CARBON MONOXIDE The Silent Killer PurposeIntention of this

CARBON MONOXIDE The Silent Killer!

Purpose/Intention of this Presentation This Presentation Was Designed to Give General Information About Carbon Monoxide for: Emergency Responders Fire EMS Police Dispatchers, AND General Public

**Disclaimer** 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

Presentation Overview 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

Presentation Overview (Cont. ) Understanding your CO Detector/Monitor Residential/Commercial Exposure Limits Local Statistics Charts Headlines Technical Data Physical and RAE Systems & Chemical Properties References

What Is Carbon Monoxide? CO is a compound of Carbon and Oxygen One atom carbon to one atom oxygen Colorless Odorless Tasteless POISONOUS Gas

Where Does It Come From? 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

What is Incomplete Combustion 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.

Common Causes of Incomplete Combustion Smoldering Fires Burning Wet Wood Burning Green Wood Lack of O 2 During Combustion Malfunctioning Appliances Malfunctioning Exhaust Systems

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

Common Sources of Carbon Monoxide Pollution WATER HEATERS & FURNACES FIREPLACES

Sources (Cont. ) VEHICLE EXHAUST SMOKING INDOORS

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

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

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

Prevent Accidental CO Poisoning List of DO’s DETECTORS DO- Install a Batteryoperated 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. UNITS WITH DIGITAL READOUT BETTER THAN UNITS WITHOUT

Prevention DO’s 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

Prevention DO’s 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

Prevention DO NOT’s 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

Note on Portable Generators 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

Prevention DO NOT’s 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

What To Do. Emergency Responders Turn On Your Gas Detector Perform a Fresh Air Calibration in Fresh Air Review Your Department SOP/SOG/OD Regarding Carbon Monoxide Calls Periodically Always Remember Safety First!

Understanding Your Detector. Civilian While the PFA does not recommend specific brands, we suggest detectors with digital readers give you more accurate information than those without 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

Understanding Your Monitor Emergency Responder The User Should Review Monitor’s Instruction Manual Periodically If You Have Further Questions, Refer to Your Department’s Monitor Technician(s) Monitor Should Be Properly Calibrated Every other shift (on each shift’s first day) Anytime It’s Exposed to 200 ppm or Higher

Exposure Limits 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

Action Levels- Lower Limits 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

Action Levels- Medium Limits 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

Action Levels- Higher Limits 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

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

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

Treatment of CO Poisoning For Victims of Acute and/or Mild Exposure 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

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

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

Most Common Culprits (in order): 1. 2. 3. 4. 5. HVAC (44% of All CO Calls) Water Heater Other Appliances (Stove, Oven, Dryer) A Running Vehicle Parked in the Garage or Drive Way (With the Front Door Open) Wood Stove, Fireplace (Gas or Wood)

Interesting Tidbits 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%

More Statistics 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 O 2

General Symptoms by Exposure -From NFPA 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

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 13 Minutes of Exposure

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

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

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.

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

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

References http: //www. osha. gov/SLTC/healthguidelines/carbo nmonoxide/recognition. html http: //www. carolinafirejournal. com/Articles/Article Detail/tabid/191/Article. Id/107/Carbon-monoxide -poisoning. aspx http: //www. carbonmonoxidekills. com/32/carbon_ monoxide_facts http: //www. osha. gov/Publications/3282 -10 N-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. a sp http: //www. cdc. gov/mmwr/preview/mmwrhtml/mm 5650 a 1. htm http: //www. homedepot. com/Buying-Guide-Smoke. Carbon-Monoxide-Detectors/h_d 1/NCC 1701/h_d 2/Content. View? pn=Smoke_Carbon_Mon oxide_Detectors&store. Id=10051&lang. Id=1&catalog. Id=10053 http: //www. osha. gov/SLTC/healthguidelines/carbo nmonoxide/recognition. html