DRAEGER SAFETY

1
HYDROGEN CYANIDE IN FIRE OPERATIONS Captain Rick
Rochford Jacksonville Fire Rescue
Department Incident Safety Officer Craig Rogers-
Draeger Safety
2
PRESENTATION CONTENT

• Toxic Gases Generated by Fire
• Hydrogen Cyanide in Smoke
• Health Effects of HCN
• Gas Detection Options
• Questions Answers

3
TOXIC GASES GENERATED BY FIRE
Toxic Gases Generated by Fire
4
Clark County Fire Fighter Fatality

• Crews operating at the scene of a commercial dice
  factory fire
• Heavy smoke and fire conditions
• All crews are instructed to utilize standard PPE
• SCBA are used by all responders

5
Clark County Fire Fighter Fatality

• What are some of the hazards present?
• As a Incident Commander, what types of injuries
  or conditions may you expect?

6
Clark County Fire Fighter Fatality

• All crews are ordered out of the structure.
• As crews leave the factory, they remove their
  SCBA masks.
• A Fire Captain removes his mask as he walks out
  of the smoke. He collapses outside the structure.
• He is in cardiac arrest.

7
Clark County Fire Fighter Fatality

• The Captain did not survive his injuries
• Coroner ruled this fatality due to cyanide
  toxicity.
• Clark County Fire Department
• Captain Frank E. Testa, April 11, 1970

8
2005 FIRE STATISTICS

• In 2005, there were 1,602,000 fires reported in
  U.S.
• 511,000 structure fires
• 3,105 civilian deaths
• 15,325 civilian injuries
• 9.2 billion in property damage
• 87 firefighter deaths in all types of fires
• gt4000 firefighters injured by smoke inhalation
• It is estimated up to 80 of all fire fatalities
  are attributable to smoke inhalation

9
ANATOMY OF FIRE SMOKE

• Toxic composition of smoke varies from fire to
  fire
• Nature of the burning materials
• Temperature
• Oxygen level
• Ventilation
• Conditions of high temperature and low oxygen
  enhance degradation of synthetics quickening
  chemical release

10
Partial List of Fire Produced Gases and Vapors
TOXIC GASES GENERATED BY FIRE

• Carbon Monoxide
• Carbon Dioxide
• Hydrogen Cyanide
• Hydrogen Chloride
• Nitrous Gases
• Phosgene
• Hydrogen Sulfide
• Sulfur Dioxide

• Acrolein
• Ammonia
• Formaldehyde
• Glutaraldehyde
• Acetaldehyde
• Benzaldehyde
• Benzene
• Various PNAs (polynuclear aromatic hydrocarbons)

11
CYANIDE TOXICITY IN SMOKE

• Historically, carbon monoxide asphyxiation has
  been considered the primary cause of deaths of
  those overcome by smoke
• Focus of gas monitoring
• There is mounting evidence that hydrogen cyanide
  is directly responsible for many more deaths than
  previously assumed
• Cumulative effect with CO worse than either
  individually

12

• Cyanide toxicity from
  smoke inhalation in a structural or enclosed
  space fire is the most likely cause of
  cyanide toxicity that EMS fire
  professionals will encounter
• JEMS Communications Summer 2004

13
HYDROGEN CYANIDE IN SMOKE
Hydrogen Cyanide in Smoke
14
CYANIDE PRODUCING MATERIALS

• Cyanide production in a fire
• Hydrogen cyanide is produced by incomplete
  combustion of nitrogen and carbon containing
  substances (-CN)
• Natural Fibers (wool, silk, cotton, paper)
• Synthetic polymers (nylon, polyurethane)
• Synthetic rubber
• Melamine (resins for molding, laminating, etc.)

15
HCN RELEASING POLYMERS

• Synthetic polymers found extensively in
  structures
• Insulation
• Cushioning
• Carpets
• Bedding (mattresses and pillows)
• Building materials
• Materials can burn up to 2-3 times hotter and
  faster than natural materials
• Quicker flashovers increase speed of HCN release
  ---

16
Sources of Cyanide

• Other small scale uses
• - Photography labs - Blue printing -
  Engraving computer chips - Cleaning or
  reconditioning of jewelry - Found at clandestine
  drug labs - manufacturing phencyclidine (PCP)

17
Key Cyanide Studies

• Two independent studies performed on CN
  toxicity - Paris France (1988-89) - 109
  fire victims( 66 survivors and 43 fatalities)
  144 controlled individuals(drug intoxication
  and CO poisoning) - Dallas County
  Texas - 144 smoke inhalation patients at
  University of Texas Health Science Center
  Emergency Department - 43
  deceased individuals at Dallas County
  medical examiners office.

18
KEY CYANIDE STUDIES

• Final Conclusion - Cyanide and
  carbon monoxide were both important
  determinants of smoke inhalation-associated
  morbidity and mortality. - Cyanide
  concentrations were directly related to the
  probability of death. - Cyanide may have
  dominated over CO as a cause of death in some
  fire victims. - Cyanide and CO may have
  potentiated the toxic effects of one
  another

19
THE STATION NIGHTCLUB FIRE

• Most notorious incident of deaths from toxic mix
  of hydrogen cyanide and carbon monoxide was at
  West Warwick Rhode Island nightclub fire Feb
  20,2003
• Pyrotechnics instantly set substandard sound
  suppressing foam to sheet of flame
• HCN and CO levels soar and people are quickly
  overcome by the smoke
• 100 deaths and 200 injuries

20
The Station Night Club Fire

• National Institute of Standards and
  Technology the high temperatures, low oxygen,
  high carbon monoxide, and high HCN levels within
  the test room in the absence of a sprinkler all
  contributed to a non-tenable condition within 90
  seconds after ignition.
• Health care providers at all levels of this
  tragedy did not consider HCN exposure during
  course of treatment for the surviving victims.
• New England Journal of Medicine published
  report despite the signs and symptoms
  indicating CN poisoning, the victims were
  treated with standard modalities for burns and
  CO toxicity

21
Cyanide Poisoning Of Providence Rhode Island
FirefightersMarch 2006

• Thursday March 23 2006 1031 hrs 1197 Broad
  Street
• Providence Rhode Island Firefighters responded to
  a fast food restaurant relatively
  uneventful Engine 3s crew member
  experienced symptoms of headache,
  dizziness, difficulty breathing a cough, and at
  times talking incoherently. Transported to
  Rhode Island Hospital Level 1 Trauma
  Center. Tested for HCN to find high levels of
  blood cyanide at 57 ug/dl Placed on antidote
  therapy
• Upon learning of Engine 3s firefighter
  department contacted all members responding to
  the call 16 members sought medical
  attention. 14 members went to Rhode Island
  Hospital 4 found to have whole blood cyanide
  levels above 20 ug/dl

22
Cyanide Poisoning of Providence
FirefightersMarch 2006

• March 23, 2006 1735 hrs. 125 Knight Street
• Providence Rhode Island firefighters
  responded to a fire in a six-unit residential
  apartment Fire in a different part of the
  city after shift change. Most of the personnel
  from fast food restaurant relived No injuries
  reported
• March 24, 2006 0207 hrs. 70 Ralph Street
• Providence Rhode Island firefighters responded
  to a house fire All firefighter responding to
  Ralph St. had previously responded to Knight
  Street fire. At 0223 hrs. Firefighter
  Kenneth Baker collapsed at the scene suffering a
  heart attack. Immediately resuscitated and
  transported to Rhode Island Hospital

23
Cyanide Poisoning of Rhode Island
FirefightersMarch 2006

• In light of the cyanide cases from the previous
  day testing was conducted on Firefighter
  Baker. Lab test showed that FF. Baker had
  whole blood cyanide level of 66ug/dl
• After consulting with doctors at Rhode Island
  Hospital, all members who responded to any of the
  three fires were instructed to go to Rhode Island
  Hospital if they experienced any symptoms to
  cyanide poisoning. 28 members sought
  medical care 27 had their cyanide levels
  tested 8 members tested high (above 20 ug/dl)
  for cyanide
• Fire Chief David Costa appointed a five member
  committee to investigate the causes of cyanide
  poisoning, review existing policies and
  procedures, and make recommendations to prevent
  this from happening again.

24
HEALTH EFFECTS OF HCN
Health Effects of HCN
25
CYANIDE DOSES

• Small amounts of cyanide are present in the
  environment and in humans.
• Normal levels of whole blood are believed to be
  between 0 to 20 micrograms per deciliter
  (ug/dl).
• Cyanide levels as low as 50 ug/dl in the blood
  have proven to be toxic, and blood cyanide levels
  of 250 300 ug/dl fatal.
• With a half-life of one hour, cyanide is short
  lived in the blood stream. Standards in the
  procedures for collection of whole blood
  samples such as -carboxyhemog
  lobin saturation
  -methemoglobin content of sampled blood
  -time between blood sampling and assay
  storage temperature of blood samples on
  the measured concentration of cyanide can
  complicate the interpretation of assay results
  or introduce sources of errors.

26
ACUTE CYANIDE POISONING

• Hydrogen cyanide is a cellular asphyxiant
• Inhaled HCN inhibits enzyme system responsible
  for cell respiration (oxygen utilization by cell)
• Cessation of cell respiration makes normal cell
  function impossible, leading to cell mortality
• There is no quick test that allows on-site
  confirmation of HCN toxicity
• There are some signs that can lead to assumption
  of HCN exposure and administration of
  countermeasures
• Disorientation and weakness/Drowsiness
• Shortness of breath and chest tightness(Tachypnea,
  Dyspnea Tachycardia)
• Headache
• Bright red discoloration in skin
• Smell of almonds on breath
• Soot around mouth and nose/burns
• Carbonaceous sputum

27
CHRONIC EFFECTS OF HCN

• Chronic effects of hydrogen cyanide
• Breathing problems/Respiratory Depression to
  Respiratory Arrest
• Chest pain / Cardiac arrhythmia/Cardiovascular
  collapse
• Eye irritation/vision dimming
• Palpitations
• Headaches
• Loss of appetite
• Weakness in extremities/ Paralysis
• Enlargement of thyroid gland

28
Acute Cyanide Poisoning

• Significance for advocates of sucking the
  carpet - carpet fibers are a large source of
  HCN - fumes develop long before carpet catches
  fire.
• Quantitative decomposition - long period of
  time when gas is emitted without the warning
  presence of flame. - decomposition stage of
  the fire is more toxic than those emitted
  during actual burning. - decomposition stage
  is the real killer because of its high
  toxicity and long period of time between
  attainment of quantitative decomposition
  temperature and ignition temperature

29
Acute Cyanide Poisoning

• Narcotic effects of HCN -blamed for bizarre
  and irrational behavior - instances where
  victims, including firefighters fought with
  rescuers until becoming totally overcome by
  the smoke.
• Southwest Supermarket fire Phoenix Arizona -
  Brett Tarver - rescue teams were hampered on
  several occasions - succumbed to the
  environment and pulled through debris and out
  of the building.

30
HCN LETHALITY
DOSE MAKES THE POISON
Concentrations mg/m3 PPM Effect
300 mg/m3 270 ppm Immediately Lethal
200mg/m3 180 ppm Lethal after 10 minutes
150mg/m3 135 ppm Lethal after 30 minutes
120-150mg/m3 108-135 ppm Highly dangerous (Fatal) after 30-60 minutes
20-40mg/m3 18-36 ppm Light symptoms after several hours
31
HCN LEALITY NOISH Chemical Pocket Guide

• HCN is 35 times more toxic than CO
• TWA HCN 4.7 ppm CO 35 ppm
• IDLH HCN 50 ppm CO 1200 ppm
• LEL HCN 5.6 CO 12.5
• UEL HCN 40 CO 74
• Fl P. 0 F
• VD 0.94 air 1
• BP 78 F
• Sp. Gr. 0.69 water 1

32
ACUTE CYANIDE POISONING

• Recently has there been first FDA approved
  cyanide treatment, Hydroxocobalamin, that can
  safely be administered at fire scene
• Detoxifies CN by binding it to form
  cyanocobalamin (B12)
• Marketed as Cyanokit
• Used in France for 10 years
• Previously, only supportive measures were
  available on site
• 100 oxygen application
• Sodium bicarbonate to counter metabolic acidosis
• Cardiopulmonary support and anticonvulsants
• Existing antidote involved nitrates that needed
  to be monitored under hospital care to avoid
  lethality when combined with CO
  Taylor Kit Lilly
  Kit Pasadena Kit

33
PHOENIX OVERHAUL STUDIES

• Removal of respiratory equipment during overhaul
  can potentially expose firefighters to a variety
  of toxic gases
• Overhaul phase of fire lasts an average of 30
  minutes
• Liberated gases, vapors and particulates may
  remain in overhaul environment for extended
  periods of time
• Vapors may use airborne respirable particulates
  as entry vehicle into firefighters lungs
• Maximum concentrations of selected contaminants
  can exceed occupational exposure limits
• Adverse health effects may occur from exposure to
  mixture of products even if individual components
  are below exposure limits
• Monitoring CO concentrations alone should not be
  used to predict presence of other contaminants
  found in the overhaul environment
• Bolstad-Johnson, et al

34
PHOENIX OVERHAUL STUDIES

• Conclusions of Phoenix Studies
• Without the use of respiratory protection,
  firefighters are overexposed to irritants,
  chemical asphyxiates and carcinogens
• Respiratory protection is recommended during fire
  overhaul
• SCBA should be utilized in atmospheres with CO gt
  150 ppm
• APRs may be considered when CO lt 150 ppm, but
  additional studies to confirm effectiveness in
  overhaul operations are recommended
• NIOSH cartridges for APR dont provide CO
  protection
• 150 ppm equates to avg. 18.75 ppm exposure based
  on 60 minute exposure and 8-hour working day
  (TLV 25 ppm)
• - Post-fire fuels are still off-gassing, SCBAs
  should be used.

35
Recommendations for prevention of cyanide
exposures

• Training - Explanation why cyanide is
  more significant today than ever
  before. - Chemistry of cyanide -
  Identification of cyanide containing fuels -
  Medical concerns of cyanide - Why
  firefighters cannot merely rely on their past
  experiences to determine whether or not a
  particular atmosphere is safe.
• Equipment - Deploy cyanide detection
  equipment into the field for use at fires.

36
Recommendations for prevention of cyanide
exposures

• Compliance - There needs to be enhanced
  compliance with the existing mandatory mask
  regulation. - Enhanced compliance will require
  a cultural change on the part of
  firefighters. - Company officers must focus on
  the protection of their members, and ensure
  that SCBAs are utilized when necessary
  and face pieces removed outside the
  contaminated area when exiting the structure.

37
Recommendation for prevention of cyanide exposures

• SCBA Training for difficult operations - All
  personnel need physical training with SCBA to
  enhance the comfort level of members when
  engaged in difficult operations such as -
  climbing ladders - operating on roofs -
  operating in confined spaces - communicating
  on air
• SCBA Air Management SCBA alarms activated
  during initial extinguishment and during overhaul

38
Recommendations for Prevention of Cyanide
Poisoning

• Post-Fire Decontamination - Wash turnout gear
  after each fire - Shower and change their
  clothes - Issue second set of gear

39
Recommendations for Prevention of Cyanide
Poisoning

• Fire Research - How much cyanide is
  generated at fire scenes?
• - What conditions yield higher verses lower
  concentrations of CN? - Whether CN that is
  released in a fire remains localized (in a
  area around the fuel that is off gassing)
  or does it spread out throughout the
  building? - Is CN released only under
  certain fire conditions or is it released more
  commonly whenever CN containing products
  burn?

40
Recommendations for Prevention of Cyanide
Poisoning

• Public Education - General public, media
  and legislators need to be educated about the
  dangers of smoldering and burning plastics and
  other cyanide containing fuels. - Public needs to
  know the dangers associated with CN may be
  present before the presence of any flames and
  possibly incapacitated by the invisible gases
  during the incipient stage which could
  prevent them from escaping.

41
Clark County Fire Fighter Fatality

• Crews operating at the scene of a commercial dice
  factory fire
• Heavy smoke and fire conditions
• All crews are instructed to utilize standard PPE
• SCBA are used by all responders

42
Clark County Fire Fighter Fatality

• What are some of the hazards present?
• As a Incident Commander, what types of injuries
  or conditions may you expect?

43
GAS DETECTION OPTIONS
Gas Detection Options
44
DETECTION TECHNOLOGY AND HCN

• DETECTION TECHNOLOGY AND HCN
• Colorimetric Chemistry
• Short-term Detector Tubes
• Long-term Detector Tubes
• Chip Measurement System
• Electrochemical Sensors
• Infrared Sensors
• Gas Chromatographic Methods
• Flame Ionization (FID)
• Thermionic
• Ion Mobility Spectrometry (IMS)
• Photo Ionization (PID)
• NO High IP 13.9 eV

45
COMMON MONITORING OPTIONS

• There are 2 commonly available detection
  technologies that can measure hydrogen cyanide
  and other non-organic toxics at TLV
• Portable instruments with electrochemical sensors
• Colorimetric detector tubes

46
ADVANTAGES OF DETECTOR TUBES

• Inexpensive
• Simple to use
• No calibration
• Wide variety of gases vapors

47
ELECTROCHEMICAL SENSORS

• Based on a chemical reaction that produces an
  electrical response/signal.
• The more gas that is present, the larger the
  signal that is generated by the sensor.
• This signal is directly proportional to the gas
  that is present.

48
SINGLE GAS OPTIONS

• Standard Version
• Accepts all Draeger EC Sensors (Toxic O2)
• Full Menu
• Hygiene Version
• Standard Datalogging

49
SINGLE GAS OPTIONS

• PAC 7000 has a simple menu structure
• Fresh Air, Span Cal
• STEL, TWA, Peak Value
• Bump Test
• COHb option with CO version (set w/PC)
• Calibration On-board
• Calibrate w/o a PC
• No life limiting feature
• Replaceable sensors
• Not exchangeable to different gases
• Dedicated to the original gas purchased