Don’t let your guard down on routine medical calls

Near Miss reports show why your firefighters should carry carbon monoxide detectors into every call


By Brad Van Ert

Medical calls represent the clear majority of incidents for most fire departments. It’s easy to listen to the dispatch information and assume it’s just another routine fall or sick person call.

The following Near Miss reports will underscore the importance of avoiding complacency as we respond to medical calls. Any time we respond to an emergency incident, we must maintain a heightened sense of awareness.

CO is a colorless, odorless gas that is a product of incomplete combustion. It is not always obvious when someone has been exposed. It is slightly lighter than air. (Photo/Wikimedia Commons)
CO is a colorless, odorless gas that is a product of incomplete combustion. It is not always obvious when someone has been exposed. It is slightly lighter than air. (Photo/Wikimedia Commons)

Anyone who has worked for any amount of time in our industry has probably figured out that we can’t rely solely on information provided by a caller and relayed through the dispatcher. Whether it’s the burning electrical odor that turns out to be an attic fire or a sick person call that turns out to be a combative patient with a gun, we must always expect the unexpected.

Maintain CO vigilance

Based on many Near-Miss reports received by the Firefighter Near Miss Reporting System, carbon monoxide calls are one type that frequently catches responders off guard. A report of someone generally “feeling sick,” or experiencing a headache, nausea, dizziness or shortness of breath can result from carbon monoxide exposure.

It is not uncommon to see these calls increase during the winter months when people are using improperly vented wood stoves, fireplaces furnaces, and auxiliary generators. As we will see in the following reports, CO exposures aren’t confined to just the winter months. These atypical reports highlight the need to maintain our vigilance on calls that may appear routine in nature.

Our first report deals with a medical call. According to the reporter, temperatures were “unseasonably warm, and the air temperature was still in the 80s early in the morning hours.”

“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 being 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 1600 ppm of CO was found in the basement. In all, the two initial occupants and four additional responders were treated for CO poisoning.

The occupants had turned on air conditioners in the structure, due to the heat of the day. One A/C was pointed at the thermostat for the furnace, which caused the unit to start. For some unknown reason, the occupant had disconnected the furnace from the chimney in the basement.”

To view the entire report visit: “Medical Call Turns into CO Incident.”

This is a report that demonstrates the value of paying attention to the big picture. A perceptive crew was alerted to the fact that two patients were experiencing similar complaints and decided to delve further into the possible cause. How many of us might have missed these clues?

The next incident involves another case that could easily have been missed had it not been for a carbon monoxide detector attached to the medical bag.

“We responded to a juvenile who had reportedly become sick, threw up and fainted for a short time in the pool area. Our medical bags have an ambient CO monitor attached to them at all times. Once we were just a few feet inside the pool area, the monitor began to alarm. The area was immediately evacuated, the power and natural gas lines to the pool area were shut down, and additional CO meters were sent in to monitor the environment. Readings of 400 ppm at the door and 500 ppm near the boiler room for the pool were recorded. The hotel hallways were monitored, and readings of 135 ppm were recorded. The hotel was evacuated for a short time, and positive pressure ventilation was used to ventilate the hotel hallways and rooms. Once clear, guests were allowed to return. No CO monitors were installed in the hotel.”

To view the entire report visit: “CO Exposure in Hotel Pool Area.”                                                                  

Both of these reports could have had negative outcomes had firefighters not recognized the warning signs. There is a good reason that carbon monoxide is referred to as “the silent killer.” CO is a colorless, odorless gas that is a product of incomplete combustion. It is not always obvious when someone has been exposed. It is slightly lighter than air.

In the United States, during the six-year period from the beginning of 2010 until the end of 2015, 2,244 people died due to unintentional carbon monoxide poisoning. More than one-third of these deaths occur during the winter months of December, January and February, according to the CDC. The table shows the effects of increasing levels of CO on the human body.

Parts per million (ppm)

Symptoms

35

 

Headache and dizziness within 6-8 hours

200

 

Headache, dizziness and nausea in 2-3 hours

400

 

Life-threatening after 3 hours

800-1,000

 

Convulsions and loss of consciousness after 1 hour, death within 2-3 hours of exposure

3,200

Collapse and loss of consciousness within 30 minutes of exposure

 

6,400

Loss of consciousness and potential death in 10-15 minutes

 

In both of these near-misses, readings of over 500 ppm were noted. If your crews do not already carry carbon monoxide detectors into every call, these reports should help convince you and your crews of the importance of doing so.

The value of studying near-miss reports such as these is to make us aware of unusual cases we may not have experienced ourselves. The intent is to share lessons that someone else has learned so that we do not miss critical information. Instead of just sharing these stories with our crew, the Firefighter Near Miss Reporting System enables us to share them with our brothers and sisters throughout the fire service. Although we can learn from the mistakes of others, we can also learn from incidents like these where an astute crew analyzed available information and made the correct decision.

You can use the Firefighter Near Miss Reporting System by visiting www.firefighternearmiss.com. Share your stories by entering a report for others to read. Learn from reports submitted by others. Distribute these lessons to your crews. By typing keywords such as “carbon monoxide,” “building collapse,” “vehicle accident” or any other topic into the “Search Reports” feature, you can review reports on the hundreds of topics that have been submitted to the system over the last 13 years since its inception in 2005. Be a part in improving the safety culture in the fire service!

About the author

Brad Van Ert has 37 years in the fire service. He served for 32 years with the City of Downey (CA) Fire Dept. with over 20 years as a captain. He is now the EMS division chief with the Northern Lakes Fire Protection District in Hayden, Idaho. Brad earned a Bachelor’s Degree in Occupational Studies and a Master’s Degree in Emergency Services Administration at California State University, Long Beach. He has been an advisor with the IAFC Near-Miss Reporting System since 2005.

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