# Single Gas CO Meter



## Tigger (Dec 26, 2015)

We recently ran an unconscious party in a rental house, decorticate posturing, leftward gaze, and responsive to only significant painful stimuli. Following a clear CT the patient's ABGs apparently revealed significantly elevated CO levels. They called us, we called fire, fire opened the front door and their meter pegged to 1500ppm. The patient's bedroom was adjacent to the utility room with the rest of the family staying upstairs, so no one else in the house was ill, though with those levels I'm not sure how we were not overcome after 15 minutes spent in the room.

In any case, I'm looking into getting single gas CO monitors to attach to our Lifepaks. Any one else have these? What kind do you use? What sort of testing do they require? How do you have them attached? Anything else to consider.

We have a lot of "homebuilt" construction in our area and improperly installed furnaces and wood stoves are not an uncommon call.

Example: http://www.pksafety.com/gascliptech-single-gas-co-monitor-sgc-c.html


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## chaz90 (Dec 26, 2015)

We carry CO meters attached to our LP15s. I forget the brand off the top of my head, but they last for 24 months I believe. After 24 months, I think they just need a new battery and possible recalibration. We keep them attached via some sort of metal "quick clip" that attaches via alligator like prongs and tightens on to the strap itself near the handle of the monitor. They actually seem to work very reliably, and there have been several calls in our system even in the past year where they were the first indication of extremely dangerous CO levels. 

I can look at our CO meters when I work my next shift on 12/29 after vacation to tell you the exact brand. I'll post some pics of our attachment method as well.


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## Tigger (Dec 26, 2015)

chaz90 said:


> We carry CO meters attached to our LP15s. I forget the brand off the top of my head, but they last for 24 months I believe. After 24 months, I think they just need a new battery and possible recalibration. We keep them attached via some sort of metal "quick clip" that attaches via alligator like prongs and tightens on to the strap itself near the handle of the monitor. They actually seem to work very reliably, and there have been several calls in our system even in the past year where they were the first indication of extremely dangerous CO levels.
> 
> I can look at our CO meters when I work my next shift on 12/29 after vacation to tell you the exact brand. I'll post some pics of our attachment method as well.


I'd appreciate that a lot. Yesterday was a bit of a wakeup call, CO never even crossed my mind.


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## chaz90 (Dec 26, 2015)

Do you guys use CO-oximetry?


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## Tigger (Dec 26, 2015)

chaz90 said:


> Do you guys use CO-oximetry?


Funny you should mention that. The LP15s were placed in service last winter with zero in service training on them aside from "it's got a color screen, everything else is the same as a 12." I asked if we had ordered them with spCO, which the supervisors and supply guy answered with either "no, too expensive" or "I don't know." In any case, every now and again the spO2 would switch to CO when someone had a reading over 10. How could this be if the monitors don't have them I asked???

"Well it probably doesn't work," was the answer. Oh it worked on this call alright. Values of 35 to 38 pre RSI. But as I had been told to discount it, we ignored it (my partner had no idea such a feature even existed on LPs). My supervisor then proceeded to ask us why I "blew off that reading since it made sense." It made absolutely no sense given presentation and environment and he was not aware that the monitors could that either. 

I like where I work, but the lack of in service training has always irked me, and yesterday that was reaffirmed. It would not have changed much except that she probably would have ended up in the hyperbaric chamber quicker.


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## NomadicMedic (Dec 26, 2015)

In paramedic school I went on a call for CO poisoning. It was a family that was using a hibachi for indoor cooking and heating. 5 patients, one RSI, the others were not critical. 

I was the only one who knew where the RAD57 was and how to use it! (And only because the medic I was with told me I needed to know the location of EVERY ITEM on the truck).

I've not had an instance to use the rainbow set on the LP15 aside from the limited training in DE, but our service just ordered 5 new LP15s as front line monitors so I'm sure I'll play with it.


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## CALEMT (Dec 26, 2015)

Carbon monoxide, the gas that nobody think about. While we don't carry CO meters out here (that I know of) I'd guess that you would want something that goes off around 80ppm (garden variety home CO detector). Im curious Chaz, do you know how much CO it takes to set off your alarms?


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## DesertMedic66 (Dec 26, 2015)

CALEMT said:


> Carbon monoxide, the gas that nobody think about. While we don't carry CO meters out here (that I know of) I'd guess that you would want something that goes off around 80ppm (garden variety home CO detector). Im curious Chaz, do you know how much CO it takes to set off your alarms?


PSFD has them clipped on their airway bags. Some CalFire guys have them attached on their radio straps.


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## CANMAN (Dec 28, 2015)

DesertMedic66 said:


> PSFD has them clipped on their airway bags. Some CalFire guys have them attached on their radio straps.



I would agree. Personally, and your practices might differ, but I don't bring the monitor in on every call. However our airway/first in bag comes in on every single call. So I would clip it to a bag like that or a person vs. a monitor if that's not routine for you to bring in on every call. 

We have a CO meter on said bag, as well as one in the back of the unit. Think it's a great idea/must have tool for EMS units.


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## DesertMedic66 (Dec 28, 2015)

CANMAN said:


> I would agree. Personally, and your practices might differ, but I don't bring the monitor in on every call. However our airway/first in bag comes in on every single call. So I would clip it to a bag like that or a person vs. a monitor if that's not routine for you to bring in on every call.
> 
> We have a CO meter on said bag, as well as one in the back of the unit. Think it's a great idea/must have tool for EMS units.


We only have 2 bags. I take them in on all calls. It's just habit


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## CANMAN (Dec 28, 2015)

DesertMedic66 said:


> We only have 2 bags. I take them in on all calls. It's just habit



Sorry, my reply was directed towards the OP for their future implementation. And really both bags and monitor for every call huh?


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## DesertMedic66 (Dec 28, 2015)

CANMAN said:


> Sorry, my reply was directed towards the OP for their future implementation. And really both bags and monitor for every call huh?


Well 1 bag and 1 monitor. Since there are several things in the monitor I kind of just consider it a bag. 

And yeah. The monitor and the bag stay on the gurney while responding to a call. When we get on scene the gurney comes out and goes inside the residence with the bag and monitor. Gurney gets lowered inside the house. I grab the monitor and my EMT partner grabs the bag and we make patient contact.


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## Jim37F (Dec 28, 2015)

CANMAN said:


> And really both bags and monitor for every call huh?


At my last department we carried the Zoll, BLS bag (with both trauma and airway supplies) and the paramedic drug box on every call per department policy.


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## CANMAN (Dec 28, 2015)

Meh to each their own. Just more crap I gotta put back when I get my refusal haha jk.


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## DesertMedic66 (Dec 28, 2015)

CANMAN said:


> Meh to each their own. Just more crap I gotta put back when I get my refusal haha jk.


Sadly we don't get a lot of refusals here.


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## reaper (Dec 28, 2015)

DEmedic said:


> In paramedic school I went on a call for CO poisoning. It was a family that was using a hibachi for indoor cooking and heating. 5 patients, one RSI, the others were not critical.
> 
> I was the only one who knew where the RAD57 was and how to use it! (And only because the medic I was with told me I needed to know the location of EVERY ITEM on the truck).
> 
> I've not had an instance to use the rainbow set on the LP15 aside from the limited training in DE, but our service just ordered 5 new LP15s as front line monitors so I'm sure I'll play with it.


The rainbow set on the LP15 actually works very well for CO levels. It will set off on smokers, but normally they stay below 15. Anything above 20 and it makes me start looking at things.

Had a call where a lady had cut her finger while cooking. Transported her for stitches. While en route, the LP15 picked up a reading of 25. Had FD sent to her home and levels were 1200ppm. She was lucky that we were called for cut finger. She had no signs of Co poisoning.


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## ThadeusJ (Dec 29, 2015)

Masimo has a lot of stories about detecting CO when it wasn't expected.  I heard of a story where they were demo'ing it in a hospital and everyone was trying it out on themselves.  One of the part-timers had elevated levels and subsequent investigation discovered a faulty furnace at home.  

I see these CO devices at a lot of shows and talked to the guy who sells them.  There are a few out there to choose from but ask about battery life and calibration (frequency of, do you have to ship out to perform and/or how expensive are the kits if you do them in house).  SpCO works well but only detects it once its inside you, so that's locking the door after the horses have bolted.  

Again (for those who have listened to my drivel over the years), there's a device in Canada that removes CO from the body but it has been delayed by the FDA for over a decade (still ongoing).  Its called the ClearMate from Thornhill Research and for anyone interested in cool technology, you should Google is up.  I was involved with it about 8 years ago and I still consider it to be one of the most undervalued devices ever invented.


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## NomadicMedic (Dec 29, 2015)

We use the ToxiRAE at my current service. (It was same meter we used in DE prior to the new meters.) It's attached via a a ziptie to a D ring on the first in bag.


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## chaz90 (Dec 29, 2015)

ThadeusJ said:


> Again (for those who have listened to my drivel over the years), there's a device in Canada that removes CO from the body but it has been delayed by the FDA for over a decade (still ongoing).  Its called the ClearMate from Thornhill Research and for anyone interested in cool technology, you should Google is up.  I was involved with it about 8 years ago and I still consider it to be one of the most undervalued devices ever invented.


Very cool technology! If I'm understanding what I  read correctly, does this device just allow one to increase ventilation rates while maintaining isocapnic CO2 levels? It would be a big change if this kind of therapy were readily accessible for areas without hyperbaric chambers.


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## ThadeusJ (Dec 29, 2015)

chaz90 said:


> Very cool technology! If I'm understanding what I  read correctly, does this device just allow one to increase ventilation rates while maintaining isocapnic CO2 levels? It would be a big change if this kind of therapy were readily accessible for areas without hyperbaric chambers.


That's exactly the concept.  True hyperventilation is breathing at a rate and volume that decreases the PaCO2 levels below normal levels.  You can't use a rebreathing system because you are trying to eliminate the CO or other hydrocarbons that are also being exhaled.  So the device entrains a percentage of fresh CO2 in with the inhaled oxygen.  This allows you to maximize your minute ventilation to eliminate the CO while maintaining normal PaCO2 levels.  The inventor created it to rapidly eliminate anaesthetic gases in a few minutes but quickly realized that it would work for CO, methanol, etc.  He did perform test on humans beside a hyperbaric chamber and found that the chamber had a half life elimination of 9 minutes, while the ClearMate had one of 10 minutes.  I know the inventor and his team in Toronto and they are performing more robust testing for the FDA.


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## chaz90 (Dec 31, 2015)

Evidently we use the BW Honeywell Gasalert Extreme Clip. Quite the mouthful...

The newer version (nearly identical) is linked here. 

http://www.pksafety.com/bw-clip-2-year-single-gas-detector-co.html

They're pretty cheap and work well for what we need. They alarm audibly, visually, and vibrate. Measured PPM displays on the meter as well. I don't believe the battery or sensor is replaceable, and they don't need calibration. I guess when the batteries die after 24 months the department will just buy a new set of meters. 

Edit: They alarm at 35 PPM.


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## Tigger (Dec 31, 2015)

Thanks for the pics!

100 bucks seems pretty reasonable.

As for putting it on the monitor: The monitor comes in on 90% of calls. I am particularly concerned about responding to LE requests for a deceased party. They only want one provider and the monitor to come in and that's where I think a large exposure risk comes into play.


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## meatanchor (Jan 30, 2016)

The BW Clip is like $99 and is designed to be disposable.  They last 2 or 3 years without any service, depending on the model.
http://www.honeywellanalytics.com/en/products/BW-Clip

If you're not going to be using these for confined spaces and servicing them regularly, get the single-gas disposable.  Anything with an O2 sensor will need regular maintenance.


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## Bullets (Feb 8, 2016)

Late to the party but we issue ToxiRae Pros to our staff which they carry on their person while on shift. They are rechargeable and have replaceable sensors so in hazmat setting, you can hot swap the sensors based on the incident. We mainly keep CO but we also have HCN for monitoring during fires. We used to use ToxiRae 3s but they are single sensor and alkaline battery


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