New awareness of smoke inhalation by firemen in the US
Smoke inhalation from house fires is a frequent cause of fatalities. According to an article published in the online journal www.emsresponders, firefighters know that most fatalities in house and building fires are the result of smoke inhalation.
In the US, it is estimated that smoke inhalation causes between 5,000 and 10,000 deaths each year. In addition, 23,000 injuries from smoke inhalation occur every year, including some 5,000 firefighters (1). Hydrogen cyanide gas is not always recognized as a significant hazard in smoke inhalation. Cyanide gas is produced by the combustion of natural products such as wool, silk, cotton or paper. Synthetic substances, such as plastics and other polymers, also produce cyanide
Increasing evidence suggests that victims of smoke inhalation also often suffer from cyanide poisoning.
Two studies, one in Dallas, Texas, and the other in Paris, France, evaluated the role of cyanide in fire-related morbidity and mortality. A total of 109 fire victims were studied – 66 who survived and 43 who died. The data was compared against 114 control subjects – 40 with drug intoxication, 29 with carbon monoxide poisoning and 45 with major trauma.
The Paris study showed that in some victims who died, blood levels of cyanide were in the potentially lethal range while blood levels of carbon monoxide were in the non-toxic range. The results of this study showed that smoke inhalation victims did not die only from carbon monoxide. Instead, both cyanide and carbon monoxide were important in determining morbidity and mortality associated with smoke inhalation. The study also showed that cyanide concentrations were directly related to the probability of death and that cyanide poisoning may have been the leading cause of death in some fire victims.
The other study conducted in Dallas County compared 144 smoke inhalation victims who arrived alive over a two-year period at the University of Texas Health Science Center emergency room versus 43 smoke inhalation victims who were dead on arrival at the Dallas County Medical Examiner’s Office during the same period.
In the study, it was observed that mean blood cyanide concentrations in victims arriving alive at the emergency room were lower than concentrations in victims who were dead on arrival. The Dallas County study concluded that elevated cyanide concentrations were more frequent in smoke inhalation victims. It also concluded that cyanide concentrations were directly related to the probability of death, and cyanide poisoning may have been the leading cause of death, exceeding deaths from carbon monoxide poisoning.
In conclusion, cyanide poisoning from fire smoke inhalation is of increasing concern and heightened awareness is necessary to successfully recognize and treat it.
Ludwig, Gary. Firehouse Magazine Fire Service EMS Contributor. www.emsresponder.com/smoke inhalation.
(1) Borron SW et Baud FJ. Toxicity Cyanide. www.medicine.com/emerg/topic118