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APHA Scientific Session and Event Listing

Recorded presentation

Scott F. Wetterhall, MD, MPH, Health Security and Systems Research, RTI International, 2951 Flowers Road, Suite 119, Atlanta, GA 30341, 770-234-5046, jane@writemedicine.com and Richard C. Dart, MD, Rocky Mountain Poison & Drug Center, 777 Bannock Street, Mail Code 0180, Denver, CO 80204.

Purpose: The public health importance of cyanide toxicity is increasingly recognized, particularly as a consequence of smoke inhalation (the most common cause of cyanide toxicity) or intentional release by terrorists. Prehospital medical preparedness for cyanide exposure in the United States has not been systematically assessed. The purpose of this survey was to assess cyanide preparedness and practices among US emergency medical services (EMS) providers. Methods: A questionnaire was administered via the Internet, mail, or telephone to a nationally representative sample (n=832) of advanced life support (ALS) providers. Responses were summarized by census region. Results: The number of respondents returning surveys was 507 (61%). There was little regional variation in the proportions of respondents indicating that (1) the greatest risk of cyanide exposure is from inadvertent release during transportation (national mean, 42%) versus fires (41%); (2) antidotes are rarely considered standard treatment for cyanide poisoning; and (3) cyanide antidotes are not stocked on ALS vehicles (79%). Regions differed in whether or not data on cyanide-related deaths are readily available, factors determining number of antidotes stocked, and whether or not the cyanide treatment protocol requires a cyanide blood test before treatment is given. Conclusion: In all US census regions, antidote supply and protocols for use are inadequate for an effective response by ALS providers to a cyanide incident. The results emphasize the need to improve preparedness for cyanide poisoning across the United States and to develop national guidelines for prehospital stocking of antidotes and empiric treatment of suspected cyanide poisoning.

Learning Objectives:

• Describe cyanide risk preparedness among first-responder emergency health care providers in the United States as shown by a nationally representative survey
• Summarize best practices in the recognition and treatment of cyanide poisoning and evaluate current cyanide preparedness against these best practices
• Understand regional differences in cyanide risk and preparedness and the implications of regional differences for antidote stocking and treatment protocols

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation