The officer of Engine 6 requested Haz-Mat 1 to respond to assist in checking the building and to ensure the meter was reading correctly. Upon arrival HM-1 was briefed on the situation, and additional meters were deployed to confirm Engine 6’s findings. It was quickly learned that the building had no gas service, natural gas or propane. This quickly narrowed the sources of the CO. The apartment was on the second floor so the likelihood of car exhaust was minimal especially with the proximity of the closest parking spots.
The family was questioned more in depth as to the occupation of the patient. They advised that he made jewelry and other craft items. With this additional information it was suspected his work place could be the source of the CO. We asked if they were familiar with his place of work, and they looked to the parking lot as they answered. They pointed to a conversion van sitting in the parking lot. They stated he made the jewelry in his van at craft shows and flea markets.
The family quickly handed the responders the keys to the vehicle so that it could be checked. Nothing in the vehicle seemed to be the source, so the vehicle was started. A meter was set on the dash and the door was shut on the van. Within seconds we started getting CO readings and after a minute we were over 100ppm of CO. The family was advised that the van was the source of the CO and that it should be taken to a repair facility as soon as possible. They would deliver the findings to the family member in the hospital.
Facts about CO
Calls involving carbon monoxide (CO) are a very common call, especially in the winter months. The Center for Disease Control (CDC) reported that from 2001-2003 nearly 15,000 people were seen in Emergency Rooms each of the three years, and approximately 500 of those died from CO poisoning, not related to fires. Those most at risk are young children and the elderly according to the Occupational Safety and Heath Administration (OSHA). Non-Hispanic men greater than 65 years of age are among the highest demographic.
Carbon monoxide is a colorless, odorless and tasteless gas that is a common product found in the combustion process. It is lighter than air, but only slightly which leads to its ability to move throughout a structure easily. Common sources of CO are poorly vented heaters, improperly adjusted gas appliances, running gas powered machinery indoors, automobile exhaust and wood stoves.
The CDC reported in 2009 that the number of non-fire related CO deaths were on the rise. They attributed this to the economy and the drastic rise in the number of utility customers that were suffering shut-offs of service for lack of payment. The correlation with the number of shut-offs reported by the National Energy Assistance Directors Association helps justify this.
People will ultimately find an alternative energy source to keep warm. This may be a generator to power heating sources, or perhaps charcoal barbeques in the residence. Both give off alarming parts per million of CO. Responders should keep this in mind when visiting homes during cold weather.
Symptoms of CO Poisoning
Signs of an exposure to CO are not much different than flu-like symptoms making it often go undiagnosed especially in the winter when it is more prevalent. Common symptoms of a CO exposure are headache, nausea, fatigue, dizziness and confusion. When dealing with a suspected CO poisoning make sure to question the residents in depth. If symptoms are severe do not delay transport to the hospital.
Common things to ask in addition to their symptoms are when do they feel bad? If they feel bad in the evenings after returning from work, but they feel better at work, this is a good indicator the problem is in the home. Find out what appliances use gas as an energy source. Just because you do not smell gas does not mean CO is not present, and conversely if you smell gas there is a good chance CO is not present. I often run into people that think natural gas and CO are present together. Remember CO is the result of the combustion of the fuel, so if the leak is prior to the burner no CO will be present as a result of the leak.
The red blood cell has an affinity for carbon monoxide nearly 250 times more than oxygen. This makes it difficult for the blood to transport oxygen throughout the body. Even after removing a patient to fresh air the CO will remain in the blood stream for many hours. Without any treatment CO has a half life of five hours, but by simply administering oxygen through a non-rebreather this is cut down to 80 minutes, and hyperbaric treatment will reduce the half life to less than 25 minutes.
A quick way to help determine CO poisoning is by the use of a pulse CO-oximeter. A carboxyhemoglobin level above five percent in a non-smoker and up nine percent for a smoker can be considered acceptable, but serious toxicity will occur around 25 percent. This technology along with conventional atmospheric monitoring will help point the responder in the right direction.
One thing to remember is that even though the carboxyhemoglobin level is within the acceptable range does mean the patient was not poisoned. If the exposure took place hours before being monitored the levels will indicate the patient is OK, while they are still suffering from the effects of the previous exposure.
How to Detect CO
When entering a structure always ensure proper PPE including SCBA are worn until levels can determined. Determine what the levels are in the structure before looking at any one appliance or source. Do not run through the structure too fast with the meters. Check with the manufacturer of your particular meter to determine the reaction time of the meter. The reaction time can take as long as two minutes for a single reading. I have witnessed firefighters walk through an entire structure in less than two minutes and report no readings, only to return to a room and register a significant reading of CO.
Because CO is slightly lighter than air it will move freely in an enclosed structure. If a lot of people have been walking around inside prior to the meter arriving on scene, then the CO will be moved around. Knowing this, it is important to monitor at the floor, waist high and at the ceiling level. Check in areas like bathrooms and walk-in closets as they are often left undisturbed. In the corners of a room at ceiling level are good places as well.
Once the structure has been checked, then begin to check gas appliances. Just because an appliance is new do not rule it out. More than often installers will not properly complete the job, or it could be completed by a non-certified installer. Be sure to ask detailed questions; such as when was the unit last serviced, or was it installed by a certified installer.
Ask the occupant(s) how long they have felt bad or suspected CO. If they have a CO detector this is most likely the source for your being called. First check the detector and confirm it is a carbon monoxide detector. I have been handed a smoke detector on more than one occasion while being told by the homeowner/renter it was a CO detector. Next ask what type of sounds it was making. This can often be a comical point in the call while the home owner imitates the detector. Read the back of the detector, because the homeowner normally does not. The result is typically a bad battery. For this reason I suggest keeping a spare nine volt on the rig.
Home CO detectors will typically activate around 30 ppm and can go up through several hundred ppm. They can often detect at lower levels around 10 ppm, but will not alarm until higher levels are reached to avoid false alarms. If installing a CO detector for a resident or at the residence responding to a call, check on the location of the home CO detector. The meter should be mounted close to bedrooms since this is typically where homeowners spend the most time in any one place. Make sure it is at 15 feet away from any gas appliance as the CO level may be higher around that area; this will avoid false alarms in the future.
Many Departments set their action level for residential CO readings at nine ppm based on the Environmental Protection Agency (EPA) recommendations for home air quality. This takes into account the young children and elderly population. Many of the other standards look at the average adult or average worker.
Ensure the occupant has read the manual as the CO detectors are more technical than an ordinary smoke detector. If they no longer have the booklet it can most likely be found on the internet. The detectors work on a weighted average so activation of the detector can be difficult to explain to the occupant.
Carbon monoxide calls are a frequent call for fire departments and Haz-Mat units, especially in the colder months. It is important that all personnel are aware of the dangers that can be present when dealing with CO. These calls are not always easily handled and require a little bit of detective work to truly provide customer service. Do not confuse the action levels of the CO detected in a residence and the CO after a structure fire.
Jason Krusen the Special Operations Chief for the Columbia Fire Department in Columbia, SC, with over 18 years of experience. He serves as the President on the Board of Directors for the Fire Smoke Coalition. He has an Associate’s Degree in Fire Service Administration. Krusen is a Planning Manager with State Urban Search and Rescue Team, SC-TF1, Team Coordinator for the Type II Collapse Search & Rescue Regional Response in Columbia, and a Planning Section Chief for the Type III Midlands Region IMT. He is also the Project Manager and Instructor for E-Med Training Services, LLC.