Res 21-08RESOLUTION NO. 21-08
A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF
DELRAY BEACH, FLORIDA, REQUESTING FUNDS FROM THE
PALM BEACH COUNTY EMERGENCY MEDICAL SERVICES GRANT
AWARD PROGRAM FOR FY 2007/2008.
WHEREAS, the Delray Beach Fire-Rescue Department represents the emergency medical services
interests of the Ciry of Delray Beach; and
WHEREAS, the Delray Beach Fire-Rescue Department is requesting funding for FY 2008/2009
through the Palm Beach County Emergency Medical Services Grant Award program for the purchase of
four (4) Masimo Rad S7-C carbon monoxide detectors; and
WHEREAS, the Ciry of Delray Beach Fire-Rescue Department is eligible to receive funds collected
by the Office of Emergency Medical Services pursuant to Chapter 401.113, Florida Statutes; and
WHEREAS, the equipment to be purchased with these funds will enhance the City's overall
emergency medical services operation and improve the delivery and level of emergency medical care
provided to the citizens of and visitors to the Ciry of Delray Beach and the entire Fire-Rescue service area.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE
CITY OF DELRAY BEACH, FLORIDA, AS FOLLOWS:
Section 1. The Ciry Commission of the Ciry of Delray Beach is supportive of this initiative to
secure grant funds for this service enhancement; and
Section 2. That the Mayor of the Ciry of Delray Beach is hereby authorized to execute all
documents which are necessary to complete the request for funds from the Palm Beach County Emergency
Medical Services Grant Award program.
PASSED AND ADOPTED in regular session on this 17`'' day of June, 2008.
~~ ~~
ATTEST:
Acting Deputy Ciry Clerk
MAYOR
MEMORANDUM
TO: Mayor and City Commissioners
FROM: David C. James, Fire-Rescue Chief
THROUGH: City Manager
DATE: June 9, 2008
SUBJECT: AGENDA ITEM 8.E. -REGULAR COMMISSION MEETING OF JUNE 17, 2008
PALM BEACH COUNTY GRANT/EMERGENCY MEDICAL SERVICESBESOLUTION 21-08
ITEM BEFORE COMMISSION
Resolution of the City Commission indicating support of an application for an Annual Non-Matching
Grant from Palm Beach County, Department of Emergency Medical Services.
BACKGROUND
The Fire-Rescue Department is submitting an application for an Annual Non-Matching Supplemental
Grant from Palm Beach County, Department of Emergency Medical Services to purchase four (4)
Masimo RAD 57C carbon monoxide detectors in the amount of $15,000.00.
Delray Beach Fire-Rescue currently own two Masimo RAD-57C's and this grant would bring our total
number to six. We currently have six ALS Rescue vehicles, and having the Masimo RAD-57C on each
of our Rescues would enable any crew at any time to perform as the rehabilitation unit. This would
decrease any confusion on scene of trying to find the unit that has the RAD-57C on it, and this would in
turn improve our patient and rescuer assessments by identifying poisoning as a possible cause of the
patient's condition in a much timelier manner. Finally, having the equipment readily available would
enable DBFR to be compliant with the changes incorporated in the new NFPA 1584 standard.
RECOMMENDATION
Approve the resolution indicating the City's support of this application.
RESOLUTION NO. 21-08
A RESOLUTION OF THE QTY COMMISSION OF THE QTY
OF DELRAY BEACH FLORIDA, REQUESTING FUNDS
FROM 'I~IE PALM BEACH COUNTY EMERGENCY
MEDICAL SERVICES GRANT' AWARD PROGRAM FOR FY
2007/2008.
WI ]EREAS, the Delray Beach Fire-Rescue Department represents the emergency
medical services interests of the C.iry of Delray Beach; and
WHEREAS, the Delray Beach Fire-Rescue Department is requesting funding for
FY 2008/2009 through the Palm Beach County Emergency Medical Services Grant Award
program for the purchase of four (4) Masimo Rad 57-C carbon monoxide detectors.
WTdEREAS, the City of Delray Beach Fire-Rescue Department is eligible to receive
funds collected by the Office of Emergency Medical Services pursuant to Chapter 401.113, Florida
Statutes; and
WHEREAS, the equipment to be purchased with these funds will enhance the
C,it~s overall emergency medical services operation and improve the delivery and level of
emergency medical care provided to the citizens of and visitors to the City of Delray Beach and the
entire Fire-Rescue service area;
NOW, TT-~REFORE, BE IT RESOLVED BY TTY QTY COMMISSION OF
'I"I IE QTY OF DELRAY BEACH, FLORIDA, AS FOLLOWS:
Section 1. The City Commission of the City of Delray Beach is .supportive of this
initiative to secure grant funds forthis service enhancement; and
Section 2. That the Mayor of the Cary of Delray Beach is hereby authorized to
execute all doctunents which are necessary to complete the request for funds from the Palm Beach
County Emergency Medical Services Grant Award program.
PASSED AND ADOPTED in regular session on this the - day of June, 2008.
MAYOR
AT'T'EST:
Cary Clerk
DEPARTMENT OF PUBLIC SAFETY
DIVISION OF EMERGENCY MANAGEMENT
OFFICE OF EMERGENCY MEDICAL SERVICES
PALM BEACH COUNTY EMS GRANT AWARD APPLICATION
SUPPLE1~+dEiITTAL GR.A~1'T REQUEST
Note: The total for all your primary requests must not be more than
$50,000.00.
1. Organization: De~.ray Beach Fire-Rescue
Authorized Official: David C. James Title: Fire Chief
Alternate Official:
Mailing Address: 501 W. Att.antic Avenue
Title:
Telephone: 56I.-243-7410 FAX: 561-243-746I.
2. Authorized Contact Person: Danielle Connor
Title: Division Chief - Emergency Medical Services
Mailing Address: Delray Beach Fire-Rescue
Telephone: 561-243-7440 FAX: 561-243-7461
3. Agency's Legal Status: City/Municipality
4. First Responders: Please attach a copy of your Memorandum of
Understanding (MOU) with a licensed provider. If you do not have a
MOU, attach documentation that you made reasonable efforts to get
one, that you cooperate with the provider, or that you requested
but did not receive a response from the providers in your area.
5. Your Federal Tax ID Number: VF 59-6000308
6. Identify the EMS county plan goals this project will accomplish in
whole or in part. A copy of the goals is attached to this
application.
2D: Identify and implement new technology and procedures into the
EMS system to'improve patient outcome. This does not apply to
specialized response units.
7. Communications Projects: All grant applications which involve
communications equipment and/or services, in total or in part, will
be reviewed by the State of Florida Division of Information
Technology. FINAL APPROVAL MUST BE OBTAINED PRIOR TO ANY PURCHASE
COMMITMENT. Copy of approval from the State must be submitted to
the County EMS Office with request for reimbursement.
SUPPLEMENTAL EMS GRANT AWARD APPLICATION
ORGANIZATION: Delray Beach Fire-Rescue
8. Background: Describe your agency, its operations, and how it
relates to other EMS agencies in your area. Also, provide a
description of your major resources including the number of
employees, vehicles, and equipment.
The Delray Beach Fire-Rescue Department responds to all calls for assistance within the City of
Delray Beach and contracted areas of the Town of Gulf Stream and Town of Highland Beach. These
services include fire suppression, special operations, fire prevention and safety, CPR/AED training to
the public, injury prevention, disaster response and emergency medical services including ALS and
BLS transportation.
We began our EMS service in the 1950's providing basic frst aid, evolving into the paramedic level
of service in 1979. Currently, we provide first response medical assessment and treatment at the
advanced life support level and transportation to local hospitals, including stroke and trauma centers.
Additionally, we employ mutual aid agreements with all neighboring agencies.
Our annual budget is $22.4 million.
We have 154 full time employees. We operate six (6) paramedic rescue vehicles with (3) in reserve
for back-up and maintenance, all with cellular phone capabilities. Our remaining fleet consists of
seven (7) Engines, three (3) Aerial Trucks, one (1) Brush Truck, one (1) Special Operations Truck,
one (1) Tanker, two (2) Command vehicles, two (2) Special Events Response Vehicles (SERV), one
(1) Public Education unit, twelve (12) staff cars for a total of thirty-eight (38) units. Other resources
are provided under an existing countywide mutual aid agreement.
9. Grant History:. Briefly describe your current and previous grant
awards €or the past three years. Explain how this application does
not conflict or duplicate them.
)rn the past three (3) years, Delray Beach )E'ire-Rescue has received grant awards that enhanced our
medical equipment and response including Stryker Power Cot Stretchers, AED's, ALS upgrade
for lire Suppression vehicle (Engine), and a new S1ERV unit with AILS package.
SUPPLEMENTAL EMS GRANT AWARD APPLICATION
ORGANIZATION: Delray Beach Fire-Rescue
10. Project Need Statement:
Write a clear, concise statement describing the need(s) addressed
by this project. This must include: 1) numexic data; 2) time
fxame for the data; 3) source of the data, and; 4) the involved
target population and geographic area.
Carbon Monoxide (CO) is a colorless, odorless, and non-irritating
gas produced primarily as a result of incomplete combustion of any
carbonaceous fossil fuel. (Keo LW, Nanagas KA. Emerg Med Clin N Am,
2004;22:985-1018). Carbon Monoxide has long been identified as a
"silent killer" and affects thousands of firefighters and victims
of fires each year. Additionally, sources indicate that upwards of
40,000 annual emergency department visits are attributed to CO
poisoning, with victims ranging from rescuers and victims of fires,,
to residents yr employees within areas of slow, insidious CO leaks.
The increased popularity and usage of portable generators in and
around residences during Florida's hurricane season 'has also
provided an unfortunate and unanticipated surge in CO poisonings.
The Center for Disease Control completed a study of emergency room
patients during the 2004 hurricane season in an attempt to evaluate
the problem. The study focused on only 10 hospitals that were
located within fifty miles of the center of the hurricane as it
passed through .the state. All information was gathered from August
13, 2004 through September 28, 2004. The study confirmed 167
poisonings and six fatalities from carbon monoxide. (CDC, 2005)
Delray Beach Fire-Rescue responded to 207 first alarm fires in
fiscal year 2007. An average of fifteen responders are on scene
for all first alarms structure fires, not counting any mutual aid
that may provide assistance. The new NFPA 1584 guidelines have
added CO monitoring into the firefighter rehabilitation protocol.
Zn addition to vital signs including heart rate, respiratory rate,
temperature, and pulse oximetry, CO monitoring has now been added
as one of the criteria for returning to duty. Departmental Standard
Operating Procedures mandate that CO readings during rehabilitation
must be less than 10% in order for a firefighter to be permitted to
return to work.
Delray Beach Fire-Rescue currently own two Maximo RAD-57C's, and
with this grant, would bring our total number to six. We currently
have six ALS Rescue vehicles, and having the Maximo RAD-57C vn each
of our Rescues would enable any crew at any time to perform as the
rehabilitation unit. This would decrease the chaos on scene of
trying to find the unit that has the RAD-57C on it, and this would
in turn improve our patient and rescuer assessments by identifying
CO poisoning as a possible cause of the patient's condition in a
much timelier manner.
SUPPLEMENTAL EMS GRANT AWARD~APPLICATION
ORGANIZATION: Delray Beach Fire-Rescue
11. Project Outcome Statement:
Write a concise quantifiable statement describing the degree to
which the need(s) will be changed by the project. This must
contain the same four characteristics as the need statement and
indicate the evaluation methods used to measure the efficiency
and/or effectiveness of the project's outcome.
With the addition of four RAD-57's to DBFR's current inventory of
two, we would be able to equip all six front line ALS Rescue
vehicles with carbon monoxide capabilities. In this manner, we
would better be able to serve the residents and visitors of Delray
Beach by identifying CO poisoning cases. In addition, compliance
with NFPA 1584 would provide for better firefighter safety and
wellness. Evaluation methods to measure the usage and effectiveness
of the RAD-57 would include an analysis of firefighter
rehabilitation records to identify personnel and/or fire victims
that maintain high CO levels despite being asymptomatic. A contrast
study against national statistics to verify the effectiveness of
our program would be instituted, as well.
SUPPLEMENTAL EMS GRANT AWARD APPLICATION
ORGANIZATION: DELRAY BEACH FIRE-RESCUE
11. Major Activities and Time Frames:
If grant is awarded, you must follow your schedule. If, for some
reason, the schedule cannot be followed, please advise the EMS
Office of the activity change.
Please indicate time frame as l5t quarter, 2nd quarter, 3rd quarter, 4tn
quarter and fill in the year.
First Quarter = October 1 through December 31
Second Quarter = January 1 through March 31
Third Quarter =April 1 through June 30
Fourth Quarter = July 1 through September 30
Activit
Order RAD 57's
Conduct in-service training and education on use, maintenance,
and proper interpretation of RA.D 57 device.
Implement new equipment into inventory and begin use
Conduct field audits in conjunction with Risk Management
and Town Clinic to evaluate the reduction of patient and employee injuries.
Time Frames
First Quarter
Second Quarter
Third Quarter
Fourth Quarter
SUPPLEMENTAL EMS GRANT AWARD APPLICATION
ORGANIZATION: DELRAY BEACH FIRE-RESCUE
12. Budget:
The applicant must submit a written price quote for each line item.
For equipment include, the cost per item, quantity, and cite vendor
information. For each type of position, include the pay per hour,
number of hours, and cost of each benefit. For expenses, include
unit costs (if rental, give the cost per square foot).
Items/Quantities and Positions/FTEs Cost Per Unit Total
(4) Nlasimo RAD-57C Portable Co-Oximeter with $3750.00 $15000.00
SPO2/SPCO and Rainbow IDCI-DC-3 finger
sensor/znulti unit discount
Total requested $15000.00
SUPPLEMENTAL EMS GRANT AWARD APPLICATION
ORGANTZATTON: DELRAY BEACH FIRE-RESCUE
13. Medical Director's Approvals: These are. required for all projects
which involve professional education, medical equipment, or both.
(1) Professional Education: All continuing education described in
this application will be developed and conducted with my input
and approval.
Medical Director:
Printed Narne:
gnature Date
(2) Medical Equipment: I hereby affirm my authority and
responsibility for the use of all medical equipment in this
project.
Medical Director:
Signatures Date
Printed Name: Randall Wolff, M.D.
14. Resolution: A resolution from the Governing Board(s),i.e. City
Commission; Town Council, Board of Directors, etc. is required once
the Grant is awarded and before the purchase of any items. This
resolution will certify that monies from the EMS County Grant Award
will.
(1) Improve and expand prehospital services in that coverage area.
(2) will not be used to supplant existing provider's budget
allocation.
(3) Meets the goals and objectives of the EMS County Grant Plan.
15. Certification:
I, the undersigned official of the previously named entity, certify
that to the best of my knowledge and belief, all information
contained in this application and its attachments are true and
correct.
I understand my signature acknowledges that I will comply fully
with the State Bureau of Emergency Medical Services' and Palm Beach
County's Rules and Regulations governing the administration of the
State of Florida Emergency Medi a Services Grant Program for
Counties.
Authorized Official: ~ ~ ~~
Signat~zr~ JDalte
Printed Name David C. James Title: Fire Chief
.~
.~~, ~.}.
5200 Rings Rd. Ste. A
Dublin, OH 43017
Phone; 800-533-0523 Fax; 800-257-5713
Account Name: DELRAY BEACH FD
SILL. TU:
Contact Name:
Account Manager
Chic Price
Oa(~®~~~~®~
Date: 5/12/2008
Valid Until: 7/11/2008
Quotation #:
Account Number: 113197
SHIP TO:
Phone No:
Ship Method
shipping
Payment Terms
Sales Tax applies to customers who are non-exempt.
Shipping charges will be prepaid and added to the invoice unless otherwise stated.
asalm~= E"i"°` tttaet~e ~~enb®~e~""~'~c(~~~~~~y
1'he first Technology to Noninvasively and Continuously Measure the Dyst-emoglobins: Carboxyhemoglobin
(CCHb%1 and Methemoglobin (MetF6b%)
The Masimo SET with Rainbow Technology Pulse CO-Oxlmeter platform is
anew technology that represents the latest in system theory and adaptive
signal processing. Rainbow is based on Masimo SET technology-the
acknowledged performance standard in pulse oximetry and the only
pulse oxlmeter solution that can read through motion and low perfusion
states. Rainbow Pulse CO-Oximeter technology uses multiple (7+) distinct
wavelengths of light, giving clinicians the ability to noninvasively and
continuously measure Carboxyhemoglobin (SpCOT"} and methemoglobin
(SpMetTx~), together with the unmatched accuracy of Masimo SET Sp02,
Pulse Rate, and the Perfusion Index (PI). The ability to obtain these
measurerYients noninvasively and continuously will facilitate earlier detection
of compromised oxygenation status for more timely, effective treatment
decisions that should impact positive outcomes. These initial parameters
available on the Rainbow platform are expected to be augmented by the
future availability of additional parameters.
The following is a guide to the large and growing body of published literature
on the prevalence and significance of acquired methemoglohinemia and
carboxyhemoglobinemia in the acute care environment. The literature summaries demonstrate that carboxyhemoglobinemia
and methemoglobinemiaore not rare conditions within the acute care setting, and the ability to continuously and noninvasively
assess these dyshemoglobins can reduce the morbidity and mortality associated with elevated levels. The various sources
of medication proven to cause elevated methemoglobin are ubiquitous in the hospital settiny, from the various 'Caine topical
anesthetics (benzocaine, lidoceine, etc.) to the rapidly growing application and use of inhaled nitric oxide (iN0}. Meanwhile,
carbon monoxide poisoning is a problem common to all areas of industrialized society. CO poisoning Is the number one source
of poisoning reported in patients who report to the emergency room. It can be caused by inhalation of combustion byproducts
(engines, generators, furnaces, wildfires, etc.}, by medications (sodium nitroprusslde), and in some circumstances by the
anesthesia circuit during a surgical procedure. 8ot17 methemoglobin and Carboxyhemoglobin can be dangerous silent killers
and are difficult to detect, masked lay equivocal and potentially misleading patient symptoms. If untreated, both have significant
morbidity and mortality consequences In a.ll areas of care.
uMASiMo
Card®e~ 1®/i®e~®xiide Poi®ining
Kao LW, Nanagas RA. Emerg Med Clin NAm. 2004;22:985-1018.
"The following patients may be encountered during an emergency department (ED) shift: a 7-
year-old with a first time seizure, an 80-year-old with syncope, a family with flu-like illness, a
pregnant patient with vomiting and dizziness, a 45-year-old with chest pain, a comatose patient
from a house fire, and a factory worker with a headache. Although these complaints may sound
diverse, carbon monoxide (CO) exposure may account for all of these clinical scenarios. CO
exposure, often goes unrecognized and can lead to significant morbidity and mortality. Rapid
recognition and appropriate therapy can improve outcomes signi-fuantly."
This comprehensive literature review of the acute and latent effects of carbon monoxide
poisoning considers epidemiology and sources, pathophysiology, clinical effects, diagnosis,
and treatment of the CO poisoned patient. The paper explores proper dispositioning of the CO-
exposed patient and briefly discusses prophylactic measures that may reduce the incidence of this
insidious poisoning,
Epidemiology, and Sources
CO is a colorless, odorless, and non-irritating gas produced primarily as a result of incomplete
combustion of any carbonaceous fossil fuel. CO poisoning accounts for an estimated 40,000
annual ED visits in the United States, and is the leading cause of poisoning mortality in
the US. Misdiagnosis may result in the patient(s) being discharged back to the dangerous
environment with subsequent serious exposures. An estimated one-third of CO poisoning
may go undetected, emphasizing the importance of entertaining the diagnosis in patients
with suggestive symptoms.
Pethophysiology
Initially, the pathophysiology of CO poisoning was thought to be exclusive to cellular hypo~da imposed
by replacing oxyhemoglobin by COHb and producing a relative anemia. Yet CO poisoning exerts it is
toxic influence in much more complex ways, including a combination of hypoxia/ischemia involving
direct toxicity at the cellular level. CO binds to many heine-containing proteins other than hemoglobin,
includ.i~ig cytochromes and myoglobin. Cellular respiration may be impaired via inactivation of
mitochondria) enzymes. The role of nii;ric oxide (NO) in the setting of CO poisoning is discussed. NO
seems to play a pivotal role in the events culmin.atin:g in oxygen damage to the brain, which may be
responsible for the clinical syndrome of delayed neurologic sequelae (DNS).
Conical E¢Fects
Acute -The clinical effects of CO poisoning are diverse and easily confused with other illnesses, such as
nonspecific viral illness, benign headache, and various cardiovascu).ar and neurologic symptoms. Initial
symptoms after CO exposure include headache, nausea and dizziness. As exposure increases, patients
develop more pronounced and severe symptoms, with oxygen-dependent organs showing the earliest
signs of injury. The .brain and heart are the most oxygen-dependent oxgans and the most
sensitive to the toxic effects of CO. [See Table 1].
Delayed -The effects of CO poisoning are not confined to the period immediately after
exposure. Persistent or delayed neurologic effects also have been reported. Most intriguing
is a syndrome of apparent recovery from acute CO poisoning followed by behavioral and
neurologic deterioration after a latency period of 2 to 40 days. The paper discusses the
myriad of evidence that linl~s CO poisoning to delayed neurologic sequelae.
Chronic -The effects of chronic CO exposure (usually occupational complicated by cigarette
smolffng) are discussed. Chronic CO exposure may accelerate atherosclerosis. As well, chronic
exposure has been associated with polycythemia and cardiomegaly.
i4h('
.~~ ~l~1 q ~~
,~(~C z~tL':,!
fiy ¢~ .rh~.i ~~{~ - ~~r ~„~kr.. qy r ~ ,~u€ 3 r~ ricx-~ 3: ~+~. ,rte R,.~r ~v Fyn ~fi~c~~§~~^/~ ' c~„
:
~ P•5~ ~ iui C~V il'f~. ~ Z;'~'t
~ +
51tLUi3~J
Q~~~
'G'~~'~li ,p ~ad.ta a t 6th
L'Di~fai '03'71°
~ `d.G~',u'L'a
~
~
~
+
,
I` S"~.Ft ~3".~ r
.: l~k; ~a`'7r.TiX ~
'W
k~5.
ih. "
+
1
,~c.
(~
...k
I'
kG'7_ P~~t.~'(Y Sl 'Fk9 AAIh(:~ a"
~
~ ~M r~r ~
i i~~~ ~" ~~
i ~ L ra y. {
~ y?f a'~a'+~'A{~i ~i
~bSi 11~ 23
~ A SL
~1':i
~.~ -
tl. '~ Ot R 1)Il L!
3"
%
}`1 ,.
eE1.`~ /~~a '`nl' ai` 5-ry'W".Cy ~~ r ~ lt~s' ,~. ~~ ~
:~ SS ail i~ 1:'-C~ (7711 yrx ~~ac~b~2~ ~,~.aI7~~t,
k d hJ')! ~ ~49
'
F M
-7~45. h~y~
' A
k~._ v'a7lLn ~«< Cc
ww
`i~~Z~~y~~riV~~ ~
_~.<xr.+a.:k~+.dt..;u.,< .J
I V
- ~~ V~ x . ~.om. ..
;,,e: xg s. ~... ~
//
K~
~ ~. u n T ~.: fA'b7 '~•'~ r~ Fl,,l~ "Y +µ~
a.4 +... Yr.,7~: .e.;,~i~-Sr...,:ti:~V~ie^h1~rt...r«8~..c 74Y 1!1:,1'iE<O ... w.x.....w..,r~
Diagnosis
The severity of clinical symptoms is related not only to the concentration of CO, bu.t also to the duration
of the exposure. COHb levels ehould be measured with a CO-Oximeter. Routine blood gas analyzers
without CO-Oximeters calculate rather than measure oxyhemoglobin saturation and do not recognize
the contribution of abnormal. hemoglobins. Pulse oximetry maybe falsely elevated in the setting of
significant CO poisoning because carboxyhemoglobin is indistinguishable form oxyhemoglobin by two
wavelength pulse oximetry.
`L reatment
Treatment begins with supplemental oxygen and aggressive supportive care. High flow oxygen therapy
should be imrnedi.ately administered to treat CO-imposed hypoxia. An extensive literature review of
the use of hyperbaric oxygen, compared and contrasted with normobaric oxygen delivery, is presented.
Hyperbaric oxygen treatment may prevent adverse neurologic sequelae. Increasing the partial
pressure of oxygen decreases the half-life of carboxyhemoglobin.
Summary
"CO poisoning produces diverse signs and symptoms, which often are subtle and can be
misdiagnosed easily. Failure to properly diagnose CO poisoning may result in significant
m.orbi.dLity and mortality and allow continued exposure to a dangerous environment. In
the emergency department, a high index of suspicion must be maintained for occult CO
exposure:' Treatment begins with inhalation of supplemental oxygen. While absolute indications of
hypexbaric oxygen treatment remain controversial, this treatment accelerates dissociation of CO from
hemoglobin and may prevent delayed neurologic sequelae. 7.`he emergency physician may be coni'ron.ted.
with the difficult decision regarding disposition and even transfer of the CO-poisoned patient to a
hyperbaric facility.