HAZMAT/EMS: Carbon Monoxide Emergencies


HMN- So what do the last three letters of problems spell…? EMS. When was the last time you specifically trained on EMS response and treatment of patients exposed to hazardous materials? For the time being lets think past rapid decon of the patient and focus on the meat and potatoes of recognition and treatment of medical patients, or responders, who have been exposed to hazardous materials.

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This is not going to be a detailed guideline to replace any SOP or SOG in your organization. This should be an eye opener to spur your mind to want to know more and to ask why. Asking the question why we do, or do not do, certain procedures should not be shunned. Sometimes the answer, “This is the way we have always done it.” is not the best answer.

This is just part one. The next couple of posts are going to discuss different types of hazardous materials exposures and EMS’s response.

Depending on where you live right now it may or may not be getting colder. With the change in seasons, for most of the country, the temperature starts to drop and people start relying more on fossil fuel based heating for their homes. When fossil fuel burning appliances malfunction or are not vented properly we get carbon monoxide exposures.

CO emergencies are probably one of the most common hazardous materials calls most departments get. Since these calls are very common people become complacent. It is that complacency, because it is one of the most common hazmat calls, that dulls our edge.

So lets get into what we know about CO.
Colorless and odorless gas
Just slightly heavier than air
Easily mixes in the air

Since its almost equal to air it is not going to rapidly sink on its own to the lowest point in the space it is leaking from. Chances are its going to be well mixed in the room at about waist to chest level and you will not see much if any stratification. If there is not a lot of air movement throughout the house or business the higher concentrations should be closer to the source of the CO.

So what does all of that mean for the EMS response? Depending on air movement in the house, and the person’s location, you can get drastically different levels of CO exposure. How do you know how much CO the patient or responder has been exposed to if they meet you on the front lawn? What does your department, or maybe a neighboring department, have that can give you an idea of the amount of exposure a person has had?

There are many different machines being made today that use similar technology called rainbow spectrometry. If you have not heard this term before just think of it as a very fancy pulse oximiter like we normally use on EMS runs, but with the ability to see the CO bound to the hemoglobin. This technology gives you a ballpark reading of how much CO the patient has been exposed to. The manufacturers have some great information you can find correlating percentage of CO in the body to signs of symptoms of the patient. Remember this is just a tool to be used in evaluating people who have been exposed. We still have to go back to the old adage, does this person appear to be sick or not sick based on what we are seeing.

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While we are all told to trust the patient versus the machine, how do you know if this patient was exposed to CO? Prior to having the patient sign a refusal of care you should include carboxyhemoglobin monitoring. Don’t forget, your special population patients such as children, elderly and pregnant patients have a greater need in seeking medical attention.
So the decision has been made to transport the patient. Which hospital do you take the patient to? Is the closest hospital the best transport option for the patient? Depending on where you live the closest hospital may be forty five minutes away and its a basic care hospital with no specialist.

Definitive care for high exposure CO incidents is going to be a hyperbaric chamber. Do you know where your closest chamber is? Does your protocol stipulate where CO patients are to be transported? Does your protocol allow you to bypass the closest hospital if you have reason to?
Maybe transport to the closest facility by ground is not your best option. Consideration should be made for air transport, if available, to the nearest appropriate facility. When considering your transport options think of the patient as your best friend. Would you want your friend sitting in a local hospital for a few hours when you can get treatment for him or her hours sooner by sending them to the most appropriate facility versus the closest facility?

Maybe your department is only the first responding agency and you have a dedicated ambulance company who will be transporting the patient. What part, other than patient removal, does the fire department play in the treatment of that patient?

Has it ever been discussed about what information the hospital needs that we may not have thought to pass on to the transporting ambulance?

How many ppm was found in the residence? When was the last time someone saw the patient awake or alert?
How long has it been since the first symptoms started?

Take a second and ask your local medical facilities what information they want want to know. The more information they get the quicker they can make treatment and transfer decisions.

Last thought food for thought, has your department considered placing CO monitors on your medical bags? Since more than half of our calls for service are EMS related, the medical bag is usually always in the residence with us. Having a single gas CO meter attached to our medical bags is a great way of detecting a dangerous atmosphere when we may not have been called for that problem.

I hope that you are now thinking about what you may not be doing, or could improve upon, when you respond to the mundane CO emergency call. Remember to always keep pushing forward, because there is always something new we can learn even with the “routine” calls. It doesn’t hurt to ask why or why not.

Stay tuned to HAZMATNATION for part 2 and beyond!

Author: Nicholas Wadler

Nicholas Wadler, is from Rock Island Illinois. He is a Firefighter/Paramedic with the Rock Island Arsenal Fire Department.

Nicholas Wadler

The department is part of the MABAS Hazardous Materials Team for the region. In addition to mutual aid responsibilities the primary response district is comprised of heavy manufacturing and general use offices. Rock Island is located on an island in the middle of the Mississippi River.

Nicholas has been in the fire service since 2001, when I started in Upstate New York. He became an EMT in 2003 and an ALS provider in 2008. He began my career as a paid firefighter in 2008 at the Newport News Fire Department located in Virginia. Almost five years later He made the transition to the Federal Fire Service, which is where his interest in Hazardous Materials developed. “I am passionate about all aspects of hazmat but especially the integration of paramedicine and the hazmat response”.

Nicholas is married with two children. “I wouldn’t be able to maintain my work schedule and home responsibilities if it wasn’t for my wife.”

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