Digital Supplement, Special Topics

September 2010 Supplement, The Silent Killer

This supplement to JEMS, sponsored by Masimo Corporation and ZOLL Medical Corporation, discusses carbon monoxide (CO) poisoning and outlines how CO-oximetry can improve your assessment and treatment of potential CO poisoning patients through proper screening and triage.

‘Sensing’ the Effects of CO Exposure

Not long ago, the only definitive way for us to know if patients (or potential patients) had carbon monoxide (CO) poisoning was to take them to an emergency department (ED), where blood could be drawn and analyzed, a process that not only delayed diagnosis but also patient care.

Sneak Attack

Carbon monoxide (CO) leads poisoning deaths worldwide and masquerades as a variety of medical maladies resulting in frequent misdiagnoses.(1) Whether on scene of a general illness call, providing rehab to firefighters at a major fire or responding to a CO detector alarm, EMS providers need more than a list of signs and symptoms to reliably evaluate, treat and safely transport patients affected by carbon monoxide.

Where There’s Smoke

This past year, there were 90 on-duty firefighter deaths in the U.S., fewer than the 114 on-duty deaths that occurred in 2008.(1) Regardless, even one firefighter death is one too many. Although the total number of firefighter deaths has been steadily declining over the past decade, the number of firefighter deaths per 100,000 fire incidents has remained relatively unchanged.

Safety For All

One theme is consistent among the members of the International Association of Fire Chiefs (IAFC ). The safety of all firefighters and emergency response personnel is imperative. Chief fire officers, whether it’s in the fire station, responding to the scene or on the scene, are responsible for the safety, health and well-being of their firefighters and other emergency response personnel.

In 2009, 90 firefighters lost their lives in the line-of-duty. This was the lowest number of firefighters killed in the line-of-duty since 1993, when it was 81.

CO Close Calls

Until just a few years ago, patients who complained of vague, flu-like symptoms typical of carbon monoxide (CO) poisoning may not have been transported to a hospital. Instead, well-meaning EMTs and paramedics may have had these patients sign a release after advising them to contact their primary physician if they continued to feel ill. Without knowing that their home or hotel room was filled with toxic gas, some patients were later found dead due to lethal levels of CO.

E Series Monitors with Integrated CO Measurement

This past December, ZOLL Medical Corporation announced the introduction of an integrated, non-invasive carbon monoxide (CO) assessment tool using Masimo Rainbow SET technology in the E Series monitor. The feature provides early detection and significantly reduces the immediate and long-term health risks associated with elevated CO levels.

A Standard of Care

After successfully rescuing two trapped Fire Department of New York (FDNY) firefighters, an officer complained of lightheadedness and mild shortness of breath. Initial assessment revealed him to be normotensive, slightly tachycardic and tachypneic with a pulse oximetery reading of 100%. Paramedics using a CO-oximeter device determined his carboxyhemoblobin (COHb) level was 22%—a dangerously high level; subsequently, he received ALS care and was transported to a hospital facility.

The New Vital Sign Parameter

A 58-year-old man experiencing “chest pain and shortness of breath” calls EMS. By the time EMS arrives, the man is unresponsive with extremely labored breathing. The patient goes into cardiac arrest en route to the hospital and is ultimately pronounced dead in the emergency department (ED).

Daily Poison

Carbon monoxide (CO) is the leading cause of poisoning deaths in industrialized countries. When studied, most accidental CO poisonings were found to be due to house fires, automobile exhaust fumes, indoor heating systems, gasoline-powered portable electric generators, stoves and other appliances, charcoal grills, camp stoves, water heaters, and boat exhaust fumes.

Firefighter Risk

Firefighters take risks every day. Risks are inherent to the job. They’re necessary. Although today’s firefighters are protected by an array of modern, high-tech equipment and life-saving tools, the rate of “line of duty” firefighter deaths is alarming. The number one killer of firefighters is not fire … or building collapse … or explosions. It’s heart attack. And, evidence is mounting that a great contributor to firefighter strokes, heart attacks and heart disease comes from both acute and long-term exposure to carbon monoxide (CO).

Shake the Money Tree

So now that you’ve read all about the benefits of CO monitoring in patient management and firefighter rehab, you might be asking yourself, “How can I afford the equipment I need to establish an effective CO-monitoring program?”