Physicians often have limited experience of carbon monoxide poisoning, and regional and national poison units are regularly contacted for advice. To improve the situation a 24-hour/365 days a year advice line was created to advise both hospital accident and emergency departments and poison units. This service started in January 1996. All calls to the service are initially dealt with by a first responder whose aim is to identify ‘critical answers’ and act accordingly. If the patient’s poisoning is sufficiently severe, then onward referral to a hyperbaric unit may be appropriate. In addition to patient care, the CO advisory service provides training and lectures for all hospitals that request this support. To date the total referrals can be broken down as accidental poisoning (51%), smoke inhalation (27%), non-accidental poisoning (21%) and cause unknown (1%). This is in contrast to the general perception that non-accidental poisonings make up the vast majority of cases. The service undertakes to follow the progress of the patient until all issues are resolved and to remain available to provide advice and support until it is no longer required. In the future the service hopes to provide data for research and eventually to provide leadership in organising and running treatment trials including the efficacy and value of hyperbaric oxygen therapy.

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