1. C YANIDE IN F IRE SMOKE Presumptive - Antidotal Treatment

2. Cyanide’s Destructive Qualities Blocks aerobic metabolism and energy production: cellular hypoxia –Cells immediately starve for oxygen and die –No amount of supplemental oxygen can overcome the deficit in affected cells –Causes shift to anaerobic metabolism Byproducts of anaerobic metabolism (e.g., lactic acid) accumulate Death from central respiratory arrest

3. “Aftermath” To address the complexities of HCN treatment, the Fire Smoke Coalition produced “Aftermath” – a comprehensive video production about smoke inhalation, which includes the presumptive diagnosis for consideration of cyanide poisoning. This is not just about the firefighter population – it includes civilians as well.

4. FDA Approved Cyanide Antidotes CAK (Cyanide Antidote Kit) which contains Amyl Nitrite, Sodium Nitrite and Sodium Thiosulfate, is the most readily available antidote in most hospitals and the ONLY known to most physicians. Which drug is contraindicated In smoke inhalation patients?

5. FDA Approved Cyanide Antidotes - Nithiodote (a new cyanide antidote approved by the FDA in 2011) – but without new drugs (Sodium Nitrite and Sodium Thiosulfate) which will be marketed to hospitals for use as a new “cyanide antidote.” Again, Nitrites.

6. FDA Approved Cyanide Antidotes - Cyanokit, which contains (2) 2.5mg vials of Hydroxocobalamin (Vitamin B12) - Not contraindicated in smoke inhalation victims and a preferred antidote by Coalition experts. The Challenge: $$$ vs. Shelf Life (3yrs)

7. The Greatest Challenge with Cyanide Antidotes Very few physicians and poison control centers are aware of the difference between industrial cyanide poisoning and cyanide poisoning from smoke inhalation AND, THEREFORE, elect to use any “cyanide antidote” without understanding fire smoke cyanide poisoning.

8. You are the Messenger You, the firefighter / first responder, will be responsible for educating your local medical community. How? -Deliver a copy of “Aftermath” -Share the “SMOKE publications

9. Does your Department need a life-saving cyanide antidote? What good is RIT without a Cyanokit?

10. Questions www.Firesmoke.org www.FSCommunity.com