One of the Lts on my shift called me to his scene because a FF was accidentally stuck by a needle from a mark-1 kit auto-injector. After 9-11, a lot of us have these “failsafe” kits on our units. Everyone needs to know that they can discharge accidentally – the syringe came loose and free of it’s base; possibly from jostling in the truck. The kit outer case is made from soft foam and the FF’s hand brushed against it in the compartment under the LT seat while getting chalk to mark an accident scene. We give those auto-injectors to people experiencing “sludgem” due to neurological agent release. The medicine dries them out, and stops the “sludgem” but on a “healthy” body, the med dries it out from the inside out. The “C” chemical auto-injector shot through his fingertip, apparently ricocheting off the bone. The needle bevel was bent and the needle itself was bent. The FF pulled the needle out as soon as he realized what happened. Thankfully, the FF and Paramedics on the scene “milked” the finger to get some product out before it could be circulated and absorbed. Additionally, since the tip of the finger was injected, only the wrist and hand seemed to be affected. The hand looked so dried out, it appeared frost-bitten. The tip of the finger took in 2ccs of fluid that is meant to be injected into a large muscle. It is a known fact that the agent causes severe pain at the injection site. The firefighter’s finger was x-rayed for fracture, but none was found. He was kept overnight for observation because delayed effects of the medication include bronchospasm and muscle rigidity. He did well in that regard, but experience excruciating pain at the injection site and the finger remained bulbous for several days. No amount of pain medication seemed to ease his pain. He was discharged the next day and returned to full duty his next shift. This was a scary event due to the lack of knowledge by responders and emergency room personnel about the effects of this auto-injector on a healthy body. Every person (doctor) we called for assistance that morning expressed an “oh no” attitude. Thankfully, one of our medical directors is on a USAR team and was well versed in the side effects of the medication. Back at the fire department, we took immediate steps to secure all of the injection kits in rigid plastic containers. We also checked the discharged kit for defects and found that the syringe had come off of it’s “safety” base, enabling discharge with any pressure to the end of the syringe. Once the emergent nature of the call calmed down, the department Chaplain was called to the hospital to help out the FF and his wife. Due to the many unknowns, this was an extremely stressful situation for both the affected FF and the crews that worked on him.
We all must absolutely know what we carry on our units, to include side-effects, antidotes, and proper handling procedures. Nothing had ever come out suggesting we couln’t store the kit as it was, and we were convinced it was failsafe. Additionally, for something so volatile and obscure, we should have definitive guidelines on how to handle an accidental discharge. We also learned that neither poison control nor the emergency room personnel had any knowledge about this kit’s medications. We are following-up with a written guideline for any similar incident that will be placed in the emergency room. Another lesson learned is that if you have received information from your medical director on the seriousness of the incident, and the hospital staff doesn’t seem to take things as seriously as you would feel comfortable with, leave one or two paramedics in the ER with the injured FF until the critical time has passed. Chances are very high that a field paramedic on a special operations team (as both were)will know a lot more about these agents than an emergency room doctor or nurse, and they can be of valuable assistance. One more lesson is that a good working relationship with your medical director is essential and invaluable, as is a good relationship with your Chaplain.