Tis the Season

CO poisoning presents a silent threat to victim & rescuer alike

Many parts of the country remain unseasonably cold, and that can make for dangerous conditions for both the public and rescue personnel. Combine cold temperatures with a bad economy in which people are living on the edge, and you have a recipe for disaster.  

Each year more than 500 deaths and 15,000 hospitalizations are attributed to the effects of carbon monoxide (CO) poisoning in the United States.

Although some of these deaths and exposures are vehicle related, most are household emergencies. And although many of those household exposures are a result of older and malfunctioning heating devices, some are caused by improper ventilation of portable heating devices, generators—even barbeques brought indoors when the power has been shut-off to the home. Bottom line: There are many causes of CO poisoning.

CO poisoning is often called the invisible killer for good reason: It’s a colorless, odorless and tasteless. Early exposure symptoms manifest themselves in headache, dizziness, weakness, nausea, vomiting, confusion and disorientation.

Severe exposure can result in what is known as a “winter heart attack”—dysrhythamia, hypotension, syncope and, in prolonged and severe cases, death.

A Local Case
A standard medical incident response may not be so standard inside a home where the silent and invisible killer is lurking. One of our engine companies recently responded to a report of a sick child. En route, an updated report identified that five children were sick inside the home. On arrival, the engine company captain identified eight victims, three adults and five children, with three of the children unconscious and the other victims complaining of headache, dizziness and vomiting.

After calling for a full first-alarm assignment and expanding the event into a multi-casualty incident, another crew entering the home using a portable gas monitor that indicated CO at 1,200 ppm at the doorway. They immediately donned SCBA and found a 4000-watt portable generator that had been placed in the basement of the home.

The home owner stated he had started to use the generator after the power had been turned off by the utility company because he had not paid his bill in almost a year. The decision to use a portable generator was an act of desperation to keep the lights on in a 1,400-square-foot home that was occupied by as many as 17 people.

All eight occupants recovered with no long-term negative side effects.

The story received significant media attention not only because of its potential implications but also because it occurred days after three girls had been found dead in their vehicle due to carbon monoxide poisoning in Lake Tahoe.

We received many inquiries by concerned citizens who wanted to help the families living in the home. Some even wanted to pay the utility bill, but the home was already in foreclosure—an unfortunate sign of the times.

Fire inspectors and the county building official determined the home couldn’t be reoccupied because of code violations—wiring and construction modifications—a common problem in overcrowded and illegally modified structures.

Safety Considerations
Fire and Rescue personnel must be careful that they themselves do not become victims. This means treating EMS calls that may seem initially like simple heart attack or nausea cases with extra caution.

The IDLH threshold for the use of SCBA in atmospheres with saturations of CO is 1,200 ppm, but could be lower based upon individual agencies’ policies.

In a recent event in California, a three-person engine company responded to an EMS call inside a home where the occupant was found in cardiac arrest in the bathroom. After moving the victim to the living room, and just 6 minutes after their arrival, one of the firefighters started to lose consciousness and the two others began to experience the signs of acute CO poisoning.

Neither the crew nor the dispatcher had been advised by family members that they had removed a running generator from inside the home prior to their arrival. The family members had responded to the home after the occupant failed to answer her phone. After finding her unresponsive in the bathroom, they called 911.

Levels inside the home were reported to be between 13,000 and 15,000 ppm. The firefighters were treated and fully recovered. Unfortunately the occupant did not recover.

Conclusion
Firefighters and rescue personnel are finding themselves with a front-row seat to a bad economy. As people become more desperate, they may make poor decisions that will present us with unusual challenges and threats to our own safety if we don’t handle them properly.

Harold Schapelhouman is a 28-year veteran firefighter with the Menlo Park (Calif.) Fire Protection District. At the start of 2007, he became the first internally selected fire chief in 21 years for his organization. Previously, he was the division chief in charge of special operations, which includes all district specialized preparedness efforts, the local and state water rescue program, and the local, state and national Urban Search and Rescue Program (USAR).

Schapelhouman was the task force leader in charge of California Task Force 3, one of the eight California USAR teams and one of the 28 federal Department of Homeland Security (DHS/FEMA) teams.