An Insidious Hazard
Editor's note: In May JEMS, the article "Noninvasive CO Measurement," by James J. Augustine, MD, challenged readers to visit jems.com to review a CO case they could be dispatched to manage. JEMS Editor-in-Chief A.J. Heightman presents the following scenario, which at first glance appears safe. Carbon monoxide poisoning could be a factor in your next call. Are you ready?
We live in an industrial and technologically advanced society. In many households, each person owns a vehicle. Frequently, both parents work and take their children (and often their children's friends) to extracurricular activities. Garages are also full of lawn mowers, pressure washers, space heaters, weed trimmers and other gasoline-powered products.
With the increased use of vehicles and machines that produce combustion by-products comes the opportunity for odorless and tasteless carbon monoxide (CO) fumes to overcome unsuspecting victims. Thus, the benefit of CO monitoring and co-oximetry in the field is becoming increasingly emphasized.
Two examples of how individuals can be easily overcome by fumes recently became apparent to me. While visiting relatives after delivering a training program to several EMS and fire agencies on the East Coast, I watched as my nephew filled a football with air from a hose located in a vehicle trunk, piggybacked off the vehicle's air shock compressor. The vehicle was in the garage with the motor running and the garage door open (see Photo 1).
However, while the football was being inflated, I could smell exhaust fumes that remained trapped inside due to poor cross-ventilation in the garage (see Photo 2).
Nearby, a child was sleeping in his stroller after a hectic day of entertaining his visiting relatives (see Photo 3). Or was he? Was he be dozing off due to the effects of inhaling CO produced by the vehicle running so close? How would we know?
Realizing that CO fumes were filling the poorly ventilated garage, I decided to assess the CO level of all occupants of the garage and inside the home with a Rad-57 CO-oximeter I had with me for use during my training assignment. I wasn't surprised that the levels on the people exposed in the garage were in the 7 9% range (see Photo 4).
But I was surprised when I assessed the people sitting around the kitchen table just inside, and found that in just five short minutes, enough carbon monoxide had seeped into the kitchen via the garage-to-home entry door to cause each of the occupants to register CO levels in the 4 6% range (see Photos 5 and 6).
After ventilating the home and having the occupants breathe a few minutes of fresh air, each of their CO levels registered at just 1% (see Photo 7).
This case indicates that in just five minutes, an entire family can be affected by carbon monoxide. It also shows what an important tool CO monitoring can be in the prehospital arena.