Carbon monoxide poisoning from devices used in disaster recovery

Carbon monoxide (CO) is responsible for more fatalities in the United States each year than any other toxicant. While CO exposure is a year-round problem, fatal and nonfatal CO exposures occurred more often during the fall and winter months, and the majority of nonfatal CO exposures were reported to occur in the home. Postdisaster CO poisoning is an emerging hazard. Unintentional CO poisonings have been documented after natural disasters like hurricanes, floods, ice storms, and power outages. Overwhelmingly, CO exposure results from common sources such as portable generators, gas grills, kerosene and propane heaters, pressure washers, and charcoal briquettes. Although disaster events are thought to create victims immediately and in great numbers during the initial impact, some disasters are more deadly to people during the recovery phase, when people are thinking the disaster is over. More are injured during the cleanup phase than from the storm itself.

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Pediatric Carbon Monoxide Poisoning

Cognitive and Behavioral Abnormalities of Pediatric Diseases ◽

10.1093/oso/9780195342680.003.0073 ◽

2010 ◽

Author(s):

Ramona O. Hopkins

Keyword(s):

United States ◽

Carbon Monoxide ◽

Internal Combustion Engines ◽

Methylene Chloride ◽

Carbon Monoxide Poisoning ◽

The United States ◽

Emergency Department Visits ◽

Co Poisoning ◽

Vehicle Exhaust ◽

Pediatric Populations

Carbon monoxide (CO) exposure has been described ever since humans developed products of combustion (e.g. fire, burning charcoal). The Romans realized that CO poisoning leads to death (Penney 2000). Coal fumes were used in ancient times for execution, and the deaths of two Byzantine emperors are attributed to CO poisoning (Lascaratos and Marketos 1998). Admiral Richard E. Byrd developed CO poisoning during the winter he spent alone in a weather station deep in the Antarctic interior (Byrd 1938). Further, CO poisoning took the life of tennis player Vitas Gerulaitis (“Died, Vitas Gerulaitis,” 1994; Lascaratos and Marketos 1998) and may have contributed to Princess Diana’s accidental death in 1997 (Sancton and Macleod 1998). Carbon monoxide is a colorless, tasteless, odorless gas by-product of the combustion of carbon-containing compounds such as natural gas, gasoline, kerosene, propane, and charcoal. The most common sources of CO poisoning are internal combustion engines and faulty gas appliances (Weaver 1999). Carbon monoxide poisoning can also occur from space heaters, methylene chloride in paint removers, and fire (Weaver 1999). The most frequent causes of pediatric CO poisoning are vehicle exhaust, dysfunctional gas appliances and heaters, and charcoal briquettes (Kind 2005; Mendoza and Hampson 2006). Less common sources of CO poisoning include riding in the back of pickup trucks, and while swimming and recreational boating (Hampson and Norkool 1992; Silvers and Hampson 1995). Among pediatric populations, minorities are disproportionately affected by CO poisoning compared to Caucasians, and Latinos and non-Latino blacks were more commonly poisoned by charcoal briquettes used for cooking or heating (Mendoza and Hampson 2006). Carbon monoxide is the leading cause of poisoning injury and death worldwide (Raub et al. 2000) and accidental and intentional poisoning in the United States. In the United States carbon monoxide poisoning results in approximately 40,000 emergency department visits (Hampson 1999) and 800 deaths per year (Piantadosi 2002). Children are particularly venerable to CO poisoning. The Center for Disease Control reports children younger than 4 years have the highest incidence of unintentional CO poisoning but the lowest death rates (2005).

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Storm-Related Carbon Monoxide Poisoning

Social Marketing Quarterly ◽

10.1177/1524500413493426 ◽

2013 ◽

Vol 19 (3) ◽

pp. 188-199 ◽

Cited By ~ 5

Author(s):

Scott A. Damon ◽

Jon A. Poehlman ◽

Douglas J. Rupert ◽

Peyton N. Williams

Keyword(s):

Carbon Monoxide ◽

Carbon Monoxide Poisoning ◽

The United States ◽

Attitudes And Beliefs ◽

Matrix Approach ◽

Co Poisoning ◽

Protective Behaviors ◽

Home Safety ◽

Severe Storms ◽

Summer Storm

Carbon monoxide (CO) poisonings in the United States consistently occur when residents improperly use portable gasoline-powered generators and other tools following severe storms and power outages. However, protective behaviors—such as installing CO alarms and placing generators more than 20 feet away from indoor structures—can prevent these poisonings. This study identified knowledge, attitudes, and beliefs that lead consumers to adopt risk and protective behaviors for storm-related CO poisoning and post-storm generator use. Four focus groups (32 participants in total) were conducted with generator owners in winter and summer storm-prone areas to explore home safety, portable generator use, CO poisoning knowledge, and generator safety messages. Discussions were transcribed, and findings analyzed using an ordered meta-matrix approach. Although most generator owners were aware of CO poisoning, many were unsure what constitutes a safe location for generator operation and incorrectly stated that enclosed areas outside the home—such as attached garages, sheds, and covered porches—were safe. Convenience and access to appliances often dictated generator placement. Participants were receptive to installing CO alarms in their homes but were unsure where to place them. These findings suggest a deficit in understanding how to operate portable generators safely and a need to correct misconceptions around safe placement. In terms of behavioral price, the simple installation and maintenance of inexpensive CO alarms may be the most important strategy for ultimately protecting homes from both storm-related and other CO exposures.

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Carbon Monoxide Poisoning: Implications for Patient and Family Care in the Emergency Department

Clinical Scholars Review ◽

10.1891/1939-2095.1.1.46 ◽

2008 ◽

Vol 1 (1) ◽

pp. 46-49 ◽

Cited By ~ 1

Author(s):

Courtney E. Reinisch

Keyword(s):

Emergency Department ◽

Carbon Monoxide ◽

Practice Nurse ◽

Early Recognition ◽

Carbon Monoxide Poisoning ◽

Family Care ◽

The United States ◽

Emergency Department Visits ◽

Advanced Practice ◽

Co Poisoning

Carbon monoxide (CO) is a colorless, odorless gas that can produce a constellation of noxious symptoms and potentially death when it reaches certain levels. Exposure to CO can be intentional (suicidal) or unintentional (accidental). CO poisoning is responsible for up to 40,000 to 50,000 emergency department visits and 5,000 to 6,000 deaths per year, making it one of the leading causes of poisoning death in the United States. When patients present to the emergency department with a constellation of symptoms, the advanced practice nurse should include environmental exposure in the differential diagnosis. This is especially important when family members present with similar complaints, such as headache or euphoria. Early recognition of CO poisoning is vital to identify individuals in need of prompt treatment and to prevent harmful and potential deadly exposure to others. Since patients often present with constitutional symptoms, including headache (most common), malaise, nausea, and dizziness, providers need to be cautious not to misdiagnose patients as having acute viral syndromes where CO poisoning could be the cause. Vigilance is needed during the winter months in cold climates when unintended poisoning is most common.

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Carbon Monoxide Poisoning in the Veterans Health Administration, 2010 - 2016

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v9i1.7710 ◽

2017 ◽

Vol 9 (1) ◽

Author(s):

Gina Oda ◽

Russell Ryono ◽

Cynthia A. Lucero-Obusan ◽

Patricia Schirmer ◽

Mark Holodniy

Keyword(s):

Carbon Monoxide ◽

Carbon Monoxide Poisoning ◽

Veterans Health Administration ◽

The United States ◽

Time Frame ◽

Urgent Care ◽

Veterans Health ◽

Co Poisoning ◽

Health Administration ◽

Self Harm

ObjectiveTo describe characteristics of Veterans Health Administration(VHA) patients with ICD 9/10 CM inpatient discharge and/oremergency department (ED)/urgent care outpatient encounter codesfor carbon monoxide (CO) poisoning.IntroductionIt is estimated that in the United States (US), unintentional non-firerelated CO poisoning causes an average of 439 deaths annually, and in2007 confirmed CO poisoning cases resulted in 21,304 ED visits and2,302 hospitalizations (71 per million and 8 per million population,respectively)1. Despite the significant risk of morbidity and mortalityassociated with CO poisoning, existing surveillance systems in theUnited States are limited. This study is the first to focus specificallyon CO poisoning trends within the VHA population.MethodsQueries were performed in VA PraedicoTMPublic HealthSurveillance System for inpatient discharges and emergency roomand urgent care outpatient visits with ICD 9/10 CM codes for COpoisoning from 1/1/2010 – 6/30/2016. A dataset of unique patientencounters with CO poisoning was compiled and further classified asaccidental, self-harm or unspecified. Patients with carboxyhemoglobin(COHb) blood level measurements≥10%2for the same timeframewere extracted and merged with the CO poisoning dataset.We analyzed for demographic, geographic and seasonal variables.Rates were calculated using total unique users of VHA care formatching time frame and geographic area as denominators.ResultsThere were a total of 671 unique VHA patients identified with COpoisoning. Of these, 298 (44%) were classified as accidental, 104(15%) self-harm, and 269 (40%) unspecified. A total of 6 patientsdied within 30 days of their coded diagnosis, however only 1 ofthese was directly attributable to CO poisoning. The overall rate ofCO poisoning over the study time frame was 18 per million uniqueusers of VHA care. CO poisoning diagnoses were obtained from396 (59%) outpatients, 216 (32%) inpatients, and 59 (9%) patientswith both and outpatient visit and inpatient admission. Patientswith self-harm classification were less likely to be seen in the ED(only 24 (6%) unique patients compared to 190 (48%) accidental and182 (46%) unspecified classifications). Of patients seen in the ED andsubsequently admitted, patients with the classification of accidentalpoisoning made up the largest percentage with 36 unique patients(61%). There were 71 (11%) females compared to 600 (89%) males.The highest represented age group was 45-64 with 342 unique patients(51%). Rates by US Census Region were highest in the Midwestand Northeast (27 and 23 per million unique users, respectively)compared to the West and South (15 and 13 per million uniqueusers, respectively) (Figure 1). Accidental CO poisonings showed aseasonal pattern with peaks occurring in late fall, winter, and earlyspring months (Figure 2). CO poisonings classified as unspecifiedhad a similar but less pronounced pattern, while those classified asself-harm were too few to observe any pattern over time. COHb bloodlevels≥10% were present in 111 (17%) of patients with CO poisoningcodes. Of patients with COHb measures≥10%, those with self-harmclassification were least represented with only 7 unique patients (6%).Accidental and unspecified classifications were equally representedwith 53 (48%) and 51 (46%) unique patients, respectively.ConclusionsThe impact of CO poisoning on the VHA patient population hasnot been well studied. The geographic distribution of the majorityof cases in the Midwest and Northeast, and the seasonal distributionof accidental cases in colder months seems to be appropriate withrespect to what is known of unintentional CO poisoning as oftenassociated with heat-generating sources3. Opportunities for furtherinvestigation include how potential CO poisoning cases are evaluatedin VHA given the low percentage of cases with COHb blood levelmeasurements.

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Carbon monoxide poisoning can act as a stress test to reveal underlying coronary artery disease: case report

Undersea and Hyperbaric Medicine ◽

10.22462/01.03.2020.17 ◽

2020 ◽

pp. 151-169

Author(s):

Lindell K. Weaver ◽

◽

Keyword(s):

Carbon Monoxide ◽

Hyperbaric Oxygen ◽

Carbon Monoxide Poisoning ◽

Stress Test ◽

The United States ◽

Brain Inflammation ◽

Smoke Inhalation ◽

Co Poisoning ◽

Exposure Limits ◽

Disease Case

Despite established exposure limits and safety standards as well as the availability of carbon monoxide (CO) alarms, each year 50,000 people in the United States visit emergency departments for CO poisoning. Carbon monoxide poisoning can occur from brief exposures to high levels of CO or from longer exposures to lower levels. Common symptoms can include headaches, nausea and vomiting, dizziness, general malaise, and altered mental status. Some patients may have chest pain, shortness of breath, and myocardial ischemia, and may require mechanical ventilation and treatment of shock. Individuals poisoned by CO often develop brain injury manifested by neurological problems, including cognitive sequelae, anxiety and depression, persistent headaches, dizziness, sleep problems, motor weakness, vestibular and balance problems, gaze abnormalities, peripheral neuropathies, hearing loss, tinnitus, Parkinsonian-like syndrome, and other problems. In addition, some will have cardiac issues or other ailments. While breathing oxygen hastens the removal of carboxyhemoglobin (COHb), hyperbaric oxygen (HBO2) hastens COHb elimination and favorably modulates inflammatory processes instigated by CO poisoning, an effect not observed with breathing normobaric oxygen. Hyperbaric oxygen improves mitochondrial function, inhibits lipid peroxidation transiently, impairs leukocyte adhesion to injured microvasculature, and reduces brain inflammation caused by the CO-induced adduct formation of myelin basic protein. Based upon three supportive randomized clinical trials in humans and considerable evidence from animal studies, HBO2 should be considered for all cases of acute symptomatic CO poisoning. Hyperbaric oxygen is indicated for CO poisoning complicated by cyanide poisoning, often concomitantly with smoke inhalation.

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Carbon Monoxide Poisoning Situation Encounters

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00044721 ◽

1985 ◽

Vol 1 (S1) ◽

pp. 277-279

Author(s):

Kusum Saxena

Keyword(s):

United States ◽

Carbon Monoxide ◽

Energy Conservation ◽

Solid Fuel ◽

Methylene Chloride ◽

Carbon Monoxide Poisoning ◽

The United States ◽

Exhaust Systems ◽

Poisonous Gas

Accidental or intentional carbon monoxide poisoning is common throughout the year. In the Midwest, however, accidental exposures are more common during the winter months when the furnaces are overworked or malfunction. Consequently, enmasse exposures to the poisonous gas are frequently encountered during this season. Adding to the problem are the energy conservation efforts. Doors, windows and other ventilation avenues are tightly sealed, and solid fuel might be substituted to save other expensive conventional fuels. Other causes of carbon monoxide poisoning are blocked exhaust systems, automobiles with inadequate mufflers, fires and solvent (methylene chloride, etc.) usage in poorly ventilated areas, e.g., basements. The exact incidence of nonfatal subacute carbon monoxide poisoning is not available. National Clearinghouse Bulletin reported that in 1978, out of 376 reported exposures, there were eight fatalities. A figure which has been frequently quoted in the literature is that each year in the United States, approximately 3,500 deaths are caused by carbon monoxide poisoning.

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