Abstract: Employee #1, age 20, and a coworker were cleaning out a 25,000 gallon storage tank when they began to have difficulty breathing. The coworker was able to exit the tank, but Employee #1 collapsed inside. Two other workers attempted to enter the tank and retrieve him, but they were unsuccessful and rescue personnel had to be summoned. Employee #1 was taken to the hospital, where the emergency room physician immediately suspected exposure to cyanide but lacked an antidote kit. One was flown in from the nearest medical facility, which was a 30-minute flight. After he was administered the antidote, Employee #1 began to respond. His blood cyanide level had been 1.3 milligrams per liter, where 0.5 milligrams per liter is considered toxic. Employee #1 suffered permanent brain damage. At the time this report was written, he was undergoing rehabilitation.