1. Chemical suicides

2. Objectives Recognize the warning indicators of a chemical suicide
Learn the methods, chemicals and equipment used in chemical suicides
Provide a safe approach to chemical suicides

3. Background Originally developed in Japan beginning in 2007
Goal is a relatively painless and easily accomplished means of death
First cases in the US occurred in 2009
Number rising every year
25% of the injuries from chemical suicides have occurred in emergency responders and bystanders

4. Hydrogen Sulfide H2S Smell of rotten eggs (sulfur)
Heavier than air (1.19:1)
Vapors will tend to sink
However, when contained, it will likely completely fill the space from top to bottom
TLV-TWA is 1 ppm
REL is 10 ppm
STEL is 10 ppm
IDLH is 100 ppm
TLV-C is 20 ppm

5. Monitoring
Standard configuration 4 gas detectors used in confined space monitoring include hydrogen sulfide as one of the 4 items monitored
Single gas, detection paper, PIDs and other devices are also capable of detecting this gas

6. Health Hazards Paralyses the olfactory nerves in the nose
After a brief exposure to the gas, the odor of rotten eggs will suddenly go away
The gas is still present! Your ability to smell it has been taken away!
Will continue to paralyze nerves, eventually stopping breathing
Nearly instantaneous death at 1000 ppm

7. Other Hazards Flammable in concentrations of 4.5-45%
Take fire precautions as necessary
Ventilation is generally the preferred method of managing the fire risk, though a hose line should also be deployed as protection
Note that the health effects level is well below 4.5%!
1 ppm is
4.5% is .045

8. Decontamination Decontamination
Potential for splatter from the chemical should be accounted for
Both parts of the most commonly used chemicals can cause skin burns and associated injuries
Thorough rinsing with water is recommended
Both as decontamination
And as continued therapy for eye/skin injuries
Clothing should be removed, as it will be saturated with both the gas and possibly the acid and/or base

9. Treatment BLS ALS Treat for shock Amyl nitrate inhalation therapy
Keep warm (especially post decontamination)
High flow O2
NRB mask
BVM or BVM + airway adjunct
ALS
Amyl nitrate inhalation therapy
Sodium nitrate IV

10. Body Handling
Do Not transport the body in an enclosed vehicle unless sealed in a air tight body bag!
The body may continue to off gas (both through decay and through lung exhalation) which may over come a driver!
Numerous sources recommend transportation in the back of a pickup truck

11. How Do They Do It? Commonly puchased materials
Hydrochloric acid/muratic acid
Used to balance pH in swimming pools and clean limestone/concrete +
Lime sulfur (Bonide) (antifungal treatment for plants)
Pesticides/insecticides

12. Cyanide
Special note:
There are documented cases of botched chemical suicides where the product created wasn’t hydrogen sulfide, but rather hydrogen cyanide!
This chemical will not kill you so quickly, but will kill you just as dead
Harder to recognize the presence of
Harder to test for (48 hours to do a blood test)
Antidote available on ambulances and in ED (cyanokit)
Smells like bitter almonds

13. Warning Signs Online sources recommend that warning signs be used
The victim is suicidal, not generally homicidal, so they usually are not trying to take others out
These signs often have the biohazard symbol and include wording like “Keep Out!” or something similar

14. Location
By design, the chemical suicide has to occur in a confined space
Something that will confine the gas to the space the victim occupies
Often a vehicle
Sometimes a room or closet

15. Indicators Obscure location Smallish space Warning signs
Woods, trail, closet, unoccupied area
Smallish space
To fill the space with the chemical
Warning signs
Tape/plastic covering openings like vents, cracks, windows
“Unconscious” person with no obvious signs of trauma

16. Indicators Suicide note Empty acid, cleaner, pesticide containers
Odors like rotten eggs or almonds
Others complaining of symptoms like difficulty breathing or loss of smell
Splattered material on victim or walls/surfaces
Visible mixing container (often between the legs)

17. Special Notes
While it is not usually the intention of these victims, remember that this has the potential to escalate to an intentional act with intent to harm others
Treat all incidents as a crime scene and act accordingly

18. Responding
Beware the “driver slumped over the wheel” call, especially in remote locations
Beware the unresponsive victim who is not immediately accessible (locked door, inaccessible location)
Resist the urge to immediately open a door/window and reach in to yank the person out
Doing so may expose you to the same thing that did them in!

19. Responding Carefully examine the scene
Look in the windows for signs of movement
Look for things like containers, an obvious note (dash, passenger seat, lap) or evidence of smoke/splattered chemicals
Pay attention to the presence of a smell of rotten eggs or bitter almonds
Look around the area for chemical containers

20. Responding Check the area with a 4 gas meter Deploy
You are primarily looking for an H2S reading but do not forget the possibility of cyanide
Some departments are now carrying meters capable of cyanide detection because of its presence in structure fires
Deploy
PPV for ventilation of the space
Hose line for fire control

21. Responding Full PPE including hood and SCBA should be used
Turnout gear can be contaminated/saturated by the gas and by splatter products
If you choose to remove the victim, place them a distance away from the source and close the door!
Control release of the gas. It isn’t 100% effective, but will still help limit the gas in the surrounding environment

22. Responding If you choose to treat:
Continue to wear PPE including SCBA until the victim’s clothing is removed and has been ventilated by BVM for several minutes
Consider water based decontamination
Keep victim warm
Otherwise BLS treatment is as per usual

23. Responding Remember that this should be handled as a crime scene
Do what is necessary to save a life (including your own)
But once you identify a non-viable victim, STOP!
Law enforcement and the coroner should be contacted to respond
Control scene access and do not disturb anything further
Document the actions you took up to the time you stopped

24. Responding Consider the possibility of hostile intent
Secondary devices
In this case, you should NOT release the scene to anyone else and go home
It is a hazardous situation which has not been mitigated
Consider NMFT response
Consider contacting the SFM office hazmat division
Remind the coroner’s office of special handling considerations for the body

25. Responding
Finally, consider the need for special needs regarding the mental health of responders

26. Conclusion
Chemical suicides are special situations that do not often initially look like anything special
Warning signs and indicators can be easy to ignore
Be alert and cautious!
Make sound decisions!