Plastics and glues used in the manufacture of household furnishings and products have become a nightmare for emergency medical crews. Increasingly, they must contend with victims of the carbon monoxide and hydrogen cyanide gases emitted when those synthetic materials burn.
As a remedy, the Fulton County Commissioners will consider a request by county EMS Medical Director Dr. Dan Hoffman to purchase innovative equipment and antidotal medicine to detect and fight the effects.
Dr. Hoffman wants to see each fire station in the county in possession of at least one RAD-57, an oximeter that almost instantly detects carbon monoxide levels in the body. Portable and lightweight, the machine can be carried from person to person at an emergency scene, and determine what level of treatment is necessary.
Manufactured by the Masimo Corporation of Irvine, Calif., the RAD-57 would be carried on county ALS units to calls at industries and homes. Dr. Hoffman said an infrared light on the machine analyzes a person’s blood in seconds to determine whether it contains carbon monoxide, and in what amount. An EMS protocol then places the amount at one of three levels to decide whether the victim requires treatment at a hospital or within a hyperbaric chamber.
Area EMS crews presently use a bulkier carbon monoxide monitor that possible victims of carbon monoxide poisoning must be taken to. The hand-held RAD-57 can conveniently be carried from person to person, and operates similarly to the pulse oximeter routinely attached to a hospital patient’s finger.
It’s especially handy for checking firefighters, who are required to be tested for carbon monoxide before switching to a new oxygen tank. “The beauty of it is that it takes less time to do the test than it does to change an oxygen bottle,” Dr. Hoffman said.
He said he is pushing for the purchases because the release of harmful gases is becoming more prevalent at emergency scenes. Carbon monoxide can be insidious due to its undetectable odor, and can mislead by causing heart attack-like symptoms. It also can have a delayed effect in which symptoms don’t appear until later.
Although available for the past several years, the RAD-57 has improved with advancements in technology.
“The synthetic products that are burned in the home release more carbon monoxide than they used to,” Dr. Hoffman said. “When everything was made of wood, carbon monoxide was not a big deal. The reason for the push for the RAD-57 is that more and more it’s become a problem.”
In his 12 years at the Fulton County Health Center he can’t recall the emergency room treating as many cases of carbon monoxide poisoning as occurred this past winter. He said the increase might be attributed to the unusually cold weather and the shortage of propane.
He became aware of the RAD-57 during a Smoke Coalition seminar he attended with Wauseon Fire Chief Rick Sluder in Lansing, Mich., last summer. The theme was that poison gases “are really emerging as a big problem for victims and firefighters,” he said.
Dr. Hoffman has also requested the county purchase Cyanokit, which contains a new form of antidote to counteract the effects of hydrogen cyanide poisoning. Also released by manufacturing plastics and glues, the cyanide is 35 times more lethal than carbon monoxide and can kill in small doses.
Injected in an intravenous form, the antidote in the kit is the only field antidote for hydrogen cyanide, also called prussic acid. The antidote scavenges cyanide off of body cells and creates vitamin B12 in its place. It is harmless if injected into a person without hydrogen cyanide poisoning.
Sluder said if concentrated enough, hydrogen cyanide can be fatal in a single breath of smoke. A person felled by the lethal toxin must receive the antidote within seven to 10 minutes. “That’s why we need to have (the Cyanokits) on the squads,” he said.
He added that the kit, manufactured by Meridian Medical Technologies, would have been useful during two or three emergency situations in the county last year.
The RAD-57 can retail for $795; one injection of antidote in the Cyanokit costs an estimated $600-$800. Both Dr. Hoffman and Sluder hope the expense won’t be considered cost prohibitive.
“We think it’s important everyone has access to it, but we also understand we have budgets with which to operate,” Dr. Hoffman said. “We have not excluded any options in paying for them.”
Sluder said both “are a great investment for everyone in the county. It’s not a lot of money when you look at the big picture.”
He said, dependent upon the situation, the cost of the antidote may be covered by health insurance.
Commissioner Paul Barnaby said the commissioners will likely decide on Dr. Hoffman’s recommendation within the next couple of weeks.
“We’re leaning that way, but I can’t say we’ve officially made that decision,” he said.
Commissioner Bill Rufenacht said a meeting to gather input from the county’s fire chiefs will be scheduled.