-30 ppm: Breathing is difficult (IDLH) 50-100 ppm: Serious injury; pulmonary edema

Vinyl Chloride Key component of plastics industry (PVC) Known carcinogen Affects liver, CNS, lymphatic system Toxic by inhalation and absorption OSHA PEL: 1ppm

Poly Vinyl Chloride Wire insulation, electrical conduit, plumbing pipe, molded plastic furniture, etc. Decomposition temperature: 450-500 degrees F

Fiberglass – SMF’s Inhalation of microscopic shards of glass coated with phenol-formaldehyde.

Particulates - Soot - Byproduct of incomplete combustion - Known human carcinogen; lung cancer - PAH’s – polycyclic aromatic hydrocarbons OSHA PEL: 0.2 mg/m3 Toxic by inhalation, ingestion

Carbon Monoxide Poisonous, colorless, odorless, tasteless and highly flammable Flammable Range: 12%-74% Present in incomplete combustion OSHA PEL: 50 ppm - IDLH : 1200ppm Target Organs: CVS, Blood, CNS

Fire Smoke A Source of Cyanide Cyanide produced by combustion of both synthetic and natural substances Most common source of acute cyanide poisoning in the US Contributes significantly to smoke inhalation injury and death

Sources of Cyanide in Fire Smoke Natural substances Wool Silk Cotton Paper Synthetic substances Plastics Other polymers Plastics

Cyanide Compounds 10 ppm: Threshold limit value 20-40 ppm: Slight Symptoms after several hours of exposure 50-60 ppm: Maximum amount that can be inhaled for 1 hour without serious disturbance 120-150 ppm: Dangerous in 30 minutes to 1 hour 3000 ppm: Rapidly fatal

Cyanide Compounds Half-life of cyanide in the body is about 1 hour Cannot be detected by smell in 40%-60% of the population Deficit is greater in men by 3:1 35 times more toxic than CO

HCN – An Invisible Threat . . . Absence of a rapidly returnable diagnostic test for cyanide poisoning reinforces the perception of carbon monoxide as the primary contributor to smoke inhalation injuries and deaths. Eckstein M, Maniscalco PM. Prehosp Disast Med. 2005;21:s49-s55. Watson WA, et al. 2004 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System.

. . . or Just Ignored? Substrates for hydrogen cyanide frequently found in modern buildings (natural and synthetic substances containing carbon and nitrogen, such as wool, silk, and some plastics) Release of hydrogen cyanide highly probable and to be expected in enclosed-space fires Cyanide can act independently from carbon monoxide Eckstein M, Maniscalco PM. Prehosp Disast Med. 2005;21:s49-s55. Alaire Y. Critical Reviews in Toxicology. 2002;32;259-289. Flomenbaum NE, et al. Goldfrank’s Toxicologic Emergencies. McGraw-Hill. 2006.

Toxicity of Fire Smoke: Conclusions Cyanide is likely to be present in appreciable amounts in fire victims’ blood Cyanide is a common product of combustion – which is treatable if diagnosed. Frequent co-exposure to carbon monoxide and cyanide occurs Although carbon monoxide is likely a major toxicant in fires, cyanide can sometimes be the principal cause of death Numerous deadly toxicants exist in toxic fire smoke, which if exposed acutely or chronically (NOT ON AIR) – can cause disease or death. Alaire Y. Critical Reviews in Toxicology. 2002;32:259-289.

CO or CN

CN?

Indication

Administration

Dispatching of Cyanokits Central County Emergency 911 is the point of contact for requiring this resource. For East Central Dispatch agencies, Clayton Fire Department, has the kits. When ECDC notified by the Incident Commander of a WORKING FIRE, PERSON’S TRAPPED or a MAYDAY within one of the eight cities, 3203 to be automatically dispatched as CYANOKIT unit. If 3203 is not available and the call is in one of the eight cities, dispatch 3116. If ECDC receives reliable information that person(s) are trapped in the initial call / dispatch Will make every attempt to ascertain how many person(s) are trapped and relay that information to the IC and/or 3203 If request is out of the ECDC cities, Central County Emergency 911 will contact ECDC and request CYANOKIT - 3203 will be dispatched by ECDC. Maplewood Fire Department has two available as a backup.

Availability In Central Core Area: Clayton 3203 Clayton 3217 Maplewood 3116 (2) Other sources: Florissant Fire Mehlville Fire Monarch Fire St. Louis City Fire Rock Township Ambulance St. Charles County Ambulance