Insert new text: There have been an increasing number of incidents of …
| Issue: | Insert new text: There have been an increasing number of incidents of individual chemical exposure in the UK, often occurring in the confines of the victim’s vehicle, which may or may not have warnings posted on the outside. There are a variety of different agents now commonly used in attempted chemical suicide, including: • hydrogen sulphide (made by mixing a combination of household chemicals) • aluminium phosphide (from rat poison) • cyanide salts • helium gas (from a cylinder for blowing up balloons) • nitrogen gas • carbon monoxide (for example, by lighting a disposable barbecue in a confined space). Hydrogen sulphide is a colourless gas characterised by a rotten egg smell. It affects the body in three different ways: it causes paralysis and asphyxiation, and acts as a chemical irritant to the eyes and respiratory system. It can be fatal in just a few breaths. The same gas is responsible for deaths in agricultural incidents involving slurry tanks. In addition to claiming the suicide victim, ambulance personnel and bystanders can be exposed to significant risk, even when the scene has been vented, as the victim’s body and clothes may emit dangerous gases for a considerable period of time afterwards. However, this risk can be minimised by moving the body into an open space so that the gas does not collect. If attending a victim of chemical suicide, a dynamic risk assessment should be made regarding possible identification of the hazard, ease of access to the patient, and starting ventilation of the scene. If there is concern about exposure to poisonous gases, then no attempt should be made to access the patient until specialist help such as the Fire Service, Hazardous Area Response Team (HART) or Special Operations Response Team (SORT) are on scene with respiratory protection. These teams will be able to manage the incident, and make arrangements for the removal of the patient so that a formal clinical assessment can be made as to whether any resuscitation attempt would be likely to be successful, or if Recognition Of Life Extinct (ROLE) is more appropriate. Once ROLE has been performed, then the body is the responsibility of the police. Under no circumstances should a victim of chemical suicide be taken to the emergency department, due to the risk of continued emissions of dangerous gases. If, by agreement, the body is removed by specialist ambulance teams to a mortuary, then the nature of the chemical must have been determined and appropriate arrangements should have been made to ensure the safety of mortuary staff. |
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| Resolution: | Inserted in v1.3 reprint |
| Book: | Clinical Practice Guidelines |
| Location: | 41, Section 2 Resuscitation |
| Type of update: | Feedback |
| Year: | 2013 |
| Date update posted online: | January 5, 2015, 12:00 am |
