Barry Hickerson, EMT-P
SONORA, Calif. — On November 11, 2006 at 2307 hours, Tuolumne Medic 41 was dispatched with a California Department of Forestry (CDF) engine to an address on Highway 120, approximately 12 miles east of Groveland in California's Sierra Nevadas, for a 58 year-old female complaining of dizziness.
Upon arrival of both firefighters and medics, the patient was found sitting in a recliner in her mobile home, complaining of severe dizziness that had caused a fall with injuries four days ago. The prior fall resulted in an ambulance transport and an emergency room visit with facial x-rays and repair of soft-tissue injuries to the face. She returned home after the ER visit and continued to have problems with dizziness which remained undiagnosed.
The patient had a very extensive respiratory and cardiac history. She answered questions appropriately (GCS 15) and did not appear to be in severe distress. When the RAD-57 was applied to obtain the SpO2 reading, the alarm began to sound due to a SpCO level of 13%. Given that the patient's room air O2 sat was 83%, her fractional saturation was at best 70%, so it was no surprise she was dizzy. The room was filled with cigarette smoke and after further questioning, we discovered that her husband had turned on their furnace for the first time that season about 5 days ago.
The patient was removed from the house, placed on a non-rebreather oxygen mask at 15 LPM and transported to the local hospital. Her vitals were monitored with a continual improvement of her saturation up to 96% and a gradual decline in the SpCO from 13% to 7% over the 45 minute transport. Her heart rate fell from 130 to 105 and respirations fell from 32 to 24. Upon arrival at the emergency room the patient had no complaint of dizziness. The prior visit was thought to be related to the elevated CO in the house and the fire department was contacted for a follow-up of the house and her husband. The patient continued to improve during her emergency department stay. The hospital did not have a CO-oximeter in the facility and relied on our RAD-57 readings to make their assessment and treatment decisions.
The RAD-57 helped us identify the CO poisoning that had most likely been missed four days prior by fire, EMS and ER crews. While a SpCO of 13% by itself is not terribly high, combine that with her complex medical history and the patient's condition becomes dangerous. The positive CO reading from the RAD-57 led to the woman's prompt diagnosis and treatment, prevented her condition from continuing or worsening, and kept her husband from becoming the next patient.
Tuolumne County Ambulance service is the exclusive ambulance provider for Tuolumne County and is based in Sonora, California. Tuolumne County is located in the Sierra Nevada mountain range of Central California which includes a large portion of Yosemite National Park. Ambulance services are provided form four location throughout the county including a new joint operations center for both ambulance and fire service in Sonora, California. The ambulance service covers over 2,000 square miles with an annual call volume of just over 6,000 calls.
