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  1. #1
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    Exclamation CO incident EMS wore personal monitors

    I stopped by the store and was turned away: 6abc.com: From the Philadelphia news leader: Dozens suffer carbon monoxide poisoning 8/29/08

    EMS crew was wearing personal CO monitors, which sounded so they called the cavalry. Good lesson for us all. CO alarms not required in commercial buildings. Note how quickly it crossed over into the drugstore next door causing people there to need treatment. So far, none required hyperbaric oxygen treatment that we know of but facts still coming in. Apparently, somehow the exhaust fans in the bakery shutdown . Don't know if they are not interlocked or if a safety failed.
    I will be talking with this fire station tomorrow for details.
    Stay tuned,
    Bob

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  2. #2
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    Default Re: CO incident EMS wore personal monitors

    Bob, can you provide more information about the CO detectors the EMS/Fire crew wear?

    Might be a nice safety device for HI's to wear.

    "The Code is not a peak to reach but a foundation to build from."

  3. #3
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    Default Re: CO incident EMS wore personal monitors

    Quote Originally Posted by Bruce Ramsey View Post
    Bob, can you provide more information about the CO detectors the EMS/Fire crew wear?

    Might be a nice safety device for HI's to wear.
    Bruce
    There are a number of brands of single gas detectors that would work. Draeger, MSA, 3M all make personal single gas detectors that are light, simple to operate and tough. My FD doesn't carry these (personal monitors) because we always use SCBA on any call where we might suspect CO presence.
    From what I recall the units run from about $300 and up, depends on the number of bells and whistles.
    Alton


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    Default Re: CO incident EMS wore personal monitors

    Quote Originally Posted by Alton Darty View Post
    My FD doesn't carry these (personal monitors) because we always use SCBA on any call where we might suspect CO presence.

    That's the point of this - they *did not* suspect CO, they were simply responding to a lady in distress, everyone else was okay, they were attending to her when their CO monitors went off.

    No telling what the end result would have been if your FD responded, no SCBA and no personal CO monitors, could have turned into a mass CO poisoning fiasco with other people falling ill and requiring more FD responders.

    The entire point here is that *because* they were wearing personal CO monitors, they were alerted to the CO problem - where none was suspected.

    Jerry Peck, Construction / Litigation Consultant
    Construction Litigation Consultants, LLC ( www.ConstructionLitigationConsultants.com )
    www.AskCodeMan.com

  5. #5
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    Default Re: CO incident EMS wore personal monitors

    Quote Originally Posted by Jerry Peck View Post
    That's the point of this - they *did not* suspect CO, they were simply responding to a lady in distress, everyone else was okay, they were attending to her when their CO monitors went off.

    No telling what the end result would have been if your FD responded, no SCBA and no personal CO monitors, could have turned into a mass CO poisoning fiasco with other people falling ill and requiring more FD responders.

    The entire point here is that *because* they were wearing personal CO monitors, they were alerted to the CO problem - where none was suspected.
    I understand why you might think that this might turn into a fiasco but that would not have been the case. We have drilled on this exact scenario on many occasions. SOP with more than one victim showing symptoms of CO poisoning would dictate that this incident change from a simple "person in distress" call to something more serious. I assure you that air sampling would have begun in VERY short order. All FD crew would have changed modes, and more resources would have been on the way quickly. Also local hospitals would be notified of a possible Multiple casualty incident, law enforcement would have been dispatched and everyone from this building would have been evacuated. SOPs are in place, training and response are taken seriously and every suspected haz mat incident is dealt with at an elevated level of response. In a post 9/11 world an incident such as this would be taken very seriously from the start.
    Alton


  6. #6
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    Exclamation Re: CO incident EMS wore personal monitors

    Alton, I agree with 99% of what you're saying. However, it is all predicated upon the first responders having a some information that gives them a high "index of suspicion" which would lead them to sample the air or call in the cavalry. That is the essence of the CO problem. If you are waiting on symptoms, you are already late, already personally exposed and if the patient is passed out, you may not get any symptoms. What if you respond to a person unconscious from an unknown etilology? Sure, once in the ambulance you do a finger stick for blood glucose, start an IV and give one amp of 50% dextrose followed by Narcan to rule out hypoglycemia and narcotic OD. However, there is no national protocol to field test for COHb.

    I myself ran into such calls and had to piece together what was going on not from what I was told but what I observed. When you have an entire house zonked out (medical term) and youi smell the oven burning, its rather easy to put 2 and 2 together. But, when one person is out of it in summer when you're not using heating appliances, you normally run through your list of medical maladies: glucose, dope, stroke, hearth attack, trauma, etc. The main call for the paramedic is if there is the need for spinal precautions or not. A good medic will package them up on a spine board and C-collar just in case. You get them the heck out of there and on the way to the ER---no dilly dallying. If there is not someone there providing clues, no other patients and nothing discernable going on at the scene, you would not know to get out the CO monitors.

    That is why ALL EMS, FIRE, and Police should wear personal CO monitors. I would include any public servants who enter buildings and I would include ALL service techs whether cleaning carpets or servicing the furnace.

    There was a study done at a Rhode Island ER. They screened 100% of patients coming in regardless of chief complaint. In six months, of the 30 something found with elevated carboxyhemoglobin levels requiring treatment, 11 came in for complaints totally unrelated to CO! That means someone came in for a urinary infection or cut toe and was found to have CO poisoning.

    Alton, your station obviously trains thoroughly and often. Not all FDs do. Some are lucky to have two SCBA on board and only a few volunteers know how or when to use them. Not all stations have CO analyzers, much less that are within calibration. In this incident, one firefighter required treatment. That means that even though they were responding to a suspected CO incident, someone let a guy in without SCBA. Now, was it one of the paramedics first on the scene who raised the alarm or a later firefighter responding? I will try to find out this afternoon when I stop by their station.
    Stay tuned,

    Keep the fire in the fireplace.

  7. #7
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    Default Re: CO incident EMS wore personal monitors

    Quote Originally Posted by Bob Harper View Post
    That is why ALL EMS, FIRE, and Police should wear personal CO monitors. I would include any public servants who enter buildings and I would include ALL service techs whether cleaning carpets or servicing the furnace.
    I can go along with most using CO monitors. I have a problem with engine and ladder company personnel wearing a monitor that will go into alarm on nearly every call. A device that alarms on nearly each call would be turned off, ignored or simply not turned on. Haz mat incidents, confined space or below grade rescues are a different story, and FD personnel involved in these incidents should be sampling air at regular intervals. So I can go along with Haz Mat and Rescue companies using multi gas personal monitors. But as far as engine and ladder companies go it is much better to train FD personnel to always wear SCBA on each call where a toxic or dangerous atmosphere may be present, and to not remove them until air sampling shows that the area is clear. This is the SOP used by my department and after a short time it has become second nature. And yes the air sampling equipment always comes off the truck quickly and it gets used each time because everyone knows the drill by now.
    Engine companies usually have the roles of initial fire attack, rescue and water supply. Ladder or truck companies usually are assigned to forcible entry, rescue, ventilation, and providing ground and aerial ladders to allow access to or above the fire. These crews usually confront smoke conditions on the majority of calls and monitoring for the presence of CO is not needed because these crews know that it is present and use the proper respiratory protection.
    Sorry for the thread drifting away from inspecting and getting into emergency response, hard habit to break.
    Alton

    Last edited by Alton Darty; 08-31-2008 at 01:32 PM. Reason: bad choice of wording

  8. #8
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    Default Re: CO incident EMS wore personal monitors

    Great thread Bob!

    I was wondering how close you were to this incident beings it's in your backyard, didn't know you were that close though.

    I don't think people realize how common CO really is in the places we visit often.

    Look forward to hearing what you find out.

    Measured Performance more than just a buzzword

  9. #9
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    Default Re: CO incident EMS wore personal monitors

    Quote Originally Posted by Bob Harper View Post
    That is why ALL EMS, FIRE, and Police should wear personal CO monitors.
    Quote Originally Posted by Alton Darty View Post
    on each call where a toxic or dangerous atmosphere may be present,

    Alton,

    Which way do you want it?

    You just stated that they should wear SCBA *ON EACH AND EVERY CALL* (because each and every call "may" fall into what you stated "may be present").

    Yet, you do not want them to wear personal CO monitors be, what to heck, if it goes off all the time, they will ignore it.

    That is what friggin' *TRAINING* is for. If you have people wearing personal CO monitors and they ignore those alarms, they have failed in their training.

    We are talking about an incident which involved *ONE SINGLE PERSON* (so don't bother trying to hide your position behind "SOP with more than one victim") and which saved CO poisoning of many others simply because the responders *were wearing personal CO monitors*.

    You department *WOULD NOT HAVE KNOWN* about the CO until it was potentially too late, and trying to justify that by repeating "SOP with more than one victim" when *THERE WAS ONLY ONE SINGLE VICTIM* shows lack of training and professionalism.

    Are you saying that 'that one single victim was expendable in the view of your fire department' - but 'you would have been able to save the others' ... once more than one started showing signs of CO poisoning?

    Jerry Peck, Construction / Litigation Consultant
    Construction Litigation Consultants, LLC ( www.ConstructionLitigationConsultants.com )
    www.AskCodeMan.com

  10. #10
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    Default Re: CO incident EMS wore personal monitors

    Quote Originally Posted by Jerry Peck View Post
    Alton,

    Which way do you want it?

    You just stated that they should wear SCBA *ON EACH AND EVERY CALL* (because each and every call "may" fall into what you stated "may be present").

    Yet, you do not want them to wear personal CO monitors be, what to heck, if it goes off all the time, they will ignore it.

    That is what friggin' *TRAINING* is for. If you have people wearing personal CO monitors and they ignore those alarms, they have failed in their training.

    We are talking about an incident which involved *ONE SINGLE PERSON* (so don't bother trying to hide your position behind "SOP with more than one victim") and which saved CO poisoning of many others simply because the responders *were wearing personal CO monitors*.

    You department *WOULD NOT HAVE KNOWN* about the CO until it was potentially too late, and trying to justify that by repeating "SOP with more than one victim" when *THERE WAS ONLY ONE SINGLE VICTIM* shows lack of training and professionalism.

    Are you saying that 'that one single victim was expendable in the view of your fire department' - but 'you would have been able to save the others' ... once more than one started showing signs of CO poisoning?
    Would my department have known that this was a CO incident before we had more than one victim? Probably not. But then with only one victim the FD probably would not have been responding anyway. EMS (not affiliated with the FD) would have been called and the FD probably would not be dispatched until the CO alarms the medics carried would have gone off or until the incident escalated to "more than one victim". Then my FD would have been called and we would have more than one victim and this incident would have moved up to a "probable haz mat release". Under SOPs first in personnel from the FD (engine & ladder companies) would be wearing SCBA and air sampling would be done to determine cause and extent of release.
    Sorry but I work with a small department, we train constantly but the FD members do it all here. We cross train in each field that falls under the auspices of the fire department. We can't do it all perfectly, and we don't expect to, we do the best we can on each call and we learn from each call that we make. SOPs are constantly under review and do change from time to time.
    Alton


  11. #11
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    Exclamation Re: CO incident EMS wore personal monitors

    I stopped by and chatted with two members of the first responding Manoa Fire Station, which also sent the EMS crew. This station is within sight of the shopping center. The call originated as someone having "fallen down" in the grocery store. The first responding EMS crew happened to be their volunteer Advanced Life Support unit, which includes paramedics. Clipped onto their jump kit was a personal CO monitor. They set the bag next to the patient and began their assessement and vital signs. When one medic reached for something from the bag, he noted 44 ppm on the CO monitor and instantly knew they had a CO incident. They called for backup and began to take spinal precautions so they could remove that patient from the environment as quickly as possible. The store management was alerted and asked to herd together anyone working back in the bakery, where the first patient fell or if they felt any symptoms whatsoever. Even so, they corraled ALL people in the store, opened but blocked the doors and waited the 2-3 minutes for the rest of the FD to arrive. The responding crews from Manoa and Llanerch (sister volunteer station) all had CO analyzers AND Masimo RAD 57 portable carboxyhemoglobin pulse oximetry meters on board for a total of 3. They began triaging every person in the store. If they were symptomatic or had a COHb of 5% or higher, they were triaged to EMS. A total of 31 patients were treated at area hospitals. The Asst. Chief told me each FD crew carries one personal monitor at min. plus about 6 members carry their own including the chief, who responds on 90% of all calls. That way, more than one personal CO alarm enters every building on every call. They get them calibrated annually by a company that sells and services fire service equipment.

    They were a little nervous talking to me at first so I avoided questions as to the cause and orgin of the incident, which I'm sure he would not speak on anyway, as he shouldn't. I congratulated them on getting it right citing examples such as Ocean City, Md. where the first EMS crew missed a fatal CO poisoning and I cited that study in Rhode Island where they screened all ER patients and found 11 needing treatment that were asymptomatic and no indication of CO poisoning.

    Rad-57

    I'll try to get more details as I can. Good job Manoa FD!
    Bob

    Keep the fire in the fireplace.

  12. #12
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    Default Re: CO incident EMS wore personal monitors

    I wish they were all handled like that Bob, sounds like those guys are setting a great example for others to follow.

    Measured Performance more than just a buzzword

  13. #13
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    Exclamation Re: CO incident follow up

    The Fire Dept. surveyed and evacuated 6 adjoining stores to make sure they knew the extent of CO spread and locate all victims. They even evacuated a pet dog that stays at one store every day. Everyone got tested for COHb before being released home. The local gas utility, PECO responded within minutes to survey for CO with their analyzers, document the levels, extension and determine the cause. As it stands, the unofficial cause was the exhaust fans were not manually turned on. surprising there is not some form of interlock with a draft proving switch and hi limit switches. It may take years to get the truth but I will do what I can to get more facts. I plan on "shopping" there tomorrow to see what kind of equipment is located in the bakery.

    The original call was for an old lady who fell in front of the bakery--no mention of CO, gas, etc.

    That fire company's other two EMS units are Basic Life Support (BLS) and currently do not carry personal CO monitors on their jump kits. After my talk with them, these crews and eventually every firefighter will have one.

    I will also try to find out why one firefighter had to be treated at the ER. Supposedly, all patients were treated and released. No word on if any had to be transferred to the Hospital of the Unniversary of Penn (HUP), which is a Level I trauma center and has the local hyperbaric oxygen (HBO) center. I'm surprised more hospitals do not have HBO capability since it is approved by medicare for over 20 maladies and is the treatment of choice for clostridium gas gangrene and CO poisoning.

    The half life of COHb is about 3hrs. That means every 3 hrs, your blood level reduces on its own by half. By administering 100% O2 at 3 Atmospheres Absolute (ATA) you can drive this time down to minutes instead of hours in clearing CO out of your system. Meanwhile, any tissues that got ischemic from hypoxia are rejuvenated by the super concentrated O2.

    Stay tuned to this channel

    Keep the fire in the fireplace.

  14. #14
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    Default Re: CO incident EMS wore personal monitors

    Bob,

    Thanks for the behinds the scenes information. Sounds like lots of good things are being accomplished with these two departments.

    Alton,
    I was a volunteer firefighter for a couple of years and then a volunteer technical rescue squad member for 10+ years. Confined Space, Trench, Building Collapse, Swiftwater, High & Low Angle Rope, and SAR. Equipment and training varies considerably between departments.

    Google showed up a personal CO monitor for about $60. Looks like about the size of a pager from the pics. Don't have all the info yet. Just wondering what equipment the responders were using.

    "The Code is not a peak to reach but a foundation to build from."

  15. #15
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    Cool Re: CO incident EMS wore personal monitors

    These crews carried older MSA models. Newer models have better features such better alarm options, batteries, sensor lifespan without calibration, etc.

    I saw the kitchen today while "shopping". They have a hand written sign on the one bake oven stating: "Out of service- do not use". An unnamed inside source told me this oven was known to all the staff as having a history of malfunctions including possibly having overridden a primary safety control -an exhaust fan interlock with the gas control. Everyone in the bakery knew you had to manually turn on the exhaust fan for this particular oven yet it was not repaired and was left in service. Already, employees are coming out claiming symptoms for several weeks.

    Somebody is going to have to get their checkbook out on this one! This is going to be good.

    Keep the fire in the fireplace.

  16. #16
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    Default Re: CO incident EMS wore personal monitors

    Thanks for the update Bob!

    Measured Performance more than just a buzzword

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