The

Silent 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 Note production of CO from
 Natural Gas 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 Note the bright blue &
Stoves Safe (right) uniform flames- indication of
Complete Combustion
WATER HEATERS &
FURNACES FIREPLACES
VEHICLE EXHAUST SMOKING INDOORS
 PORTABLE PROPANE
PORTABLE GENERATORS 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
 UNITS WITH DIGITAL READOUT
DETECTORS 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
 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)
REASONS FOR CO
SUSPICION
 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

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
 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 • Difficulty in
• Dizziness Coordinating
• Irritability • Difficulty in Breathing
• Confusion/Memory • Chest Pain
Loss • Cerebral Edema
• Disorientation • Convulsions/Seizures
• Nausea and Vomiting • Coma
• Abnormal Reflexes • 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 7. October
 8.
. November
 5 June
 9. Septe
. March
 6. mber
 10. July

April
 11. August
 12
. May
1. HVAC (44% of All CO Calls)
2. Water Heater
3. 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 Reported

NFPA 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  OSHA- Occupational

on the risk of Safety & Health Admin
cardiovascular effects  NIOSH- National
 The ACGIH limit is based Institute for
Occupational Safety and
on the risk of elevated Health
carboxyhemoglobin levels
 ACGIH- American
(a Condition where CO is Conference of
Present in Red Blood Cells Governmental
Instead of Oxygen) Industrial Hygienists
http://www.osha.gov/SLTC/healthguidelines/c
arbonmonoxide/recognition.html
http://www.carolinafirejournal.com/Articles/Ar
ticleDetail/tabid/191/ArticleId/107/Carbon-
monoxide-poisoning.aspx
http://www.carbonmonoxidekills.com/32/carbo
n_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_guidanc
e.asp
 http://www.cdc.gov/mmwr/preview/mmwrht
ml/mm5650a1.htm
 http://www.homedepot.com/Buying-Guide-
Smoke-Carbon-Monoxide-Detectors/h_d1/NCC-
1701/h_d2/ContentView?pn=Smoke_Carbon_Mo
noxide_Detectors&storeId=10051&langId=-
1&catalogId=10053
 http://www.osha.gov/SLTC/healthguidelines/c
arbonmonoxide/recognition.html