A 2011 Health Canada decision is forcing gold mining operations in Canada to adopt a new cyanide poisoning treatment kit. Miners must do away with traditional cyanide antidote kits (CAKs) as they expire and replace them with the Cyanokit. The new kit, despite being a more effective treatment, presents logistical issues for gold miners, particularly those operating in remote areas, because people need to be trained in how to use it. The replacement was made necessary by Health Canada’s de-listing of the CAK, and its April 2011 approval of the Cyanokit for the treatment of known or suspected cyanide poisoning.
Cyanide is commonly used in the gold extraction process, and moderate to high concentrations of cyanide can cause severe injury or death within minutes, as it makes blood cells unable to use oxygen. For this reason, it is important that adequate treatment is provided – and quickly.
The addition of Cyanokit’s oxygen treatment component is driving a training blitz across the country, both for miners and health care professionals.
Better safe than sorry
Accurate figures on the incidence and level of specific cyanide exposures are difficult to obtain. Megan Waqué, a Workplace Safety North (WSN) spokesperson, says she is aware of just one case during the past 10 years of lost-time injury due to cyanide exposure in Ontario.
“In reality, the number of cyanide exposures is low,” says Farah Kassam, manager of safety and health at Goldcorp. However, she adds, “You always need to be prepared for the potential of cyanide exposure. Mitigating the risk is very important to us.” The company currently has three gold mines operating in Canada with another two in development.
Kassam and other safety experts agree the old kit carried risks when treating cyanide exposure. Because cyanide is very fast-acting, treatment has to be given immediately to anyone suspected of being poisoned, which created a danger using the old method. “The CAK antidote could be harmful to someone who wasn’t exposed to cyanide, but you thought they were,” says Kassam. “CAK treatment also involved the use of amyl nitrite, which is normally a restricted substance and potentially dangerous for patients with heart disease.
“On the other hand, the Cyanokit is harmless if administered to someone who does not have cyanide poisoning,” she says. Purchasing the kit no longer requires a special permit from Health Canada, and it can now be bought directly from the manufacturer, Kassam adds.
Despite the new treatment method’s advantages, the training of staff to administer it is a logistical hurdle that each mine needs to solve independently. “The Cyanokit requires that patients receive immediate oxygen therapy, to be continued until intravenous therapy is administered,” says Waqué. “That means gold mines and mills need to have people trained in oxygen administration on site during operating hours, an adequate supply of oxygen on hand, and a system to ensure the equipment is properly maintained.” Mines also require an evacuation plan that sees the patient and Cyanokit reach a doctor, registered practical nurse or other qualified person to intravenously administer the hydroxocobalamin included in the kit as soon as possible. The compound binds to the cyanide in the blood and allows it to be safely excreted in the urine.
WSN has been disseminating information about the Cyanokit and fielding questions from industry about transitioning to the new treatment package. “It’s more expensive than the old kit but more versatile in cases of cyanide smoke inhalation,” says Waqué. “At the end of the day, it’s the only cyanide antidote kit now available in Canada and has to be used.”
The changeover has been a big task but a necessary one for all gold miners. “Goldcorp has increased the level of training at all its sites throughout Canada,” says Kassam, who adds that getting each site up to protocol varied depending on its location, staff and backup procedures. The company has organized emergency response teams at remote sites, but less remote locations such as Timmins, Ontario, have presented a different challenge.
“When we were doing risk assessment for the new kit, we found out that the local emergency medical services who respond to after-hours calls were not trained or permitted to start an intravenous procedure,” she recalls. “We had to train our nurses in IV [administration] and liaise with the city to make sure their first responders were similarly trained. We also had to make sure local hospitals understand our emergency procedures and their kits are the same ones we use. It turns out that the old (CAK) kits in Ontario hospitals expired in April, at the same time as ours.”
Lack of consultation
The gold industry is a relatively minor consumer of cyanide antidotes when compared with hospitals, fire departments and other emergency services. Still, some gold miners have grumbled about inadequate consultation from Health Canada during its consideration of the Cyanokit. At Goldcorp, not everyone was convinced at first that the new kit was an improvement. Its adoption meant a culture change for some front line staff. “The presence of a [CAK] safety kit has provided a sense of security for many workers, especially those who’ve been in the mining industry a long time,” points out Kassam. “It’s important to explain why you are taking something familiar away from them and replacing it with something else, as this may cause uncertainty. In this case, there was concern about the Cyanokit because the new antidote was not widely understood and many people thought oxygen therapy wouldn’t work.”
To smooth the way, the company conducted an information and training campaign for all levels of its 7,000 staff in Canada and fostered communication on the issue between sites. Each site also had to produce Cyanokit action plans that were inspected to ensure they were effective and met the standards required for the new treatment method.
“Once people understood how the new antidote removed cyanide from the body,” says Kassam, “everyone came together.”