把十一年的遺憾，變成下一次的可能

1. The Day I Carried a Brother Out

Years ago, an underground parking garage fire.

Smoke had nowhere to go in a sealed space. I went in with the search team.

I found him myself. I carried him out.

Later, I stood in the hospital corridor, watching the resuscitation.

I won't go into detail about that period. But standing in that hallway, one image stayed with me — the line between what frontline crews can do, and what they can't. We did what we could. But there were things, in that moment, we simply could not do.

Hours later, the search team was called in. Not to be asked what happened, or how he went down, or what the system could learn. We were called in to help draft a statement for the press.

That was the day I understood that, in this system, a line-of-duty death is often a public relations problem before it is a safety problem.

I carried that for many years.

2. I Chose to Stay on the Outside

After that event, I made a choice.

I did not chase early promotion. I stayed at the outpost — a frontline team member, shift after shift, on fires and on EMS calls. I was only promoted to squad leader in February 2026.

It was not that the promotion path was closed. It was that the promotion path led into the room I had become angry at.

I like helping people directly. On a dispatch, in a patient's home, at the entrance to a fire, in the back of an ambulance — there is no middleman between what I do and the person who receives it.

This position has no administrative authority. But over time, I noticed something unexpected: in certain matters, this position carries more weight than the office.

International EMS peers do not write to the deputy chief asking whether he has seen smoke from a fire. Professional journals do not invite the EMS division clerk. Reporters covering the scene do not ask the section chief.

I am here. I see, I respond, I can speak.

So I stayed, and started working from outside in. Writing notes, organizing materials, producing visible work — making the shape of the problem clear, putting solutions on the table, turning paths already walked into facts that can be checked.

Often, the rest takes care of itself.

3. Seeing the Problem Clearly

If you stay on the line long enough, your eyes adjust.

Smoke from a structure fire is not a single toxin. Carbon monoxide is well known, but synthetic building materials — carpets, sofas, PVC, polystyrene — release hydrogen cyanide when they burn. This is not a textbook hypothesis. It is a documented occupational risk for fire EMS responders worldwide. The problem: high-flow oxygen handles CO, but it does nothing for cyanide. If the frontline only has oxygen, the toolkit is incomplete for inhalational poisoning.

I read what needed to be read. AHA guidelines. International protocols. Mechanism, side effects, storage, dispatch logic, pricing, how various EMS systems deploy it. Not because I'm an academic, but because that is how I operate — to do the right thing, you have to do your homework, or your first sentence gets blocked at the door.

Hydroxocobalamin (brand name Cyanokit) is one of the few cyanide antidotes that can be given prehospital, binds cyanide directly, and has an acceptable safety profile.

For the clinical comparison, AHA guidance, and deployment design, see the case page. This essay stays with the reason the work mattered.

This was already standard in advanced EMS systems abroad. Taiwan was not on that line.

4. Houston, November 2024

From November 19 to 28, 2024, the New Taipei City Fire Department sent three people to the United States: the deputy chief, the EMS division secretary, and me — an outpost team member.

The mission was to attend the Texas EMS Conference and visit the Houston Fire Department (HFD). The trip is documented in the New Taipei City Government's public overseas mission report (system ID C114AB007).

In Houston, I saw with my own eyes how Cyanokit is stored, dispatched, and used. They keep it on EMS Supervisor vehicles and District Chief vehicles — not in a hospital pharmacy, but on the units that actually drive to fires.

It was on this trip that I met Dr. Chris Souders. We talked at length.

On the flight home, the question from many years earlier came back.

"If we'd had this option then, would things have been different?"

Medically, no one can answer that with certainty. But from that moment, the question became a charge: I had to do something with it.

5. Writing to Chris

A few months after returning home, on May 1, 2025, I wrote to Dr. Souders in English.

One paragraph in that letter was the first time, in over a decade, that I wrote that day out in complete sentences for someone who hadn't been there:

"years ago, I was directly involved in a tragic line-of-duty incident where a fellow firefighter lost his life. I found him at the scene and did everything I could to save him, but sadly, it was in vain. That moment has stayed with me ever since, and it continues to drive my commitment to improving clinical care and occupational safety in emergency services."

Two days later, on May 8, 2025, Chris replied. He attached Houston's Cyanide Treatment Page and Hydroxocobalamin Drug Page, and described HFD experience with firefighters who suffered severe fire-smoke exposure and cardiac arrest, received CPR and hydroxocobalamin, and ultimately returned to work.

"Returned to work."

I read that line many times.

6. Not Everyone Agreed

Through this whole period, I was still an outpost team member. I was not in the decision room.

Medical director meetings are typically attended by EMS division staff, designated physicians, brigade nurses, and EMS coordinators. Frontline crews don't usually sit at that table — you need a proposal to be invited in. By design, the frontline are the hands and feet.

But over time you learn: hands and feet think too. And the things that need to be done still need someone to do them.

I used the methods I had. I met designated physicians one by one. I laid out the guidelines. I described what Houston was doing. I put the fire toxicology evidence on the table.

The result was roughly half and half. Half supportive, half reserved.

The reservations were reasonable. One was "the evidence is not strong enough" — but in fire toxicology, no specific antidote can be tested in a double-blind trial; that is ethically impossible. The other was economic — drug cost, cost-effectiveness, deployment overhead. These are fair questions.

But I was not alone on this road.

A few physicians were willing to talk, willing to help, willing to stand with the proposal. Their support kept the work moving.

I was not trying to convince everyone. I was working with the people willing to engage, paving the road one stretch at a time.

7. Doing the Work

What followed was less photogenic, but each step mattered.

Mapping AHA 2025 guidance to local practice. Compiling domestic emergency toxicology literature. Building slides on mechanism and side effects. Presenting to the medical advisory committee. Writing for the EMS newsletter. Drafting an internal cyanide antidote protocol. Running Demokit training. Translating Houston's deployment logic into a configuration that could work in our context.

Not the work of one person. Not the decision of one meeting.

On September 11, 2025, I wrote to Chris again:

"our department is set to receive three vials of Hydroxocobalamin this November. This is a pioneering step for EMS in Taiwan."

Three vials, for a city of 2,052 square kilometers and over four million people. I told Chris that compared to Houston, our density was nowhere close, and asked for his guidance on deployment strategy.

He wrote back the next day, explaining Houston's logic of 10 EMS Supervisor vehicles plus 21 District Chief vehicles, and why placing it on units that "always go to the fire" works better than spreading it across every station.

I printed that letter.

8. Three Vials, In Place

In November 2025, the three vials of Hydroxocobalamin arrived in New Taipei.

Following the deployment plan, they went onto two TP+ advanced life support units and one urban search and rescue team. Those three locations were not chosen because the drug "lives there." They were chosen because they are where the drug is most likely to actually be used by people trained to use it.

In spring 2026, during an industrial fire response, the dispatch center for the first time issued the order in writing:

For the first time, the words "carry cyanide antidote" appeared in writing in a New Taipei dispatch log.

The drug was not administered in this case. But the words "we can dispatch it" — for eleven years, that was something we did not have.

9. Putting It in Print

In October 2025, the Taiwan Emergency Medical Services Newsletter published my article: "Local Innovation: No Longer Powerless at the Fire Scene — Bringing Hydroxocobalamin to Prehospital Care."

The article covered the mixed toxicity of fire smoke, the mechanism of Cyanokit, the AHA 2025 guideline, the Houston experience, and where Taiwan stood.

Midway through, I wrote a sentence I had been carrying for eleven years:

"This also brings back the regret I have carried since 2014, from a colleague's line-of-duty death — we have to make sure the next time becomes a survival, not a loss."

It was the first time I had connected that day to today, in a professional publication, under my name.

10. Road Not Yet Walked

Three vials is not the end.

The Ministry of Health and Welfare's toxicology unit prefers to keep these antidotes in hospitals. From a clinical standpoint that's reasonable — hospitals have laboratories, monitoring, and data.

But the AHA 2025 guideline direction is clear: for life-threatening or highly suspected cyanide poisoning, do not wait for laboratory confirmation. Treat early based on clinical findings, exposure risk, and medical direction.

"Time is life" is not rhetoric in fire smoke.

Hospital versus prehospital is a long-standing tension between medicine and EMS. I understand the medical side's call for data — that is professional caution. But EMS sees the other side: by the time the data comes in, the person may already be gone.

If they want data, we will accumulate data. Every correct activation, every correct non-activation, every dose delivered within the golden window — all of it is data.

I will keep walking this road.

11. Why I Keep Doing This

I push for Cyanokit not only because it aligns with AHA guidance, and not only because advanced EMS systems are already using it.

The deeper reason: I have stood in that corridor.

That feeling — "we did everything we could, but we didn't have the tool" — I know what it is.

I cannot say with medical certainty that things would have been different back then. No one can.

But I can do this: give the next colleague standing in that corridor one more option in the kit — one with evidence behind it, training under it, and a dispatch process around it.

To make "powerless" a little smaller.

To give "returned to work" a chance to be said in Taiwan.

That is why, for these eleven years, I have stayed on the line.