High Alert Institute



A Homeland Security Role for Vitamin B12

by | Jun 18, 2007

Research into transmucosal absorption of intranasal Vitamin B12 gel supports a significant absorptive capacity for Vitamin B12 by this route.  Given that the mucosal thickness of the intranasal mucosa compared to the sublingual mucosa is approximately the same in that mucosal vascularity is also approximately the same such dispirit results between the two routes would not be expected based on a pharmacokinetic difference alone.  Given that both areas are supplied by branches of the carotid artery and therefore have the same flow rates, vascular profusion also fails to explain the disparity of results that is in fact seen when these routes are compared.  The most logical and obvious explanation is that the intranasal administration allowed for a retention time greater than found in sublingual administration of Vitamin B12 gel.  This “holding time” allowed for greater absorption of the Vitamin B12 gel.


Although this has interesting implications for the treatment of Vitamin B12 deficiency in a number of patient types including those with Dumping Syndrome and Pernicious Anemia, all other patient populations with Vitamin B12 deficiency have been shown to be adequately supplemented by high-dose oral Vitamin B12.  The intranasal use of Vitamin B12 gel does represent an opportunity to treat those patients for whom oral Vitamin B12 is either unacceptable as an administration route or ineffective due to decreased intestinal transit time or the lack of intrinsic factor.


Of far greater potential if the application of this research to the treatment to cyanide poisoning.  The incidence of cyanide poisoning as an industrial exposure continues to this day to be a significant occupational risk worldwide.  Although that risk is significantly lower in industrial countries due to the shift to a more technological economy third world countries continue to use large volumes of cyanide and its conjurers in the manufacture of precious metals and the processing of gemstones and other products.  The most famous of these accidents occurred in Bhopal, India in 1984 when 40 million tons of methyl-isocyanate was inadvertently released by a union carbide plant worker.  The number of casualties quickly outstripped the medical capabilities of the local community and the casualty rate both for disabled and dead was astronomical.


The loss of the amyl nitrate-based cyanide treatment kit has created a void in the continuum of care for cyanide-exposed patients.  The amyl nitrate-based cyanide treatment kit allowed for a bystander with no medical training to read simple picture-based instructions and administered the first, life-sustaining step in cyanide treatment.  In many cases, individuals exposed to cyanide can self treat in using this first amyl nitrate-based step since it required only that the amyl nitrate ampoules be open and poured on gauze or another cloth which could then be held to the face and the medicine breathed in.


The new Vitamin B12-based cyanide treatment kit, while safer, requires the reconstitution of powdered Vitamin B12 and administration by use of an intravenous infusion.  While this is a relatively simple procedure for an experienced health care professional it is beyond the reach of most bystanders and prohibitively difficult if not impossible to be performed by cyanide-exposed individuals upon themselves.


Transmucosal administration suggests a potential solution that will fill the void between immediate field care between cyanide toxic related toxicity and dissentative intravenous care using a Vitamin B12 base cyanide treatment kit. The volume of Vitamin B12 gel required would exceed that reasonable for intranasal use, but an intrarectal route would provide both adequate volume capacity and holding time. 


Currently, there are several intra-rectal treatments utilized in toxicology and emergency medicine.  Intra-rectal diazepam is utilized for the treatment of seizures by school nurses, parents, and in a limited number of situations by patients during their pre-seizure aura.  Kayexalate is utilized extensively for hyperkalemia whether a result of renal failure or muscular injury from glass or crushed trauma intra-rectal kayexalate.


In both of these treatments volumes of medication between ten and 120 milliliters are instilled and retained in the rectum allowing for the absorption of medication across the rectal mucosa.  Like the intranasal mucosa the rectum mucosa is relatively thin and of approximately the same vascularity and profusion rate.


The scientific literature suggests that a Vitamin B12 gel at a concentration similar to that described in multiple British research projects (15 to 20 milligrams per milliliter) would result in a dose comparable to half of the total Vitamin B12-based cyanide treatment kit.  This dose of 1.8 to 2.4 grams could be repeated in four hours allowing for the administration of the entire recommended 5 gram Vitamin B12 dose for moderate to severe cyanide toxicity within the recommended six hours via the rectal retention method alone.


Although further, more specific research on the utilization of high-dose Vitamin B12 intra-rectal gel in the treatment of cyanide toxicity would be required before a definitive recommendation could be made for this route of administration; the potential of this route is clearly supported by the literature. Transmucosal Vitamin B12 may represent the missing link in the care of cyanide-related toxicity both in industrial and tourism-related exposures.


Griffin Works offers Pawsitive Interactions with Service Dogs During Response Operations©, an audience-customized training that breaks down barriers by offering hands-on handling training and demonstrations with working service dogs for fire departments, EMS agencies, and public safety organizations.

Part of the National Domestic Preparedness Consortium and home to the National Emergency Response and Recovery Training Center, TEEX has been leading homeland security training since 1998. The major TEEX programs include fire and rescue, infrastructure and safety, law enforcement, economic and workforce development, and homeland security. As a member of The Texas A&M University System, TEEX is unique in its ability to access a broad range of emerging research and technical expertise. Beginning with course design and development all the way through hands-on instruction and national certification testing, TEEX delivers comprehensive training through both classroom and hands-on instruction and as online courses.

The National Child Traumatic Stress Network (NCTSN) was created by Congress in 2000 as part of the Children’s Health Act to raise the standard of care and increase access to services for children and families who experience or witness traumatic events. This unique network of child-serving professionals, caregivers and young adults, researchers, and national partners is committed to changing the course of children’s lives by improving their care and moving scientific gains quickly into practice across the U.S. The NCTSN is administered by the Substance Abuse and Mental Health Services Administration (SAMHSA) and coordinated by the UCLA-Duke University National Center for Child Traumatic Stress (NCCTS). 

The Emergency Management Institute (EMI) is part of the Department of Homeland Security’s Federal Emergency Management Agency (FEMA). The EMI provides national leadership in developing and delivering training to ensure that individuals and groups having key emergency management responsibilities possess the requisite skills to effectively perform their jobs.

The High Alert Institute maintains a list of reviewed courses provided by governments, universities and professional organizations. This list is geared towards the non-emergency management person who participates in disaster planning, preparedness, response, recovery or mitigation as part of their job responsibilities.

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Koi need forever homes, too! For pond enthusiasts, freshwater exotic and ornamental fish may not be available through pet stores or rescues in their area. The High Alert Institute Aquatic Pet Shelter Rehoming Program will be happy to assist you in stocking your new pond or adding a new finned friend to your school. Coming soon – when you adopt a Koi from the High Alert Institute Aquatic Pet Shelter Rehoming Program, we can arrange for delivery to your door anywhere in the continental United States.

Have you always wanted a Koi pond but don’t have the space one? Sponsor a Koi in our community shelter pond and we send you photos of your sponsored animal. Coming soon are live Koi Cameras above and below the water to enjoy your sponsored Koi anytime.

Dumping of freshwater non-native species and exotic aquatic pets into wild habitats is a man-made disaster that is truly preventable. The Institute’s Aquatic Pet Welfare Partnership works to raise awareness and reduce the impact on healthy ecosystems through education, as well as rescue and rehoming. Joined by champions of animal welfare and environmental stewardship, this  association of aquatic pet rescue operations and aquatic pet shelters across the United States aims to save our finned friends and preserve our waterways together.

Want to share our cause with family, friends, and colleagues? Looking for a non-traditional way to celebrate a birthday or honor someone special? Support the Institute by starting your own Peer-to-Peer fundraising challenge! Let your contacts know why our mission is important to you and what they can do to support your cause. START YOUR OWN FUNDRAISER for the High Alert Institute.

From the staffing pool to the shelter ponds, from the boardroom to the classroom, and from reading the science to writing the analyses, High Alert Institute programs and services benefit from the experience, expertise, and generosity of our volunteers. Put your talents to use for good and to good use – VOLUNTEER TODAY.

Make your donation twice as nice by rehoming aquatic pets and providing a rehabilitation companion pet to a deserving person, family, or facility. Sponsor part or all of a Joy of Koi Program pond installation – complete with rehomed koi – and give the gifts of love and recovery.

Professional photographers, amateurs, and legal copywrite holders are all welcome to participate in the High Alert Institute Nature Photo Donation Program. Sales of the images benefit the Institute and donors are eligible for tax deductions equivalent to the fair market value of their photos. Landscapes, seascapes, animals, flowers – all may be accepted – whether new or vintage  images. People may be included in the photo but only if unidentifiable (i.e., blurred figures at a distance).

Did you know that unused patents and copyrights can be donated to charity? Intellectual Property (IP) just sitting on a shelf will lose value as it becomes obsolete. The High Alert Institute IP Donation Program seeks to rescue stranded, technology-related IP with the potential for development into marketable products. Once accepted by the program, the owner/inventor is eligible for a tax deduction equivalent to the fair market value of the IP. The Institute receives the patent licensing fees or revenue from the sale of the IP to businesses, helping us to fund our mission. In turn, businesses are able to advance their markets and create jobs for less money than starting a project from scratch.

Disasters are defined as situations in which needs exceed or overwhelm available resources. Some disasters affect an entire community, while other disasters impact individuals and families. Crises of physical or psychological health can be very personal disasters.
The therapeutic value of pets during illness, trauma, and recovery is well established. And Koi fish may be well suited for people who are not able to provide verbal pet commands or physically care for pets like dogs and cats. Koi ponds are also a source of beauty and peace, providing an ideal setting for quiet reflection or meditation.
We are working to partner with pond installers and aquatic pet rescues/shelters to offer free or reduced-cost ponds with rehomed Koi fish to people seeking this type of pet therapy.

Disasters disrupt life and impact our sense of personal, family, and community safety. Survivors and responders alike often are not aware of the emotional, psychological or spiritual challenges that they may face from disaster onset through recovery. With two decades of experience training responders and communities to prepare for the behavioral health aspects of disasters, we will continue to provide education and a curated list of resources to groups or individuals.

Non-medical factors that impact overall health are termed Social Determinants of Health or SDoH. Noise pollution, poor air quality, and poor water quality are three environmental factors known to have a strong link to overall health. And the same environmental factors that impact humans impact their pets and other animals in their care. We continue to assist in advocacy, education, and technology development to mitigate the impact of SDoH on humans and animals alike.

Our efforts in shelter and rescue are the main focus of our environmental stewardship, reducing the environmental impact of non-native aquatic animals being dumped into public waterways. The High Alert Institute also assists innovators with the design, development, and evaluation of green and renewable energy technologies. Reducing the carbon footprint associated with disaster preparedness, response, and recovery furthers our continued mission to mitigate risk and improve resilience.

We partner with public and private organizations, sharing resources and fostering partnerships to improve disaster preparedness, response, and recovery, and mitigation.

The High Alert Institute team has over a century of combined research experience in medical, nursing, behavioral health, and disaster sciences. Our team provides support to researchers and technology developers through comprehensive literature searches and reviews, as well as failure mode database searches and adjudicated reviews.

When disaster strikes, most aquatic pet owners have limited options to secure the safety of their pets. Sheltering in place may not be possible if there is no power to provide aeration and “pet-friendly” shelters do not include ponds or aquariums. Our goal is to provide an option for aquatic pet owners in need of rescue and shelter for their finned friends.

Our goal is to share our two decades of disaster readiness experience with animal welfare organizations, shelters, caretakers, and pet owners, as they implement contingency  plans for natural and manmade disasters.

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