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Carbon monoxide: A year-round threat to rescuers

CO poisoning is a life-threatening emergency and victims must be removed from the environment immediately without placing the rescuers in danger

Carbon monoxide alarm

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Each year, approximately 420 people die from accidental carbon monoxide (CO) poisoning in the United States. It is estimated that many other deaths occur but are reported as structure fire-related deaths. Additionally, over 100,000 people are seen in emergency departments each year for symptoms of exposure to the toxic gas.

What causes CO poisoning

Carbon monoxide is a colorless, odorless gas resulting from the incomplete burning of organic fuels, such as natural gas, kerosene, fuel oil, coal, propane, wood and gasoline.

While many of these incidents are the result of home heating system or other gas appliance failures, CO may also be associated with:

  • Indoor use of charcoal grills
  • Improper use of stoves, ovens or kerosene devices to heat homes
  • Indoor operation of generators (or operation too close to structures)
  • Warming up vehicles parked in garages

CO poisonings may also occur in industrial environments when internal combustion machines, such as forklifts, are used in enclosed places, or other machines or manufacturing equipment is used improperly. Workers may inadvertently be exposed to the toxic gas when ventilation systems fail.

An increase in CO cases is also often associated with natural disasters, when homes are without electricity, and families use other methods to warm their homes, cook meals and produce electricity.

CO poisoning signs and symptoms

Carbon monoxide poisoning may be related to short exposures to a high level of the gas in the environment or a prolonged exposure to lower levels.

Signs and symptoms of CO poisoning may include:

  • Altered level of consciousness
  • Confusion
  • Dizziness
  • Dyspnea on exertion
  • Fatigue
  • Headache
  • Impaired judgement
  • Nausea and vomiting
  • Seizures

CO poisoning presents not only a danger for immediate illness and potential death, but the toxin also has long-term consequences. CO is damaging to myocardial tissues as well as the neurologic system. The effects vary considerably based on the amount of exposure, treatment and the patient’s overall health. Repeated exposure to CO at fire scenes is a major concern in the fire suppression industry and a reason all firefighters should wear SCBA when conducting salvage and overhaul operations after the initial fire has been put out.

Regardless of the method of onset, CO poisoning is a life-threatening emergency and victims must be removed from the environment immediately without placing the rescuers in the same danger.

CO dangers to first responders

A recent story about a malfunctioning furnace at an ice hockey rink in New York highlighted how CO poisoning can quickly and quietly sicken large numbers of patients. As many as 90 patients sought medical attention after spending time in the hockey rink. Some of those affected initially attributed symptoms to being tired from playing hockey. People did not fully realize something was wrong until multiple players reported a relapse of symptoms after returning to the arena and others began vomiting.

The danger to first responders is that the signs and symptoms of CO poisoning are vague and easily attributed to other causes. Further, the presence of CO may not be considered without the aid of a CO alarm or detector.

Several first responders have become ill from CO poisoning after caring for patients across the country and not just during the winter months. Imagine working a cardiac arrest in a home, not recognizing that the patient succumbed to CO and not a heart attack or arrhythmia. Without being alerted to dangerous levels of CO gas in the structure, providers could easily work the arrest in the dangerous environment for 20 or 30 minutes, putting themselves at risk.

I personally know an EMS crew that this happened to. Thankfully, they did not become seriously ill.

Think back to the hockey arena story and consider how easy it would be to conclude that spectators and players were getting sick due to food from the concession stand.

The best defense emergency personnel have against exposure to carbon monoxide is a portable gas detector. Devices are available that detect single gases, such as carbon monoxide, hydrogen sulfide or sulfur dioxide. These battery-operated detectors are generally maintenance-free and can be attached to a crewmember’s belt or an equipment bag. Some devices require occasional testing and calibration or have a limited lifespan before replacement is required. The detectors can be found for less than $200.

Fire departments commonly have multi-gas meters that may be used to test an environment for dangerous levels of hazards like CO, but these resources would need to be requested by EMS and may not be available during the initial phases of patient assessment and care.

Equipping emergency crews with single-gas carbon monoxide detectors may be an opportunity for a community fundraising project. The devices may also qualify for various emergency equipment or responder safety grants.

However you go about it, take steps now to protect emergency crews from the silent killer – carbon monoxide – by providing portable CO detectors.

Michael Fraley has over 25 years of experience in EMS in a wide range of roles, including flight paramedic, EMS coordinator, service director and educator. Fraley began his career in EMS while earning a bachelor’s degree at Texas A&M University. He also earned a BA in business administration from Lakeland College. When not working as a paramedic or the coordinator of a regional trauma advisory council, Michael serves as a public safety diver and SCUBA instructor in northern Wisconsin.