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
the fire on right
 Natural Gas
 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        7.      October
3.      February             8.      June     9.     
4.      November        September     10.    July
5.      March        6.           11.    August
April             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_Monoxide_Detectors&storeId
=10051&langId=-1&catalogId=10053
 http://www.osha.gov/SLTC/healthguidelines/c
arbonmonoxide/recognition.html