Group recommends the mandatory use of air packs by firefighters in the face of a poisonous invisible enemy — hydrogen cyanide. They always knew that inhaling smoke was dangerous. But until now, they didn’t know about the invisible deadly toxin becoming prevalent in modern-day fires.
Two months after several Providence firefighters suffered cyanide poisoning fighting structure fires, a five-member task force formed by Fire Chief David Costa released a report yesterday on their investigation and recommendations.
The report contains 16 recommendations for the fire service, the medical community and the public. The task force advocates training firefighters about the risks and to consistently wear their air masks, educating the medical community to routinely test smoke-inhalation victims for cyanide poisoning, and teaching the public that there’s no time to spare in getting out of smoky buildings.
Above all, the task force is pressing to end the traditional “smoke-eater” culture of fire departments, in Providence and nationwide.
“Firefighters use their experience and skill in determining when to wear their air packs and when not,” said Deputy Assistant Chief J. Curtis Varone, chairman of the task force. “We went by the level of heat, the volume of smoke and the taste of smoke. And we have to realize that our own experience has been letting us down.”
The changes are prompted by what happened to more than two dozen firefighters on March 23 and 24.
What seemed to be three routine business and house fires ended up sending 28 firefighters to hospitals with headaches, dizziness and incoherence.
Twenty-seven were tested for cyanide poisoning over that two-day span. Eight had elevated levels of cyanide in their blood; two were serious enough to need an antidote.
The worst happened to firefighter Kenneth Baker, the chauffeur on Engine 6, who collapsed with a heart attack while manning the pump outside a house fire. He was brought back to life at Rhode Island Hospital. He is recovering at a rehabilitation facility in Easton, Mass.; he has no memory of the fire.
Costa immediately assembled the task force of high-ranking fire officials and firefighters to investigate the fires and research the impact of hydrogen cyanide in smoke. They found that cyanide is a much bigger problem for firefighters than most people in the fire service realized.
Hydrogen cyanide gas is emitted from smoldering and burning plastics, often from common household goods, foam, asphalt and other construction material. The gas is invisible, it is odorless to some; others can detect the scent of bitter almonds. Inhaling it can cause headaches, dizziness, or seizures and death.
“All of us were caught by surprise by how much cyanide there is in the fire [environment],” said Varone.
The Fire Department has already adopted some of the recommendations, such as having an air supply unit respond to a structure fire so the firefighters’ air masks can be quickly replenished, Costa said. The department is planning to train all its firefighters on the hazards of cyanide in smoke. Firefighters will have to wash their turnout gear immediately after every fire to prevent contamination by chemicals in the smoke.
Costa said more firefighters than usual will be called to fire scenes now, so that can relieve each other as their air masks are depleted. He couldn’t answer questions yesterday about whether this practice will eventually require hiring more firefighters.
The report answers in thorough detail about what happened at the fires. But even the chief admitted there are still questions.
The task force recommends more scientific and medical research. They found that Rhode Island Hospital is the only major hospital in New England that performs cyanide testing in-house, and there are only eight laboratories in the country that perform whole blood cyanide tests. Hospitals that can’t perform the tests in-house can wait up to a week to get test results, which is useless when determining whether a critically ill person has been poisoned by cyanide.
The report is being sent to the National Institute of Occupational Safety and Health, which recently sent a team of doctors to investigate the cyanide incidents. The NIOSH team is expected to release its report in several months, and might end up recommending a wider investigation into how prevalent hydrogen cyanide is at fire scenes — and what firefighters nationwide should do to protect themselves.
The nation should move quickly to develop and approve new cyanide antidotes that can be used safely to treat victims of smoke inhalation, the report says. The only antidote now on the market in the United States is known as the Lilly, Taylor or Pasadena kit, which includes a series of drugs to counteract and eliminate cyanide from the bloodstream. The kits contain amyl nitrite, which is inhaled, followed by sodium nitrite and sodium thiosulfate, which are given intravenously.
But the current antitode can be dangerous: it decreases the amount of hemoglobin in the blood and causes severe low blood pressure. This antidote couldn’t be used at the fire scene because of the serious side effects.
A promising alternative that’s been used for years in France is being considered by the U.S. Food and Drug Administration. The antidote is hydroxocobalamin, a precursor to Vitamin B-12, which neutralizes cyanide to form cyanocobalamin. Cyanide binds to hydroxocobalamin and is no longer toxic, and is eliminated harmlessly from the body through urination.
If approved, it could be used at a fire scene to treat firefighters and civilians overcome by smoke and who have symptoms of cyanide poisoning.
Meanwhile, the department is teaming with a Middletown, Conn., company, biosystems, to develop sensors that firefighters can use to test for cyanide at fire scenes.
Varone contacted the company with questions about whether such equipment existed. The technology for cyanide detection is available, Jeffrey A. Emond, a senior chemist for Biosystems, said, but the equipment firefighters need must be sensitive enough and tough enough to work in a burning building.
As the company develops the equipment, Providence firefighters will test it. Starting today, each fire company is getting a detection sensor, which is about the size of a deck of cards, to carry with it. The sensor has a screen on the front that can display the cyanide levels in the atmosphere, Emond said. The sensors can be carried on the firefighters’ belts and vibrate to warn them of fatal levels or lower levels of cyanide, he said.
“It’s great to work on a ground-breaking opportunity,” Emond said.
Recommendations meant to protect
An investigative task force formed by Fire Chief David Costa has come up with 16 recommendations meant to protect firefighters and civilians from hydrogen cyanide produced by fires. These recommendations are being forwarded to the National Institute of Occupational Safety and Health. They include:
kly incapacitate anyone trying to escape a fire.
01:00 AM EDT on Wednesday, May 31, 2006
Journal Staff Writer