Medical call leads to CO poisoning of firefighters

A Near-Miss report details the circumstances in which four first responders experienced CO poisoning

By Andrew Beck

As temperatures fall across the country, the opportunity for carbon monoxide (CO)-related incidents increases. CO is produced by incomplete combustion of fuels, such as propane or natural gas. A broken flue pipe, plugged chimney, faulty fuel-fired appliance or vehicle can rapidly fill a structure with CO, causing occupants to experience flu-like symptoms, such as headache, nausea, vomiting and lethargy – and even death.

Because it is colorless and odorless, CO is detectable only with metering equipment. As such, firefighters can unknowingly walk into a contaminated atmosphere while responding to medical calls for individuals feeling sick. Without realizing it, we can become secondary victims ourselves. Depending on the concentration of CO, victims can become rapidly incapacitated. The longer we are in the environment, the higher dose of CO we will receive – and the greater the likelihood of serious injury or death.

By staying aware of the potential for carbon monoxide, firefighters can keep themselves safe and successfully treat their patients as the temperatures drop this winter.
By staying aware of the potential for carbon monoxide, firefighters can keep themselves safe and successfully treat their patients as the temperatures drop this winter. (AP Photo/Nati Harnik, File)

The following CO-related report, “Medical Call Turns into CO Incident,” was received by the Firefighter Near Miss Reporting System.

Near-Miss report details CO poisoning

“Our department responded to a medical call as first responders, due to no available BLS unit. The initial patient was a female occupant complaining of heart palpitations.

While assessing the patient, it was noted that her husband was lying on the sofa in another room with his feet on the back of the sofa. The wife indicated he does this frequently, whenever he has a headache and that he suffers from mild dementia. While initially refusing medical aid, he consented to be checked out. An additional fire and mutual aid BLS unit was requested due to the possibility of having two patients.

Due to the symptoms exhibited and the fact that there were multiple patients with similar symptoms, a firefighter was sent to get a CO meter. 700 ppm of CO was found upon entering the structure. An immediate evacuation of the structure was ordered. A RAD-57 pulse/co-oximeter, carried by FD, was placed on the occupants and all responders. Elevated CO readings were found in all, and some were actively showing the effects of CO exposure.

An MCI was declared with a possibility of nine victims of CO poisoning. During a search of the structure in full PPE, a peak reading of 1,600 ppm of CO was found in the basement.

In all, the two initial occupants and four additional responders were treated for CO poisoning.”

In the full report, “Medical Call Turns into CO Incident,” the reporter states that an air conditioner was directed at a thermostat for the furnace, and had inadvertently caused the furnace to start. For some reason, the furnace flue pipe had been unhooked, causing exhaust gases to be directly vented into the building.

Quick thinking by responding units led to monitoring the house for CO and identifying the hazard. This action prevented other people on scene from being overcome and leading to additional patients.

Simple steps to detect CO on scene

CO calls are a response encountered in virtually all parts of the country. Even in warmer climates, CO from vehicle exhaust can contaminate a structure. This can unfortunately be a method of suicide as well, creating an additional opportunity for responder exposure. Industrial processes, charcoal grills and even portable space heaters can emit CO.

How can we keep ourselves out of harm’s way when dealing with this invisible hazard?

A quick way is to obtain a single-gas CO meter that will connect to a medical bag. This way, any time the bag enters a room, it will alert if CO is present and in what concentration. Crews can then remove themselves and patients to fresh air before becoming overcome. Basic hazmat training also tells us that any time we have multiple victims of an unknown ailment, we should consider the possibility of a hazardous material present.

A personal close call with CO

I once found myself in this situation when responding to a reported seizure. Upon arrival, our crew found two individuals seated on the porch outside of their apartment. The patient had suffered what family stated was seizure-like activity. She had no prior history of seizures and appeared very anxious – not normal behavior for a typical postictal patient.

As we started to obtain vitals and follow-up on patient history, I began to get a strange feeling about the call. Other family members also stated they had headaches and felt ill.

I entered the open front door to see if there was any evidence of drug use or some other reason for the patient’s complaints and ultimately decided to return to the truck to grab our four-gas meter.

After a successful fresh air setup, I entered the home and found CO levels of over 160 ppm. I immediately exited the house and relayed the findings to my partner.

We placed the first patient on high-flow oxygen. I was then approached by the family members who lived in the basement apartment stating that they had two sick children, complaining of headaches and nausea. I contacted our dispatch center, relayed that we had a CO incident and a total of five patients. In this case, a routine medical call quickly turned into a hazmat incident – and somewhat of a mass casualty incident as well. In all, five patients were treated, with one remaining overnight at the hospital.

Our department has small CO meters on our medical bags, but in this case, the patient was already outside, so the alarm did not detect the CO. In another situation, this alarm sounding would have provided an indication of the presence of CO and allowed responders to take appropriate precautions. Being aware of the potential hazard and using caution while investigating a call kept everyone involved safe.

By staying aware of the potential for carbon monoxide, we can keep ourselves safe and successfully treat our patients as the temperatures drop this winter.

About the Author

Andrew Beck has been a member of the program staff for the IAFC’s Firefighter Near Miss Reporting System since 2015 as an instructor, reviewer and subject-matter expert. Beck started his fire service career in 2002 with the U.S. Fish and Wildlife Service, working in wildland fire operations. He then worked in wildland fire for the U.S. Forest Service from 2003 to 2006, when he transitioned to structural fire with the Mandan City (ND) Fire Department. He is currently the training officer, managing department training programs and live-burn operations. Beck teaches thermal imaging at various regional fire schools and is a live-fire instructor for the state firefighter’s association.

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