Urban communities are under constant threat of numerous potential disasters, including cyanide exposure events. Exposure can occur in settings such as structure fires, industrial accidents, or even intentional acts of terrorism. The typical treatment modality for cyanide toxicity employs the antidote, hydroxocobalamin. While studies regarding antidote availability have been conducted in Korea and Hong Kong, a literature search did not reveal any such studies in any part of New York City.

The borough of Brooklyn has a population of 2.57 million people. In the setting of a mass casualty incident (MCI) involving cyanide toxicity, such as a large structural fire or a chemical attack, it is uncertain of the region's capability to provide hydroxocobalamin. The objective of this study is to assess the stockpile of hydroxocobalamin across acute care hospitals in Brooklyn.

The amount of hydroxocobalamin required to treat a cyanide-related MCI was based on recommendations from the 2018 US Expert Consensus Guidelines for Stockpiling Antidotes. Ten grams of hydroxocobalamin are needed for each 100-kg patient. Theoretically, a minimum of 50 grams of hydroxocobalamin would be required for a mass casualty incident (5 patients).

Fifteen acute care hospitals within Brooklyn were identified as potential treatment sites for cyanide exposure. Each site’s emergency manager was sent a survey identifying hydroxocobalamin availability in both their pharmacy and their emergency department.

All 15 hospitals responded to the survey. Two of the 15 hospitals had at least 50g of hydroxocobalamin in their inventory, however, no hospital had 50g stored in their emergency department. The median amount of hydroxocobalamin stored was 20g or two doses.

Should a mass casualty incident involving cyanide exposure occur, only two hospitals in the borough of Brooklyn would be prepared to treat five or more patients presenting to their hospital.