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EMS News in Focus
by Arthur Hsieh

5 tips for treating possible carbon monoxide poisoning

Important reminders about scene management issues related to carbon monoxide exposure

By Arthur Hsieh

Editor's note: Responders discovered carbon monoxide poisoning in a Calif., home and transported three to the hospital. Editorial Advisor Art Hsieh says as the days get colder, it's time to remind our communities to be vigilant about the dangers of carbon monoxide.

Update April 7, 2015

When cold temperatures arrive and winter precipitation increases EMS must remind our communities to be vigilant about the dangers of carbon monoxide.

Every winter people fire up old heaters that have not been used or maintained in many months. The indoor use of outdoor heat sources, such as gas grills or generators, and other inappropriate or illegal devices is a recipe for disaster.

For us responders, it's time to remind ourselves about scene management issues as related to carbon monoxide:

1. Identify potential for an MCI

The Pasadena responders did a terrific job quickly identifying the potential for a mass casualty event when they entered the scene. Unfortunately there will probably be more than a few stories being reported this winter about first responders becoming ill while treating patients within the toxic environment. Stay alert! The vast majority of the time the patient with a headache, nausea, vomiting and fatigue is in fact someone with flu or severe cold symptoms; try to consciously ask whether a heater is in use, and if so, where. Having more than one victim on the scene with similar signs is a red flag.

2. Evacuate! 

If the potential for carbon monoxide exists, evacuate immediately. Prevent curious bystanders and other rescuers from entering the home. Make the scene safer for yourself, other responders, and the patients by evacuating.

3. Call for additional resources

If you can leave with the patients safely, then do so, but your safety is the primary concern. If you are trained to use SCBA, retreat and don the necessary equipment to regain access safely. If not, call for additional resources and prepare to receive the patients out in the cold zone.

4. Understand the pathophysiology of CO

Carbon monoxide kills by robbing hemoglobin of their ability to hold oxygen. This causes the patient to effectively suffocate. High concentrations of oxygen can begin the process of bumping carbon monoxide molecules off the hemoglobin cells. Assess that the patient is ventilating effectively — look for adequate rate and depth of breathing. Don't trust your pulse oximeter, as it will show abnormally high readings. A carbon monoxide monitor can provide key information.

5. Follow local protocols for transport to a hyperbaric chamber

In more severe cases of CO poisoning, a facility that has access to a hyperbaric chamber may be needed. Oxygen under increased atmospheric pressure will help drive more CO off the hemoglobin. Review your destination policies and procedures to make sure you are transporting to the appropriate facility.

About the author

EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at
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