CyaIns_FE_0608 7/18/06 4:39 PM Page 2 SMOKE PERCEPTIONS, MYTHS, AND MISUNDERSTANDINGS Photo: Steve Redick Educational Supplement sponsored by the Cyanide Poisoning Treatment Coalition CyaIns_FE_0608 7/17/06 9:43 AM Page 3 Photo: David Traiforos Photo: David Table of Contents INTRODUCTION . 1 By Rob Schnepp FOREWORD . 2 By Chief David D. Costa HYDROGEN CYANIDE IN FIRE SMOKE: AN UNRECOGNIZED THREAT TO THE AMERICAN FIREFIGHTER . 4 By Donald W. Walsh, PhD, EMT-P AIR MANAGEMENT ON THE FIREGROUND: THE NEED- THE MANDATE - THE SOLUTION . 9 By Mike Gagliano, Casey Phillips, Phil Jose, and Steve Bernocco FIRE OVERHAUL, REHAB, AND A COMPREHENSIVE RESPIRATORY PROTECTION PROGRAM . 12 By Phil Jose, Steve Bernocco, Mike Gagliano, and Casey Phillips SMOKE ASSOCIATED CYANIDE EXPOSURE: THE IMPORTANCE OF PROMPT RECOGNITION AND PROTOCOLS FOR PREHOSPITAL TREATMENT . 15 By James Augustine, MD and Donald W. Walsh, PhD, EMT-P ACUTE CYANIDE POISINING: A PARIS FIREFIGHTER RECOVERS FROM SEVERE SMOKE INHALATION. 19 By J.L. Fortin, S. Waroux, A-M Arvis, JP. Giocanti, C Fuilla, D. Walsh, M Ruttiman, and M Eckstein CyaIns_FE_0608 7/17/06 9:43 AM Page 4 READING SMOKE IS ONE THING - BREATHING IT IS COMPLETELY DIFFERENT BY ROB SCHNEPP, Supplement Editor REVOLUTION: a drastic and far-reaching in the smoldering debris, breathing all smoke inhalation victims may be futile. change in thinking and behavior. those products of incomplete com- The last piece, written by Dr. Jean-Luc bustions? Why do we put so much effort Fortin, offers a look inside a successful Americans are, by and large, into rapid intervention teams, when the resuscitation of a firefighter in Paris, assaulted with a steady stream of current method of medically treating France. The firefighter, overcome by so-called “revolutions.” There’s been no someone after the rescue is largely smoke after getting lost inside a structure shortage of fitness and dietary revolu- ineffective? We’ve figured out a better way fire, is alive and well today because of tions over the years, each one offering to rescue our own, but have not com- aggressive pre-hospital care and an unbelievable results with a money pleted the loop by providing an effective antidote for cyanide poisoning. back guarantee. The ongoing technol- antidote to correct a potential cause of The bottom line is this - the fire ogy revolution has promised increased death in smoke inhalation victims - service needs to become better educated productivity and more free time, while cyanide poisoning. Typically, when about smoke. Hopefully, an increased the computerized banking industry someone dies in a fire, it’s attributed to level of knowledge will reinforce the has almost rendered cash obsolete. the nebulous cause of “smoke inhala- importance of respiratory protection on And while each of these examples has tion.” In truth, it’s more complicated the fireground, and the need to prop- had an impact on daily life, they appear than that - we just haven’t been looking erly manage your air supply. It’s better to be more evolutionary than revolu- at it the right way. We haven’t really digest- to avoid getting into trouble than tionary. It’s gotten to the point where ed the combustion chemistry to truly relying on a rapid intervention team to “revolution” has become synonymous understand why the smoke is so nasty. come in and find you! Unfortunately, a with benign terms like change, devel- Understanding the basics of combustion low air emergency does not come with opment, or progress. Unfortunately, chemistry is the first step toward a “money back” guarantee. such common usage of the term has gaining a new respect for an old foe. Smoke has become such a constant watered down its meaning. It’s fitting that this smoke revolution companion for us that we may have In reality, true revolutions are finds its roots in a busy fire department lost respect for it. According to Chief anything but benign. like Providence, Rhode Island - a key Costa, his department was shocked by Revolutions are fueled by a new player in the American Revolution. In the cyanide exposures. “We haven’t way of thinking, risk taking, and the this supplement, Chief of Department come up with a firm grasp of what will courage to do things completely dif- David Costa provides a detailed be different,” he says. “It’s too early to ferently. Something the American fire description of a series of fire incidents tell. There is, however, a lot of lively service is not entirely comfortable that are emerging as a shot heard discussion going on around the with. This is not to say that the fire ‘round the world for the fire service. firehouse coffee table.” service is backward or unable to He describes an investigation that And that’s what we need to better embrace new ideas. It is however, reached an unexpected conclusion: a appreciate the immediate and long accurately characterized as 200 years large number of his firefighters were terms effects of breathing smoke - a of tradition unimpeded by progress. exposed to cyanide - from the smoke - lively discussion. We also need a drastic Why all the talk of revolution? after fighting a series of structure fires. modification of our attitude toward Because the fire service is on the eve These firefighters were operating at the smoke. Most of all, it’s important to of one. A far-reaching and possibly same kind of fires occurring every day keep an open mind about the research tumultuous revolution that will chal- in each and every part of this country - and data presented here. You might lenge everything we thought we knew the typical residential structure fire. discover some solutions on the follow- about smoke - the constant companion I encourage you to read about ing pages, but more than anything, I of the firefighter. Chief Costa’s journey. A journey that hope it raises some questions. Research conducted over the years every Fire Chief hopes to avoid - one has proven that smoke is bad - we all that ends with a visit to a firefighter’s Rob Schnepp is the Chief of EMS and Special know that. We all know that smoke spouse, telling them that their loved Operations for the Alameda County (CA) Fire kills more people than flames and that one has been injured on the job. Department. He is the primary author of breathing smoke isn’t good. So why do I hope you’ll take the time to read a textbook entitled “Hazardous Materials: we still go to fires and not wear our the articles following Chief Costa’s Regulations, Response & Site Operations,” SCBA? And I’m not talking about wear- foreword. You’ll learn about combus- by Delmar Publishing, and is on the editorial ing the tank with the mask dangling tion chemistry, better ways to manage advisory board for Fire Engineering magazine. around your neck. After the fire is your air while fighting fire, the signs Rob is a member of the NFPA Technical and symptoms of smoke inhalation, knocked down, why is it that firefighters Committee on Hazardous Materials Response. drop their SCBA and perform overhaul and why current methods of treating 1 CyaIns_FE_0608 7/17/06 9:44 AM Page 5 About 5:45 PM, I received a telephone symptoms of cyanide poisoning. FOREWORD call at home from a dispatcher saying Including the initial 16 firefighters who that a member that operated at the received medical attention, 28 sought DAVID D. COSTA restaurant fire earlier in the day was at evaluation and treatment. Cyanide Chief of Department Rhode Island Hospital and had been exposure was confirmed in 27 firefight- Providence Rhode Island Fire Department diagnosed with high levels of cyanide in ers, 8 of whom were identified as having his blood. The firefighter had received high levels of cyanide in their blood. the standard cyanide antidote kit. Exposure to cyanide from the Having consulted with the fire- products of combustion is much more fighter and his doctor, I decided that prevalent than many in the fire service March 23, 2006 began like most days every firefighter who responded to the are aware. A graduate of the Executive in the City of Providence. I started the restaurant fire should be instructed to Fire Officer Program at the National day by attending several meetings seek medical treatment if they experi- Fire Academy with a Bachelors Degree dealing with the administrative issues enced symptoms possibly indicative of in Fire Science, I was disturbed that I that every chief of a fire department cyanide poisoning. Sixteen firefighters was not aware that cyanide is pervasive encounters. I did not know that the sought medical treatment; 4 of the 16 in fire smoke. While every firefighter is next 24 hours would trigger a series of were confirmed to have high levels of taught the basic information about the incidents that would thrust me into cyanide in their blood. dangers related to hydrogen cyanide the forefront of a nationwide debate As I discussed the situation further and other products of combustion, the over the testing and treatment of with doctors, my officers, and fellow depth of our understanding pales in smoke inhalation victims and air man- firefighters, there did not seem to be a comparison to the information available agement at fireground operations. clear answer to what could have in medical journals. The Providence Fire Department is a fully paid fire department with a uni- formed strength of 469 personnel. We “ The cyanide exposure incidents have brought a protect the capital city of Rhode Island, which has a population of 173,618 in a harsh reality to our department about the real 20-square-mile area.