Hydrogen Sulfide Suicide

Think back through your EMS career, whether it is a long one or short one. How many times have you been dispatched to this call: “Unconscious in a vehicle” or “Person slumped over the wheel?” I know in my ten years a paramedic, that’s happened more than a few times. Today, however, those calls carry a great risk that could injure you, your partner, other responders, or the unsuspecting public.

Back in 2008, Japan saw an increase in their suicide rate due to something called Hydrogen Sulfide poisoning. The person would mix household chemicals together into a potent combination that with just a few breaths can render someone unconscious, and put them into Respiratory Arrest. This also poses a risk to rescuers and bystanders, because often, these suicides take place in confined spaces, which does not allow the gas to dissipate. When access is gained to the potential patient by rescuers, they could also be overcome by the fumes.

In the spirit of Scene Safety, what should you be looking for as warning signs?

1. The Dispatch — As previously mentioned, these suicides often take place in confined spaces, such as a bathroom or closet. Most often though, it is encountered in motor vehicles.

2. Warning “signs” — Thanks to the Internet, information on Hydrogen Sulfide poisoning is easily accessible. Many of the sites that advocate for this form of suicide also share the risks to those around them. Quite often, the suicidal party will place signs around where they are to warn potential rescuers of the risks presented before them. They will often say “Warning: hazardous gas” or “Do not open, HAZMAT team required.”

3. Rotten egg smell — Quite often, there is a detectable rotten egg or sulfur smell present, although if the patient is inside a car, you might not be able to smell it.

4. Presence of chemicals/mixtures — Take a good look inside the car before you open the door. Is there a bucket on the passenger seat? Are there any bottles visible in the car? If so, take a big step back, and wait for more help.

Hydrogen Sulfide is created by mixing a Strong Acid source with a Polysulfide, or pesticide source. Common ingredients include but are not limited to several toilet bowl cleaners, pesticides, oil paints, and even dandruff shampoo. It goes without saying though that if you see any bottles or buckets, and especially if you see signs posted on the vehicle, expect the worst.

Let’s say that you’re dispatched to that “Unconscious in the vehicle.” You and your partner respond from your station or street corner, and you’re the first one there. Sitting in the car is a younger male in his 20’s, slumped over the wheel. In the driver and passenger windows are signs that say in big letters “WARNING! HAZARDOUS GAS INSIDE! DO NOT OPEN!” What should you do next?

Take a big step back and ask for more help. Get the police department there and the fire department as well. Go through your normal chain of command and advise anyone else that your local protocols say to. If there are any bystanders around, ask them to move away from the area. If they ask why, tell them that it isn’t safe for them to be there. Be tactful, but don’t incite a riot. Once the Fire Department gets there, let them know what they’re dealing with. Share the presentation, and stress the need for some sort of HAZMAT response. This is no time to be a hero. No one should use this as an opportunity to find out how long they can hold their breath for, or to use a non-rebreather to keep the “bad air” out. Also, it should be noted that N-95 and other safety masks that you might carry in your bus won’t help either.

Again, lets take the worst case scenario into consideration. Someone opens the car, gets a big breath in, and down they go. You safely remove them from the scene. What should you do next? Start with your ABCs. Oxygenate the person as best you can, whether that is by non-rebreather, BVM, or intubation if needed. Then, get them to the hospital. Beyond that simple care, there isn’t much that we can really do for them in the prehospital setting with the tools that we have.

For more information on Hydrogen Sulfide poisoning, look no further than the Internet. There is a wealth of information out there. Most of what I’ve posted here came from a Special Research Report done by the Regional Organized Crime Information Center. Just follow the link to get to the PDF.

Above all else, always be aware of what is going on around you, and look out for yourself and your partner.