Ossining VAC CO Incident discussion Nov 12, 2010

[helicopper 1,050]

Stamford EMS has been carrying one CO device per unit for about six months. We have a RAD unit from Massimo on the tour supervisor's truck, and we're switching to LP-15s with CO monitoring capability. That being said, OVAC has always been among the first to field new diagnostic tools including glucometers and pulse oximetry. Many agencies are still in the process of adopting CO monitors-but remember, change occurs at different rates in different organizations. Criticizing an agency without knowing the internal structure(s) that govern change is a pointless exercise.

A couple of points of clarification please.

When you say "RAD" unit is that a name brand, abbreviation, or radiation detector?

With regard to all the CO monitors that are being discussed, particularly with those associated with pulse oximetry or LP-15 (or similar), are these ambient air monitors for CO or for end-tidal CO2 monitoring?

Thanks!

[Ladder44 73]

Dräger X-am 5000 the ideal companion for personal protection.

Used by FD's here in the county attached to portable radio straps...on all calls.

As far as calling it CO2 instead of CO that could be a training issue. PD's quite often dispatch calls as CO2 activations.

Glad the OVAC crew is recovering. This could happen to anyone of us !

http://www.draeger.com/US/en_US/

If its worn on all calls then wouldn't it go off in fire conditions with all the off product of a fire??

[TR54 239]

If its worn on all calls then wouldn't it go off in fire conditions with all the off product of a fire??

correction except during fire attack with full PPE SCBA ie. hose line advancement.

EMS calls "yes" ie. flu-like symptoms ect. Found a resident heating his room with a BBQ prior toa friend calling for EMS. This was due to no heat in the apartment.Pt was unresponsive .

Even on fire inspections of commercial businesses where levels of CO were found from a defective Hot Water heater in a popular store. Repairs were made by the store chain and the vent pipe was checked at a later date.

Good tool to have.

[ny10570 745]

But as multi gas detector, its a bit overkill. A simple single gas CO detector is cheap and so easy to use. Rugged ones on the market today for around $200 are water resistant, impact resistant, have at least a 5 year life cycle and need calibration every 6 months or as long as 2 years. Attach it to your bag turn it on, and forget about it till it makes a noise, because they tell you when they need to be calibrated, have the battery changed, or what CO levels your getting. Hell, even FDNY took their sweet time rolling them out, but after this no agency in the area should be without them. There is zero excuse with all the powered stretchers and short ambulance life span in Westchester.

[antiquefirelt 994]

When you say "RAD" unit is that a name brand, abbreviation, or radiation detector?

The RAD-57 by Massimo is a CO in blood measuring device that works like a pulse oximeter, non-invasive. We've had one since they came out and it's been great for convincing those who try to sign off instead of being seen in the ED. At first the ED was skeptical, and after hearing from their respiratory docs, they now trust the instant reading to begin treatment or shipment to a hyperbaric chamber as they wait for blood gas results.

[ny10570 745]

Be careful with the Rad57. In the largest independent study yet comparing the Rad57 readings to the lab measured values, the Rad57 was so inaccurate as to make it unreliable for treatment decisions or triage. In my personal experience, ensuring the light blocking cover is used and the finger is clean helped get more consistent readings, but I have no idea if they're accurate.

Study Link

Edited November 24, 2010 by ny10570

[DR104 141]

correction except during fire attack with full PPE SCBA ie. hose line advancement.

EMS calls "yes" ie. flu-like symptoms ect. Found a resident heating his room with a BBQ prior toa friend calling for EMS. This was due to no heat in the apartment.Pt was unresponsive .

Even on fire inspections of commercial businesses where levels of CO were found from a defective Hot Water heater in a popular store. Repairs were made by the store chain and the vent pipe was checked at a later date.

Good tool to have.

Good tool to have when doing overhaul too

[jack10562 414]

Good tool to have when doing overhaul too

Absolutely. This is a critical time where many guys (gals) are most vulnerable, especially if stuff is still smoldering, (still making CO, and whatnot) people are working in there, usually with no mask.

[antiquefirelt 994]

Be careful with the Rad57. In the largest independent study yet comparing the Rad57 readings to the lab measured values, the Rad57 was so inaccurate as to make it unreliable for treatment decisions or triage. In my personal experience, ensuring the light blocking cover is used and the finger is clean helped get more consistent readings, but I have no idea if they're accurate.

Study Link

Interesting, as always there are studies on both sides of this. Thankfully, our pre-hospital use is relegated to "ruling in" CO poisoning vs. ruling it out. Meaning, if you're exposed to abnormal CO levels we'll try and convince you to go, the RAD-57 can help. We would not use the RAD 57 to determine a person is safe to sign off, though the higher the number the more convincing it can be to get them checked in the ED. Any patient displaying sign/symptoms will get the RAD-57, but the care would be the same with or without, high flow O2 and recommendation for the hyperbaric chamber. Sadly in Maine where diving is an industry as well a past time, there are only 2 hyperbaric chambers statewide.

[Bnechis 3,961]

A couple of points of clarification please.

When you say "RAD" unit is that a name brand, abbreviation, or radiation detector?

None of the above. Its an adjective, like great; AWESOME; COOL. Somewhat antiquated - more commonly used in the 1980s. From "radical". i.e. that skateboard is totally rad.

Goes along with narly & dude.

[ny10570 745]

Interesting, as always there are studies on both sides of this. Thankfully, our pre-hospital use is relegated to "ruling in" CO poisoning vs. ruling it out. Meaning, if you're exposed to abnormal CO levels we'll try and convince you to go, the RAD-57 can help. We would not use the RAD 57 to determine a person is safe to sign off, though the higher the number the more convincing it can be to get them checked in the ED. Any patient displaying sign/symptoms will get the RAD-57, but the care would be the same with or without, high flow O2 and recommendation for the hyperbaric chamber. Sadly in Maine where diving is an industry as well a past time, there are only 2 hyperbaric chambers statewide.

This is the largest independent study of RAD57 results. Everything else was either a very small sample set or performed by Mossimo as a part of the FDA approval process.

[Tapout 42]

Barry, your post is the funniest thing I have heard all day. Rough shift. Needed it. Thanks, dude!

[antiquefirelt 994]

This is the largest independent study of RAD57 results. Everything else was either a very small sample set or performed by Mossimo as a part of the FDA approval process.

While it's the largest, there have been numerous other studies showing consistent favorable results. Like so many other medical products (drugs, treatments and equipment) the results seem to vary. Right now, this is the only pre-hospital product available to assist in ruling in CO, and with many medical directors and respiratory docs putting their faith in the device, short of an FDA recall, I doubt you'll see these fall out of favor. Of course the negative study, proves why all of us should be highly skeptical when signs, symptoms and known exposures do not produce anticipated results. Treating the patient rather than any device is wise.

[helicopper 1,050]

While it's the largest, there have been numerous other studies showing consistent favorable results. Like so many other medical products (drugs, treatments and equipment) the results seem to vary. Right now, this is the only pre-hospital product available to assist in ruling in CO, and with many medical directors and respiratory docs putting their faith in the device, short of an FDA recall, I doubt you'll see these fall out of favor. Of course the negative study, proves why all of us should be highly skeptical when signs, symptoms and known exposures do not produce anticipated results. Treating the patient rather than any device is wise.

Results of studies depend a lot on who is funding the study. Interesting how that seems to work out.

[ny10570 745]

Results of studies depend a lot on who is funding the study. Interesting how that seems to work out.

thank you for understanding the importance of the first large independent study being so negative