From an interview with (RET) FDNY Chief Anthony Bruno
Throughout his career, Chief Bruno took the initiative to research and investigate the health effects of carbon monoxide exposures to first responders. Standardized blood samples showed reports of lethal levels of carbon monoxide in the system three or four hours after the event. Because of this, he implemented the use of advanced testing devices (c/o the NY EPA) to check for CO levels in the exhaled breath- with 97% accuracy. Chief Bruno saw the value in this testing protocol as he proposed a department-wide screening program to identify those suffering from too much exposure.
SURVIVING THE FIRE SERVICE& THE "NEW KILLER SMOKE"
During active duty, Chief Bruno claimed to directly know (and work with) firefighters who died from frequent exposures -- having gone to three or four fires each shift while never getting tested for carbon monoxide. "From what we now know, early detection and regular exposure testing could have prevented a lot of occupational injuries. Learning from history is also why the firefighter is much more protected these days. Today's use of masks is much more universal and mandatory, unlike the old days where firefighters hardly used them. Technology evolved and eventually so did we... but sometimes a little bit too late."
Referencing historical fires in NYC with recorded health effects to the responders, Chief Bruno noted landmark disasters including the 1975 NY Tel Fire and the 699 firefighters who were all exposed to the most lethal black smoke from burning PVC's and hazardous plastics. He also shared his own experience as the covering captain in 1979 at the fire in St. Batholomeow's Church (several blocks from St. Patrick's Cathedral) where he recognized great similarities to both incidents - including the deadly effects of burning pool & gardening chemicals and PVC's from the church. Responders of both fires (within the same era) identified "a new type of fire"- incinerating high levels of carcinogens resulting in latent mortality cases.
The Diagnosis and Treatment of Carbon Monoxide Poisoning:
The treatment aims in particular to prevent long-term harms, such as cortical dysfunction, Parkinson‘s syndrome, Parkinson‘s disease, dementia, cardiac complications, as well as reduce mortality in the long term. All patients with symptomatic carbon monoxide poisoning should be treated with 100% oxygen as soon as possible. In severe cases of fire fume intoxication, combined poisoning with CO and cyanides should be considered. The evidence for the benefit advantage of hyperbaric oxygen is weak in view of the heterogeneity of the available studies. The decision in favor of HBOT seems sensible in severe CO intoxication or in pregnant women.
Assessment of hyperbaric oxygen therapy versus normobaric oxygen therapy
According to a report from the NIH, the intracellular and extracellular effects of carbon monoxide poisoning affect in particular the organs without oxygen reserves (heart, brain). Toxicologically, the quickest possible elimination of the poison is the most sensible way to prevent further injury. The higher the partial pressure of oxygen provided, the shorter the elimination period—which would in theory support hyperbaric oxygen therapy (HBOT). In practice, however, HBOT is the subject of controversial discussion (20, 21). Critics point out the great logistical challenges and lacking evidence. In actual fact, the heterogeneity of the studies to date (in terms of study design, kind of exposure, severity of intoxication, delay in treatment, treatment pressures applied, and follow-up period) barely allows for any evidence-based recommendation regarding the type and extent of HBOT (25). What adds to the dilemma is the fact that the HBOT therapy schemes applied vary widely across Europe (e57), which imposes limitations on future meta-analyses and their validity too. (See complete report on NIH)
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Having a cough here or a wheeze there is not enough for most first responders to raise the flag of alarm. Seasoned specialists like Dr. Schulster recognizes that unique and unusual symptoms or maladies do not reach the patient's consciousness for quite some time. Ignoring or not paying more attention to these "little" anomalies tend to often be the norm. These coughs may progressively grow worse over the years and then one day they begin to wheeze a little more than usual and wind up with advancing shortness of breath. Once this becomes significant and finally enters their consciousness, only then will the thought of seeking medical help actually come to mind.
In a pulmonologist's tool kit exists certain standard pulmonary function examss- including the SPIROMETRY . This test estimates the narrowing of your bronchial tubes by checking how much air you can exhale after a deep breath and how fast you can breathe out . This allows us to see the best way of determining the lung function in numbers, more or less, is a complete pulmonary function test. Next is the METHACHOLINE CHALLENGE  - also known as an asthma trigger that, when inhaled, will cause mild constriction of your airways. If you react to the methacholine, you likely have asthma. This test may be used even if your initial lung function test is normal.  Another test used is THE COLD AIR CHALLENGE . The patients generally come with having had those in the past and most are positive for asthma. In the asthmatics.