Emerg Med J 30:43-48 doi:10.1136/emermed-2012-201106
  • Original articles

‘Do you know where your cyanide kit is?’: a study of perceived and actual antidote availability to emergency departments in the South West of England

  1. Nick Mathieu6
  1. 1Emergency Department, Derriford Hospital, Plymouth, UK
  2. 2Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  3. 3Emergency Department, Royal Cornwall Hospital, Truro, UK
  4. 4Emergency Department, Musgrove Park Hospital, Taunton, UK
  5. 5Emergency Department, North Devon District Hospital, Barnstaple, UK
  6. 6Emergency Department, Torbay Hospital, Torquay, UK
  1. Correspondence to Dr Ian Higginson, Emergency Department, Derriford Hospital, Plymouth PL6 8DH, UK; ianhigginson{at}
  1. Contributors LM, IH, and LS devised the study methods and standardised data collection forms. LM, JF, JG, CL, NM and LS collected the data at each of the five trusts involved in the study. LM collated the data obtained, and LM and IH co-authored the initial drafts of the study. JS had significant input in later drafts, and all authors were involved in reviewing the final drafts of the paper.

  • Accepted 29 January 2012
  • Published Online First 2 March 2012


Objective The authors set out to investigate perceived and actual availability of antidotes recommended for stocking in emergency departments (EDs) by the College of Emergency Medicine in EDs in the South West of England.

Methods Data collectors were asked to physically locate each relevant antidote in the ED, and check whether the recommended quantity was available. If the antidote was not available in the department, the data collector located where in the hospital stocks were available. Senior medical and nursing staff were asked to specify where they believed the antidotes were stored or who they would ask if they did not know. It was then ascertained whether their source of advice would have known the location.

Results 5 out of 6 departments returned data with an overall response rate from senior medical and nursing staff of 80%. Knowledge of common antidote locations was variable, and stocking of antidotes did not universally meet the College of Emergency Medicine recommendations.

Conclusion Stocking of important antidotes should be rationalised and simplified using central locations, preferably close to the ED. Clinically important antidotes may not be available for patients when they need them. Clear guidance should be available for staff detailing the location of antidotes. There is a need for clarification around the treatment of cyanide poisoning to facilitate rational antidote stocking for this potentially lethal condition.


  • Competing interests None.

  • Authors' note The Toxbase references require a log in.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

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