Skip to content

Carbon Monoxide (CO)

Quick Reference

What is CO?

Colorless and odorless gas produced by incomplete combustion of carbon containing compounds such as petroleum products (gasoline, oil, propane, natural gas) and wood.

Crew Safety

  1. Staging/Perimeter
    • No specified distance, Paramedics are not to enter an area with carbon monoxide present
  2. Additional Resources
    • Paramedics are not to rescue patients. If patients require retrieval the fire department will be required.
  3. PPE requirements
    • SCBA required for rescue. Once patient has been extricated to a safe location no PPE is required.
  4. Safely initiating patient contact
    • Patients can self-extricate or be brought to a safe location in ambient air or an otherwise well-ventilated space to meet paramedics.

Effect on the Patient

Primary physiological effect is mediated by biding to hemoglobin. It has a greater affinity for hemoglobin then oxygen, thus causing hypoxia. Notably SpO2 readings are normal. CO also binds to cytochrome-c-oxidase, thus impeding cellular respiration. Skin may appear pink or flushed. Symptoms may vary from a headache, dizziness or nausea (mild) to an altered level of consciousness (moderate) to unconsciousness, seizures or dysrhythmias (severe). Consider CO as a possible toxicant if multiple patients from one location present with similar symptoms.

Patient Decontamination

  • If not involved in a structure fire no decontamination is needed.
  • If rescued from a structure fire removal of clothing followed by decontamination with soap and water. Clothing should not be transported with the patient.

Patient Treatment

  • All patients with suspected CO poisoning should be treated with continuous high-flow O2 and transported to the hospital for assessment and observation.
  • Consideration of transportation to VGH for hyperbaric oxygenation if indicated. Indications = any one of: 1) COHb >25% or >15% if pregnant, 2) loss of consciousness at any time, 3) Cardiac dysrhythmia, 4) focal neurological deficits, 5) altered LOC or 6) severe metabolic acidosis (pH<7.25).

Safe Transfer of Care

No concerns from isolated CO exposure. It does not off-gas and does not remain in clothing or on skin. Patients rescued from structure fires should be decontaminated prior to transport.

Paramedic and Equipment Decontamination

  • No decontamination of personnel or equipment required.

Quick Access Resources

DPIC Monograph

BC DPIC (PDF)

Paramedic Specialist Safety Data Sheet

PS Chemical Response Sheet (PDF)

Emergency Response Guidebook

ERG (PDF)

Revision History

Version Date Changes Author
1.0 2026-05-01 Initial version Clinical Hub