FORT WAYNE – By the time the patient was brought to the emergency room, he was unresponsive.
There had been a house fire, the patient was stuck inside the home, and paramedics had had only a short time to perform CPR as he was taken to Parkview Regional Medical Center.
The prognosis was not good.
I did not expect that person to survive, said Dr. Tom Gutwein, the medical director of Parkview Health’s emergency departments, who began treating the patient.
Gutwein immediately diagnosed that the patient was suffering from smoke inhalation, so he ordered a small, 6-by-8 box brought from the pharmacy to the ER.
He took out the contents – a vial, tube and an assortment of other materials – and injected the patient with a concoction of medication.
Within 24 hours, much to Gutwein’s surprise, the patient was awake and well.
That was nine months ago, and it was the first time Gutwein used what’s called a Cyanokit to treat someone suffering from smoke inhalation.
Approved by the Food and Drug Administration in 2006, Cyanokits provide a cyanide antidote to those caught in house fires – many of which involve materials that, when gone up in flames, release cyanide into the air.
Since the kits’ approval, they’ve been used at hospitals and emergency medical service units across the region.
What’s become a complex issue, though, is whether to store these kits on ambulances so they can be accessed at the scene – as some fire departments and EMS units across the country do – or at hospitals, which is done in many other parts of the nation.
When fire consumes a home, nearly everything inside can burn.
This includes plastic, foam, paper and cotton.
When these everyday household items burn, they can emit dangerous levels of cyanide, which can be released by virtually any material comprising carbon and nitrogen.
People trapped in house fires can be killed by these levels of cyanide.
Cyanokits were originally created as an anti-terrorism measure but have been used in Europe to combat smoke inhalation for roughly 15 years.
Inside the kits are doses of the drug hydroxocobalamin, according to its makers, and its makers advertise that it can be used at a scene of a fire or in a hospital.
As the kits became available across the country, some fire departments and EMS systems began stocking ambulances with at least one Cyanokit.
They did so especially after several Rhode Island firefighters were found to have high levels of cyanide in their systems after battling a multiple blazes within hours of each other in 2006.
The kits came to this area in 2007, when DeKalb EMS received four – one for each ambulance – and a fifth to be kept in the emergency room at Auburn’s DeKalb Memorial Hospital.
But while some departments across the nation put them on ambulances, others have not.
And that goes for Parkview, which oversees EMS systems in several surrounding counties, and the Fort Wayne Fire Department.
One Cyanokit can cost $600.
It also expires relatively quickly, Gutwein said.
Parkview runs EMS in several counties, including Allen, LaGrange, Noble, Whitley and Huntington.
It does not stock ambulances with Cyanokits in those counties, though it does have them on its two Samaritan helicopters.
We made the decision to not keep them on the ambulances because of cost and expiration time, said Gutwein, who noted that Parkview has 23 ambulances throughout the counties it covers.
Instead, the Cyanokits are kept at Parkview’s various campuses across the region.
Likewise, the Fort Wayne Fire Department doesn’t stock its vehicles with Cyanokits because of treatment restrictions.
The department’s medics do not administer IVs in the vehicles, and therefore it couldn’t administer the IV from a Cyanokit either, District Chief Matt Peckham said.
Officials with the Three Rivers Ambulance Authority, which covers Fort Wayne, are aware of the kits.
The authority is overseen by a board of medical professionals from several hospitals.
So far, there has not been any recommendation from the board to carry them, TRAA spokesman Mike Gillespie said.
If there was a need or a specific run looked at where they might be needed, it would be passed on to us, he said.
Complicating the issue of stocking Cyanokits on ambulances is the actual diagnosis of cyanide poisoning, Gutwein said.
When you have cyanide poisoning, you have to diagnose it clinically, he said. A patient may not be breathing, or they have low blood pressure. You have to think through the possible causes of an extreme situation.
With kits kept at each hospital in Parkview’s system, Gutwein believes there is enough time to get patients possibly suffering from cyanide poisoning to kits in time for treatment, he said.
In the past year, Parkview doctors have used the kits on patients at least three times, Gutwein added.
Given the kits’ cost and short shelf life, that’s a relatively low number.
I don’t think it’s cost-effective for them to be on the ambulance, he said.