Selected Topics: Prehospital Care
Unrecognized Carbon Monoxide poisoning Leads To a Multiple-Casualty Incident

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Abstract

Background

Carbon monoxide (CO) is regarded as a leading cause of morbidity and mortality. It endangers not only patients, but also health care professionals, especially emergency medical services (EMS) personnel because CO exposure is often unknown at the time EMS is called.

Objective

Our objective was to report a case of unrecognized CO exposure during the treatment of a patient that finally led to the hospitalization of 11 EMS personnel.

Case Report

A 71-year-old man was found unconscious in the basement of his house. EMS was called and, due to ST-segment elevations on electrocardiogram, the patient was treated for acute coronary syndrome. Unknown to EMS personnel, ongoing CO exposure was the cause of the patient's symptoms. EMS staff finally had to be evacuated by firefighters, and a total of 12 persons, including the initial patient, had to be hospitalized.

Conclusions

In the prehospital setting, hazardous environments always have to be considered as potential causes of a patient's altered status. Together with the correct use of modern equipment, such as permanently switched-on CO detectors, this can help avoid harm to both patients and staff.

Introduction

Poisoning by gaseous agents endangers not only patients, but also emergency medical services (EMS) personnel. Within this group, carbon monoxide (CO) is regarded as a leading cause of morbidity and mortality, with 20,000 affirmed exposures and 439 deaths per year in the United States, not including fire-related cases 1, 2. During a 6-month period, suburban Chicago fire departments responded to 777 calls for sounding CO detectors, and a Pittsburgh emergency medical response center was called 101 times within 3 months because of possible CO poisoning 3, 4.

Section snippets

Case Report

Local EMS in a town of 11,000 inhabitants was contacted by a woman who found her husband lying unconscious on the floor of their house's basement at 5:30 pm. Austria, similar to Germany, operates a mainly physician-based EMS. Emergency medical technicians (EMTs) receive only basic training (260–740 h), and have to call a physician for all invasive procedures. Therefore, in case of a suspected life-threatening event, emergency dispatch centers will send out an ambulance crew consisting of an

Discussion

The pathophysiology of CO poisoning is primarily based on two mechanisms. On the one hand, CO binds to hemoglobin (Hb) with an affinity 210 times higher than oxygen. In the first place, oxygen is displaced easily, later CO hardly liberates from Hb, again decreasing the fraction of Hb available for oxygen transport. On the other hand, CO has also been shown to cause direct cell damage (5). The heart is especially prone to CO-mediated damage. Because oxygen extraction is already at a maximum

Conclusions

This is a report of a case in which unrecognized exposure to CO during the treatment of an unconscious STEMI patient led to the hospitalization of 11 EMS personnel. Hazardous environments must always be considered as potential causes of a patient's altered status. Together with the correct use of modern equipment, such as permanently activated CO detectors, this might help to avoid harm to both patients and staff.

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