Traditional Cyanide antidote kit now off the market in Canada

Thursday, June 07, 2012

Background

Cyanide is used in gold mines and mills as part of the extraction process to remove gold from ore. Cyanide is highly toxic by all routes of exposure and may rapidly impair the nervous, cardiovascular and respiratory systems leading to death within minutes to hours.

Gold mines and mills have historically used a Cyanide Antidote Kit (CAK) that contains three components: amyl nitrite, sodium nitrite, and sodium thiosulfate. Amyl Nitrite was discontinued in February 2012 and the traditional CAK is no longer available in Canada. As the traditional kits expire throughout the year, gold mines and mills will need to replace them with the only available cyanide antidote kit on the Canadian market, Merck’s Cyanokit.

Advantages of the Cyanokit over a CAK
The kit was approved by Health Canada in September 2011. Cyanokit has been used successfully in France for the past ten years and was recently recommended by France, the UK and Health Canada as the preferred treatment for cyanide poisoning. While the Cyanokit is more expensive than a CAK, it does have key advantages:

  • The kit does not require a special permit from Health Canada. It can be ordered by contacting Methapharm Specialty Pharmaceuticals.
  • The antidote is harmless if administered to someone who does not have cyanide poisoning (cyanide treatments are always given to suspected cases due to the immediate need for treatment). Amyl Nitrite is potentially dangerous for patients with heart disease.
  • The antidote is safe for suspected cyanide poisoning cases from smoke inhalation. The CAK antidote was considered dangerous to administer to someone with carbon monoxide poisoning as it would make the body more hypoxic.

How this will affect your procedures
The Cyanokit requires oxygen therapy as the first aid response. The product information kit requires oxygen therapy to begin immediately and to continue until intravenous therapy (IV) is being administered. To administer Cyanokit properly, gold mines and mills will need to have the following in place:

1. You will need a procedure to have an adequate number of people trained in oxygen administration on site during operating hours.
2. You will need an adequate supply of oxygen on hand at your worksite(s).
3. You will need a procedure to maintain and ensure the oxygen equipment is maintained as per manufacturer's recommendations.
4. The label on the boxes containing the antidote will need to be changed to reflect the new product and explicit directions for use (as per subsection 282(3) of Regulation 854 under the OHSA))
5. An evacuation plan to have the patient and Cyanokit reach a doctor, Registered Practical Nurse (RPN) or qualified person as soon as possible to begin the preparation and administration of the Cyanokit intravenous therapy.

Note to Remote Locations
Similar to the CAK, the Cyanokit requires a peripheral IV to be set up and administered to the patient as soon as possible. The workplace must have a doctor or Registered Practical Nurse (RPN) or other qualified person located onsite or nearby to administer the Cyanokit IV to the patient.

Regulations
Workplace parties at gold mines and mills are required to comply with the Occupational Health and Safety Act (OHSA) and its regulations. Section 282 of Regulation 854 (Mines and Mining Plants) under the OHSA sets out the following requirements relating to antidotes:

Section 282 (2) At every mining plant where poisonous or dangerous compounds, solutions or gases are present, there shall be kept or installed in a conspicuous place, as near the compounds, solutions or gases as is practical,

(a) antidotes and washes;

(b) eye wash fountains; and

(c) where necessary, showers for treating injuries received from such compounds, solutions or gases.

(3) Antidotes and washes required under subsection (2) shall be properly labelled and explicit directions for their use shall be affixed to the boxes containing them.

Ministry of Labour
The Ministry of Labour (MOL) and its health and safety partners will continue to work with stakeholders in the mining sector to protect workers’ health and safety on the job. Health and safety associations such as Workplace Safety North provide education and awareness, and the Ministry enforces health and safety legislation.

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