1. Carbon Monoxide Review Prepared by: FF/P Dennis Wenner 2016 Haz-Mat and C/Space In-service

2. Overview for Carbon Monoxide The Silent Killer

3. Overview Introduction Carbon Monoxide (CO) Properties Possible sources of CO CO Health Hazards Suggested Fire Department Operational Guidelines CO levels – what they mean

4. Discussion Points will include This Presentation Was Designed to Give General Information About Carbon Monoxide for: Emergency Response – Fire – EMS General Public

5. General Information for Carbon Monoxide Incidents This Presentation is Merely a General Informational Guide About: – Carbon Monoxide (CO) – CO Accidental Poisoning, AND – Detection, Symptoms, Tools and Treatments Additional Information is Available Online and/or in Books Please Use the Handy Reference at End of Presentation for More Information

6. Introduction Purpose: – Familiarize Howard County Fire/Rescue personnel with the dangers and properties of CO – Provide Howard County Fire/Rescue personnel guidance on developing response protocols for CO emergencies

7. Carbon Monoxide Incidents Background: – CO associated with 500 non-fire related deaths each year – 60% of deaths from motor vehicle exhast – 40% of deaths from consumer products

8. Complete Combustion 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

9. Properties of Carbon Monoxide Odorless, colorless, tasteless, non-irritating gas Virtually undetectable without specialized equipment A natural by-product of incomplete combustion from equipment burning carbon based fossil fuels such as: – Gasoline – Wood – Coal – Propane – Oil – Methane

10. Properties of Carbon Monoxide Flammable gas – Auto ignition temperature = 1128° F – Lower Explosive Limit 12.5% – Upper Explosive Limit 74% Vapor Density of.968 – Slightly less than that air – CO will rise with warm air – CO disperses evenly once it cools

11. Possible Sources of CO Attached garages with running automobiles Cooking and heating appliances – Improperly vented – Not serviced – Inefficient/improper operation

12. Sources of Carbon Monoxide Pollution WATER HEATERS & FURNACES FIREPLACES

13. Sources of Carbon Monoxide Pollution VEHICLE EXHAUSTSMOKING INDOORS

14. More Sources- Common in Power Outages PORTABLE GENERATORS PORTABLE PROPANE HEATERS

15. Health Hazards A “silent killer”: CO will kill before its presence is known No early warning signs Displaces O2 in the bloodstream Victims die from asphyxiation

16. Health Hazards Absorbed into the body through lungs Transferred to the blood Combines with hemoglobin to become carboxyhemoglobin (COHb) CO poisoning is measured by the % of COHb in the blood

17. Health Hazards Reduced O2 reduces functions of the brain, cardiac muscle, and respiratory system CO has a greater affinity for hemoglobin than O2 at 210 times to 1

18. Health Hazards Individual CO poisoning levels depend on several factors Initial COHb concentration Concentration of CO inhaled Length of exposure Activity while inhaling CO Body size and physiological factors

19. The Hidden Dangers of CO 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

20. At Risk Populations 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

21. Operational Guidelines Responding to CO investigations, CO alarm activations, and true CO emergencies: Differ from jurisdiction to jurisdiction This program offers a suggested practice in managing CO incidents Conduct research and determine what the appropriate response protocol is for your jurisdiction

22. Operational Guidelines Dispatchers: First point of contact with the public and must: – Know the properties of CO – Know signs and symptoms of CO exposure – Obtain pertinent information – Query reporting party to determine appropriate level of response – Dispatch appropriate emergency personnel and apparatus – Instruct occupants to evacuate and seek fresh air

23. Operational Guidelines Dispatchers (continued) Obtain signs and symptoms – Head ache – Nausea – Dizziness/drowsiness – Fatigue – Confusion – Fainting – Irritability – Loss of consciousness – Unconsciousness – Coma – Death – Seizure – Permanent brain damage

24. Operational Guidelines Dispatchers (continued) Determine the following from the reporting party: – Name, address, telephone – Are occupants experiencing signs and symptoms – Is a CO alarm sounding

25. Operational Guidelines Dispatchers (continued) Advise reporting party to: – Evacuate the structure – Do not re-enter under any circumstances At a minimum dispatch: – Fire apparatus – EMS personnel

26. Operational Guidelines Incident Commander Determine level of assistance required Ensure EMS performs patient assessment – Treat and/or Transport Assess all possible CO sources (inside and outside the structure) Ensure Firefighters use full PPE

27. Operational Guidelines Incident Commander Determine level of assistance required Ensure EMS performs patient assessment – Treat and/or Transport Assess all possible CO sources (inside and outside the structure) Ensure Firefighters use full PPE

28. Operational Guidelines Incident Commander NOTE: If CO is present in dangerous levels, an Immediately Dangerous to Life and Health (IDLH) atmosphere exists. You must consider the 2-in 2-out OSHA ruling. Consider Rapid Intervention Team, if appropriate.

29. Operational Guidelines Incident Commander (continued) Conduct informal interview with occupants Determine if anyone is experiencing symptoms of CO Poisoning Locate fossil fuel powered appliances Ascertain where and what occupant activities were prior to their call Determine onset and length of time symptoms present

30. Operational Guidelines Operations If interview determines likelihood of CO: – Evacuate the structure – Inspect exterior for blocked vents – Establish baseline CO meter readings outside structure – Record your measurements

31. Operational Guidelines Operations (continued) Take measurement near entrance inside doorway Measure and record interior meter readings through out structure When checking CO producing appliances, maintain distance of 5 feet. Do not take readings near vents or flue pipes Record all measurements taken

32. Operational Guidelines Operations (continued) Upon locating source: – Open all windows and doors – Ventilate structure – Properly shut off and secure the appliance – Advise occupants not to use appliance until serviced by a licensed technician Occupants can return when levels fall below 9 ppm Reset the CO alarm device

33. Operational Guidelines Operations (continued) Advise the owner to call 911 if: – The CO alarm sounds again – They experience any signs or symptoms of CO poisoning

34. Symptoms of CO Poisoning 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

35. Symptoms (Cont.) 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

36. Treatment of CO Poisoning For Victims of Chronic and/or Moderate to Extreme Exposure 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

37. Chronic/Extreme Exposure (Cont.) 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

38. CO Levels What They Mean Less than 9 ppm Advise occupant you did not find high levels of CO If call was for CO alarm activation, review manufacturer’s instructions If alarm was manufactured before Oct 1, 1998, replace the alarm

39. CO Levels What They Mean Levels above 9 ppm If located, turn off source of exposure If source is permanently installed, have occupant notify qualified service technician Advise occupant to have CO producing appliance serviced by a license professional at least annually Occupants may return when levels fall below 9 ppm If alarm manufactured prior to Oct 1, 1998, replace the alarm

40. IDLH 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

41. Carbon Monoxide Facts from NFPA The dangers of CO exposure depend on a number of variables, including the victim's health and activity level. Infants, pregnant women, and people with physical conditions that limit their body's ability to use oxygen (i.e. emphysema, asthma, heart disease) can be more severely affected by lower concentrations of CO than healthy adults would be.

42. Carbon Monoxide Facts from NFPA A person can be poisoned by a small amount of CO over a longer period of time or by a large amount of CO over a shorter amount of time. In 2010, U.S. fire departments responded to an estimated 80,100 non-fire CO incidents in which carbon monoxide was found, or an average of nine such calls per hour. The number of incidents increased 96 percent from 40,900 incidents reported in 2003.

43. A National Problem 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

44. Technical Data- Chemical & Physical Properties

45. Chemical & Physical Properties Physical Data 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

46. Chemical & Physical Properties Reactivity 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 Reported NFPA 704

47. Chemical & Physical Properties Flammability 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.

48. Exposure Limits Detail 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

49. Exposure Limits Detail (Cont.) RATIONALE 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) AGENCIES OSHA- Occupational Safety & Health Admin NIOSH- National Institute for Occupational Safety and Health ACGIH- American Conference of Governmental Industrial Hygienists

50. Summary Introduction Carbon Monoxide (CO) Properties Possible sources of CO CO Health Hazards Recommended Fire Department Operational Guidelines CO levels – what they mean

51. Reference Sources: References: – U.S. Consumer Product Safety Commission Guide, Responding to Residential Carbon Monoxide Emergencies – Standard Operating Guidelines from fire departments throughout U.S. – NFPA Home Safety for Carbon Monoxide – HCDFRS GO# 330.02 Hazardous Material/WMD- CBRNE Plan – HCDFRS MO09.002Carbon Monoxide Evaluation Using SET RAD-57