TheSilent Killer!

This Presentation Was Designed to Give General Information About Carbon Monoxide for:

Emergency Responders Fire EMS

Police Dispatchers, AND General Public

This Presentation is Merely a General Informational Guide About: Carbon Monoxide (CO) CO Accidental Poisoning, AND Detection, Symptoms, Tools and Treatments

This Presentation is NOT Intended to be a Comprehensive, All Encompassing Resource about CO

More in Depth Information is Available Online and/or in Books

Please Use the Handy Reference at End of Presentation for More Information

CO Basics- the Hidden Danger At Risk Populations Accidental Poisoning Prevention What to do when you encounter CO

Both the Public and Emergency Responders Symptoms of CO Poisoning Treatments

Civilian BLS ALS

Understanding your CO Detector/Monitor Residential/Commercial and RAE Systems Exposure Limits

Local Statistics Charts Headlines Technical Data

Physical & Chemical Properties References

CO is a compound of Carbon and Oxygen

One atom carbon to one atom oxygen

Colorless Odorless Tasteless POISONOUS Gas

CO is Produced by the Incomplete Combustion of Various Fuels (Hydrocarbons) , Including:

Coal Wood Charcoal Oil Kerosene Propane Natural Gas

Note production of CO from the fire on right

Reaction That Does Not Convert All of a Fuel's Carbon and Hydrogen Into Carbon Dioxide and Water, Respectively Example, Incomplete

Combustion of Carbon Produces Carbon Monoxide, Carbon Dioxide and Water.

Smoldering Fires Burning Wet Wood Burning Green

Wood Lack of O2 During

Combustion Malfunctioning

Appliances Malfunctioning

Exhaust Systems

When a Hydrocarbon Burns Completely

Usually in Environment Abundant in Oxygen

Emitting Carbon Dioxide & Water

Zero Emissions of CO Makes Indoor Gas Cook

Stoves Safe (right)Note the bright blue &

uniform flames- indication of Complete Combustion

WATER HEATERS & FURNACES FIREPLACES

VEHICLE EXHAUST SMOKING INDOORS

PORTABLE GENERATORS PORTABLE PROPANE HEATERS

Carbon Monoxide Poisoning is the Most Common Exposure Poisoning in the United States

Carbon Monoxide is Not Easily Recognized Because the Signs and Symptoms Are Similar to Those of Other Illness

This Odorless, Colorless Gas Can Cause Sudden Illness and Death

DUE TO THE CHANGES IN PHYSIOLOGY AND EXPOSURE, THE FOLLOWING POPULATIONS ARE

AT THE GREATEST RISK: The Very Young The Very Old Pregnant Women & Most Important- their Fetus

Fetal Hemoglobin has an Even Higher Affinity for CO Than Adult

People With Existing Respiratory Compromise Firefighters

DETECTORS UNITS WITH DIGITAL READOUT BETTER THAN UNITS WITHOUT

DO- Install a Battery-operated CO Detector In Your Home check or replace the

battery when you change the time on your clocks each spring and fall

If the Detector Sounds Leave Your Home Immediately and Call 911.

DO- Have Annual Inspections of Your Solid-Fuel and/or Gas Appliances in Your Home By a Qualified Technician; Including: Home Heating Systems Water Heaters Fireplaces & Chimneys And Any Other Gas, Oil, or Coal Burning

Appliances

DO- Seek Prompt Medical Attention If You Suspect CO Poisoning

You and/or Family Feeling: Dizzy Light-headed Nauseous

Especially if CO Alarm is Sounding

DO NOT- Use The Following Appliances Inside Your Home, Basement, or Garage or Near a Window: Portable Generators Charcoal Grills Camp Stoves Any Other Gasoline or Charcoal-Burning

Devices

During Power Outages Place Portable Generators at Least 50 Feet From Your Home

If Possible, Place Generator Downwind and Away From Any Openings in Your Home: Windows Doors Vents/Air Intakes

DO NOT- Run a Car or Truck Inside a Garage Attached to Your House Even if You Leave the Garage Door Open

DO NOT- Burn Anything in a Stove Or Fireplace That Isn't Vented to the Outside

DO NOT- Attempt to Heat Your House With A Gas Oven

If You Suspect the Presence of CO in Your Home and/or Office: Immediately Evacuate the Building of ALL People Evacuate Pets (if you can do so Safely and Quickly) Call 911- From Outside

From Cell Phone Neighbor House/Business

DO NOT Re-Enter the Building Until Safe to Do So- Typically After Building Deemed Safe by:

Fire Department, and/or Your Gas Company (such as Excel)

DO NOT REASONS FOR CO SUSPICION

Please Do Not Open Windows & Doors This is a Common

Reaction A Closed Building Helps

Fire/Gas Company Learn Full Exposure

Levels Potentially Locate

Source(s)

CO Detector Alarming Sudden and/or

Extreme Headache- Especially Multiple

People in Same Building For More Symptoms

See “Symptoms” Slides Later in this Presentation

Turn On Your Gas Detector (QRAE) Perform a Fresh Air Calibration in Fresh Air Review Your Department SOP/SOG/OD

Regarding Carbon Monoxide Calls Periodically At PFA This is The Operational Directive Section

3.3.4: “Carbon Monoxide Alarm Response” Always Remember Safety First!

If the Resident Does Not Have a Functioning CO Detector, Give Him/Her a “Portable Peace of Mind”

Instructions Are on the Back of this Unit

Be Sure the Individual Understands this Detector and its Limitations

Encourage the Resident to Purchase and Install a Battery Operated CO Detector ASAP

Read & Understand Detector Instructions Before Use

Detectors Should Be Battery Operated or Backed Up

Check/Change Batteries Each Time you Change Your Clocks (Daylight Savings)

If your CO Detector Sounds, Call 911 For Assistance

While the PFA does not recommend specific brands, we suggest detectors

with digital readers give you more accurate information than those without

The User Should Review Monitor’s Instruction Manual Periodically

If You Have Further Questions, Refer to Your Department’s Monitor Technician(s) At PFA- Station 10

Monitor Should Be Properly Calibrated Once Per Month Anytime It’s Exposed to 200 ppm

or Higher

A Properly Ventilated Building With Properly Functioning Appliances Should Have Zero CO Present

Generally Speaking, Levels Between 0-5 parts per million (a Measurement of Substance in Air, Indicated by the Letters- ppm) are Commonly Found Indoors and is Considered Safe

For Greater Details, Please See “Exposure Limit Details” Slides in the Technical Data Section Towards the End of This Presentation

0 to 9 ppm- Normal No Action: Typically from multiple potential

sources 10 to 35 ppm- Marginal

This level could become problematic Actions: Occupants should leave the building

and be advised of a potential health hazard to small children, elderly people and persons suffering from respiratory or heart problems

Find source and mitigate/fix problem

36 to 99 ppm- Excessive: Medical Alert Conditions must be mitigated Actions: Ask occupants to step outside and query

about health symptoms Call 911 Contact Gas Company and/or Contractor Advise occupants to seek medical attention

If occupants exhibit any symptoms of CO poisoning, they should be immediately transported to a medical facility

Preferably by ambulance Professionals Required From this Point On-

Fire/EMS Gas Company/Contractor

100 – 200 ppm- Dangerous: Medical Alert Emergency conditions exist Actions: Evacuate the building immediately and

check occupants for health symptoms Call 911 All occupants Should Be Evaluated by EMS Personnel

If occupants exhibit any symptoms of CO poisoning, they should be immediately transported to a medical facility

Preferably by ambulance Greater than 200 ppm- Very Dangerous:

Medical Alert Actions: Same as Above

• ANY OR ALL OF: • Headache• Dizziness• Irritability• Confusion/Memory

Loss• Disorientation• Nausea and

Vomiting• Abnormal Reflexes

• Difficulty in Coordinating

• Difficulty in Breathing

• Chest Pain• Cerebral Edema• Convulsions/Seizures• Coma• Death

BE HIGHLY SUSPICIOUS OF CO POISONING IF:

Any of the Symptoms Found on Previous Slide is Present in More Than One Individual in the Building

Any of these Symptoms are Sudden (Acute)

Any of these Symptoms Accompanied by a Sounding CO Detector

If you Suspect Faulty Appliances

Move Victims to Fresh Air Immediately this will only relieve immediate symptoms of

acute poisoning Activate the Fire/EMS System (if not

already) Administer High-Flow Oxygen Monitor Vital Signs Transport via ALS if Symptom(s) persist

Move Victims to Fresh Air Immediately Call 911 From a Safe Location Administer High-Flow Oxygen Monitor Vital Signs Monitor Level of Consciousness Monitor for Respiratory Problems Get a Carboxyhemoglobin (Cohb) Test to

Check for Carbon Monoxide Levels in the Blood

Consider Early Transport to a Hyperbaric Oxygen Chamber for Severely Poisoned Patients

Any Patient Found Unconscious, Seizing, or With EKG Changes and With an Associated History Should Be Treated as a Severe Carbon Monoxide Poisoning Until Proven Otherwise

The Information in the Following Seven Slides Was Compiled by:Kevin Contreras and Gil Fisher

63% of PFA Calls Involving CO Come in as "CO" Detector Calls

The Rest are Odor/Leak, Service or EMS Calls

On Average, 53% of Those Calls Revealed CO Levels Greater than 35ppm The CO Level at Which

Our QRAEs alarm

        1.      January        2.      December        3.      February        4.      November        5.      March        6.      April       

7.      October

     8.      June     9.      September     10.    July     11.    August     12.    May

1. HVAC (44% of All CO Calls)2. Water Heater3. Other Appliances (Stove, Oven, Dryer)4. A Running Vehicle Parked in the Garage

or Drive Way  (With the Front Door Open)5. Wood Stove, Fireplace (Gas or Wood)

Other Interesting Culprits: Whole House Fans Large Fans in Windows Perhaps Most Interesting-

A Room full of Cigarette Smoke

Carboxyhemoglobin & Smokers Non-smokers Generally Have Less

Than 1.5% CO In Their Blood Smokers Tend To Have Between 3-15%

Carbon Monoxide Is the #1 Cause for Poisoning Deaths in the U.S.

Effects of Co Poisoning Can Generally Be Experienced With as Little as 10%

According to Information Provided by Mary Makris, People Recover 4-5 Times Faster When Administered High Flow O2

50 ppm: No Adverse Effects With 8 Hours of Exposure

200 ppm: Mild Headache After 2-3 Hours of Exposure

400 ppm: Headache and Nausea After 1-2 Hours of Exposure

1,600 ppm: Headache, Nausea, and Dizziness After 20 Minutes of Exposure

3,200 ppm: Headache, Nausea, and Dizziness After 5-10 Minutes; Collapse and Unconsciousness After 30 Minutes of Exposure

6,400 ppm: Headache and Dizziness After 1-2 Minutes; Unconsciousness and Danger of Death After 10-15 Minutes of Exposure

12,800 ppm: Immediate Physiological Effects, Unconsciousness and Danger of Death After 1-3 Minutes of Exposure

The Lofgren Family Photo; Parker, Caroline, Owen and Sophie

A Prominent Denver Family Perished in a $9 Million Dollar Home in Aspen

The Family of Four All Died in Their Sleep This Tragedy Could Have Been Avoided

With the Proper Use and Installation of CO Detectors

The Center for Disease Control and Prevention Has Concluded that Between 1999-2004 an Average of 439 Persons Died Annually From Unintentional, Non--fire-related CO Poisoning

Rates Were Highest Amongst Persons 65 Years Old and Older

The Average Number of Deaths Was Highest During January

Molecular Weight: 28.01 Boiling Point (At 760 Mm Hg): -191.5 Degrees C

(-312.7 Degrees F) Specific Gravity (Water = 1): 1.25 at 0 Degrees

C (32 Degrees F) Vapor Density: 0.97 Freezing Point: -205 Degrees C (-337 Degrees F) Vapor Pressure at 20 Degrees C (68 Degrees F):

Greater Than 1 Atmosphere (760 Mm Hg) Solubility: Sparingly Soluble In Water; Soluble in

Ethanol, Methanol, and Some Organic Solvents Evaporation Rate: Not Applicable

Conditions Contributing To Instability: Heat May Cause Containers of Carbon Monoxide to Explode

Incompatibilities: Contact of Carbon Monoxide With Strong Oxidizing Agents, or Halogen Compounds Causes a Violent Reaction

Hazardous Decomposition Products: None Reported

Special Precautions: None ReportedNFPA 704

The National Fire Protection Association Has Assigned a Flammability Rating of 4 (Severe Fire Hazard) to Carbon Monoxide

Flash Point: Not Applicable Autoignition Temperature: 609 Degrees C

(1128 Degrees F) Flammable Limits in Air (Percent By

Volume): Lower, 12.5; Upper, 74 Extinguishant: Let a Small Fire Burn Unless

the Leak Can Be Stopped Immediately. Use Water Spray, Fog, Or Regular Foam to Fight Large Fires Involving Carbon Monoxide.

OSHA Permissible Exposure Limit (PEL) is 50 ppm of air as an 8-hour Time-Weighted Average (TWA)

NIOSH has Recommended Exposure Limit (REL) of 35 ppm as an 8-hour TWA and 200 ppm as a ceiling

ACGIH assigned a Threshold Limit Value (TLV) of 25 ppm as a TWA for a normal 8-hour workday and a 40-hour workweek

RATIONALE AGENCIES The NIOSH limit is based

on the risk of cardiovascular effects

The ACGIH limit is based on the risk of elevated carboxyhemoglobin levels (a Condition where CO is Present in Red Blood Cells Instead of Oxygen)

OSHA- Occupational Safety & Health Admin

NIOSH- National Institute for Occupational Safety and Health

ACGIH- American Conference of Governmental Industrial Hygienists

http://www.osha.gov/SLTC/healthguidelines/carbonmonoxide/recognition.html

http://www.carolinafirejournal.com/Articles/ArticleDetail/tabid/191/ArticleId/107/Carbon-monoxide-poisoning.aspx

http://www.carbonmonoxidekills.com/32/carbon_monoxide_facts

http://www.osha.gov/Publications/3282-10N-05-English-07-18-2007.html

http://en.wikipedia.org/wiki/Carbon_monoxide

http://www.cdc.gov/co/ http://emergency.cdc.gov/disasters/

co_guidance.asp http://www.cdc.gov/mmwr/preview/

mmwrhtml/mm5650a1.htm http://www.homedepot.com/Buying-Guide-

Smoke-Carbon-Monoxide-Detectors/h_d1/NCC-1701/h_d2/ContentView?pn=Smoke_Carbon_Monoxide_Detectors&storeId=10051&langId=-1&catalogId=10053

http://www.osha.gov/SLTC/healthguidelines/carbonmonoxide/recognition.html