A Silent Death

   When transporting by ground ambulance, consider traveling nonemergently if the patient's vital signs are stable. There is no evidence that the few minutes saved will make a difference in the patient's long-term outcome.

Documentation

   As with all EMS calls, an important part of the patient's care is documentation of the circumstances and events leading up to 9-1-1 being called. In the case of CO poisoning, it is helpful to note:

• Source of the CO
• Duration of exposure
• Location of the source
• Location of the patient and relation to the source
• That the source is being managed and further poisonings are being averted
• Ambient air CO readings, including whether any ventilation of the room or building has been done prior to reading.

   This information may be helpful in determining definitive treatment, as well as assisting agencies such as the CDC or CPSC to do research and work to prevent future poisonings.

Conclusion

   When the tragic and unnecessary death of EMT Steenland made headlines across the industry, did your service take a moment to make sure your facilities are monitored by CO detectors? Will you learn from the responders in Wisconsin and carry personal gas detectors? Both of these pieces of equipment are inexpensive, easy to use and critical for responder safety. Once on scene, be aware of potential sources of CO and the subtle symptoms with which a patient may present. Early detection will not only minimize the severity of the exposure, but it could save the patient's life, along with other family members and rescuers.

Public Education Opportunities

EMS providers have an important opportunity to educate the public on carbon monoxide poisoning prevention year-round, as well as during natural disaster emergencies. Important messages may include:

• Every home should have at least one functioning carbon monoxide detector. More may be necessary, depending on the size and layout of the home.
• If letting a vehicle idle to warm up in cold weather, make sure it is outside and the garage door is closed so CO does not flow back into the garage.
• Place generators a minimum of 15 to 25 feet from the home and away from windows, doors, vents and air conditioners. Never run a generator indoors.
• Do not use propane, kerosene or charcoal briquettes to cook or heat indoors, in tents or in campers.
• Do not leave stove-top burners on or oven doors open to heat a room.

The CDC and CPSC each have lines of educational materials available, including on CO awareness while boating, camping, in the home and during times of natural disaster. The availability of these materials, plus our close ties to the response to and care of CO poisoning victims, makes it a good opportunity for a public education project.

Public Education Opportunities

EMS providers have an important opportunity to educate the public on carbon monoxide poisoning prevention year-round, as well as during natural disaster emergencies. Important messages may include:

• Every home should have at least one functioning carbon monoxide detector. More may be necessary, depending on the size and layout of the home.
• If letting a vehicle idle to warm up in cold weather, make sure it is outside and the garage door is closed so CO does not flow back into the garage.
• Place generators a minimum of 15 to 25 feet from the home and away from windows, doors, vents and air conditioners. Never run a generator indoors.
• Do not use propane, kerosene or charcoal briquettes to cook or heat indoors, in tents or campers.
• Do not leave stove-top burners on or oven doors open to heat a room.
• The CDC and CPSC each have lines of educational materials available, including CO awareness while boating, camping, in the home and during times of natural disaster. The availability of these materials, plus our close ties to the response to and care of CO poisoning victims, makes it a good opportunity for a public education project.

REFERENCES

1. EMT identified in fatal Texas carbon monoxide exposure. The Associated Press/ El Paso Times (Texas). www.emsresponder.com/article/article.jsp?siteSection=1&id=14335.

2. Reinisch CE. Carbon monoxide poisoning: Implications for patient and family care in the emergency department. Clinical Scholars Review 1(1), 2008.