Multiple Victims of Carbon Monoxide Poisoning in the Aftermath of a Wildfire: A Case Series

Abstract

RESUMOIntrodução: A intoxicação por monóxido de carbono pode ocorrer em diversos contextos. Results: The studied sample included 37 patients, mean age of 38 years, 78% males. Ten were firefighters, four children and two pregnant victims. Neurological symptoms were the most reported. Median carboxyhemoglobin level was 3.7% (IQR 2.7). All received high-flow oxygen from admission to delivery of hyperbaric oxygen. Persistence of symptoms was the main indication for hyperbaric oxygen. Median time to hyperbaric oxygen was 4.8 hours (IQR 9.5), at 2.5 ATA for 90 minutes, without major complications. Discharge in less than 24 hours occurred in 92% of the cases. Thirty days follow-up: five patients presented clinical symptoms of late neurological syndrome; twelve patients were lost to follow-up. Carboxyhemoglobin levels on admission and mean time to hyperbaric oxygen were no different between those who did and did not develop the syndrome at 30 days (p = 0.44 and p = 0.58, respectively). Discussion: Late neurological syndrome at 30 days occurred in 20% and no new cases were reported at 12 months. Conclusion: Use of hyperbaric oxygen appears to have reduced the incidence of the syndrome. This seems to be the first Portuguese series reporting use of hyperbaric oxygen in carbon monoxide poisoning due to wildfires. The authors intend to alert to the importance of referral of these patients because the indications and benefits of this treatment are well documented. This is especially important given the ever-growing issue of wildfires in Portugal.

Outdoor air pollution and cancer: An overview of the current evidence and public health recommendations

“…Major primary air pollutants, those emitted directly into the environment largely as a result of combustion of fossil and biomass fuels, include gaseous pollutants (such as sulfur dioxide [SO 2 ], nitrogen dioxide [NO 2 ], carbon monoxide [CO], and volatile organic compounds [VOCs]) and particulate matter (PM) (including carbonaceous aerosol particles, such as black soot). Although CO levels are often low outdoors in the developed world today (because of the use of emission controls such as catalytic converters on automobiles), high levels can be experienced near biomass burning sources, including wildfires 3 . In addition, secondary air pollutants are formed in the atmosphere from primary pollutants and include gaseous ozone (O 3 ), a major component of photochemical smog, formed in the atmosphere when nitrogen oxides (NO x ) and hydrocarbons such as VOCs react in the presence of sunlight.…”

“…Although CO levels are often low outdoors in the developed world today (because of the use of emission controls such as catalytic converters on automobiles), high levels can be experienced near biomass burning sources, including wildfires. 3 In addition, secondary air pollutants are formed in the atmosphere from primary pollutants and include gaseous ozone (O 3 ), a major component of photochemical smog, formed in the atmosphere when nitrogen oxides (NO x ) and hydrocarbons such as VOCs react in the presence of sunlight. Similarly, particulate sulfate (eg, sulfuric acid [H 2 SO 4 ]) and nitrate (eg, ammonium nitrate [NH 4 NO 3 ]) aerosols are commonly created in the atmosphere from SO 2 and NO x , respectively.…”

“…3 In addition, secondary air pollutants are formed in the atmosphere from primary pollutants and include gaseous ozone (O 3 ), a major component of photochemical smog, formed in the atmosphere when nitrogen oxides (NO x ) and hydrocarbons such as VOCs react in the presence of sunlight. Similarly, particulate sulfate (eg, sulfuric acid [H 2 SO 4 ]) and nitrate (eg, ammonium nitrate [NH 4 NO 3 ]) aerosols are commonly created in the atmosphere from SO 2 and NO x , respectively. Primary combustion particles and secondary particles are small in diameter and are often referred to as fine particulate matter, or PM 2.5 (particles ≤2.5 µm in aerodynamic diameter).…”

The Current Status of Cigarette Smoking and Air Pollution Associated Lung Cancer

“…A meta-analysis carried out in North America and Europe reported that PM2.5 and PM10 were both found to have a strong adverse association with lung adenocarcinoma. Particularly, the risk for lung cancer incidence or mortality rate increased 8% and 9% per each 10ug/m 3 increase in PM2.5 and PM10 concentration, respectively (198,203). In the participants who reported spending more than one hour per day outdoors, an adverse association of exposure to outdoor pollutions with adenocarcinoma was implicated (204).…”

Outside Dynamic Evacuation Routes to Escape a Wildfire: A Prototype App for Forest Firefighters

“…The costs are not only economic. The World Health Organization (WHO) affirms that fire trapping causes the main consequences of mortality from the incident during evacuations and air, nautical, and traffic accidents produced by reduced visibility to the firefighters, rescuers, and civilian population [10,11]. The risks are always implicit in a fire; for a forest firefighter, these would re-power when they do not have communication with the personnel to locate the fire origin point, not being able to define the spread direction for the creation of firebreaks, or not have well-identified safe areas and escape routes [12].…”