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CO and the EMS providers

Is your EMS agency prepared to handle a CO event   1 member has voted

  1. 1. Do you feel safe with what you have to use at a CO event as an EMS provider

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    • I don't have to worry I am a Fire based EMS agency
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22 posts in this topic

With all these CO calls happening in our area, Are we really shocked at how many patients are coming out of these incidents. In this month only at lest 10-15 people (Some EMS providers themselfs) have fell victim to the "Slient Killer"

As a Volunteer EMS/ and a career EMS Professional, I see the wide differance in care, and protection aganst CO. That is wrong.. <_< There should be no differance at all when it comes to personal safe. In the Volunteer side, I have been provided a CO meter attached to one of our first in bags. As a Career provider I have not. As a Volunteer, I have been provided a Rad-57 Pulse CO-Oximetry™ to help in the aid of treating CO patients, wether from a CO alarm, or a working fire. As a career provider I can only relie on my common sense ( which everyone should have no matter what ) and clincal knowlege of sign and symptoms, and even with all that sometimes that may fails. Case and point...

and this is in no way shape or form a personal attack agaist any agency or person B)

OVAC CO incident

This is a prime example of how you can have the best EMS crew in the world, and go for something totally one thing, and get a curve ball and get something else.

and more recently

Sleepy Hollow CO w/ MCI

Did this crew have a CO meter on them, did it go off?

How many EMS agencies here teach there members about CO emergencies?

How many Hyperbaric chambers are there in the hudson valley region?

Is it exceptable for an EMS agencies from Northern Westchester to tranport a patient to an appropriate medical facility for CO exposure wether it be Jacobi, Monti, Mount Vernon, or the otherway around for Southern Westchester EMS agencies?

Here are some fun facts for everyone regarding CO Part per million..

0-9 ppm (parts per million) CO: no health risk; normal CO levels in air.

10-29 ppm CO: problems over long-term exposure; chronic CO problems such as headaches, nausea- not the most dangerous level

30-35 ppm CO: flu-like symptoms begin to develop, especially among the young and the elderly

36-99 ppm CO: flu-like symptoms among all; nausea, headaches, fatigue or drowsiness, vomiting; most CO detectors sound off here

100 ppm + CO: severe symptoms; confusion, intense headaches; ultimately brain damage, coma, and/or death, especially at 300 to 400 ppm+

So what it comes down to is.. Do you feel prepared for a CO emergencey in your area, If not how can you change that is the better question?

As REMEMBER585 always says...... TRAIN LIKE YOUR LIFE DEPENDED ON IT.. CAUSE IT DOES... :D;)

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Here are some fun facts for everyone regarding CO Part per million..

0-9 ppm (parts per million) CO: no health risk; normal CO levels in air.

10-29 ppm CO: problems over long-term exposure; chronic CO problems such as headaches, nausea- not the most dangerous level

30-35 ppm CO: flu-like symptoms begin to develop, especially among the young and the elderly

36-99 ppm CO: flu-like symptoms among all; nausea, headaches, fatigue or drowsiness, vomiting; most CO detectors sound off here

100 ppm + CO: severe symptoms; confusion, intense headaches; ultimately brain damage, coma, and/or death, especially at 300 to 400 ppm+

So what it comes down to is.. Do you feel prepared for a CO emergencey in your area, If not how can you change that is the better question?

As REMEMBER585 always says...... TRAIN LIKE YOUR LIFE DEPENDED ON IT.. CAUSE IT DOES... :D;)

Remember these are all time vs. exposure based. In actuality, OSHA sets the permissible exposure limit at 50 PPM over an 8 hour day, NIOSH reduces that to 35 PPM with a 200 PPM ceiling value. The Industrial Hygienists call fro a 25 PPM TLV over an 8hr day for 40 hrs a week. So as you can see a limited exposure to a low concentration may not manifest into any signs or symptoms or issues. Of course the age and size of the human must also be considered.

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In order to help keep our EMS responders safe, we have CO detectors that stay on at all times that are clipped to our 1st in bags. A very worthwhile expense that I feel all services should have. God forbid you're in someones residence treating a patient and there is high levels of CO. We also have to CO monitoring cable on our LP 15's. More expensive but it is 2010!

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We also have to CO monitoring cable on our LP 15's. More expensive but it is 2010!

Are you sure this is CO monitoring and not End Tidal CO2 monitoring? hadn't seen CO monitor, but quite likely as Massimo makes the Pulse Ox stuff for the LP 15, so no stretch to imagine adding their CO oximetry to it I guess.

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EMSbuff, thanks for the post and the stats. However, I have to add that the theoretical numbers often OVERESTIMATE the limits at which people actually become symptomatic and at risk for serious injury and/or death.

The Sleepy Hollow incident involved 3 people brought to the Phelps ER, of vastly different ages and sizes. The woman, otherwise healthy and very young, had a temp of 102 and a CO level of 30. She was seizing, vomiting and non-responsive.

Her child, 5 years old and also otherwise healthy, was also unresponsive, also febrile at 103.6, vomiting and also post-ictal but without a previous seizure hx. Dad told me she was probably seizing like the Mom has done in the past- like mimicking her somehow. I almost could have bought that, but kids can't mimick fever too. The child's lips and orbits around her eyes were cherry red. The child's CO level was only around 13.

The man who carried both in turned out to be Dad. He only complained of a bad headache but his eyes were bloodshot and he looked like he was wearing red lipstick. His CO level was 32.

After 100% O2 all around those CO levels drastically and immediately dropped. Turns out the FD found CO levels in the multi-dwelling house of over 30. If the other 3 kids and 2 adults had not been removed from the building, they'd all have died. No question.

After the child brought to Phelps got the oxygen, her temp dropped to 99.2 and she woke up. Mom also woke up and wanted out of the hospital ASAP. Dad was awake the whole time but stopped complaining of a headache. All were transferred to Jacobi and all will (thank GOD) live to tell the tale and hopefully never BBQ in the house again.

My points:

1. Don't go only by the CO level. ANYTHING OVER 5 IS POTENTIALLY LETHAL, regardless of the age of the victim.

2. If you ever find 2 victims suffering ANY of the same symptoms, regardless of age, get the FLIP out of the environment, call the FD and let them check out the environment from which the victims came.

3. If you, as an EMS provider, EVER show up and find someone down for any reason, and YOU suddenly find your head and/or eyes hurting, GET THE FLIP OUT of the environment and call the FD! Even if it is not CO, the FD will still thank you for playing it safe. And you might save your own life and those still in the house if it DOES turn out to be CO.

Please read this twice, at least. Being handed an unresponsive kid was traumatic enough and will stay with me a long time. But saving her was the best Christmas gift I'll get this year, bar none. We in this business know we rarely get such a good alignment of the planets and actually end up high-fiving each other over a save. Know what you're getting into early, know when to ring the bell and back the flip out. Then call in the calvary so you can get home safely to your peeps so you can tell them the tale as you pat yourself on the back for seeing it BEFORE you became a victim of it.

Be safe.

Tapout B)

Medic137 likes this

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However, I have to add that the theoretical numbers often OVERESTIMATE the limits at which people actually become symptomatic and at risk for serious injury and/or death.

The woman, otherwise healthy and very young, had a temp of 102 and a CO level of 30.

The child's CO level was only around 13.

His CO level was 32.

My points:

1. Don't go only by the CO level. ANYTHING OVER 5 IS POTENTIALLY LETHAL, regardless of the age of the victim.

Tapout, Great post.

A minor clarification needs to be added. Most of the numbers everyone else is listing is PPM of CO in air. Yours if I'm not mistaken are the carboxyhemaglobin values (CO in blood).

5 ppm in air is considered normal backround levels (up to 9ppm is considered normal by EPA) and I've find 5ppm to be common in kitchens from normal cooking, small rooms with 2 heavy smokers and even just well insulated homes.

antiquefirelt likes this

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You are right, B. But actually the FD readings and the carboxy numbers correlate closely enough to each other. So 5 in air or blood are both limits. These pt readings were the same from pulse ox CO sensor and by mixed venous blood. Thanks.

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You are right, B. But actually the FD readings and the carboxy numbers correlate closely enough to each other. So 5 in air or blood are both limits. These pt readings were the same from pulse ox CO sensor and by mixed venous blood. Thanks.

I think you'd better study up on the CO in air part. Look at the OSHA/NIOSH permissible exposure limits. These are time weighted averages. A short term exposure to 35 ppm is nothing, in fact many home CO monitors/detector won' t alarm until 50 ppm. It certainly in no way is a one for one ppm in air to blood saturation reading. If it is, it merely a coincidence.

As BNECHIS stated 5 ppm in air is pretty common in most smokers homes, in basements with fuel burning appliances, or in many industrial settings. I think you're confusing the RAD-57 reading with the blood gas results which most often should be very close, but neither measure the CO in air, which are the numbers BNECHIS was trying to clear up. Your post was right on the money given the CO in blood readings, they just cannot be confused with CO in air, which does not directly correlate.

It is possible the FD readings you're noting are RAD-57 CO oximetry readings, not the PPM in air?

Edited by antiquefirelt

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LP15 does come with a pulse ox/CO monitoring option. And the Rad 57 technology is not that accurate. You cannot rely on the Rad57 to rule out CO exposure patients, only to confirm your suspicion of CO poisoning.

As usual, treat the patient and not the device. If they've been inside a CO filled room for a while, they go to the ER. If they've taken enough smoke to cause them distress, they go to the ER. If they have any symptoms, no matter what the Rad57 reading, they go to the ER.

Here's the full article

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Are you sure this is CO monitoring and not End Tidal CO2 monitoring? hadn't seen CO monitor, but quite likely as Massimo makes the Pulse Ox stuff for the LP 15, so no stretch to imagine adding their CO oximetry to it I guess.

FD828 is correct, the 15 has CO monitoring. I think you're thinking of capnography. I think someone mentioned earlier, but there are CO monitors that can simply clip on a finger and give you a CO reading on an incorporated LCD display - i just think they are pretty expensive though.

Edited by Goose

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LP15 does come with a pulse ox/CO monitoring option. And the Rad 57 technology is not that accurate. You cannot rely on the Rad57 to rule out CO exposure patients, only to confirm your suspicion of CO poisoning.

As usual, treat the patient and not the device. If they've been inside a CO filled room for a while, they go to the ER. If they've taken enough smoke to cause them distress, they go to the ER. If they have any symptoms, no matter what the Rad57 reading, they go to the ER.

Here's the full article

Thanks, I looked the Life Pak page with the options for CO monitoring. So can the LP15 CO reading be trusted any more than the RAD-57? Same technology, same maker? Our success with the RAD57 has been in two cases using it to convince people who were exposed to high CO levels to get checked out. In both cases the victims wanted to refuse treatment/transport as they were "fine". In both cases we were able to convince them using a device that told them they had abnormal levels of CO in their blood. Not every just "goes" to the ER when they feel fine, especially those worried about how they'll pay for it.

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True, though the mom and kid were both unconscious and brought in. No one spoke a word of English. No one had insurance. Probably wasn't even a legal apartment. All IRRELEVANT. I am still so happy all picked up on what we were dealing with early and acted appropriately and aggressively. Because of it, they'll live to tell the tale.

We have 3 fancy, expensive Massimo pulse ox AND CO monitors. Not end tidal CO2. Actual CO. Bring us anyone seizing and febrile. Chances are it is CO poisoning. Hopefully it will be during the day so we can also use our big azzz hyperbaric chamber and fix them on the spot.

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FD828 is correct, the 15 has CO monitoring. I think you're thinking of capnography. I think someone mentioned earlier, but there are CO monitors that can simply clip on a finger and give you a CO reading on an incorporated LCD display - i just think they are pretty expensive though.

Is the CO monitoring based upon an oximetry sensor or ambient air? I'm guessing the former because the latter isn't really a use for the LifePak 15.

I think we're talking about apples (ambient air monitors that can alert responders) and oranges (patient specific diagnostic tools), right?

:blink:

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Is the CO monitoring based upon an oximetry sensor or ambient air? I'm guessing the former because the latter isn't really a use for the LifePak 15.

I think we're talking about apples (ambient air monitors that can alert responders) and oranges (patient specific diagnostic tools), right?

:blink:

Right, the 15 is an oximetry sensor. I think FD828 mentioned it as one tool, in addition to ambient air warning devices, to deal with CO emergencies....having the CO oximetry capability be it via a LP15 or a finger probe is crucial not only for treating patients but treating ourselves and fellow responders (ie: rehab/monitoring of firefighters).

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Are you sure this is CO monitoring and not End Tidal CO2 monitoring? hadn't seen CO monitor, but quite likely as Massimo makes the Pulse Ox stuff for the LP 15, so no stretch to imagine adding their CO oximetry to it I guess.

Absolutely positive. It is a seperate cable exactly like the pulse ox cable, even plugs in the same port on the LP 15. Measures Carbon Monoxide.

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Absolutely positive. It is a seperate cable exactly like the pulse ox cable, even plugs in the same port on the LP 15. Measures Carbon Monoxide.

As I noted a few posts back I found the option on Life Pak's website, thanks for the education. :) That being said, my original post was commenting on the difference in the numbers: the concentration of CO in ambient air vs. the carboxyhemoglobin measurement. One of the first posts gave some good info on the blood gas number, but could easily have been mistaken as very inaccurate numbers for PPM in air.

Edited by antiquefirelt

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Are there any fire or EMS units that have CO meters as part of the crash bags????

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Are there any fire or EMS units that have CO meters as part of the crash bags????

Yes for the last 6 years or so. They have saved a number of lives (members and the public).

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Yes for the last 6 years or so. They have saved a number of lives (members and the public).

CO meters Have been around for a number of years. Why isn't It a requirement for emergency responders? Which departments out there have them?

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CO meters Have been around for a number of years. Why isn't It a requirement for emergency responders? Which departments out there have them?

Under OSHA's the general duty clause it is:

SEC. 5. Duties

(a) Each employer --

(1) shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees;

(2) shall comply with occupational safety and health standards promulgated under this Act.

( 3) Each employee shall comply with occupational safety and health standards and all rules, regulations, and orders issued pursuant to this Act which are applicable to his own actions and conduct.

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Under OSHA's the general duty clause it is:

SEC. 5. Duties

(a) Each employer --

(1) shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees;

(2) shall comply with occupational safety and health standards promulgated under this Act.

(B) Each employee shall comply with occupational safety and health standards and all rules, regulations, and orders issued pursuant to this Act which are applicable to his own actions and conduct.

So having a CO meter should be required?

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So having a CO meter should be required?

If there is a potential to come in contact with CO as part of your response yes. And since CO poisoning is the #1 type of poisoning its very likely that you can come in contact with it.

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