Smoke inhalation is the most common cause of fire-related deaths. Fire victims are exposed to toxic gases like hydrogen cyanide and carbon monoxide. High levels of cyanide can cause rapid symptoms like confusion, breathing problems and collapse. The body’s cells can’t use oxygen efficiently, which can quickly lead to cellular death and organ failure, so rapid treatment is vital. CYANOKITS containing the powerful and effective antidote to cyanide, hydroxocobalamin, have been carried by our FDNY ALS Units and EMS officers since 2008. In late 2020, REMAC protocols changed, requiring all ALS units in New York City to carry the kits. And lives have been saved. Captain Randy Li welcomes EMS Special Operations Command’s Captain Joseph Spinelli to the podcast to discuss this life-saving treatment.