High concentrations of cyanide gas can cause death in minutes however, low concentrations may produce symptoms gradually, causing challenges for the triage officer.

Persons whose clothing or skin is contaminated with cyanide-containing solutions can secondarily contaminate response personnel by direct contact or through off-gassing vapor.

A comprehensive source for the selection of chemical identification equipment is the Guide for the Selection of Chemical Detection Equipment for Emergency First Responders, Guide 100-06, January 2007, 3rd Edition published by the Department of Homeland Security to assist with this process.

Devices - M256A1 chemical agent detector kit (liquid and vapor), Chemical Agent Detector C2 Kit (liquid and vapor), M18A3, M90 chemical agent detectors (vapor), Draeger CDS Kit (vapor and aerosol), M272 chemical water testing, Hazmat Smart Strips (qualitative).

Identification Tools - CHEMM-IST, WISER, Cyanide Chemical Properties.

General information on these identification technicques is located in Emergency Response Guidebook.

Responders should obtain assistance in identifying the chemical(s) from container shapes, placards, labels, shipping papers, and analytical tests.

Liquid agent, which is readily absorbed through skin ( especially in young children and pregnant women), can produce symptoms immediately or be delayed up to an hour.

Signs and symptoms may present over a much longer period of time if the the poisoning is gradual with lower doses.

With higher doses the time of onset of symptoms typically is seconds following inhalation of gaseous hydrogen cyanide and may cause abrupt onset of profound CNS, cardiovascular, and respiratory effects, leading to death within minutes.

The amount of cyanide, the duration of exposure, and the route of exposure all influence the time to onset and the severity of illness.

Hydrogen cyanide is highly toxic by all routes of exposure.

Perception of the odor is a genetic trait (20 % to 40 % of the general population cannot detect hydrogen cyanide).

The odor of hydrogen cyanide is detectable at 2-10 ppm (OSHA PEL = 10 ppm), but does not provide adequate warning of hazardous concentrations.

Hydrogen cyanide has a distinctive bitter almond odor, but some individuals cannot detect it and consequently, it may not provide adequate warning of hazardous concentrations.

Cyanide poisoning kit