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Good evening, everybody and welcome to another session with, with N in one of our in conversations. Now, um I'm joined tonight by Laura, you know, Laura, I've never said your surname out a loud but um but is it fa fa so I wasn't sure if it was how anyway, people don't need to know that I can't pronounce name. So we are gonna be joined by Laura who's gonna be telling us a whole lot more about carbon monoxide. So remember we are running this on medal as you all know, and at the end, I'll pop in the, the, the link to be able to do your evaluations and get those certificates. Um So get all the usual stuff from us, but for now I'm gonna hand over to Laura to tell us a little bit about herself and er the work that she's doing on carbon monoxide. So, so Laura tell us, tell us a little bit in the words of silla, what's your name and where you're from? Thanks so much Michaela. I'm absolutely delighted to be here with, learn with nurses. It's really wonderful to have this opportunity to talk to you and your audience as well. So my name is Laura Fatter. I'm from Policy Connect and I'm a policy and research manager for carbon monoxide. And part of that role involves providing a secretariat for the all party parliamentary Carbon monoxide group, which comprises 16 parliamentary members representing five political parties. So it's a really great job and I get a lot of exposure to different organizations and individuals who are all, you know, pulling on the bandwagon for improving carbon monoxide safety and awareness. And, and just in case anyone's not come across policy, connect anymore. Can you tell us a little bit more about that organization before we jump into, into carbon monoxide and, and what sort of other stuff you might cover as well there in case people want to go and learn a bit more? Sure, thanks for asking. Um So policy connect is a cross party think tank. We work on various different areas of public policy, one of which is health, which is where carbon monoxide policy sits. And we also work on education assistive technology and sustainability. Um So we do cover quite a variety of different areas which is really excellent and it means that we can pull on different specialities from colleagues and look at those kind of cross working areas like energy like housing like preventative health care, which affects so much of the work that we do. I have to a little root round afterwards and see what else is in there, particularly around the energy side and the health, of course, so I'm gonna jump in and our title was around carbon monoxide, you know, a poisoning and a killer. And I, I, when, when, when the RCM reached out because that's what I want to tell people. So I'm, I'm represent the RCN at the all Party parliamentary groups that Laura coordinates. And I have to say if you ever get the opportunity to get involved in one of those organizations or anything like that, if you always say yes, because it's really interesting. Um and I, I it's not that I have a passion for carbon monoxide, but I find with something like with, with something like these topics that aren't always top of the list when we're thinking of things. Unless you've been, unless it's in touched your world in some way, then you kind of don't think about it. So, for me and, and Laura knows this, the reason why I said yes, I'll happily happily get involved with carbon monoxide. Well, it's two main reasons. One, my husband is, er, was, is now into renewable energies, but he was, you know, he did boilers, central heating, all of that and the amount of times that he would talk about carbon monoxide poisoning and incomplete combustion and flus and, you know, we've been out for dinner, nothing. The state of that flu across the road and all of that sort of stuff. So it was kind of part of my DNA without me even trying. But then my friend at my daughter's and both him and his mum had carbon monoxide poisoning and was both very, very unwell as a result of it. So for me, it was a bit of a no brainer getting involved. But for anyone that's listening or joining us, because when we have this people will be joining us in a variety of different ways, either live now or on demand. It would be really useful if you could just give us a bit of a general outline on just what is carbon monoxide poisoning? What are the effects? What are the symptoms? Can you give it as a, you know, a short lesson on on carbon monoxide name, please? Laura. Yes, certainly, I'd love to. Um, so carbon monoxide as you've highlighted can form when any carbon based fuel is burnt. So that could be your gas, your solid fuel. So coals, wood oil, any kind of carbon based fuel that you might be using. And yeah, typical appliances that people associate carbon monoxide with our boilers, gas cookers can also so pose a risk as well and also even cars and generators. So carbon monoxide can be produced by a really wide variety of different appliances in the home and also can enter the home from outside as well. So it's definitely one to watch and be aware of. And as you say, I think it is something that you know, will strike people once they've had that carbon monoxide story, if they know somebody that's, you know, had a, you know, a tragic incident with carbon monoxide, that's when it, we start to think about it. And actually it's so important that we're here today because we all need to be thinking about it before harm has occurred so that we can take those preventative steps and actually stop carbon monoxide poisoning from happening. Um We all are, well, many people have heard of carbon monoxide as the silent killer and that's, you know, part of the reason why I'm so pleased we've titled the session as we have today because carbon monoxide is a killer and this is obviously one of the most severe effects, but it's also a poison that can have long term impacts for our health as well. So carbon monoxide has been associated with cardiovascular issues with brain damage. It's quite a risky for pregnant women because they have different hemoglobin. So pregnant women and fetal hemoglobin has a higher affinity to carbon monoxide and it result in low birth weight. It's been linked with cognitive and developmental problems in Children. It's also been linked with sensory impairments as well with low mobility. It, it's essentially a poisonous gas which deprives your body of oxygen. There are also other toxic effects which are the subject of further research at the moment. Um But the main sort of known and common issue is the deprivation of oxygen. So that affects your body in terms of the organs which use the most oxygen. It can also obviously cause respiratory problems because you're breathing it in. So it can be really quite um dangerous for people with asthma. Um and other respiratory issues. And the symptoms of carbon monoxide poisoning are quite nonspecific. So the typical sorts of symptoms you might get would be a headache, feeling sick, um maybe feeling a little bit dizzy, um collapsing. Um and obviously losing consciousness in those more severe cases. But what you really need to be sorry, Mna. Yeah. No, I'm here. Ok. Just a little noise on the line. I think what's really important to be aware of is that these kind of symptoms can be caused by so many things, you know, they can be caused by stress, they could be caused by dehydration. Um So it's really important that we are thinking of carbon monoxide as a possible reason because it could be very easy to misdiagnose or just to put those symptoms down to something um that we're a bit more used to seeing. Yeah. And those, when you, when you first mentioned about the symptoms and we look, you know, before and now it was just trying to imagine that, you know, so if I'm a GP I'm sitting in my practice and somebody keeps coming back in saying, oh, I just so tired, I'm just so this they, they will, you know, they're not very exciting, you know, you call them not, you know, the symptoms are really not and, and like you say, can be so many other things. Do we know at all? Um, how widespread carbon monoxide poisoning is? How, how bad is it, how many people it affects? Or, or like most things, do we actually not know because we don't have it diagnosed enough? Yeah. It's quite tricky to, to try and establish that. The estimates. I think the latest information we have from the office for national statistics indicates between 20 to 30 individuals from accidental non fire related carbon monoxide poisoning because of course, carbon monoxide can also sadly be used in suicides and can be related to fires as well. Um which we wouldn't necessarily think of as being within the sort of carbon monoxide poisoning we're trying to target because if you have a fire, then that's quite a clear link there. Um What we have seen is that a lot of people being admitted to A&E. So the latest estimates were from the, I think it's from the NHS. There were around 4000 people coming into the accident and emergency, which is obviously a huge number and we really need to be careful of that. But there are many, many individuals who potentially would have been seeking medical help as you kind of outlined those mystery patients and they would potentially never be diagnosed as having exposure to carbon monoxide. There's also lots of things that can be put down on your death certificate if you have, you know, died of carbon monoxide, if you've died of a heart attack, for example, that would be recorded as the main reason. So the way that carbon monoxide harm and data is collected is really quite challenging. And that's a big challenge for us trying to show the prevalence. I think one of the best indicators we can look at is from engineers and from faulty gas appliances where there could be carbon monoxide. So there's some recent work that it's been done by the Gas Safe Register where they've essentially mapped out the entire of the UK. And they've shown that one in six homes that they, their engineers have attended, have had a dangerous or faulty gas appliance. And that is a huge number thinking about one in six individuals. You know, if you think about that as being a street that could be tens of people. And I think that's one of the reasons we need to be very vigilant around this and make sure that people are, you know, ensuring that their appliances are serviced and that their homes are safe this winter because you might not necessarily think, oh, you know, my boiler could be making me feel ill. It's quite a difficult connection to be made for an individual and if that individual, you know, isn't going and reporting, oh, I think it's carbon monoxide, then that healthcare professional again, might not immediately make that connection. So the numbers are quite, you know, don't look huge, but when you then look at how many people have a carbon monoxide alarm in their home, it's less than half of the dwellings in England. So there is potentially a, you know, a very large number of individuals suffering without necessarily making those connections and, and getting on those kind of official records. Yeah. And actually I just, so now my little brain is ticking away as it does. So there's huge potential out there for lots of people to have what I want to call low grade carbon monoxide poisoning. So not enough to make you go to hospital, not so much to make you, well, not, you know, you don't die but, but just enough to give you really grumbly symptoms that actually can be really grotty to live with but, but not enough to, to, to come to a diagnosis. The potential is quite huge, I think particularly if it's one in six. Now. Um I'm gonna move us on to um some, some, some let's let's drill down now into thinking as um what nurses can do. Now, of course, we're not nurses who join them with nurses on the call or, or on the sessions. But um but given that when we say nurses, we're thinking about health care professionals and what are the impact there? Now, I've got a call, I've got a question that's coming in and um for anyone that's joining us later on on demand, you won't be able to see the questions. But I'm um but I'm so I'm gonna read them out. And what um so originally we're gonna, well, we're all going to still talk about. So what does it mean with nurses and what do nurses need to know? But there's a really good question coming in saying do healthcare professionals have to report carbon monoxide poisoning to any agency as such? So, is there someone we have to tell? Um or ask maybe so one excellent organization I can recommend getting in touch with is the National Poisons Information Service. So they actually run a helpline if you suspect carbon monoxide and you are a healthcare professional working in a clinical setting, you can give them a call. Um They're really excellent in terms of giving advice and also in terms of recording as well. And they've just published a paper in September of this month and sort of updating of all of the calls that they've had and the trends in the data that they're seeing. So I definitely recommend getting in touch with them to get some advice and also to, you know, help us to understand that picture of carbon monoxide a little bit more clearly, you can contact them on 03 double 48920, double one. If you're in England, Scotland or Wales. And for northern Ireland, it's 0180925 double six. And that's top space. So, yeah, I definitely um suggest anyone who suspects carbon monoxide exposure in a patient should get in touch because that's exactly what this organization is set up for and they're very well placed to give you. I might, I might ask you to repeat that at the end for anybody that hasn't scribbled it down right now for anyone that's listening. let you know we'll ask that one again at the end. But so it's not a must do. It's just that you could do. So we don't have to, is that so, is that right? We don't have to officially inform anybody about carbon dioxide poisoning. Then there's no, there's no statutory obligation as far as I'm aware on healthcare professionals. I mean, I would advise anybody to check their kind of working code of practice and check what's advised by their particular trust or employing organization because there may well be some kind of internal processes. But yeah, as far as I am aware in my work, I haven't come across any duty or obligation to report on that as it were. But it's a very good question, whether there should be perhaps a duty or obligation so that we do then have, um you know, better and more accurate data and statistics and it would almost close a loop, wouldn't it, you know, as in that, in that, in that code and, and informing. So let's stay with nurses for a bit now. So what do, what do, what do nurses need to know? What do they, let's think about them? Not, not themselves, but when actually sort of themselves, like where might nurses come across carbon monoxide poisoning? Where might they see patients? So I think it's particularly important if nurses are visiting individuals in their homes or perhaps in community settings that they're aware of the signs and symptoms of carbon monoxide poisoning, they're aware of what to look out for. Um There are certain signs that you can look for as warning signs. So if you see any city marks on any appliances, so that could be your cooker, your boiler, even stove or wood burning wood burning appliance, it'd be very important to look for any condensation on windows. That might seem a little strange. But what that can indicate is that the air quality and the ventilation are not great within that home. And therefore it can be an issue that carbon monoxide can just looking up and now I had realized condensation on windows. Oh my. Yeah. So it's really important that also nurses are aware of what kind of practices people are behaving with in their homes. So certain cooking practices can pose greater carbon monoxide risk. If you're, for example, using a large pot over several hobs on your cooker that can cause a risk because it stops the fuel from burning completely. Anything which is really stopping fuel from burning completely or allowing, um, you know, things to go unchecked essentially could be a bit of a warning sign. We're also aware from excellent research from National Energy Action that there's a link between fuel poverty and carbon monoxide exposure, which when you think about it does make a lot of sense because people in fuel poverty maybe aren't as likely to be able to have their appliances serviced. Maybe they might try to use some kind of alternative heating methods for their home, especially this winter, which can come with greater risk as well. So for nurses visiting in homes, I think it's just to be aware of, you know, is this an individual in fuel poverty, are they getting the help they need? Is there a carbon monoxide alarm critically? And is it within date, has it been checked? You know, are there certain things perhaps that you would think about for um, evacuating the home if the carbon monoxide alarm were to go off? Is there a protocol for that? Do you have the gas emergency service number on your phone? Another phone number that I'm going to give for you guys today? Um, so the gas emergency service are the people to call if you think there's a gas emergency. So if you smell gas or if you suspect carbon monoxide because your alarms going off, you can call them for free on 0 800 triple one, triple nine that's 0 800 triple one, triple nine. And that should really be, I think something that we are communicating because often times people think, well, I don't know what to do if the alarm goes off. And in that moment, you know, you don't want to have to be kind of problem solving. You want to be able to follow a pathway, follow a process. What you're going to do know that there's help at the end of the line as well. Um, so I think that that's something nurses and particularly employers can really think about. Are they equipping their staff with the information and the processes they need to be safe themselves and also to keep the patients safe. And I guess it's very different to the, to the fire alarm and just wafting your tea towel because you, you know, that's, that was my, you know, that's me just opening the doors because I'm burning something that way. Whereas with carbon monoxide, we don't have those, those same indicators that we know it's because we've got smoke and stuff. It's, um, it's, it's, it's the silent killer as you say. Now, I'm just li I, I, I'm, I'm nodding and I'm hearing, I'm thinking, yeah, that's brilliant. We can do that. And now, and then I'm thinking with my nursing hat on, but I'm already going in and I've already got a million and one things to think about while I'm visiting a patient while I you know, with everything else that's going on. And I've got, and particularly when we, we think about it is, you know, it's not just nurses that go in to visit patients. We've got care workers and, and low paid workers and actually they got a limited amount of time and it becomes really challenging to then throw one more thing in. And I'm also thinking, are they gonna be thinking, oh, let me just check your carbon monoxide alarm. I can see challenges coming back um on, we just don't have the time or as Zoe's mentioning here the training and we'll come on to the training in a moment. But um but I wondered if is this something? I mean, I, I, I, I don't see, I, I think, I wonder can we have, can we be more proactive? It's just simpler ways. Could nurses do, do firemen carry their carbon monoxide? Do, can we have portable alarms? And why are nurses and health care assistants and carers got them in their bags or on their pockets? I don't know, I guess in your bag it wouldn't really work because it would be in your bag. But is that an option? Do you think that would help? Rather than having to think? Like let me check for? So let me check for this. Let me check for that. Would you just think it's gonna blip because it's going off with that work? Yeah, I think that's a really good idea. And I know that certain fire and rescue services do actually carry with them, those kind of personal monitors that you have on your body as well. Um They, I think they come, they come in at around 60 70 lbs or so. So it might be something to think about investing in because those do last a couple of years, those personal monitors and I can certainly provide some information on where to look at to find out more information about those. If you've got your own carbon monoxide alarm, I mean, you might, you might want to take it with you. The problem with that would be your carbon monoxide alarm might take a longer amount of time to sound if there are lower levels of carbon monoxide. But it's definitely something that would alert you to those acute levels and that real kind of, you know, you need to evacuate now danger. So I think if you, if you, you know, the gold standard would be, as you've said, having that kind of personal monitor. But if, if that's not available to you and you are able to have a carbon monoxide alarm and kind of take it with you, then that's certainly better than absolutely better than nothing. And I know there are some fire and rescue services which, which use, use both in either for their safe and well visits. So we, and also, you know, use the fire and rescue service, they offer safe and well visits to people in vulnerable situations. If you're concerned about somebody, you know, you don't have time. There are other services that you can connect them with the priority services register is another excellent thing to suggest. Um It's relatively simple to sign up for as far as I'm aware, it's something you can get through. Um, the patients can get through their energy suppliers and that will put them in a better position if there are going to be any kind of emergency works or if for some reason, um you know, they're going to be cut off. If they're on that register as it is, they should be treated as a, as a priority and shouldn't be kind of subjected to any sort of negative consequences that can be avoided. So there are, there is help out there, there's help available. I think that you really, you know, you make a very good point, which is that everyone working in healthcare right now is, you know, working with limited resources and we've got to prioritize the things that, you know, are the highest risk and do make the most sense for us. So I totally appreciate. It's not something we can expect, you know, nurses to suddenly become engineers or gas safety experts. Um But yeah, finding workable solutions is really, really important and we're actually running an inquiry at the moment into improving practices in health and social care where we've been doing a bit of research with people on the front line to find out what's really going to work well for them. So I'll be sure to let you know when that's available. Oh, do, do that would be really? Because I was about to put a national call out to say, I don't think that, I definitely don't think people should be buying their own carbon, you know, little portable carbon monoxide alarms. Um, but, but is there almost a responsibility by somebody's trust or organization to ensure that staff safety if they're going into? And if that one in six could be faulty, one in six could be faulty. And we're sending in, we're sending in, you know, health and healthcare workforce into places that potentially are an issue. How now you might not and I don't know this, you might, how quick from being in. So let's imagine I'm going to do a home visit. I've gone in and I'm gonna be there for 20 minutes, let's say, could I feel dizzy at that point or would it take, would I need to be exposed to it for longer? So I know I'm getting quite clinical now, but is, is, would it, would I feel it that quickly? You, yeah, you, you can definitely feel it that quickly. I mean, you can, you can, um, you know, have a fatality in less than five minutes at very high levels of carbon monoxide, you know, within a couple of minutes. So it really depends on the individual. I think it's one of the things in carbon monoxide that's tricky for us is to classify, you know, what's low level, what's high level, what can I expect to see as a clinical outcome in somebody who's been exposed to this level for this long? Because it really does depend a lot on that individual person. I think, you know, you could certainly, 20 minutes is certainly enough time for harm to happen in a situation. And if you're, you know, visiting a patient who smokes, they might have a higher resistance to you as an individual. So it may well be that you're going into that home and the patient is kind of not suffering as much as you are. And then suddenly you're actually, um you know, finding yourself becoming overcome. I think it's absolutely a workplace safety issue and all employers do have a legal obligation to provide their employees with a safe and suitable workplace. So I would be, you know, very strongly encouraging unions and other professional bodies to look at this issue quite critically, especially as, you know, we are coming up to winter and, you know, it's a really difficult time for a lot of people in terms of energy and the cost of living. And what about so, so now, now what about if we have to start somewhere? Let's imagine we have to start somewhere and if we were gonna make a a push. We're gonna start somewhere with that sort of, you know, responsibility from an employer if they say, well, we can't afford all that money for all our home visitors. All of everybody that's going in. What about if we said, well, let's start with, when women are pregnant, would that be good? Because we know that actually they're, they're more susceptible, more vulnerable. Is that right when they're pregnant and with the, and with the, with the, with their baby, would that be? Yes. Yeah, absolutely. Yeah, you're totally right. Pregnant women and young Children and obviously babies are much more susceptible to carbon monoxide poisoning due to the difference in their hemoglobin. And so that's something I think we definitely should be focusing on because obviously Children can then have developmental difficulties, which can cause some problems for all of their lives. So if we looking at preventative health care as a serious issue as we should be, you know, in terms of leveling up on the social care, white paper and all of these um you know, brilliant integrated color systems that we're hoping are gonna are gonna form and develop effectively. I think it's critical that we do prioritize pregnant women and pregnant women are generally tested for carbon monoxide during their pregnancy. But after they have their baby that doesn't tend to continue, you know, consistently. So I think if you have that equipment and you're engaging with that individual already, then just keep you know, testing for carbon monoxide, make sure that you're aware of that um, in their home. And I think if employers don't want to pay for personal monitors, there are free training courses available. And so I think that something which, you know, should be definitely given people should be given time to undertake that and be given the tools to be able to protect themselves or just to certainly be aware of when they might need to protect themselves in that situation. Now, interesting, you said training because there's another comment that's come through. Well, more of a question and it says I trained many years ago, exclamation mark, which about myself, I trained over 30 years ago and had no training as a student nurse on carbon monoxide. Do student nurses, health visitors or district nurses, et cetera receive training, do we, do we get is, is, does that, do you know, do we get training as part of our training um for being nurses? So my research has led me to believe that it's pretty inconsistent if I'm honest. Um I think that might be because, you know, as we've said, there's lots of different things people need to be trained on. And obviously we're keen to kind of, you know, not overburden the workforce. But yeah, I think it's definitely conversely if we did understand carbon monoxide poisoning better, we might have a less burdened workforce because people would not be subjected to this. And would be getting weller. So those kind of mystery patients that keep coming round and round um might not necessarily, you know, be doing that. So, um I don't think there is mandatory training. There is an RCN training module available as I know, um you know, Michaela and I'm sure we'll be sharing that as part of the information. And there's also a really great organization called Think co who provide training and who do actually provide in person workshops as well. So I can give you some information to link to some of those resources too. But it is a shame that it's not part of the sort of curriculum as it were. And it's looked at as very much, you know, something which is an extra and a kind of additional thing that you should be bolting on when maybe people don't necessarily have the time to be doing that. So, yeah, I think some really good points coming up here and also anything you've got for anyone that's attended the sessions or going to listen to the session afterwards or if you send me the stuff over, I'll upload it and, and it'll be sitting within med all. And people say, yeah, they just go in and download it direct from there and even if you send me something in two weeks time, I can upload it and it sends a little email to everyone that's attended or going to attend um to say it's here So there's a, we have a really, this, this is a great bit of software that a great plan medal that allows us to be able to do that. Now, um Sue said I was informed that a pregnant woman had a high level of CO2 and in their blood, co in their bloods and encouraged to contact gas engineers. So, is that what, so if somebody's had that they've had a high recording. So you, that's what you were saying, then they were told just contact your gas engineer and I guess they come out and fix the boiler, replace it. Put your big, do not use sticker on it. So, is that, was that the right advice to give? I'm sure I'm sure it was contact, but that means there's no need to evacuate or something at that point. Um I think it's tricky, you know, when we say a high level of co and I should just point out carbon dioxide CO2 is slightly different to carbon monoxide. I imagine you're probably talking about carbon monoxide because carbon dioxide, we exhale normally as part of our respiratory function. So, but it's a very, very common mistake and I've seen it absolutely loads of times. I think it's really good advice that she should contact those gas engineers and maybe having the gas emergency service number would be good for people in all sorts of financial situations if you're thinking, oh, I don't want, you know, a big gas bill, you might put that off and you might kind of continue to put yourself at risk. So the levels, you know, and the individual is really important and I certainly wouldn't want to critique anyone's advice. I think, you know, making that connection between, you need to get an engineer around if you've got high C is absolutely correct. I really support that and it is quite, you know, quite a jump to make that from kind of treating symptoms and treating a patient in a healthcare setting to actually say, well, perhaps it's your environment and you should, you know, maybe take action there. So I'm really pleased to see that that connection is being made. That's fantastic. Good. That's good. Now, we've got one more before we start to think about winding this session up. Um So, but we'll still chat for a few more minutes because I've got another question I want to ask you. But, but we got a direct question coming and probably one that's quite useful. And can you test levels similar like on pulse? Like would a pulse oximetry show you, would you get low oxygen sats or is it, does it have to be a blood test to be able to establish it? How, how does it work? How do we get that diagnosis? I would strongly encourage you to check with, to base and the National Poisons Information Service. I have seen some reports that pulse oximetry isn't ideal, but I would definitely not want to give a kind of opinion on that not being from a medical or clinical background myself. I think it would be a really, really good idea to contact and National Poisons Information Service via, to space and see what their advice is. And this is also, you know, a question of what equipment you have available to you. I think it depends, doesn't it? If you're in, you know, if you're in a hospital, then obviously you're much better placed. If you're in a domestic setting, you might not have that immediately available. So it's, um, yeah, it can be quite tricky and it's also known accuracy of devices. I think we know that pulse oximetry is probably not too bad, but it's not always a, a great indicator for oxygen saps. You know, in particularly with some of the ones that we randomly buy off. I don't know why I'm poking at my finger like this, but that we randomly buy off the internet. And certainly I'm thinking about devices that people wear on the wrists that might talk about um, pulse oximetry that way. And I know that or they can talk about sats and I know that certainly from a BP perspective, all of the fancy watches that will take your BP probably are not validated because what about you put your watch on at a different strap tightness and stuff. So most of those, we wouldn't say use that way. But also if you had one that was ridiculously low, then I guess you'd either double check and, you know, you've got to use your clinical judgment when it gets to that one. Now. So Sue, who said about CO2 has popped in the chat? Yeah, sorry. She meant, she meant co so it happens a lot and I also stumbled over it when I said it. So, so what about nurses themselves? So we're now, as you said, you mentioned about we've got a hard winter ahead, hard for many different reasons. One because it, you know, it's been raining a lot and it's gloomy out there and the, the financial pressures that are coming about us and that, you know, many, many women, many nurses and women, they have Children. And yeah, what, what about their own homes? What can we do to help ourselves? What can we make sure we do in our own homes? So I would definitely advise everybody to ensure they have a carbon monoxide alarm. That's whether you have fuel burning appliances in your home or not. Carbon monoxide can pass through walls and can enter from outside. So don't think that you're, you know, completely safe just if you're not necessarily on the gas grid or if you're an electric home, you could certainly have carbon monoxide from other places. So get that alarm, make sure you have your appliances serviced every year so that you need to be serviced annually. That's your gas appliances. If you have a chimney that needs to be serviced to ideally, um, you know, buy a qualified chimney sweep and, or a s approved appliance servicer, make sure that you're really being careful with solid fuel. We need to ensure that body is ventilating homes properly. So, something that I'm quite concerned about is individuals blocking air bricks or blocking ducts, vents and flus ventilation in the home is absolutely essential. And this is one of the ways that we can dissipate carbon monoxide from building up, do always ventilate when you're cooking, that's a critical time. Make sure you've got that carbon monoxide extractor fan on, make sure you understand the symptoms of carbon monoxide. So you can recognize it in family members and particularly Children or pets. Um, know that they're a higher risk, have that, er, emergency gas service number saved on your phone. So, you know what to do in an emergency and teach anyone you live with never to ignore their carbon alarm. That's absolutely vital. It's um, sadly, you know, one of the first thing that comes up, if you Google, what do I do if my carbon monoxide alarms going off is take out the batteries or put it outside. Never ever, ever do that. Please pay attention. Your alarm is there for a reason. Um, so yeah, that's really critical too and I should just mention Michaela as well before we go off, there's a series of four questions that individuals can ask to try and raise or lower the suspicion of carbon monoxide poisoning. So the question called coma and they stand for cohabits outside maintenance and alarms. So just to go through those cohabits, is, is anyone you live with feeling sick or feeling symptoms of carbon monoxide poisoning outside? Is, are you feeling better if you go outside when you're away from the source of CO M is for maintenance? So, maintenance of appliances. Have your appliances been well maintained, you know, are, are they a bit old, are they a bit dodgy and a is for alarm? So, do you have an alarm? And if so has it been going off? And if you answer yes to any of those questions, the advice is really to seek information from the National Poisons Information Service and potentially to call that gas emergency service number. Um, and certainly to, you know, take a closer look, um, at that individual, I seem to have lost you, Michaela. I'm not sure if that's the same for others, which is a little bit of a shame. Um, as I am, I can, I can hear you, I think. Ok, so that is really odd, but I think it was me that went because I lost the chat for a moment. So you, you coped very well there as you have been thrown in. Very good. But what I wanted to jump on was that where you, with the C and co have a tea. And I think that's, that's something that it's almost a, a really useful, something to know that when we're looking at symptoms is anybody else in the family having those same sort of symptoms. That really should be. I think if I, a big warning bell to anybody that, you know, because it's not normal for both of you to get the symptoms or three of you to get symptoms in the same way. And I certainly know, um, a friend of mine and it wasn't carbon monoxide poisoning but it was something else and it ended up with both her. She started and then about six months later, well, about four months later the daughter started with symptoms. It just happened to coincide that way. But, you know, they're almost going down there. Are we being poisoned in some way? Is there something in the house? Cos once you get more than one you've got to look for that, that link, what is the reason that's happening there? And I think that's a really, a really good warning bell for people to, um, to have in their minds, particularly either themselves or when they're, when they're, when they're out visiting. So I'm going to apologize for my falling off the internet briefly for a moment, er, there for anyone that might have lost us. But I think we're all back now. Well, Zoe, what am I saying? Zoe Well, Laura, I think we're almost at the end. Just, do you want to in the last moment, is there anything that you would like to ask me as a nurse or anything that we learn with nurses can do to help, to help more? So, is there anything you want to ask? Well, first of all, I'd like to thank learn with nurses very much for having me today and for helping us to raise awareness around Carbon Monoxide Awareness Week, which is running this week. This is the very first day of Carbon Monoxide Awareness Week. So we're absolutely delighted to be here. Um And really, you know, if there's any information that would be useful to you, um please get in touch, you know, if there's any um content that you find that's good to share, I mean, we obviously have that training module, but it's really good to be topical and, you know, to sort of raise individual um things we've seen in news items and so on and to keep that conversation going. I think. So, my question to you and to others here is just, you know, what would help you to improve carbon monoxide safety in your daily practice? And is there any greater information that um your professional bodies or your unions or anyone could provide that would be helpful? Well, just funny enough, somebody said, are there any so sus has just written in, are there any postcards or resources or posters with coma written on it. So is there anything that nurses can go and get or healthcare professionals can go and get that out there? Now, I know the answer is going to be yes from you. But where, where can they go or how can we cascade that information out? So I believe it is covered in a delightful blog from the Royal College of Nursing which has been done for Carbon Monoxide Awareness Week. So you can find the acronym there. There's also um some really helpful one page information from Public Health Wales that I can share with you and perhaps to attach to this and to pass on it is something we'd like to, you know, gain more attention of and promote as a greater sort of awareness raising tool. So I'm, I'm really delighted to, you know, be here and to be able to speak about it. And it's great that people find that of interest if you want to follow the campaign, the Carbon Monoxide Awareness Week, which features a lot of different resources and some of them will be, you know, more basic than what we've been talking around today. But it's just that sort of eye catching information. And there is a website with a lot further information you can follow hashtag C A No Coaw sorry, Carbon Monoxide Awareness Week or just search for Carbon Monoxide Awareness Week and you should find the information there. You can also email me I'll pass on my email address and I can add you to our mailing list as well. So you'll get all the further information um for myself. Brilliant. So, um and you did make reference to the, to the RCN bulletin that's coming out. So we will be in the next printed bulletin, which I think is due to be posted out to us all towards the end of November. So very exciting that we're gonna be in there. And a huge thanks to Laura who has helped us come up with some of a lot of the content on that because she's very knowledgeable about carbon monoxide. We also have the quiz. So if you haven't taken the quiz yet, have a little go at that one. It is only 10 questions and it is just intended like all of our quizzes just to get you a little bit keen and involved. And maybe this is something we could do every Awareness Week. Lots are not committing to every Awareness Week, Laura. But I think definitely come back and just let's do this again. Let's see what it's like this time next year, discuss any progressions, what might have changed, what might not have changed. So, you know, well, that way and um yeah, if you've got any resources that you would like us to sign posts or share, then let us know we can upload it and people can access it through a variety of different ways and we can sign posts there. So it is now 20 to 8. So at, at, at all time, you people might be watching it at a different time, you know, in another um in another, in another country or they're listening on catch up. So I did say I'd ask you to repeat those phone numbers again just in case. So can you repeat them again before I, before I say thank you and good night a moment. I would be delighted to thank you very much. So, uh the number four, top space is 03448920, triple one. I'm gonna do that again. It's 03 double 48920 triple one in Northern Ireland. That's 01809 25 double six. That's 0180925 double six. And the gas emergency service number is 0 800 triple one, triple nine. So that's 0 800 triple one triple nine. It's free to call. And if you suspect carbon monoxide when you're out and about um if you have a carbon monoxide alarm incident, please do give them a ring. Brilliant. Thank you so much for this tonight. Laura. It's been really, in fact, the whole bit. You've been very, you've been, you've been a treat I say a treat to work with. But I mean that in a, in a, in a really good way, your energy is always positive. Your knowledge is vast when it comes to carbon monoxide and everything that's going on about it. And often we end up with topics that are, you know, if I think in the health world and it's sometimes, you know, you've got to just keep pushing that stone uphill. You know, it's one of those things, you've got to keep pushing that stone uphill so well done for doing it. So Siobhan has popped in. Thank you. It's really informative. Zoe's said to help the same, really helpful and informative. Thank you. So, really the people have enjoyed this one tonight. So a huge thank you to you Zoey and to the A policy connect. I know. Well, obviously we'll see each other again because we've got more calls coming up. But er what I'm going to do now in the chat, oh Suss, put the, thank you because we've just put up the link to the RCN magazine that's there. So everyone huge. Thank you for joining us tonight on is in conversation. I've just popped in that feedback chat. Now also remember that this will be um uploaded and made live on, well, not mine made live, made on demand on the Land Nurses website. And The Amazing Union will make that happen in the next couple of days. So please do feel free to share that link to your colleagues because they can watch this anytime they want to. And then over December, I'm turning all of our in conversation sessions into podcasts as well. So you can listen whenever you want to and certainly listen to again if you want to. So, um, the feedback forms gone up, we are running into quite a quiet time now. At Learn with nurses, we're having a gentle wind down towards Christmas now because as you know, many of us, well, all of us work as volunteers at learn with nurses. We all have day jobs And so we've squeezed these ones in, in and around and it's not just the guys who do this bit, which is quite, you know, to me, this is a lovely bit nice and sitting chatting. But the guys in the back office that do the back office that, you know, and we've got lots of nurses and actually non nurses that help all the organizational and the administration type function, making the quizzes all be perfect. You know, all of that can happen without all of our volunteers. So a huge thank you to those guys. So that's it for us tonight. And thank you very much. I'm going to press the go off from being live button. And um yeah.