Pre-hospital management of smoke inhalation: are we missing something?

The recently proposed European guidelines for the management of smoke inhalation and cyanide poisoning—presented at the 6th Mediterranean Emergency Medicine Congress (MEMC) in Kos, Greece, 2011—contrast greatly with usual practice in the UK, where we tend to focus on the management of carbon monoxide (CO) and do not routinely treat or suspect cyanide poisoning. Indeed, a recent survey conducted at the College of Emergency Medicine (CEM) (Hospital Pharmacy Europe, 2011) annual conference revealed that 84% of UK emergency medicine physicians would not routinely consider treating cyanide poisoning empirically in smoke inhalation victims—a key recommendation of the new algorithms presented at the recent MEMC in Kos.

According to Department for Communities and Local Government statistics there were 33,244 accidental dwelling fires in the year ending 31^st March 2011 (Department for Communities and Local Government, 2010). With 42% of deaths in house fires coming as a result of smoke inhalation, it is the single greatest cause of mortality in house fires. This number of incidents and the associated mortality serves as an important reminder of how signifcant the problem of smoke inhalation really is.