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In some areas, paramedic personnel are authorized to use the Cyanide Antidote Kit.
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Of several cyanide antidotes available around the world, only one, the Cyanide Antidote Kit, is approved for use in the United States. Furthermore, because no laboratory test can confirm the presence of acute cyanide poisoning quickly, acute cyanide poisoning must be treated empirically on the basis of a presumptive diagnosis. Success in the treatment of cyanide poisoning is time-critical: antidote administration soon after exposure can prevent death, but delayed administration allows increased morbidity and mortality.
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In the United States, preparedness for managing individual and multiple-victim exposures to cyanide has not kept pace with increasing awareness of cyanide risk. Several instances of planned use of cyanide in terrorism have been exposed in the past 3 years in the United States alone ( Citation6).Īwareness of cyanide risk has increased with growing recognition of the role of cyanide in smoke-inhalation morbidity and mortality and its potential for use as a terrorist weapon. Cyanide is also a potential terrorist weapon ( Citation6). Acute cyanide poisoning from fire smoke also poses a significant risk to fire professionals, as illustrated by the recent confirmation of acute cyanide poisoning in five firefighters who fought a fire at a Providence, Rhode Island, restaurant in March 2006. In studies that measure it, cyanide is found in the blood of most victims of structural fires ( Citation5). In western countries, including the United States, smoke inhalation is the most common source of poisoning with cyanide, which appears to be at least as important as carbon monoxide as a toxicant in fire smoke ( Citation4, Citation5). Acute exposure to cyanide causes significant morbidity and mortality in structural fires, household and industrial accidents, suicides, attempted genocides, and wars ( Citation2, Citation3). The World Health Organization (WHO) considers cyanide to be a priority chemical with respect to the environment and human health ( Citation1).
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