Carbon Monoxide Poisoning

Patients suffering from exposure to byproducts of combustion should, when feasible, have a carbon monoxide (CO) level recorded using a co-oximeter device. These situations include fire victims or smoke inhalation exposure to CO, firefighters during rehab activities, patients or families with complaints of general illness or headache. EMS providers should make efforts to assure that firefighters are assessed for elevated levels of CO after structural firefighting activities.




  1. Refer to Airway Management protocol.

  3. Obtain vital signs.

  5. Obtain CO determination using a co-oximeter device if available.

  7. CO level 10% or greater and/or symptomatic- 100% NRB O2 and transport to nearest appropriate hospital




  1. Initiate IV Access when appropriate.
  2. Treat arrhythmias per appropriate protocol when present.




  1. Remember that pulse oximetry should not be used as a determination of oxygenation in the patient with elevated carboxyhemoglobin.

  3. Smokers may have a baseline CO level as high as 5-6%