Mass Casualty Triage in the Case of Carbon Monoxide Poisoning: Lessons Learned

Abstract

Carbon monoxide (CO) can cause mass intoxication, but no standard triage algorithm specifically addresses CO poisoning. The roles of some recent diagnostic tools in triage as well as treatment with hyperbaric oxygen are controversial. We describe a mass casualty case of CO poisoning involving 77 patients, with a focus on the triage and treatment options decided on-site. The reasons for choosing these options are reviewed, and the pitfalls that occurred and the lessons learned from this major incident are described. We discuss the potential to improve the management of such an event and strategies to accomplish this, including simplifying triage and administering oxygen to all exposed persons for 6 h. (Disaster Med Public Health Preparedness. 2018; 12: 373-378).

The diagnostic accuracy of carbon monoxide pulse oximetry in adults with suspected acute carbon monoxide poisoning: a systematic review and meta-analysis

“…In addition, a quick detection of COP with a SpCO device could be particularly useful to identify environments that could possibly be dangerous for rescuers and could be a valuable alternative to BGA in situations where it is not readily available, such as in disaster medicine. In a mass COP event that occurred in Switzerland, SpCO measurement was integrated with symptoms (e.g., transient loss of consciousness) and history (e.g., known pregnancy) in order to develop a rapid triage system that allowed for the identification of patients requiring transport to an HBO center, transport to a general hospital, or who could be treated on-site or directly discharged (21). SpCO measurement could also be of value in mass COP events following an abrupt power outage (e.g., as a result of storms, floods, and earthquakes) and the consequent use of improvised heating or burning devices (22,23).…”

Triaje en El Paciente Intoxicado

“…Se ha establecido un umbral de 2-3 mg por kg de peso en el caso del metilfenidato (27,28). En intoxicaciones masivas por monóxido de carbono se ha realizado el triaje usando el cooxímetro, para simplificar y acelerar la atención de los pacientes asintomáticos potencialmente intoxicados, así como el triaje clínico puede ser útil en la intoxicación por gases irritantes, escenario en el que se han desarrollado algoritmos más específicos que los triajes convencionales (29)(30)(31).…”

Higher pre-hospital anaesthesia case volumes result in lower mortality rates: implications for mass casualty care

“…More reports can be found in the lay literature. Mass casualty incidents involving asphyxiation from causes such as inhaled toxins, 31 avalanches, 24 and submersion 32 may have had better outcomes with improved triage, administration of oxygen, 33 or just basic airway management such as opening the airway, maintaining a patent airway, and administering antidotes to noxious agents 31 or treatment of symptoms. 34 What is the take home message?…”