The
Silent Killer!
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This Presentation Was Designed to Give General
Information About Carbon Monoxide for:
Emergency Responders
Fire
 EMS
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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
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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
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CO Basics- the Hidden Danger
At Risk Populations
Accidental Poisoning Prevention
What to do when you encounter CO
Both the Public and Emergency Responders
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Symptoms of CO Poisoning
Treatments
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Civilian
BLS
ALS
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Understanding your CO Detector/Monitor
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Residential/Commercial and RAE Systems
Exposure Limits
Local Statistics
Charts
Headlines
Technical Data
 Physical

& Chemical Properties
References
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CO is a compound
of Carbon and
Oxygen
 One atom carbon to one
atom oxygen
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Colorless
Odorless
Tasteless
POISONOUS Gas
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CO is Produced by the
Incomplete Combustion of
Various Fuels
(Hydrocarbons) , Including:
Coal
 Wood
 Charcoal
 Oil
 Kerosene
 Propane
 Natural Gas
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Note production of CO from
the fire on right
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Reaction That Does Not
Convert All of a Fuel's
Carbon and Hydrogen
Into Carbon Dioxide and
Water, Respectively
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Example, Incomplete
Combustion of Carbon
Produces Carbon
Monoxide, Carbon
Dioxide and Water.
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Smoldering Fires
Burning Wet Wood
Burning Green Wood
Lack of O2 During
Combustion
Malfunctioning
Appliances
Malfunctioning
Exhaust Systems
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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
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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:
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The Very Young
The Very Old
Pregnant Women & Most Important- their Fetus
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Fetal Hemoglobin has an Even Higher Affinity for CO Than
Adult
People With Existing Respiratory Compromise
Firefighters
DETECTORS
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DO- Install a Batteryoperated CO Detector
In Your Home
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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
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DO- Have Annual Inspections of Your SolidFuel 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
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DO- Seek Prompt
Medical Attention If
You Suspect CO
Poisoning
You and/or Family
Feeling:
Dizzy
 Light-headed
 Nauseous
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 Especially if CO Alarm
is Sounding
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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
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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:
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Windows
Doors
Vents/Air Intakes
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DO NOT- Run a Car or Truck Inside a Garage
Attached to Your House
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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
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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
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 From Cell Phone
 Neighbor House/Business
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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)
REASONS FOR CO
SUSPICION
DO NOT
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Please Do Not Open
Windows & Doors
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This is a Common Reaction
A Closed Building Helps
Fire/Gas Company
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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
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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
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At PFA This is The Operational Directive Section
3.3.4: “Carbon Monoxide Alarm Response”
Always Remember Safety First!
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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
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While the PFA does not recommend
specific brands, we suggest detectors
with digital readers give you more
accurate information than those without
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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
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The User Should Review
Monitor’s Instruction Manual
Periodically
If You Have Further Questions,
Refer to Your Department’s
Monitor Technician(s)
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At PFA- Station 10
Monitor Should Be Properly
Calibrated
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Once Per Month
Anytime It’s Exposed to 200 ppm
or Higher
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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
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0 to 9 ppm- Normal
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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
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36 to 99 ppm- Excessive: Medical Alert
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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
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Professionals Required From this Point On Fire/EMS
 Gas Company/Contractor
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100 – 200 ppm- Dangerous: Medical Alert
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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
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Greater than 200 ppm- Very Dangerous:
Medical Alert
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Actions: Same as Above
•
•
•
•
•
•
•
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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:
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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
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Move Victims to Fresh Air Immediately
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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
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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
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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
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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
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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. Septemb
er
10. July
11.
August
12. Ma
y
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)
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Other Interesting Culprits:
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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%
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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
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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
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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
The Lofgren Family Photo; Parker, Caroline, Owen and Sophie
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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
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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
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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
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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
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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.
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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
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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
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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/c
arbonmonoxide/recognition.html
http://www.carolinafirejournal.com/Articles/Ar
ticleDetail/tabid/191/ArticleId/107/Carbonmonoxide-poisoning.aspx
http://www.carbonmonoxidekills.com/32/carbo
n_monoxide_facts
http://www.osha.gov/Publications/3282-10N05-English-07-18-2007.html
http://en.wikipedia.org/wiki/Carbon_monoxide
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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-GuideSmoke-Carbon-Monoxide-Detectors/h_d1/NCC1701/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