Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-13T02:51:55.376Z Has data issue: false hasContentIssue false
  • English
  • Français

Managing a Mass CO Poisoning: Critical Issues and Solutions From the Field to the Hyperbaric Chamber

Published online by Cambridge University Press:  04 July 2016

Adriano Valerio ,
Matteo Verzè ,
Francesco Marchiori ,
Igor Rucci ,
Lucia De Santis ,
Irene Aprili ,
Lucia Antolini ,
Anna Sannino ,
Alessia Canello  and
Enrico Checchin
...Show all authors
Adriano Valerio
Affiliation:
Department of Emergency and Intensive Care Unit, Operation Center SUEM, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
Matteo Verzè
Affiliation:
Diagnostics and Public Health Department, University of Verona, Verona, Italy
Francesco Marchiori*
Affiliation:
Diagnostics and Public Health Department, University of Verona, Verona, Italy
Igor Rucci
Affiliation:
Diagnostics and Public Health Department, University of Verona, Verona, Italy
Lucia De Santis
Affiliation:
Emergency Department, Mater Salutis Hospital, Legnago (Verona), Italy.
Irene Aprili
Affiliation:
Diagnostics and Public Health Department, University of Verona, Verona, Italy
Lucia Antolini
Affiliation:
Diagnostics and Public Health Department, University of Verona, Verona, Italy
Anna Sannino
Affiliation:
Diagnostics and Public Health Department, University of Verona, Verona, Italy
Alessia Canello
Affiliation:
Diagnostics and Public Health Department, University of Verona, Verona, Italy
Enrico Checchin
Affiliation:
Diagnostics and Public Health Department, University of Verona, Verona, Italy
Francesca Mazzola
Affiliation:
Diagnostics and Public Health Department, University of Verona, Verona, Italy
Sara Ferrari
Affiliation:
Diagnostics and Public Health Department, University of Verona, Verona, Italy
Marta Garon
Affiliation:
Diagnostics and Public Health Department, University of Verona, Verona, Italy
Alberto Schonsberg
Affiliation:
Department of Emergency and Intensive Care Unit, Operation Center SUEM, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy Diagnostics and Public Health Department, University of Verona, Verona, Italy
Stefano Tardivo
Affiliation:
Diagnostics and Public Health Department, University of Verona, Verona, Italy
*
Corrrespondence and reprint requests to Dr Francesco Marchiori, Diagnostics and Public Health Department, University of Verona (AOUI), Istituti Biologici II - Blocco B, Strada le Grazie 8, 37134 Verona, Italy (e-mail: framarchiori@gmail.com).
Get access Rights & Permissions [Opens in a new window]

Abstract

Carbon monoxide acute intoxication is a common cause of accidental poisoning in industrialized countries and sometimes it produces a real mass casualty incident. The incident described here occurred in a church in the province of Verona, when a group of people was exposed to carbon monoxide due to a heating system malfunction. Fifty-seven people went to the Emergency Department. The mean carboxyhemoglobin (COHb) level was 10.1±5.7% (range: 3-25%). The clinicians, after medical examination, decided to move 37 patients to hyperbaric chambers for hyperbaric oxygen (HBO) therapy. This is the first case report that highlights and analyses the logistic difficulties of managing a mass carbon monoxide poisoning in different health care settings, with a high influx of patients in an Emergency Department and a complex liaison between emergency services. This article shows how it is possible to manage a complex situation with good outcome. (Disaster Med Public Health Preparedness. 2017;11:251–255)

Keywords

emergency medicineemergency service hospitalenvironmental exposurehealth planning organizationsinhalation exposure
Type
Concepts in Disaster Medicine
Information
Disaster Medicine and Public Health Preparedness , Volume 11 , Issue 2 , April 2017 , pp. 251 - 255
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2016 

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. Petrolini, V, Bigi, S, Vecchio, S, et al. Il monossido di carbonio: “killer silenzioso” e “grande imitatore” (parte I) [in Italian]. Emerg Care J. 2008;4:6-13.Google Scholar
2. Locatelli, C, Butera, R, Polillo, C, et al. Diagnosi semplice ed evoluzione “a sorpresa” in un episodio tipico della brutta stagione [in Italian]. Decidere in Medicina. 2002;2:7-20.Google Scholar
3. Meredith, T, Vale, A. Carbon monoxide poisoning. Br Med J. 1988;296(6615):77-79.Google Scholar
4. Cobb, N, Etzel, RA. Unintentional carbon monoxide related deaths in the United States, 1979 through 1988. JAMA. 1991;266:659-663.Google Scholar
5. Hampson, NB, Weaver, LK. Carbon monoxide poisoning: a new incidence for an old disease. Undersea Hyperb Med. 2007;34(3):163-168.Google Scholar
6. Hampson, NB, Hauf, NM. Carboxyhemoglobin levels in carbon monoxide poisoning: do they correlate with the clinical picture? Am J Emerg Med. 2008;26(6):665-669.CrossRefGoogle ScholarPubMed
7. Clardy, PF, Manaker, S, Perry, H. Carbon monoxide poisoning. UptoDate website. http://www.uptodate.com. Published October 19, 2011. Accessed June 1, 2016.Google Scholar
8. 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.Google Scholar
9. Iqbal, S, Law, HZ, Clower, JH, et al. Hospital burden of unintentional carbon monoxide poisoning in the United States, 2007. Am J Emerg Med. 2012;30(5):657-664.CrossRefGoogle ScholarPubMed
10. CDC Center for Disease Control and Prevention. Clinical guidance for carbon monoxide (CO) poisoning after a disaster. CDC website. http://emergency.cdc.gov/disasters/co_guidance.asp. Published June 20, 2014. Accessed June 1, 2016.Google Scholar
11. Locatelli, C, Casagranda, I, Coen, D, et al. Linee guida per la gestione e il trattamento del paziente con intossicazione acuta da monossido di carbonio. SIMEU-società italiana di medicina d’emergenza-urgenza e delle catastrofi [in Italian]. http://anestit.unipa.it/esiait/0401_01.htm. Published April 2001. Accessed June 1, 2016.Google Scholar
12. Mordacci, M, Vezzani, G. Linee guida SIMSI/SIAARTI/ANCIP per il trattamento con ossigeno iperbarico della intossicazione acuta da CO [in Italian]. Medicina subacquea e iperbarica. 2007;2:42-44.Google Scholar
13. Liebelt, EL. Hyperbaric oxygen therapy in childhood carbon monoxide poisoning. Curr Opin Pediatr. 1999;11(3):259-264.CrossRefGoogle ScholarPubMed
14. Lima, MA, Farage, L, Cury, MC, et al. Update on middle ear barotrauma after hyperbaric oxygen therapy-insights on pathophysiology. Int Arch Otorhinolaryngol. 2014;18(2):204-209.Google Scholar
15. Camporesi, EM. Side effects of hyperbaric oxygen therapy. Undersea Hyperb Med. 2014;41(3):253-257.Google Scholar
16. Ambiru, S, Furuyama, N, Aono, M, et al. Analysis of risk factors associated with complications of hyperbaric oxygen therapy. J Crit Care. 2008;23(3):295-300.CrossRefGoogle ScholarPubMed
17. Coric, V, Oren, DA, Kravitz, RE, et al. Carbon monoxide poisoning and treatment with hyperbaric oxygen in the subacute phase. J Neurol Neurosurg Psychiatry. 1998;65(2):245-247.Google Scholar
18. Jurič, DM, Finderle, Ž, Brvar, M, et al. The effectiveness of oxygen therapy in carbon monoxide poisoning is pressure- and time-dependent: a study on cultured astrocytes. Toxicol Lett. 2015;233(1):16-23.Google Scholar
19. Weaver, LK, Hopkins, RO, Morris, AH, et al. Hyperbaric oxygen for acute carbon monoxide poisoning. N Engl J Med. 2002;347(14):1057-1067.CrossRefGoogle ScholarPubMed
20. Zhiheng, Z, Caixia, W, Jiaji, W, et al. The knowledge, attitude and behavior about public health emergencies and the response capacity of primary care medical staffs of Guangdong Province, China. BMC Health Serv Res. 2012;12:338.Google Scholar
21. Williams, J, Nocera, M, Casteel, C. The effectiveness of disaster training for health care workers: a systematic review. Ann Emerg Med. 2008;52(3):211-222.Google Scholar
22. Chung, S, Mandl, KD, Shannon, M, et al. Efficacy of an educational Web site for educating physicians about bioterrorism. Acad Emerg Med. 2004;11(2):143-148.Google Scholar
23. Buljac-Samardzic, M, Dekker-van Doorn, CM, van Wijk, KP, et al. Interventions to improve team effectiveness: a systematic review. Health Policy. 2010;94(3):183-195.Google Scholar
24. Nilsson, A, Åslund, K, Jonson, CO, et al. Improved and sustained triage skills in firemen after a short training intervention. J Trauma Resusc Emerg Med. 2015;23:81.Google Scholar