Hydrogen fluoride inhalation injury because of a fire suppression system.

Automatic fire suppression systems (FSSs) use hydrofluorocarbons (HFCs) to chemically extinguish fires. At high temperatures, HFC can release hydrogen fluoride (HF), a toxic and potentially lethal gas. We report the deaths of three U.S. military personnel at Bagram Air Base from acute respiratory failure after the FSS in their vehicle received a direct hit from a rocket-propelled grenade. Despite presenting with little to no additional signs of trauma, these individuals all died within 24 hours from HF-induced respiratory failure. When two patients later presented with similar symptoms after damage to their vehicle's FSS, they were aggressively treated with nebulized calcium and positive pressure ventilation. Both survived. The presence of HFC-containing FSSs in military vehicles may lead to future cases of HF inhalation injury, and further research must be done to help rapidly diagnose and effectively treat this injury.