Lynn Fire tries new treatment for smoke inhalation victims

LYNN – News images from the scene of a building fire typically show a firefighter or victim suffering from smoke inhalation and being administered oxygen from a green metal tank.What the pictures don’t show is the aftermath.Today’s home furnishings and household products contain a myriad of chemicals, which means the chances of breathing in toxins such as cyanide are high. For that reason, the Lynn Fire Department on Tuesday began stocking its Medic One advanced-life-support (ALS) ambulance with a new French-made drug designed to combat the negative effects of cyanide poisoning.The action was taken after firefighters in Providence, R.I. and at other departments across the country inhaled smoke at a fire and suffered what seemed like near-fatal heart attacks, according to Lynn Fire Capt. Joseph Zukas, director of the department’s emergency medical services. The Lynnfield Fire Department has also adopted the protocol of intravenously administering the drug, hydroxocobalamin, to apparent victims of cyanide poisoning.The medication received approval from the U.S. Food and Drug Administration in December 2006. Its availability to firefighters and public safety personnel in France predates the U.S. acceptance.”There is no test for cyanide. There are only a list of symptoms, so it becomes a judgment call in the field for the paramedics, just as a lot of other protocols are judgment calls,” said Zukas, noting that two Providence, R.I. firefighters suffered serious heart attacks after inhaling smoke at a fire. They were later diagnosed with cyanide poisoning, which can rapidly turn fatal.According to Zukas, the new medication makes the skin turn reddish for a day or two, but exhibits few negative side effects. “It works like giving Narcan to an addict,” he said. “The paramedics mix it with another solution and give it to the victim through an IV.”Vials of the drug were included in the locked medical box on Medic One, stationed on Hollingsworth Street in the Highlands.Zukas said Scott Watson, a Lynn firefighter/paramedic, trained the other 21 Fire Department paramedics to administer the drug. “If somebody has been in a building fire or other smoke-filled environment, there’s a chance they’ve breathed in cyanide,” he said, explaining that symptoms may include headache, shortness of breath, chest pains, hypertension and disorientation. Other telltale signs include mental confusion, dizziness, seizures and soot in the throat, nose or septum. Severe cases may result in apnea, bradycardia and, ultimately, cardio-vascular collapse.The government’s Response Guide to Chemical and Radiological Threats lists hydrogen cyanide – a colorless gas or liquid with a faint smell of bitter almonds – among the possible agents. Homeland security experts believe hydroxocobalamin will prove a more effective antidote treatment than its precursor, a three-part drug.Hydroxocobalamin is related to vitamin B12. It binds cyanide directly to form cyanocobalamin, which is excreted in the urine. It crosses the blood-brain barrier and is quick acting.The drug’s effects were studied and actively used to treat patients in France by the Paris Fire Brigade from June 1987 through February 1994.”Cyanide has been proven in many studies to be a major intoxicant found in the smoke produced during a structure fire,” said Zukas. “This is one of many gases found in smoke that affects civilian victims and firefighters alike at the scene of a fire.”Medic One responds to approximately 250 medical emergency calls each month and is among the busier ALS ambulances on the North Shore, Zukas said.Ambulances staffed with emergency medical technicians (EMTs) and equipped for basic-life-support (BLS) do not administer intravenous drugs, perform intubations or other advanced medical procedures that are conducted by paramedics.