Russell Chisholm
Firefighter Paramedic
Miami Beach Fire Rescue
MIAMI BEACH, Fla. — On October 23, 2006 Rescue 1 'C' shift was dispatched to a suspected food poisoning call at a hotel on Ocean Drive, at the north end of the entertainment district. Once on scene, the elevator was too small for the stretcher so the crew carried its normal gear of a Lifepack 12, airbag and med box up to the room on the second floor.
Upon arrival at the room we knocked on the door. It took a few minutes for a response. When the guest finally answered the door he could barely walk and fell down frequently. He was very altered, complaining of nausea and a really bad headache. After entering the room we found that the patient's wife, who was on the commode, was in the same state of mind as her husband. Both patients were severely incontinent and their skin was a blotchy red color. Their original SpO2 saturations were in the low 90's. Rescue 1 had only been in the room for ~5 minutes before they started getting headaches. There was a distinct stale odor in the room so the windows were opened for some ventilation. Some said the odor was paint or some type of solvent. The hotel did confirm work had been done in the room not long before the guests checked in but were unsure exactly how long before.
The patients were carried out into the hallway where they were placed on high flow O2 and within 5-10 minutes started to feel better. Rescue 1 called additional units for manpower to help carry the patients downstairs. They also asked for the 4 gas meter and one of the two RAD-57s in field that night to be brought to the scene. (The other 9 RAD-57s were going into service the next day.) The 4 gas meters and RAD-57 arrived as the 2 rescue units were transporting the patients to Mt Sinai Medical Center in Miami Beach. Upon arrival at the ER, the crew on Rescue 1 alerted the nursing supervisor to the suspected CO poisoning. She took the initiative to run ABGs.
We transported another patient to the same hospital 45 minutes later. The RN presented me with the blood gas report the 2 patients. The male had a reading of 38 the female had a reading of 37. The hotel was immediately closed down and the guests
evacuated. The RAD-57 was the tool the engine and ladder crews used for the triage of the ~60 guests that night. The ranges ran from a low of 3% to a high of 21%. There were two families of 4 who were transported to the hospital, with the parent's carboxyhemoglobn levels in the low teens and the children anywhere from 6% to 10%. In total 14 people were transported to Mt. Sinai for CO poisoning. There was one guest who suffered a cardiac arrest towards the end of the call. His death was not attributed to the CO leak.
The CO value in the patient's room (on the second floor) was 242ppm, the room above was 270ppm and the room below was 239ppm. The fourth floor, above the original room, was the highest at 300ppm. The first floor CO levels ranged from 239ppm-0ppm, second floor from 242ppm - 4ppm, third floor from 270ppm - 26ppm, and fourth floor from 300ppm - 44ppm.
Later at the hospital, the original 2 patients told their story to the Rescue 1 crew. They had just been married the day before and came to Miami Beach for their honeymoon. They arrived that morning and after checking into their hotel went to the beach and had lunch. Afterwards, they returned to their room for a nap. They wound up sleeping for approx. 5-6 hrs when the female awoke with nausea, incontinence, general lethargy and an altered mental status.
All patients taken to the hospital had blood gases drawn and the values were almost identical with what the RAD-57 read. The suspected cause of the incident was a hot water heater on the north side of the building whose venting stack ran under the crawl space and up the south side of the building. The facility was closed for ~3 weeks for repairs to be made.
The City of Miami Beach is now actively trying to get an ordinance passed that would require CO detectors in all building and would be part of the annual fire inspection. This call could have had a disastrous outcome if all parties, from the hospital staff to the rescue crews, to the engine and ladder crew and the command staff didn't work together. The RAD-57 was immensely helpful with the triage of a large number of patients. If we only had the 4 gas meter, we could have tied up rescue units transporting patients who did not need transport or worse yet, left some people on scene who really needed to go to the hospital. The RAD-57 proved invaluable to all concerned.
Miami Beach is a 7.1 square mile barrier island in Dade County, Florida. We serve approximately 7.5 million tourists per year. The population of the beach is usually 90,000-92,000 with a normal weekend swelling it to over 200,000. On holidays and special event weekends the day to day population will rise from 450,000 to 500,000.
Miami Beach Fire Rescue is made up of 200 firefighters divided into 3 shifts, with each shift running 6 ALS rescue units (ambulances) with 3 medics onboard. We have two 100 ft. ALS ladder trucks and 4 ALS engines, all staffed with firefighter paramedics. The department runs ~20,000 calls per year, with about 85% of them medical in nature. Construction in the city is both old and new with the majority of the art deco hotels still under renovation.
