The last terrorist to use cyanide as a weapon got away with it. He (she?) killed seven Chicago-area victims in 1982 by lacing Tylenol capsules in stores with the deadly substance. That case remains officially unsolved 25 years later, but it has everlasting value as a cautionary tale: For a terrorist wanting to kill people, cyanide is frighteningly easy to obtain and use effectively.

     That's part of what drives the Cyanide Poisoning Treatment Coalition (CPTC), a nonprofit assemblage of individuals and groups dedicated to improving the awareness and treatment of cyanide poisoning. Coalition members include top EMS organizations and a range of individuals well-known in the emergency medical and response fields.

     Their concern isn't just terrorism; cyanide is produced during structure fires by the burning of otherwise-innocuous products like paper, plastics and cotton, and is used as a solvent in processes involving gold. It is transported throughout thousands of communities every day by road and rail.

     There are a lot of ways you might encounter it, and that makes the continuing obliviousness of most Americans-including EMS providers-tough to swallow. But oblivious they are: An RTI International survey of ALS personnel found that just 35% thought they were likely/very likely to be exposed to cyanide via a fire, and 79% who said cyanide antidote kits weren't standard equipment on their ALS vehicles.

     "Currently, there are few resources or organizations that raise awareness and educate professionals about the potential danger of cyanide exposure," CPTC president Don Walsh, PhD, EMT-P, said in a statement disseminated by the organization. "Through joint strategic initiatives to focus the required attention and resources on the issues, the members of the CPTC aim to increase awareness surrounding the dangers of cyanide exposure."

     They're doing that by amassing information and resources on their website, which includes facts about cyanide (including sources and how to protect yourself), its creation in fires and use in industry, and its utility as a terror weapon, as well as links to medical literature and other articles and news. Recently, the Coalition published the International Cyanide Antidote Database (I-CAD), which contains contact information for more than 60 drug companies and the latest in cyanide treatment information and protocols.

     All of this helps explain why the CPTC was so jazzed about Homeland Security Presidential Directive/HSPD-18. Issued by the White House in February, HSPD-18 addressed the federal strategy for medical countermeasures against weapons of mass destruction. That strategy entails focusing on threat agents that have the greatest potential to cause "catastrophic public health consequences" for Americans, and on response measures with the greatest potential for prevention, mitigation and treatment. Cyanide fits those bills.

     "With so much availability of the chemical, we need to be prepared," Walsh's statement said. "This is one of HSPD-18's most important benefits: building up our national stockpile with appropriate countermeasures. And cyanide antidotes should be a priority."

     For more information, visit www.cyanidepoisoning.org,
-John Erich, Associate Editor