Sep. 23--When the security guard arrived in the hospital emergency room, he was dizzy and had a headache -- vague symptoms that a nurse could have brushed off easily.
But in this case, the nurse, aided by a new device, triggered a series of events that led to the evacuation of 100 persons from a 20-story condo that had lethal levels of carbon monoxide, perhaps saving untold lives.
"I can't tell you definitely that people could have died, but it came close enough that it shook us up big-time," said Mary Russell, an ER nurse at Boca Raton Community Hospital.
The hospital is in the area where anthrax hit the National Enquirer offices, and its emergency room, as well as the Boca Raton fire department's hazardous materials medical response unit, now are ready for a broad range of threats.
The Boca case began at 1:50 p.m. on Sept. 7. "We had a very astute charge nurse, and when he mentioned he smelled some fumes, she asked if he had been around generators," said Russell, a research preparedness specialist at the hospital. "He said yeah. Construction was going on in the building. Carbon monoxide was already very much on our radar screen, and we had just gotten this new device, a Masimo Rad-57."
Until the arrival of this device, testing carbon monoxide levels in humans was a long and painful process, involving the removal of blood from an artery and getting a lab result. "That is exquisitely painful," said Russell. "Trust me you don't want to do it." For that reason, most nurses avoid giving the test unless it's absolutely necessary.
But Boca had recently purchased the Rad-57, for about $3,000, which measures carbon monoxide levels by simply attaching a sensor to a finger tip. The first device of its kind, it was introduced less than a year ago, says Tom McCall of the California-based Masimo.
In the case of the security guard, his levels were extremely high. The hospital called Boca Raton Fire Rescue, which rushed its HazMed unit to the building at 2800 S. Ocean Blvd.
"They got a reading of 900 parts per million in the lobby," said Glenn Joseph of Fire Rescue. "That's 100 times higher than normal." Other areas showed readings of 500.
The condo had been undergoing hurricane repairs, and the construction crews had generators going in the garage area, said Joseph. "We had them stop all operations."
Rescue crews went floor by floor, telling the 100 or so persons in the building they needed to leave.
Only one other person was taken to the hospital, said Russell. That person and the security guard were given oxygen and recovered quickly.
For ER nurses, the problem is that carbon monoxide poisoning can often present itself merely as flu-like symptoms or food poisoning. Once in the ER, patients can tend to recover quickly since they're no longer near the fumes -- complicating the ability to discover the cause.
McCall of Masimo pointed to news reports in June from Ocean City, Md., where several persons in a Days Inn were taken to an emergency room about 9:30 a.m. Neither the ER nor the rescue units thought to check for carbon monoxide, and their illness was blamed on food poisoning.
At 2 p.m., a 40-year-old Pennsylvania tourist and his 10-year-old daughter were discovered dead in an adjacent room. At least one of them was still alive earlier in the day when the first persons complained of feeling ill, according to local news reports.
UNITS IN FLORIDA
Masimo now has 41 Rad-57 units in the field in Florida, either in emergency rooms or possessed by "first responders" to the scene, McCall said.
The hospital in Boca Raton has learned to be ready for just about anything. It tested dozens of persons for anthrax after the mail scare in 2001, and after hurricanes Frances and Jeanne, it saw "whole families transported to us" with carbon monoxide poisoning caused by generators, said Russell.
"I think there's a lesson to be learned here about generators," she added. She suggested construction inspectors should do more to check for the location of generators in buildings, and she would like to see stores like Home Depot have displays for home carbon monoxide sensors (which can be as cheap as $30 to $45) right next to the generators.
She said she tried to find out how many generators were now in the state and had no luck. "I can't even tell you how much this scares me," Russell said.
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