CARBON MONOXIDE: WHAT THE HOSPITALS MAY NOT BE TELLING YOU

BY THOMAS DUNNE

An estimated 10,200 people report to hospital emergency rooms each year for carbon monoxide poisoning, according to a study conducted by the Consumer Product Safety Commission. The majority of these injuries are caused by home heating systems. Yet, hospitals that might be obliged by law or protocol to inform the fire department of injuries caused by fire may not necessarily be obligated to report that patients have been exposed to carbon monoxide.

Recently, I responded to an incident in New York City that highlighted the need for such communication. Fire units were dispatched to a two-story private dwelling at around 1130 hours for an “odor of fumes” with people overcome.

On arrival at the scene, our units detected extremely high—800 parts per million (ppm)—carbon monoxide readings in the basement. The source was found to be a defective boiler in the heating system, a very common scenario. The boiler was shut down, and the building was thoroughly vented. EMS personnel treated four residents ranging in age from nine months to 75 years for exposure to carbon monoxide.

While operating, our personnel were informed that earlier in the day (around 0945 hours) an ambulance had responded to the same building for a heart attack suffered by an elderly resident. He had been transported to a local hospital, accompanied by a relative who also lived in the same building. At the hospital, this relative complained of dizziness, and the medical staff diagnosed both of them as suffering from carbon monoxide exposure. They were treated.

However, there remained an unresolved carbon monoxide problem in their home that would not be addressed until fire department apparatus arrived at the building almost two hours later for an “odor of fumes.”

COMMUNICATION LINK NEEDED

A vital communication link was missing. The hospital hadn’t notified the fire department that it had treated patients for carbon monoxide poisoning. This lack of communication allowed the defective boiler to threaten the health of four additional residents before fire units were called to the scene.

On researching the situation, I discovered that New York State law requires hospitals to notify the fire department of burns and injuries caused by a fire, but the law does not require notification for cases of carbon monoxide poisoning.

This incident highlighted the need for such a requirement. Responses to carbon-monoxide emergencies have become routine for fire and EMS units. Many fire apparatus routinely carry a carbon monoxide meter. Emergency personnel are trained to recognize the signs of carbon monoxide poisoning such as headache, nausea, and dizziness, although it still takes a blood-gas analysis in a hospital setting to verify the condition.

Based on this experience, I recommended to my department that the law be amended so that the fire department is notified immediately whenever a hospital treats a patient for carbon monoxide exposure. Our department is currently initiating steps that may lead to legislative changes in the future.

The National Safety Council Accident Facts and Injury Facts estimated that 400 people died as a result of nonfire injuries caused by gas poisoning in 2000. This number has actually decreased significantly in the past 20 years (there were an estimated 1,200 deaths in 1980).

Growing public awareness of the problem no doubt contributed to the decline in fatalities. The death of tennis star Vitas Gerulaitis generated a great deal of media coverage. Also, the use of carbon monoxide detectors became more widespread during this time, as they became more affordable.

CONSTRUCTION MAY ADD TO THE PROBLEM

There are, however, two factors that may play a role in maintaining the current level of carbon monoxide deaths. Of the 400 estimated deaths in the year 2000, 300 of them occurred in the home. Homes are increasingly being built and renovated in a manner that makes them more airtight and heat efficient. An “air starved” building is more likely to experience a chimney downdraft. The problem of creating and maintaining elevated carbon monoxide levels is not eliminated in this kind of construction but may in fact be exacerbated.

In addition, the general aging of our society raises concerns about potential carbon monoxide deaths. A National Safety Council analysis indicates that the carbon monoxide death rate increases dramatically for those ages 65 and over. Our country’s population is evolving so that a larger percentage of our people will be in this higher-risk age category in just a decade or two.

Carbon monoxide poisoning is a health risk we will continue to face. A few months after the incident I described, I was informed of a similar situation that occurred in a different neighborhood. At that incident, a mother and two children who lived in an apartment building went to a local hospital, where they were diagnosed and treated for symptoms of carbon monoxide poisoning.

After speaking with the patients, a social worker at the hospital called 911 to relay the information to the fire department. This generated a fire apparatus response to the apartment building. Fire department units found carbon monoxide readings of 400 ppm in many areas of the building. Again, a defective boiler was found to be the source of the carbon monoxide; the fire units rectified the problem.

While searching the apartment directly above the boiler room, fire personnel found an occupant in an incoherent condition. He and one other building resident were transported to the hospital for carbon monoxide poisoning.

The hospital social worker made the 911 call on her own initiative and may well have saved the life of the resident living above the boiler room. Her action was a prime example of what standard hospital-fire department communication should be.

Both of these incidents occurred in my assigned division within a four-month period. I suspect that there have been many other cases nationwide.

What laws are in effect in your department’s response area? If there is no legal requirement for hospitals to report carbon monoxide cases, is there at least a protocol established to inform your fire units so they can abate the carbon monoxide problem in a building?

The fire service can inform the public of the dangers of carbon monoxide, recommend the installation of detectors, and issue orders for the repair of defective heating systems. When these safeguards fail and we are faced with victims of carbon monoxide poisoning, it is vital to quickly eliminate the source of the problem.

An effective hospital-fire department notification network would facilitate this process. Ideally, the law should require this networking. Any efforts your department makes to have such legislation enacted would undoubtedly save lives in the future.

THOMAS DUNNE is a deputy chief and 22-year veteran of the Fire Department of New York, with experience in mid-Manhattan and the Bronx. He is a graduate of Fordham University and an instructor at the Westchester County (NY) Fire Academy.

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