Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-24T04:03:23.434Z Has data issue: false hasContentIssue false
  • English
  • Français

Mass Casualty Triage in the Case of Carbon Monoxide Poisoning: Lessons Learned

Published online by Cambridge University Press:  10 October 2017

Mathieu Pasquier ,
Fabrice Dami ,
Pierre-Nicolas Carron ,
Bertrand Yersin ,
Rodrigue Pignel  and
Olivier Hugli
Mathieu Pasquier*
Affiliation:
Department of Emergency Medicine, University Hospital Centre (CHUV), Lausanne, Switzerland
Fabrice Dami
Affiliation:
Department of Emergency Medicine, University Hospital Centre (CHUV), Lausanne, Switzerland
Pierre-Nicolas Carron
Affiliation:
Department of Emergency Medicine, University Hospital Centre (CHUV), Lausanne, Switzerland
Bertrand Yersin
Affiliation:
Department of Emergency Medicine, University Hospital Centre (CHUV), Lausanne, Switzerland
Rodrigue Pignel
Affiliation:
Department of Emergency Medicine, Hyperbaric Unit, University Hospital Centre (HUG), Geneva, Switzerland
Olivier Hugli
Affiliation:
Department of Emergency Medicine, University Hospital Centre (CHUV), Lausanne, Switzerland
*
Correspondence and reprint requests to Mathieu Pasquier, MD, Emergency Service, University Hospital Centre, BH 09, CHUV, 1011 Lausanne, Switzerland (email: [email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

Carbon monoxide (CO) can cause mass intoxication, but no standard triage algorithm specifically addresses CO poisoning. The roles of some recent diagnostic tools in triage as well as treatment with hyperbaric oxygen are controversial. We describe a mass casualty case of CO poisoning involving 77 patients, with a focus on the triage and treatment options decided on-site. The reasons for choosing these options are reviewed, and the pitfalls that occurred and the lessons learned from this major incident are described. We discuss the potential to improve the management of such an event and strategies to accomplish this, including simplifying triage and administering oxygen to all exposed persons for 6 h. (Disaster Med Public Health Preparedness. 2018; 12: 373–378)

Keywords

carbon monoxidehyperbaric chamberintoxicationoxygen treatmenttriage
Type
Concepts in Disaster Medicine
Information
Disaster Medicine and Public Health Preparedness , Volume 12 , Issue 3 , June 2018 , pp. 373 - 378
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Valerio, A, Verzè, M, Marchiori, F, et al. Managing a mass CO poisoning: critical issues and solutions from the field to the hyperbaric chamber. Disaster Med Public Health Prep. 2017;11(2):251-255. doi: 10.1017/dmp.2016.Google Scholar
2. Mortelmans, LJ, Populaire, J, Desruelles, D, et al. Mass carbon monoxide poisoning at an ice-hockey game: initial approach and long-term follow-up. Eur J Emerg Med. 2013;20(6):408-412. https://doi.org/10.1097/MEJ.0b013e32835d1dcc.Google Scholar
3. McGuffie, C, Wyatt, JP, Kerr, GW, et al. Mass carbon monoxide poisoning. J Accid Emerg Med. 2000;17(1):38-39. https://doi.org/10.1136/emj.17.1.38.Google Scholar
4. Klasner, AE, Smith, SR, Thompson, MW, Scalzo, AJ. Carbon monoxide mass exposure in a pediatric population. Acad Emerg Med. 1998;5(10):992-996. https://doi.org/10.1111/j.1553-2712.1998.tb02778.x.Google Scholar
5. Carbon monoxide poisoning at an indoor ice arena and bingo hall--Seattle, 1996. From the Centers for Disease Control and Prevention. JAMA. 1996;275(19):1468-1469. https://doi.org/10.1001/jama.1996.03530430012012.Google Scholar
6. Ely, EW, Moorehead, B, Haponik, EF. Warehouse workers’ headache: emergency evaluation and management of 30 patients with carbon monoxide poisoning. Am J Med. 1995;98(2):145-155. https://doi.org/10.1016/S0002-9343(99)80398-2.Google Scholar
7. Paulozzi, LJ, Satink, F, Spengler, RF. A carbon monoxide mass poisoning in an ice arena in Vermont. Am J Public Health. 1991;81(2):222. https://doi.org/10.2105/AJPH.81.2.222.Google Scholar
8. Burney, RE, Wu, SC, Nemiroff, MJ. Mass carbon monoxide poisoning: clinical effects and results of treatment in 184 victims. Ann Emerg Med. 1982;11(8):394-399. https://doi.org/10.1016/S0196-0644(82)80033-4.Google Scholar
9. Cone, DC, Koenig, KL. Mass casualty triage in the chemical, biological, radiological, or nuclear environment. Eur J Emerg Med. 2005;12(6):287-302. https://doi.org/10.1097/00063110-200512000-00009.Google Scholar
10. Buckley, NA, Juurlink, DN, Isbister, G, et al. Hyperbaric oxygen for carbon monoxide poisoning. Cochrane Database Syst Rev. 2011;4:CD002041.Google Scholar
11. Carron, PN, Reigner, P, Vallotton, L, et al. Implementation of a medical command and control team in Switzerland. Disasters. 2014;38(2):434-450. https://doi.org/10.1111/disa.12043.Google Scholar
12. Hampson, NB, Dunn, SL. UHMCS/CDC CO poisoning surveillance group. Symptoms of carbon monoxide poisoning do not correlate with the initial carboxyhemoglobin level. Undersea Hyperb Med. 2012;39:657-665.Google Scholar
13. Hampson, NB, Piantadosi, CA, Thom, SR, et al. Practice recommendations in the diagnosis, management, and prevention of carbon monoxide poisoning. Am J Respir Crit Care Med. 2012;186(11):1095-1101. https://doi.org/10.1164/rccm.201207-1284CI.Google Scholar
14. Roth, D, Bayer, A, Schrattenbacher, G, et al. Exposure to carbon monoxide for patients and providers in an urban emergency medical service. Prehosp Emerg Care. 2013;17(3):354-360. https://doi.org/10.3109/10903127.2012.761306.Google Scholar
15. Risavi, BL, Wadas, RJ Jr, Thomas, C, et al. A novel method for continuous environmental surveillance for carbon monoxide exposure to protect emergency medical service providers and patients. J Emerg Med. 2013;44(3):637-640. https://doi.org/10.1016/j.jemermed.2012.02.034.Google Scholar
16. Hampson, NB. Noninvasive pulse CO-oximetry expedites evaluation and management of patients with carbon monoxide poisoning. Am J Emerg Med. 2012;30(9):2021-2024. https://doi.org/10.1016/j.ajem.2012.03.026.Google Scholar
17. Nilson, D, Partridge, R, Suner, S, et al. Non-invasive carboxyhemoglobin monitoring: screening emergency medical services patients for carbon monoxide exposure. Prehosp Disaster Med. 2010;25(03):253-256. https://doi.org/10.1017/S1049023X00008128.Google Scholar
18. Henz, S, Maeder, M. Prospective study of accidental carbon monoxide poisoning in 38 Swiss soldiers. Swiss Med Wkly. 2005;135:398-408.Google Scholar
19. Hampson, NB, Hauff, NM. Carboxyhemoglobin levels in carbon monoxide poisoning: do they correlate with the clinical picture? Am J Emerg Med. 2008;26(6):665-669. https://doi.org/10.1016/j.ajem.2007.10.005.Google Scholar
20. Wolf, SJ, Maloney, GE, Shih, RD, et al; American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Carbon Monoxide Poisoning. Wolf, SJ, Maloney, GE, Shih, RD, Shy, BD, Brown, MD. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute carbon monoxide poisoning. Ann Emerg Med. 2017;69(1):98-107.e6. https://doi.org/10.1016/j.annemergmed.2016.11.003.Google Scholar
21. Weaver, LK. Clinical practice. Carbon monoxide poisoning. N Engl J Med. 2009;360(12):1217-1225. https://doi.org/10.1056/NEJMcp0808891.Google Scholar
22. Roth, D, Herkner, H, Schreiber, W, et al. Accuracy of noninvasive multiwave pulse oximetry compared with carboxyhemoglobin from blood gas analysis in unselected emergency department patients. Ann Emerg Med. 2011;58(1):74-79. https://doi.org/10.1016/j.annemergmed.2010.12.024.Google Scholar
23. Suner, S, Partridge, R, Sucov, A, et al. Non-invasive pulse CO-oximetry screening in the emergency department identifies occult carbon monoxide toxicity. J Emerg Med. 2008;34(4):441-450. https://doi.org/10.1016/j.jemermed.2007.12.004.Google Scholar
24. Sebbane, M, Claret, PG, Mercier, G, et al. Emergency department management of suspected carbon monoxide poisoning: role of pulse CO-oximetry. Respir Care. 2013;58(10):1614-1620. https://doi.org/10.4187/respcare.02313.Google Scholar
25. Touger, M, Birnbaum, A, Wang, J, et al. Performance of the RAD-57 pulse CO-oximeter compared with standard laboratory carboxyhemoglobin measurement. Ann Emerg Med. 2010;56(4):382-388. https://doi.org/10.1016/j.annemergmed.2010.03.041.Google Scholar
26. Bledsoe, BE, Nowicki, K, Creel, JH Jr, et al. Use of pulse co-oximetry as a screening and monitoring tool in mass carbon monoxide poisoning. Prehosp Emerg Care. 2010;14(1):131-133. https://doi.org/10.3109/10903120903349853.Google Scholar
27. Lapostolle, F, Raynaud, PJ, Le Toumelin, P, et al. Measurement of carbon monoxide in expired breath in prehospital management of carbon monoxide intoxication [in French]. Ann Fr Anesth Reanim. 2001;20:10-15. https://doi.org/10.1016/S0750-7658(00)00340-3.Google Scholar
28. Clarke, SF, Stephens, C, Farhan, M, et al. Multiple patients with carbon monoxide toxicity from water-pipe smoking. Prehosp Disaster Med. 2012;27(06):612-614. https://doi.org/10.1017/S1049023X12001227.Google Scholar
29. Rose, JJ, Wang, L, Xu, Q, et al. Carbon monoxide poisoning: pathogenesis, management and future directions of therapy [published online October 18, 2016]. Am J Respir Crit Care Med. doi: https://doi.org/10.1164/rccm.201606-1275CI.Google Scholar