Treating Patients with Sodium Nitrite Poisoning

Peter Aitken made this Freedom of Information request to The Association of Ambulance Chief Executives Automatic anti-spam measures are in place for this older request. Please let us know if a further response is expected or if you are having trouble responding.

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Peter Aitken
Delivered

Dear The Association of Ambulance Chief Executives,

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We request the following information :

1) Are paramedics employed your associatied services trained to recognise the symptoms of sodium nitrite poisoning ?

2) Are paramedics employed by associatied services trained to treat patients suffering with sodium nitrite poisoning with the antidote methylthioninium chloride commonly called methylene blue ?

3) Do paramedics employed by associatied services routinely carry the antidote methylthioninium chloride commonly called methylene blue ?

Yours faithfully,

Peter Aitken

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Steve Irving, The Association of Ambulance Chief Executives

Dear Mr Aitken
Please accept our condolences on the death of your daughter.

The Association of Ambulance Chief Executives (AACE) is not a public body subject to Freedom of Information regulations. However I am pleased to reply to your enquiry as follows.
Paramedics are not trained to recognise symptoms specific to sodium nitrite poisoning. This is because the incidence of occurrence is quite rare and would not influence treatment options available to our clinicians. Any antidote could only be administered in hospital following specific testing such as advanced spectroscopy / blood gas analysis and laboratory findings.
Paramedics are competent at comprehensive assessment of clinical presentations and of gathering relevant information from a variety of sources including evidence of self-harm or likely sources of poisoning.
Your enquiry has bought to our attention the rise of sodium nitrite poisoning and we will review our current guidelines and liaise with colleagues as to how we might further educate our clinicians and improve our care.

Yours sincerely

Steve Irving

Executive Officer / ALF Conference Lead
Association of Ambulance Chief Executives
[mobile number]; [AACE request email]
PLEASE NOTE: I Work Part Time – primarily between Monday & Thursday

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Peter Aitken
Delivered

Dear Steve Irving,

Thanks for your response. Following a series of FOIA requests, we received the following information from the West Midlands Ambulance Service :

"Learning identified from a serious incident in 2019 led to a recommendation being made that the Trust was to consider Hazardous Area Response Team (HART) Teams carrying Methylene Blue for the acute symptomatic treatment of medicinal and chemical products-induced methaemoglobinaemia (MetHb). Following the subsequent coronial inquest, the Trust was sent a Preventing Future Deaths report from the coroner highlighting the concern that as sodium nitrate toxicity is a recognised method of suicide and that the coroner has heard evidence from a WMAS staff member that there is an effective antidote (methlyene blue), but this is not available on the ambulance. As a result of this in July 2020 the Trust introduced Methylene Blue into its HART capability along with clinical guidelines for the administration of Methylene Blue."

In a follow-up FOIA that we subsequently raised on 30th January, the WMAS responded on the 19th February with the following :

"We are able to confirm that since Methylthioninium Chloride (Meth Blue) was introduced to WMAS, HART has administered this 7 times in total. In relation to patient outcome we were able to see positive effects on the patient while in our care."

We also received the following response from the North West Ambulance Service NHS Trust :

"Specialist Paramedics who operate as part of the Hazardous Area Response Team (HART) and Specialist Operations Response Team (SORT) receive additional training to deal with scenarios such as sodium nitrite poisoning

HART and SORT Paramedics carry additional personal protective equipment and through the on call command structure have access to specialist advice from National Interagency Liaison Officer (NILO) and Strategic Medical Advisor. In a sodium nitrite poisoning scenario this structure has led to access to locally sources methylene blue to enable treatment."

What role can the Association of Ambulance Chief Executives play in assisting these examples of best practice to be applied nationwide which could have potentially saved our daughter ?

Yours sincerely,

Peter Aitken

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Steve Irving, The Association of Ambulance Chief Executives

Dear Mr Aitken

Thank you for sharing with me the information you received from both NWAS & WMAS.
I am pleased inform you that the NASMeD (National Ambulance Service Medical Directors) meeting next week has an Agenda item on Methylene Blue led by Dr Phil Cowburn, Medical Lead for NARU (National Ambulance Resilience Unit). As you maybe aware, NARU have oversight of the HART & SORT training and education across ambulance services.
I know that NASMeD are interested in the experience of WMAS and the trial it carried out with Meth Blue along with any other evidence of timely administration / efficacy. As you mention, sharing practical experience and evidence is key if we are to improve patient care. NASMeD is the right forum for sharing this information and AACE will continue to support the group in its work.

Steve Irving

Executive Officer / ALF Conference Lead
Association of Ambulance Chief Executives
[mobile number]; [AACE request email]
PLEASE NOTE: I Work Part Time – primarily between Monday & Thursday

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