All too often at this time of year emergency services first responders hear reports of carbon monoxide alarm activations on their emergency dispatch pagers and scanners. Fortunately, the alarm has given the occupants of the home or business a fighting chance of survival. Without warning, carbon monoxide (CO) is one of the deadliest and most frequently reported forms of poisoning in the United States each year.

Carbon monoxide is a colorless, odorless, tasteless, non-irritating gas released from incomplete combustion of any carbon-based material. Over 50,000 Americans annually seek Emergency Department treatment for CO poisoning, a figure 3 to 5 times greater than previously estimated. Called "The Silent killer," carbon monoxide represents a grave threat to the health and safety of all residents in our community.

The pervasive nature of CO poisoning is further complicated by the inability of Emergency Medical Service EMTs and Hospital Emergency Departments to easily detect its presence without Arterial Blood Gas sampling using specialized equipment. Signs and symptoms of CO poisoning mimic those commonly associated with the flu, which often results in an improper diagnosis. These include headache, dizziness, disorientation, nausea and fatigue. Other signs and symptoms include confusion, hallucinations and agitation. Ironically, with missed diagnosis, patients are returned to the toxic environment that caused their symptoms.

Carbon monoxide is an intracellular toxin that causes cell death. When carbon monoxide binds with hemoglobin, the red cell protein that carries oxygen in the blood, it reduces the blood's capacity to carry oxygen to tissues and vital organs throughout the body. It is especially harmful to cardiac function, which may cause long-term heart problems for survivors of a CO poisoning. Because these symptoms of CO poisoning are common to so many other neurological, cardiovascular and respiratory conditions and disorders, no single symptom can be considered a foolproof diagnostic indication of CO poisoning. However, if several of these symptoms are present, or more than one person is presenting with these symptoms, then the index of suspicion is much higher. Even a single exposure has potential for long-term cardiac, neurological and psychiatric problems as a result of impaired heart and brain function.

Even with laboratory capability, a Brown University study estimates that Emergency Departments nationally miss up to half of all CO poisonings, most likely because of the invisible nature of CO and its vague symptoms that suggest other medical conditions. New technology, donated by the Lewisboro Lions Club, is now allowing Lewisboro Volunteer Ambulance Corps EMTs to quickly screen residents on scene and to detect and aggressively treat suspected cases of CO poisoning.

While a year-round problem, there is an increased risk of dying from CO poisoning in the winter months when heaters, fireplaces, wood stoves and propane gas are in use. Most carbon monoxide poisonings occur in the home. People sleeping in basements are often right next to the oil burner or other sources of heat. People should never use a kitchen range or stove to heat their living space. A professional should inspect heating equipment each year, and every house should be equipped with a smoke detector and a carbon monoxide alarm. Other sources are exhaust from cars and trucks, small gasoline engines, lanterns and charcoal or wood burning stoves and fireplaces. Power outages are a time of increased risk, as people resort to the use of kerosene space heaters, fireplaces and gas ranges to heat their homes. People who are sleeping or intoxicated can die from CO poisoning before ever experiencing symptoms.

The effects of CO exposure can vary greatly from person to person depending on age, overall health and the concentration and length of exposure. Although high levels of the gas can be fatal to anyone, infants, pregnant women, and older people or those who suffer from physical conditions that make it hard to breathe are even more susceptible. CO poisoning during pregnancy is a particular danger as the developing fetal hemoglobin has a much greater affinity for oxygen compared to adults and is more susceptible to CO poisoning. As well, our firefighters, who are directly exposed to CO during structure fires, apparatus fumes and closed space rescues are especially vulnerable.

Do not hesitate to call 911 if you suspect there is a carbon monoxide leak in your home or you or others in the home or workplace show any unusual or unexplained signs and symptoms.