Baltimore County Fire Department Carbon Monoxide Standard Operational Procedure

• S.O.P. Identification: TACT #19

• Subject: Carbon Monoxide Incidents.

• Division: Emergency Operations.

• Revision Date: 12/09/16.

• Objective: To provide Baltimore County Fire Department personnel with comprehensive guidelines for responding to carbon monoxide (CO) incidents, ensuring the safety of civilians and personnel, and identifying thresholds for evacuation based on health effects and individual well-being.

General Information and Properties of Carbon Monoxide

• Definition: Carbon Monoxide (CO) is a colorless, odorless, and tasteless gas resulting from the incomplete combustion of fossil fuels, including natural gas, oil, coal, and wood. Due to its properties, it presents a significant risk for poisoning.

• Physical Characteristics:

  • Slightly lighter than air, which can lead to accumulation in enclosed spaces.

  • Flammable and explosive in very high concentrations, requiring strict safety measures during occupational exposure.

  • Vapor Density: $0.967$, indicating how it disperses in air.

  • Lower Explosive Limit (LEL): 12.5\text{%}, which is the smallest concentration in air that can ignite.

  • Upper Explosive Limit (UEL): 74\text{%}, which is the highest concentration in air that can ignite.

  • Auto-ignition Temperature: $1128\text{ }^{\text{°F}}$, the temperature at which CO can ignite without an external flame.

• Biological Mechanism: CO is absorbed into the bloodstream through inhalation, leading to carbon monoxide poisoning. It causes symptoms such as illness, coma, and death by interfering with the binding of oxygen to hemoglobin, myoglobin in the heart, and muscle tissue. Hemoglobin has an affinity for CO that is $200\text{--}300$ times greater than for oxygen. The resulting compound, Carboxyhemoglobin, inhibits oxygen transport, resulting in hypoxia and potential organ damage.

• NFPA 704m Classification:

  • Health: $3$ (high)

  • Fire: $4$ (extreme hazard)

  • Reactivity: $0$ (minimal hazard)

Detection Equipment and Capabilities

• Suppression Companies: All suppression companies are equipped with advanced gas meters capable of accurately detecting CO at various concentrations.

• EMS Units (LP15 or Newer): Equipped with high-tech cardiac monitors that can measure blood CO levels via a fingertip sensor (pulse oximeter), critical for assessing health impacts on exposed individuals.

• Medical Bag Meters: Each EMS unit's medical bag includes a single sensor CO meter designed to alarm when CO readings are between $10\text{ }PPM$ and $35\text{ }PPM$, allowing for early detection of elevated levels.

• Detector Discrepancies: Responders must clarify to occupants that fire department meters provide real-time ambient readings. Residential detectors may activate due to cumulative CO exposure over days, weeks, or months, potentially resulting in conflicting readings; thus, a fire department meter might show $0\text{ }PPM$ even if a residential alarm has been triggered.

Response Policies and Dispatch

• Detector Activation (No Symptoms):

  • Dispatch Action: Instruct the caller to leave the building immediately, taking caution as CO can be lethal.

  • Unit Response: A closest unit equipped with a CO meter is dispatched on a non-emergency basis to assess the situation.

• Detector Activation (With Symptoms): Symptoms include headache, nausea, vomiting, loss of coordination, altered mental status, or flu-like symptoms in humans or pets.

  • Dispatch Action: Advise the caller to alert all individuals in the building to evacuate to a safe location, preferably outdoors. Utilize building fire alarms if available. The caller must remain on-site until fire department arrival.

  • Unit Response: A medic unit is dispatched to assess potentially exposed individuals and determine necessary medical interventions.

• EMS Bag Alarm: If a medical bag CO sensor alarms, the crew must immediately request a CO response, evacuate themselves, and follow established evacuation procedures for the building to ensure safety.

Tactical Considerations and Investigation

• Ventilation: DO NOT VENTILATE the building until a functioning CO meter is on-scene and the source of the leak or problem is identified. Ventilation before assessment could disperse CO and complicate detection. The only exception is for life safety situations where immediate evacuation is impossible.

• PPE and Safety:

  • Personnel must evacuate immediately if a CO meter alarms.

  • If entry is necessary while a meter alarms, personnel must wear full protective equipment, including SCBA, to mitigate inhalation risk.

  • The "Two-In, Two-Out" policy must be strictly adhered to at all times for personnel safety during rescue operations.

• Over Range Readings: Readings appearing as "OR" (Over Range) signify CO levels exceeding $999\text{ }PPM$, indicating an extreme hazard. Areas registering these readings must be evacuated immediately, and additional resources may be needed.

• Adjoining Structures: If a primary structure shows CO levels of $10\text{ }PPM$ or higher, crews must monitor adjoining buildings, such as adjacent townhouses, to prevent cross-contamination and ensure overall safety.

• Appliance Mitigation: Malfunctioning appliances, such as heaters or stoves, must be shut down immediately. Occupants must be advised not to turn the equipment back on until it has been serviced by a qualified technician. Responsibilities for repairs lie with the property owner and should be documented appropriately.

Action Levels and Occupant Guidance (Form 152)

• Less than $10\text{ }PPM$:

  • Advise residents that no significant CO levels were found and suggest checking their detector per manufacturer instructions and replacing the battery/module if needed.

• $10\text{ }PPM$ to $34\text{ }PPM$ (Marginal):

  • Potential health hazard for sensitive populations, including pregnant women, small children, the elderly, and individuals with underlying heart or respiratory problems. Evacuation is strongly recommended during investigation until confirmation of safe levels.

• $35\text{ }PPM$ to $99\text{ }PPM$ (Excessive):

  • Potential health hazard for the previously mentioned sensitive groups. Evacuation is highly recommended during investigation to minimize exposure risks.

• Over $100\text{ }PPM$ (Dangerous):

  • Emergency conditions exist with serious implications for anyone exposed. Evacuation is mandatory until the source is identified and mitigated effectively.

Documentation and Reporting

• Form 153 (Carbon Monoxide Worksheet): This document guides investigations, helping to establish cause/origin and record readings (including outside background, highest inside, and final readings). It must be submitted to Fire Records via inter-office mail for accurate record-keeping.

• Form 152 (Notice of Dangerous Situation): This form must be filled out if CO levels reach $10\text{ }PPM$ or greater. It provides guidelines and documentation of fire department findings to the occupant and must be explained thoroughly and signed by the occupant for legal purposes.

• NFIRS Reporting: All data recorded on Form 153, including scene actions and recommendations to occupants, must be meticulously entered into the NFIRS report narrative and the carbon monoxide-specific tab for compliance and analysis.

• Rental Properties: If CO levels exceed $50\text{ }PPM$ in a rental property, the Department of Permits, Approvals, and Inspections (PAI) will receive the NFIRS data and conduct a follow-up inspection to ensure a licensed contractor has corrected the problem, safeguarding tenants’ health.

• Assisted Living Facilities: Any leaks identified at assisted living facilities (including private homes providing such care) must be reported to the State of Maryland Complaint Coordinator at $410\text{-}402\text{-}8184$ for immediate assistance and guidance on health and safety protocols.

Medical Symptoms and Health Thresholds

• System-Specific Signs:

  • Cardiovascular: Symptoms may include collapse, arrhythmias, angina, or acute myocardial infarction due to oxygen deprivation.

  • Respiratory: Tachypnea (increased respiratory rate) followed by slow irregular respirations, respiratory arrest, and pulmonary edema, making exposure extremely dangerous.

  • CNS: Neurological effects may manifest as depression, coma, dizziness, tinnitus, weakness, hallucinations, seizures, visual disturbances, and cerebral edema (increased intracranial pressure).

  • Skin: Symptoms can include cyanosis (a bluish discoloration of the skin), pallor, and rarely, a characteristic "cherry red" color due to high levels of CO exposure.

  • Metabolism: A risk of lactic acidosis can occur, leading to metabolic disturbances.

• PPM Exposure Effects:

  • $35\text{ }PPM$: OSHA maximum permissible exposure limit for an $8$-hour workplace exposure.

  • $9\text{ }PPM$: EPA maximum residential level over an $8$-hour average, which indicates a safe household level.

  • $200\text{ }PPM$ ($2\text{--}3$ hours): Mild headache, fatigue, nausea, and dizziness may occur, and prolonged exposure can exacerbate symptoms.

  • $400\text{ }PPM$ ($1\text{--}2$ hours): Serious headache presents; life-threatening scenarios can develop after $3$ hours.

  • $800\text{ }PPM$ ($45$ minutes): Symptoms like dizziness, nausea, and convulsions may develop rapidly; unconsciousness can occur within $2$ hours leading to death within $2\text{--}3$ hours.

  • $1600\text{ }PPM$ ($20$ minutes): Highly lethal concentrations where death can occur within $1$ hour of exposure.

  • $12,800\text{ }PPM$ ($1\text{--}3$ minutes): Causes death almost immediately due to rapid asphyxiation.

• Patient Care: Any symptomatic patients or those with high readings (particularly vulnerable populations like pregnant women) should be transported to the closest appropriate medical facility. If a symptomatic patient refuses transport, a Medical Refusal form must be completed to document the incident and the patient's condition meticulously.