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Eliminating Unrecognized CO Poisoning


View a video interview with David Aber below this article.

For most trade show conference-goers, a trip through the exhibit hall is a must-do, a highlight if you will. They collect brochures and marketing materials, talk with colleagues, and, of course, try out all the new, sometimes cutting-edge, tech tools. Sometimes that walk leads to exciting changes.

Two years ago, David Aber, NREMT-P, volunteer EMS supervisor for the Odessa (Del.) Fire Company and a full-time paramedic with New Castle County, was attending EMS Today in Baltimore when he came across a booth sponsored by Masimo Corp. What caught Aber’s eye was Masimo’s Rad-57 Pulse CO-Oximeter. The small, handheld device measures noninvasive carboxyhemoglobin (SpCO), methemo­globin (SpMet), SpO2, pulse rate and perfusion index. In short, it was a portable, high-tech patient monitor for carbon monoxide, and Aber recognized the lifesaving opportunities the small device might offer.

He stopped to talk to the Masimo representative about the device, and the state of Delaware has never been the same.

“This tool gives you the ability to read the level of carbon monoxide exposure simply by placing the probe on the finger of a patient or firefighter,” Aber says. Carbon monoxide mimics symptoms of the flu. And although carbon monoxide poisonings happen year-round, EMS responders find more CO poisoning in the fall and winter months, when people are more readily using their home heaters and furnaces. “The monitor benefits not only firefighters, but also benefits any patient that has been exposed to carbon monoxide,” says Aber.

The Birth of a Vision
The longer Aber stood in front of the Masimo booth and looked at the device, the more an idea began to percolate. A big geographic idea. These devices save lives—the lives of patients and the lives of first responders. And Aber wanted every firefighting district in the state of Delaware to have at least one of the $4,000 devices. Given that the numbers added up to around 100 agencies to be supplied statewide, including the University of Delaware and the Air National Guard, the project seemed daunting, and nearly impossible. It was just the kind of challenge Aber was looking for.

The more he thought about it, the more convinced he became that the New Castle County project could be funded by a grant through the Assistance to Firefighters Grant (AFG) and the Federal Emergency Management Agency (FEMA). But he began thinking on a bigger scale. “We decided to go for a regional grant that would cover all of Delaware,” Aber says.

He thought he had a good chance of getting the grant funding, and the devices purchased and installed throughout Delaware, because carbon monoxide monitors had been added to EMS protocols in 2008 as an optional piece of equipment. “One of the guidelines calls for medical monitoring, including carbon monoxide levels,” Aber says. It’s just the kind of thing FEMA likes to help agencies achieve, and Aber thought it was a reachable goal.

So he began the process of researching data and filling out and submitting paperwork for the $420,000 grant in May 2009, a process that took several months to complete. He gathered information and statistics from as far back as 2007, which proved difficult, but not insurmountable. “It was a project that, initially, did not seem that big of an undertaking,” says the 18-year EMS veteran. “We sub­mitted it through the Odessa Fire Company as a regional grant for the whole state. With the simplicity of the device, and the benefit, it could save firefighter and patient lives. So I gave it a shot.”

He heard back from FEMA in May 2010. It took 14 rounds of consideration before the money was awarded for the project. The award also came with a condition. Every department receiving the device had to pony up $700 of their own money for every device received. FEMA would foot the rest of the cost. All the participating Delaware agencies did just that.

The RAD-57s were ordered in June 2010 and delivered shortly after. But they came without labels and in several pieces. So Aber and members of the Odessa Fire Company assembled the devices. He also arranged for all participating agencies to undergo training, conducted by Masimo, in the maintenance and use of the devices.

Masimo flew two clinical specialists to Delaware, and more than 100 EMTs underwent the RAD-57 training, which was set up in a “Train the Trainer” format. Delaware Attorney General Beau Biden and Thomas Carper, U.S. senator for Delaware, attended the event.

“The goal was to have the EMTs take this training and then take the information back to their departments and do their own in-house training,” Aber says.

The Program Goes Statewide
Through the awarding of the grant, Delaware is now the first state in the nation to have a 100% ability to monitor carbon monoxide levels in all firefighters and patients on almost every ambulance run.

“Anytime there is a working fire in the state, as long as an ambulance is dispatched, this device will be at that fire,” Aber says. “They are not on every single ambulance, but they are at every single fire. If an ambulance goes on a call for a firefighter rehabilitation, the device goes with that ambulance. A few of the fire departments put them on their fire trucks.”

Aber is passionate that these devices be used frequently because of the nature of carbon monoxide poisoning. “Carbon monoxide is odorless, colorless and tasteless, so you don’t know it’s around. And it’s deadly,” Aber emphasizes. “It’s the No. 1 cause of unintentional poisoning in the U.S., and it’s so easily missed.”

Detecting Elusive Carbon Monoxide
Aber worries that EMS personnel and patients can be transported to the hospital with symptoms that mimic the flu or other illnesses, only to have unrecognized carbon monoxide poisoning be the real culprit.

“You don’t know if it’s been missed,” he says. Aber is adamant about not letting that happen in Delaware. “While emergency rooms do a great job, the fact is they get overwhelmed at times. Some patients may be triaged to waiting rooms and left before ever being seen.”

The state of Delaware has shown great ap­preciation to Aber for all his efforts in keeping EMS personnel and patients aware of, and safe from, carbon monoxide exposure. His efforts were recognized at the Delaware EMS Association’s 2010 state conference. A state resolution was crafted and read to Aber and the Odessa Fire Company at the association’s dinner. The resolution highlighted his innovative thinking and devotion toward acquiring this special lifesaving device for all Delaware citizens.

As a testament to the program and the effectiveness of the device, a family called 9-1-1 after they fell sick in their home. This incident occurred just two weeks after the training on and dissemination of the RAD-57 devices. An EMS crew was dispatched and arrived on scene with a room carbon monoxide detector attached to an oxygen bag. The monitor picked up carbon monoxide in the house, and the EMS crew quickly evacuated the family from the premises. “The family was immediately attached to the RAD-57s and all were found to have high levels of carbon monoxide exposure,” Aber says. The family was treated and released.

Aber would like to see other states implement and deploy the same carbon monoxide monitoring protocols as Delaware. He acknowledges that the grant process can be time-consuming and somewhat arduous, but he believes that the end results justify all the time and expense it takes to get such a program up and running—especially when it comes to saving lives.

“Carbon monoxide is easily missed, and carbon monoxide monitors are versatile tools that can help firefighters throughout the state,” Aber stresses. “Firefighters are the No. 1 frontline providers for the safety of our residents, but the device would help every resident it was applied to.”

Aber’s short trip through an exhibit hall has resulted in a statewide impact for Delaware. More than $400,000 has been awarded to cover the costs of his idea, hundreds of EMTs have been trained in the use of carbon monoxide monitors, and lives have already been saved by the use of the small, handheld devices.

One wonders just what kind of idea David Aber will have the next time he walks through an exhibit hall and stops at a booth. One wonders how many people the idea will impact. It’s certainly worth considering.

Please view the interview with David Aber that took place at EMS Today.


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