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APHA Scientific Session and Event Listing

Recorded presentation

Richard C. Dart, MD, Rocky Mountain Poison & Drug Center, 777 Bannock Street, Mail Code 0180, Denver, CO 80204 and 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.

Purpose: Sources of cyanide exposure include fire smoke, terrorist acts, industrial and occupational releases, and mishaps involving transport. Effective response to a mass-casualty cyanide incident requires local and regional availability of antidote and rapid distribution and administration. In this survey, cyanide antidote stocking practices were assessed 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 fire-service-based advanced life support (ALS) providers in the United States. Results: The number of respondents returning evaluable surveys was 507 (61%). The mean number of cyanide antidote kits available for prehospital use was 25.7 per 100,000 population. The proportions of providers responding yes, no, and don't know to the question of whether a large cache of antidotes is available as part of a local or regional disaster response plan were 36.2%, 32.1%, and 31.7%, respectively. Among those indicating availability of a cache, the mean number of kits in a cache was 683.7, and only half (51%) of these respondents indicated that a large cache of antidotes could be available in less than 1 hour. Conclusion: Responses from ALS providers suggest that US stocking practices for cyanide antidotes are inadequate for any large multiple-victim incident. Neither the number of antidotes nor the rapidity with which antidotes can be made available is sufficient for an effective response to a cyanide incident. These results reveal the need for guidelines that address regional and local stocking and distribution of cyanide antidotes.

Learning Objectives:

• Describe the nature, prevalence, and health consequences of human exposure to cyanide from various sources
• Understand antidote stockpiling and distribution needs for an effective response to a multiple-victim cyanide incident
• Assess cyanide antidote supplies and administration practices across the United States as shown in a nationally representative survey vis-a-vis the supplies and practices necessary for an effective response to a multiple-victim incident

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation