By William Shouldis
Responders cannot see it. It has no smell. It is not irritating. There are very few warnings of this hidden hazard. Carbon monoxide exposure is often considered a silent killer. However, speak with any “front line” firefighter or paramedic and they can share a “near miss” story. Fire service leaders must take steps to create a training program and purchase protective equipment for first responders.
On March 5,2003, at 2248 hours, the Philadelphia (PA) Dispatch Center received a phone call from a distressed person. The caller claimed his wife was showing symptoms of a stroke. An advanced life support (ALS) ambulance was dispatched and arrived within three minutes. The front door of the two-story house was closed. Paramedics knocked on the door and were greeted by a 19-year-old male. The paramedics were informed that the boy’s parents were in the small front room on the second floor. The mother was sick and bedridden. Medics performed a rapid patient assessment and determined that the obese woman needed immediate hospital treatment. Because of the patient’s weight and overall size, an additional unit was requested for a “lift-assist.” The paramedics began to clear a path between the bedroom and the stairs. All furniture was moved, and a portable fan had to be shut off. No windows were open at this time.
Within minutes, an engine company arrived with three EMTs. The crew’s supervisor noticed that the occupants were acting in an odd manner. They appeared disoriented and uncooperative. The occupants were rearranging the furniture and blocking access to the patient. The engine company officer ordered the family members to a first-floor location. Even the paramedics were exhibiting physical symptoms. One medic complained of a frontal headache. The other had nausea. After a brief conversation with the paramedics, the company officer suspected that this was no ordinary medical response. Lieutenant Ed Manko of Engine Co. 2 suspected and acted on the hints of an elevated carbon monoxide level.
The company officer instructed the firefighter/EMTs to ventilate the building by opening windows. He attempted to adjust the thermostat. Attempts failed. An evacuation was ordered of the ambulatory occupants and emergency responders. The Dispatch Center was alerted to dispatch a full first-alarm assignment.
As the incoming unit assembled, a Triage Sector was established to provide oxygen and medical monitoring to occupants and fire department members. Arriving crews donned SCBA and removed two nonambulatory victims and shut off the gas at the meter. A combustible gas indicator (CGI) was used and determined the dangerous level of carbon monoxide in the structure. A CO reading of 830 ppm (parts per million: the U.S. Environmental Protection Agency has established that residential levels are not to exceed 9 ppm over an eight-hour average) was detected in the basement. The battalion chief placed the incident under control after search, evacuation, and ventilation tasks were completed. Investigators from the gas company and fire department determined that a blocked flue and a poorly maintained heater caused the CO gas to leak and build up inside the dwelling.
Ambulances transported the three civilians to a hospital with a hyperbaric chamber. Two were listed in critical condition. Five emergency responders were hospitalized and given 100 percent oxygen for three to six hours before being released. On March 10, 2003, a formal post-incident analysis was held. Field and staff officers attended with an emphasis on improving preparedness. The lessons to this potentially life-threatening incident follow:
- Fire officials and the media have informed the general public on the proper actions to take in a carbon monoxide emergency, but few fire departments have properly equipped initial responders with survey instruments or monitoring devices. Today, personnel protection equipment is available. Pager size meters are economical. They are easy to wear on a belt or clipped to the medical/first-aid bag.
- Carbon monoxide affects individuals in different ways. A person’s size and medical history are influencing factors. If more than one occupant is demonstrating similar symptoms, such as reduced muscle coordination or poor judgment, check for securely sealed windows. Look for condensation on the inside windows or abnormal rusting on the top of a gas range from incomplete combustion. Be aware that the smell of stale air is precipitated by insufficient ventilation.
- 3. Don’t expect to see the so-called classic cherry red coloration of a victim. Emergency room physicians say this visible clue is subtle.
All responders must be aware of the health hazards associated with carbon monoxide. The dangers are real. This incident demonstrates the swiftness that CO can affect a rescuer. Education and engineering initiatives are needed to provide an acceptable level of personnel protection.
William Shouldis is a deputy chief with the Philadelphia (PA) Fire Department, where he has served for more than 29 years. He is an adjunct instructor for the National Fire Academy’s resident and field programs, teaching courses in fireground operations, health and safety, and prevention. Shouldis has a bachelor’s degree in fire science administration and a master’s degree in public safety. He is a member of the Fire Engineering editorial advisory board and a frequent FDIC speaker.