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Paramedics Corner: Winter Awareness Day and a silent killer
Paramedics Corner: Winter Awareness Day and a silent killer

Gary Carmack
Missouri experienced severe winter weather storms the last couple of years, which left thousands of people without power, and caused a lot of property damage. Therefore, the National Weather Service and the State Emergency Management Agency (SEMA) set Wednesday, Nov. 19, 2008, as Winter Awareness Day.

The purpose of this campaign is to encourage citizens to prepare for winter and reminds people how to protect themselves during a severe winter storm. A winter storm may range from moderate snow over a few hours to blizzard conditions lasting for several days. After the 2007 and 2008 winter storms, many areas went without power for days and many for weeks.

Two important terms to remember: WINTER STORM WATCH indicates that a severe winter storm may affect your area. WINTER STORM WARNING means severe winter weather is in the area or expected immediately.

Preparing for winter storms: First emergency planning: make a family emergency plan and create an emergency kit. Purchase a tone alert weather radio and listen for the latest weather updates. Make sure any alternate heating sources are functioning safely and appropriately; and make sure you have adequate fuel. Example, make sure your fireplace or kerosene heater works properly. Be sure you have plenty of wood or kerosene. Make sure generators are working properly. Insulate the attic and windows. Prepare an emergency winter car kit. Include blankets, a spare radio with batteries, jumper cables, flares, a shovel, sand or shingles to provide traction for your tires. Also, include some emergency food, snacks or energy-type food.

For more information check these websites:

Missouri’s Ready in 3 program: http://www.dhss.mo.gov/Ready_in_3

SEMA: http://sema.dps.mo.gov/semapage.htm then click on the 2008 Winter Awareness Link.

Missouri Department of Transportation’s Road Conditions: www.modot.org

FEMA’s Winter Awareness Campaign: http://www.fema.gov/areyouready/winter.shtm

NWS St. Louis Winter Campaign: http://www.crhnoaa.gov/lsx/?n=winterday

NWS Winter Deceptive Killer Brochure: http://www.weather.gov/os/brochures/winterstorm.pdf

Carbon Monoxide (CO).

With winter on the way and heating appliances operating this is also a good time to review carbon monoxide poisoning. Carbon Monoxide (CO) is also known as: “The Silent Killer.”

Signs and symptoms of CO poisoning may include: headache, confusion, nausea, fatigue, memory loss, seizures, vomiting, and/or loss of coordination. The victim may have chest pain, drowsiness, dizziness, pressure in the head, or roaring in the ears.

There is such a large span of variability in symptoms among different individuals having the same exposure; that rescuers should consider the possibility of CO poisoning whenever called to an epidemic of varying symptoms among a group of people sharing the same building for any period of time.

CO is produced during the incomplete combustion of organic fuels, most commonly in vehicles or home heating devices. This is why CO poisoning is predominantly a winter phenomenon.

The fire service and Emergency Medical Services (EMS) receive frequent calls for CO related problems. The fire service receives a lot of calls to respond and check for CO problems—especially in the winter. This is probably a result of better public education regarding the hidden dangers of CO. Some things we can’t see, smell, taste or hear can kill us. This is the story of CO, being an odorless, tasteless and colorless gas—CO can kill unsuspecting people.

CO is slightly lighter than air, has a specific gravity of 0.97 % and an explosive range of 12.5 % to 74 %. CO is considered a hazardous material. Co is lethal in minutes at 1.28 % and it can asphyxiate a person long before it poses an explosive danger.

What makes CO so deadly is its potent affinity for hemoglobin—200 times that of oxygen. Thus the CO takes up the receptor sites on the hemoglobin and oxygen can no longer be transported to the tissues. As CO competes with the O2 molecules for the binding sites of hemoglobin, and because CO has a much stronger affinity, the CO usually wins. The result is hypoxia at the cellular level with suffocation at the cellular level and eventual death.

Whenever a bunch of people with a bunch of different symptoms are all together in the same place, a high index of suspicion of CO poisoning is imperative! If confronted with the aforementioned criteria—suspect CO poisoning until proven otherwise. Get the people out from the site of exposure. Call 911 and request fire, police and EMS services immediately.

Keep in mind that CO from vehicles is commonly used as a way of committing suicide…or murder. If there is a death do not disturb the death scene. In some cases a scene created to appear as a suicide may turn out to be a homicide. Do not disturb the scene any more than necessary to save the person.

Remember, CO poisoning can mimic several illnesses. Many times people have mistaken CO poisoning for the flu. The flu often presents with headache, nausea, vomiting and fatigue. This requires a focus on obtaining a good history. Have other people been sick? Have the people been out in the fresh air, or inside. Is a furnace on? By the way, the old “cherry-red skin everyone was taught years ago—is a very late sign, and in fact many physicians say they rarely see the cherry-red skin. So, don’t depend on that; waiting for cherry-red skin to suspect CO poisoning may be a death sentence.

The treatment consists of first removing the victim from the environment causing the CO poisoning, then administer 100 % oxygen (O2) for a long period of time. It takes awhile to remove the Co from the body. If a person is comatose a transfer to a Hyperbaric Oxygen Chamber might be necessary to speed up the elimination time of the CO.

What you can do until emergency help arrives: Get the victim (and yourself) out of the environment causing the problem, call 911 immediately, and keep the patient as quiet and restful as possible to minimize their O2 demand.

As soon as the firefighters and paramedics arrive they will administer high-flow 100 % O2, establish an IV, and monitor the cardiac rhythm with an EKG monitor.

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