The ability of firefighters to recognize carbon monoxide poisoning.

We read the article “COHgb levels predict the long-term development of acute myocardial infarction in CO poisoning” by Kaya et al [1], as well as “Survival following extreme carboxyhemoglobin elevation” by Hampson [2] with great interest. Undoubtedly, carbon monoxide (CM) is the most common cause of fatal accidental poisonings around the world [3]. Hyperbaric oxygen therapy improves cell oxygen delivery, inhibits lipid peroxidation, and impairs leukocyte adhesion to vessel walls. Accordingly, it is essential to as soon as possible determine the degree of CM poisoning and transport of such patients to a hyperbaric chamber. Becausefirefighters often arrive on the scene faster than emergency medical service teams and are equipped with the facilities allowing them to enter and operate in the danger zone, this group should have the knowledge about identifying the symptoms of CM poisoning and adequate treatment. The aim of the study was to assess the knowledge, attitudes, and skills of firefighters with reference to patients with suspected CM poisoning. The study was approved by the institutional review board of the Polish Society of Disaster Medicine (Approval No. 14.04.2016IRB) and was conducted in April 2016. It involved 47 firefighters from the National Fire Service. Before the study, all participants completed a questionnaire with regard to knowledge and attitudes concerning CM poisoning. Then they participated in a 30-minute training on the pathophysiology, diagnosis, and treatment of CM poisoning. The training was expanded with the use of the ToxCO apparatus (Bedfont Scientific Ltd, Maidstone, United Kingdom; Figure) for diagnosing CM poisoning. A week later, the study participants filled in the abovementioned questionnaire again. The mean age of participants was 32.6 ± 5.2 years, and the average work experience equaled 8.5±3.7 years. Before the training, only 25.5% of respondents were able to name at least 5 symptoms associated with CM poisoning, 14.9% knew the reference values of COHb concentration and the volume concentration of CM in the air (in parts per million) suggesting CM poisoning. Moreover, 61.7% would apply the ToxCO device to examine a patient in the case of fire, whereas only 31.9% would do so in a patient with consciousness disorders evacuated from home in unclear circumstances. A week after the training, 97.8% were able to identify at least 5 symptoms of CM poisoning. Also, the knowledge of the reference COHb concentration value and the