Inhalation Exposure First Response

Why this matters

Bad air hurts two people at a time. The first breathed it while working; the second walks in to help and breathes the same thing. The two failures this card exists to prevent are that second casualty, and the worker who steps outside, feels better in ten minutes, and goes home without anyone looking at them, which for carbon monoxide and chlorine is exactly the wrong conclusion.

It covers the four airborne hazards a residential trade tech is most likely to meet: carbon monoxide, refrigerant, solvent vapor and chlorine. It is not training. Hands-on first-aid and CPR certification is what makes a responder; this card is what to do with that training when the problem is the air.

The first decision is where you stand

Before anything else, decide whether you can reach the person without breathing what they breathed.

• If they can walk out, or are already out, tell them to come to you, into fresh air, upwind, away from the door or vent the bad air is coming out of.
• If they are down inside, you move them only if you can do it without entering the bad air yourself: they are at a doorway you can reach from outside, or your own monitor reads normal where you would stand. Otherwise you do not go in. You call 911, say what the air is, ventilate from outside if you can (open exterior doors and windows from outside, set a blower at the opening blowing in), and keep everyone else out until responders with breathing equipment arrive.

That no-entry rule is the subject of its own card (see related: Rescuing Without Becoming the Second Victim), which covers why rescuers die in exactly this situation. The short version: the instinct that sends you in is the one that kills you, and holding your breath does not work long enough to drag an adult up a stair.

Smell is never the all-clear. Chlorine and hydrogen sulfide both deaden the sense of smell at concentrations that still injure, carbon monoxide has no smell at all, and refrigerants have little. A room that stops smelling is a reason to leave, not to go back in. The all-clear is an instrument reading or a fire department saying so.

Once the person is in fresh air

These steps follow current American Red Cross and American Heart Association guidance.

1. Call 911 if they are unconscious, confused, having trouble breathing, have chest pain, or had a seizure or collapse at any point, even if they seem to have recovered. For anything less, see the evaluation section below before deciding nobody needs to be called.
2. Not breathing normally: start CPR and send someone for the AED (see related: First Aid + AED on the Jobsite).
3. Unconscious but breathing: roll them onto their side (the recovery position) so vomit drains out of the mouth instead of into the airway, and watch the breathing until responders take over.
4. Awake and short of breath: let them sit upright or lean forward, whichever is easier. Do not lay them flat.
5. Keep them still. Do not walk them around the block to "clear their head." For refrigerant exposure especially, exertion is the wrong thing (see the table).
6. Get the product off them. Solvent- or chlorine-soaked clothing keeps off-gassing into their face. Remove it outdoors, wearing gloves. Eyes that burn get flushed (see related: How to Flush an Eye After a Chemical Splash).
7. Clear the scene. Everyone in the building, including the customer, the customer's family and pets, comes out until the source is known.

Four airborne hazards a field tech meets

The common thread for the last three: they are heavier than air. A basement, a crawlspace, an equipment pit or a pool pump vault fills from the bottom, which is where the person who collapsed is lying.

Why every serious exposure gets looked at, even after recovery

A worker who feels better in fresh air has not necessarily recovered. Each gas fools the responder a different way.

• Carbon monoxide binds to blood more tightly than oxygen does and leaves slowly. The headache easing outdoors means the level is falling, not that it is gone. Standard fingertip oximeters cannot tell carbon monoxide from oxygen on the blood and will show a reassuring number; only a carbon-monoxide-specific measurement, which many ambulances and every ER have, tells the truth. Clinicians also decide whether a pregnant worker or someone who passed out needs more than fresh air.
• Chlorine and other irritant gases (including the acid gases from burned refrigerant) can cause fluid to build in the lungs over the following hours, after the person has stopped coughing.
• Refrigerant exposure that produced dizziness, confusion or an irregular pulse can leave the heart rhythm vulnerable for a while; that needs a clinician, not a ride home.
• Solvent exposure that caused a loss of consciousness, however brief, gets evaluated, because nobody on site can tell how long the brain went without enough oxygen.

The working rule: any exposure that caused confusion, a collapse, chest symptoms, breathing trouble or an irregular pulse gets 911 or an ER, not urgent care and not "see how you feel tomorrow." A mild headache from a brief whiff that clears completely can go to a clinician the same day; when in doubt, Poison Control (1-800-222-1222 in the United States) takes inhalation calls too and will tell you which. And the shop opens the injury report either way (see related: Accident and Incident Reporting SOP), because a delayed symptom tonight needs a record of what happened this afternoon.

What to tell 911 about the air

The dispatcher's choice of who to send depends on what you say. "Worker sick in a basement" gets an ambulance. "Carbon monoxide, my monitor reads 160 parts per million at the basement stair, one worker with symptoms, everyone is out of the house" gets an ambulance plus a fire company with meters and breathing air. Name the gas, give any reading with its location, say how many people were exposed, say whether anyone is still inside, and say what you have already shut off from outside. The address and how to find the right door belong in the same call (see related: Calling 911 From a Job Site So They Find You).

Worked example: the basement that felt stuffy

A two-tech crew is replacing a water heater at a house with a gas boiler in the same basement. The lead, Ana, is upstairs at the electrical panel. Her apprentice, Theo, has left his personal carbon monoxide monitor clipped to his jacket in the van. At 2:15 pm he comes up the basement stair with a headache and nausea and says it "feels stuffy down there." Ana's monitor, set to alarm at 35 parts per million, starts sounding as she steps to the top of the stair and reads 160 ppm.

2:15. She does not go down to find the source, even though the boiler's shutoff is twenty feet away. She walks Theo outside, upwind of the boiler's exhaust, and sits him on the tailgate.

2:16. She brings everyone else out: the homeowner, her two children and the dog. The homeowner mentions the kids have had headaches since breakfast, which tells Ana this may have been going on all day and that the exposure is not just Theo's.

2:17. She calls 911 with the gas, the reading and its location, two adults and two children exposed, one worker with symptoms, nobody inside. The shop's procedure allows a trained tech to close the gas meter valve from outside; she does that, since it requires no entry, and tells the dispatcher she has.

2:20. Theo says the headache is easing. Ana's kit oximeter reads 98 percent on his finger. She tells him that number means nothing for carbon monoxide and keeps him sitting.

2:31. The fire company meters the basement, finds the boiler's vent connector separated at a joint, and ventilates. The ambulance measures carbon monoxide on Theo and the family directly; the paramedics, not Ana, decide who goes to the hospital.

The 160 ppm reading is a little over three times OSHA's 50 ppm eight-hour permissible exposure limit for carbon monoxide, 29 CFR 1910.1000 Table Z-1, which is a workplace exposure limit for employees and not a household safety line. The reading at the stair told Ana not to enter. It did not tell her how long the family had been breathing it, which is why everyone was handed to the paramedics.

If the gas had been chlorine instead. Suppose the same crew is at a pool equipment room and the helper is on the floor inside, coughing, beside a spilled bucket where acid met hypochlorite. Nothing about the room is reachable from outside. The answer flips from "walk them out" to: call 911 and say chlorine, person down inside; prop the exterior door open from outside without stepping through it; keep everyone upwind; wait. The fire company has the breathing air and the protective clothing; Ana has neither.

The failure this prevents. The version of the afternoon without a monitor reading and this card: Theo steps outside, feels better, Ana goes down to "see what's going on," and two techs are on the basement floor when the homeowner comes home.

References

• OSHA, Air Contaminants, 29 CFR 1910.1000 Table Z-1 (carbon monoxide PEL)
• NIOSH Pocket Guide to Chemical Hazards (carbon monoxide, chlorine)
• American Red Cross and American Heart Association first aid and CPR guidelines
• See related: Rescuing Without Becoming the Second Victim; Calling 911 From a Job Site So They Find You; Poisoning and Swallowed Chemicals
• See related: Carbon Monoxide Testing + Response Reference; Confined Space Entry (OSHA 1910.146)