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

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

3. 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:
Lee-Chiong TL. Postgrad Med. 1999;105:55-62.
Photo: Cyanide Poisoning Treatment Coalition (2006), Falls Church, VA.

4. ROUTES OF ENTRY
Inhalation
Absorption
Ingestion
Injection

5. 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

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

7. 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)
ppm: Serious injury; pulmonary edema

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

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

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

11. 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

12. 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

13. 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

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

15. 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
ppm: Dangerous in 30 minutes to 1 hour
3000 ppm: Rapidly fatal

16. 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

17. 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 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System.

18. . . . 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;
Flomenbaum NE, et al. Goldfrank’s Toxicologic Emergencies. McGraw-Hill

19. 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:

20. CO or CN

21. CN?

22. Indication

24. Administration

25. 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 will be dispatched by ECDC.
Maplewood Fire Department has two available as a backup.

26. 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