Section 282 of Regulation 854 (Mines and Mining Plants) under the OHSA sets out the following requirements relating to antidotes: Workplace parties at gold mines and mills are required to comply with the Occupational Health and Safety Act (OHSA) and its regulations. The workplace must have a doctor or Registered Practical Nurse (RPN) or other qualified person located onsite or nearby to administer the Cyanokit IV to the patient. Similar to the CAK, the Cyanokit requires a peripheral IV to be set up and administered to the patient as soon as possible. An evacuation plan to have the patient and Cyanokit reach a doctor, Registered Practical Nurse (RPN) or qualified person as soon as possible to begin the preparation and administration of the Cyanokit intravenous therapy.The label on the boxes containing the antidote will need to be changed to reflect the new product and explicit directions for use (as per subsection 282(3) of Regulation 854 under the OHSA)).You will need a procedure to maintain and ensure the oxygen equipment is maintained as per manufacturer's recommendations.You will need an adequate supply of oxygen on hand at your worksite(s).You will need a procedure to have an adequate number of people trained in oxygen administration on site during operating hours.To administer Cyanokit properly, gold mines and mills will need to have the following in place: The product information kit requires oxygen therapy to begin immediately and to continue until intravenous therapy (IV) is being administered. The Cyanokit requires oxygen therapy as the first aid response. The CAK antidote was considered dangerous to administer to someone with carbon monoxide poisoning as it would make the body more hypoxic. The antidote is safe for suspected cyanide poisoning cases from smoke inhalation.Amyl Nitrite is potentially dangerous for patients with heart disease. The antidote is harmless if administered to someone who does not have cyanide poisoning (cyanide treatments are always given to suspected cases due to the immediate need for treatment).It can be ordered by contacting Methapharm Specialty Pharmaceuticals. The kit does not require a special permit from Health Canada.While the Cyanokit is more expensive than a CAK, it does have key advantages: Cyanokit has been used successfully in France for the past ten years and was recently recommended by France, the UK and Health Canada as the preferred treatment for cyanide poisoning. The kit was approved by Health Canada in September 2011. As the traditional kits expire throughout the year, gold mines and mills will need to replace them with the only available cyanide antidote kit on the Canadian market, Merck’s Cyanokit. Amyl Nitrite was discontinued in February 2012 and the traditional CAK is no longer available in Canada. Gold mines and mills have historically used a Cyanide Antidote Kit (CAK) that contains three components: amyl nitrite, sodium nitrite, and sodium thiosulfate. Cyanide is highly toxic by all routes of exposure and may rapidly impair the nervous, cardiovascular and respiratory systems leading to death within minutes to hours. Cyanide is used in gold mines and mills as part of the extraction process to remove gold from ore.
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