Chemical suicides

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

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

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

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

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

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 .000001 4.5% is .045

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

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

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

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

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

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

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

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

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)

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

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!

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

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

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

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

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

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

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

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!