Chemical Assisted Suicides--------

A Safety Threat to Public Safety Personnel

So what is in your company safety plan and have you considered?

• A rapid, safe and successful response to these unusual situations requires some planning and preparation.

• The likelihood of a chemical assisted suicide incident is low, BUT public safety officials must prepare for these situations. No agency, big or small is immune to these incidents.

• It can be anticipated that the number of these incidents will rise as more people become aware of the process.

THIS DAY JUST BECAME A LARGER EVENT AND RISK

Always present during hard times

A relatively new approach to suicide - using toxic gases generated by the combination of consumer products or common household chemicals - has become more prevalent in recent years. The vapors, especially when trapped in an enclosed space, may exist in concentrations that can be hazardous to first responders and others. • The most common approaches and types

of consumer products and chemicals used• The signs to look for at the event scene

and the hazards emergency responders may encounter

• Response considerations that first responders must be aware of

Cars and Vehicles are an easy fix and access to a confined space

needed

Common Approaches and Chemicals• Chemical suicides, also called detergent

suicides, involve self-inflicted exposure to toxic gases in a confined space (for example, cars, bathrooms, or closets), gases created by mixing consumer products or common household chemicals. This technique appears to have originated in Japan and has since become an increasingly popular method for suicide in the United States and elsewhere after instructions became available online. The two most common toxic gases produced are hydrogen sulfide and hydrogen cyanide.

WHAT DID YOU ROLL UP ON?

BE ON YOUR TOES

•Unconscious Individuals

•Tape over vents, doors, and windows

•Suicide Note

•Posted Warning to First Responders of Present Danger

•Chemical containers in and around the vehicle or room

•Smell of Rotten Eggs

Chemicals Used

Include but NOT limited to:

• Bonide Sulfur Spray- Insecticide

• Hydrochloric (Muriatic) Acid (Pool Chemical)

• Toilet Bowl Cleaner

• Laundry Detergent

Mechanism of ActionHow it works• Acts as an irritant and

chemical asphyxiant• Acts as a relaxant of

smooth muscle---Vasodilator

• Mitochondrial Poison (Similar to Cyanide)

• Prevents oxygen transport by binding with hemoglobin in red blood cells

• Once in the body it is rapidly distributed to various organs– CNS, Lungs, Liver, etc.

Naturally Produced in the Body• High values present

in people who have:– Alzheimer’s Disease– Down Syndrome– Type 1 Diabetes

Chemicals of CHOICE but not limited too!

• Internet searches and chat rooms provide the potential suicide victim with a recipe for a strong acid and sulfide solution that makes the gaseous hydrogen sulfide.

• Hydrogen sulfide gas (H2S) is colorless and smells much like rotten eggs. It can be detected by the human nose at concentrations between .13 and 100 parts per million (ppm). At levels above 100 ppm and with exposures from three to 15 minutes, there is a paralysis of the olfactory nerves, which shuts down the sense of smell.

ALWAYS HAVE THE ORANGE BOOK WITH YOU!

Hydrogen sulfide gas is an asphyxiants that suffocates victims at the cellular level, rendering cells in the body unable to use oxygen:• At 100 parts per million (ppm), it is Immediately

Dangerous to Life or Health (IDLH).• As little as 400 ppm can cause

unconsciousness. • At 1,000 ppm, victims immediately suffer

cardiopulmonary arrest.• For incidents involving the release of hydrogen

sulfide gas, the 2012 Emergency Response Guidebook (ERG) suggests an initial isolation distance of 100 feet for a small spill or release of gas and a protective action distance of 0.1 miles (during the day) and 0.3 miles (at night).

• Plant and Animal Breakdown

• Swamps / Bogs• Hot Springs• Waste Disposal• Sewers• Paper

Manufacturers

• 0.13 ppm

What’s that Smell?

IF YOU FEEL ANY OF THESE BACK AWAY before it is TOO LATE

Symptoms can include:• Respiratory irritation• Coughing• Nausea• Vomiting• Headaches• Disorientation• Tremors• Suffocation• Coma• Death• Once the toxicant reaches the brain,

successful rescue is unlikely because breathing is rapidly and severely affected.

NOT ALWAYS ROTTEN EGGS IN HIGHER CONCENTRATIONS

• The easy part about recognizing this gas is that it smells like rotten eggs. The bad part is that if you are close enough to smell the rotten eggs, you are already too close. Therein lies the reason it is imperative that all first responders receive training on this issue.

• Recognition and response is the key to mitigating this scenario and ending with as safe an outcome as possible. When having a conversation about suicide, we as first responders can probably come up with a couple hundred different ways that we have either seen or heard of people trying. Some are complicated and some are not. In this case the use of hydrogen sulfide is not.

• Simply by dumping a toilet bowl cleaner and a pesticide into one pail a person has created a highly toxic gas that will kill them in less than six minutes. How easy is that! Too easy really. While most of us have probably seen or heard of someone dying of carbon monoxide poisoning, realize that when created, hydrogen sulfide is five times more toxic.

Interventions

• Set Parameters

•Establish a HOT zone•100 meters minimum•Emergency Decon?

• EMS•High Flow 02•H2S acts like Cyanide poisoning and binds with hemoglobin

IDLH 100 ppm700 ppm 1 breath = DEATH

BE H2S Trained

• When exposed to hydrogen sulfide gas from 0-50 ppm, a person suffers minor eye, nose, and throat irritation. From 10-50 ppm, the effects are headache, dizziness, nausea and vomiting, and coughing and difficulty breathing.

• Exposures to 50-200 ppm result in severe eye and respiratory irritation, shock and convulsion, coma, and possible death. Levels above 700 ppm will cause immediate death in as little as two to three breaths. Additionally, hydrogen sulfide can be flammable if exposed to an ignition source above 500 degrees (F).

Second HIGHEST Chemical Used

Hydrogen Cyanide• Another toxic gas used in chemical suicides is hydrogen

cyanide, though it is not as common because the consumer products needed for the reaction are less readily available. Hydrogen cyanide gas is created using an acid source and cyanide salts such as sodium cyanide or potassium cyanide.

Hydrogen cyanide is more easily absorbed through contact with mucous membranes, eyes, and skin. The effects and symptoms of hydrogen cyanide poisoning are similar to those caused by hydrogen sulfide:• The IDLH for hydrogen cyanide gas is 50 ppm. • Inhalation of 135 ppm for 30 minutes is fatal.• Inhalation of 270 ppm is immediately fatal. • For incidents involving the release of hydrogen cyanide gas,

the ERG suggests an initial isolation distance of 200 feet for a small spill or release of gas and a protective action distance of 0.1 miles (during the day) and 0.4 miles (at night).

• Hydrogen cyanide has a distinctive bitter almond odor. Like hydrogen sulfide, stronger concentrations of hydrogen cyanide deaden the sense of smell.

KNOW THE DIFFERENCE

• Early symptoms of exposure associated with lower doses include:

• Restlessness• Increased respiratory rate• Giddiness• Headache• Palpitation• Difficulty breathingSymptoms that may develop later with lower doses or acutely with higher doses include:• Vomiting• Convulsions• Respiratory failure• Arrhythmias• Unconsciousness• Death

WHEN YOU ROLL UP

Care should always be taken at the scene of a chemical suicide because of the possibility of residual airborne material. • Indicators of a chemical suicide include:• A confined space (e.g., a car or room with closed

doors and windows)• Tape or plastic covering the vents and windows• A victim showing no signs of trauma• Signs or placards posted by the victim warning

of toxic gas• A suicide note• Empty cleaning supply, pesticide, or paint

containers• Odors such as rotten eggs or bitter almonds• Other victims near the area complaining of

symptoms such as difficulty breathing

SIZE UP THE RISK ZERO HERO’s HERE

When responding to chemical suicides, you should:• Size up the event scene• Secure the area• Ventilate the confined space• Monitor the air for toxic gases• Decontaminate those who have been

exposed• Initiate rescue and recovery operations• Protect evidence and prepare for a

criminal investigation• Consider additional risks

THIS IS NOW A CRIME SCENE

Remember that you are dealing with a crime scene - a malevolent act rather than an accident - and that things may not be as they seem. Be alert for additional risks that may not be immediately apparent:• There may be untriggered devices that could

explode or release additional hazardous substances if disturbed.

• The event may be a homicide rather than a suicide and a perpetrator may still be in the area. The perpetrator may represent a threat to responders or may be prepared to trigger additional devices - for instance, to prevent access to the victim.

• The event may have been staged to lure responders into a hazard zone where they can be attacked, either with additional chemical releases (booby traps) or through other means.

Emerging Threats

• Involves mixing common household chemicals to create hydrogen sulfide, hydrogen cyanide, chlorine or other gases which can be “immediately dangerous to life and health” if inhaled in small, enclosed locations.

• DOT Response Guidebook 111 (Mixed Load/Unidentified Cargo)

Responder Safety

• First responders can be the first exposed to this hazard.

• Typically, persons committing this act have left hazardous warning signs displayed to anyone approaching the scene.

• This is not always the case.

Dispatch/SUPERVISOR Considerations

• Dispatchers and call takers should warn callers not to approach, or enter, vehicles, or rooms where unresponsive people may have attempted chemical suicide.

• The caller may say there are warning signs on the vehicle or location but may not volunteer this information.

Supervisor Considerations

• “Warning signs” may be removed, become detached or dislodged, or blow away before responders arrive on scene.

• The caller may not say anything about a strange or unusual smells unless prompted when they call 911.

• Proper initial questioning may yield information vital to the safety of the first responders.

• The information must be immediately passed on to the first responders by the 911 personnel.

Warnings/Indicators: Vehicle

• While using proper PPE and SCBA carefully size up any situation involving an unresponsive person in an enclosed space.

• Subject appears unconscious and unresponsive.

• Tape or plastic over vents and windows.

Warnings/Indicators: Vehicle

•Suicide note visible or posted.

•One or more posted “warning signs”.

•Buckets, pails, pots or coolers in the vehicle containing a variety of chemicals.

•Empty containers of chemicals in or around the vehicle.

•Smell of rotten eggs or unusual odors.

Response to Vehicle Incident

•Survey the exterior and interior of the vehicle•Determine responsiveness of subject•Conscious or unconscious•Appears to be breathing –chest rise and fall•If the subject is conscious can they open the door

and exit the vehicle. Have the subject walk / crawl away from vehicle to fresh air.

•Be careful when treating the patient due to the “off gassing” from the subjects clothing and exhaled breaths.

•If the subject is unresponsive and there is no apparent breathing for 30 seconds to a minute stand by for TDG and Hazmat Units and back away from the vehicle. Follow agency response guidelines!

Response Considerations

• Consider wind speed and direction when determining the need to evacuate nearby locations and structures.

• In a dorm or apartment building, consideration should be given to evacuating the entire floor or building.

Warnings/Indicators for Structures

•Any exterior visual signs as you approach the residence or apartment.

• “Warning Signs” posted on the front of the house or apartment. Doors may taped or sealed from the inside.

•Other persons from inside the location complaining of difficulty breathing.

•The smell of rotten eggs or other unusual odors in the area that gets stronger as you approach the location.

•Be prepared to evacuate the residence or apartment building.

Response Considerations

• If there’s a possibility the victim is sleeping or intoxicated, attempt to wake them with a vehicle public address system, bullhorn or siren.

• If they cannot be awakened, responders should perform a thorough recon before entering the space to assist the victim using binoculars or spotting scopes.

Response Considerations

• Signs may not be easily detected or understood by other people – including first responders!

• Signs may be hidden or obscured by condensation, frost, snow, or vapors produced by the reaction.

• REMINDER: “Victim” may not be dead and is still suicidal, thus an increased likelihood of violence.

Response Considerations

• If you can clearly see there are no chemical containers and mixing containers present anywhere in the space, they could be hidden from view.

• Please maintain your “situational awareness” and observe the entire scene.

Response Considerations

• If chemical containers are present, attempt to identify the chemicals from labels or a sales receipts.

• The reaction may utilize an acid found in many common cleaning compounds, and a sulfide present in many paints, insecticides, and shampoo to produce Hydrogen Sulfide.

Response Considerations

• Both hydrogen sulfide and hydrogen cyanide are flammable.

• There have been no incidents of fire reported with these incidents at this time.

• Concentrations may not typically reach the LEL (Lower Explosive Limit) except at close proximity to the mixing containers.

• Responders should eliminate ignition sources whenever possible.

Paradichlorobenzene poisoning

Some vacuum cleaners have an attachment for killing bugs.

The attachment holds moth crystals (Paradichlorobenzene, pronounced “para-di-chloro-benzene”)

This attachment will convert your vacuum sweeper to exterminate insects (spiders, roaches, ants, etc.).

Anything that can walk or crawl.

What do the instructions say?

One vacuum instruction book says:

How to use the crystalator:Warning: Follow directions and cautions on label of

crystal container. Keep crystals out of reach of children.Crystals may be harmful if taken internally. Do not breathe the concentrated gas from the

crystalator. Do not enter a treated closet until it has ventilated. Do not remain in a treated room until gas concentration

is reduced to safe level. If eye, throat, or skin irritation occurs, do not remain in

treated area. Return unused crystals to closed container and seal

tight. In the crystalator, use only 100% pure paradichlorobenzene with U.S.D.A. registration number on the container.

Paradichlorobenzene poisoning

• Paradichlorobenzene is a white, solid chemical with a very strong odor.

• Poisoning can occur if you swallow this chemical or inhale it in a gaseous form.

• Where Found - Toilet bowl deodorizers and Moth repellant. (not all-inclusive).

Paradichlorobenzene poisoning

Symptoms:– Burning in mouth – Breathing problems (rapid, slow, or painful) – Cough – Shallow breathing – Changes in alertness – Headache – Slurred speech – Weakness – Yellow skin (jaundice) – Abdominal pain – Diarrhea – Nausea – Vomiting

Paradichlorobenzene poisoning

Emergency Room Care• The health care provider will measure and monitor

the patient's vital signs, including temperature, pulse, breathing rate, and blood pressure.

Symptoms will be treated as appropriate. The patient may receive:

• Activated charcoal • Fluids through a vein (by IV) • Laxative • Medicines to treat symptoms • Tube through the mouth into the stomach to wash

out the stomach (gastric lavage)