Carbon Monoxide Poisoning Preventable With Simple Precautions

Hurricane Harvey was catastrophic causing over 80 deaths and numerous injuries. Hurricane Irma then struck the FL Everglades with many people spending days in ten feet of mud and toxic stormwater. Power outages caused great concern as gas portable generators were used leading to concern of carbon monoxide. Warnings were not well followed with a family of six found drowned in their car. Flood warnings and the use of gas-powered generators are both a growing concern with these summer storms bringing more and more rain (Smith, 2018). three powerful and devastating hurricanes resulted in the deaths of hundreds of people. Power outages led to deaths from carbon monoxide poisonings that could have been prevented if people just followed the advice given by officials (Issa, 2017).

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Hurricanes can cause dangerous and destructive high winds, storm surge, heavy rain, and flooding. Carbon monoxide poisoning from generators, electrocution from downed power lines and drowning from wading or driving through flood waters can cause injury and even death. The CDC has released methods to stay safe before, during and after the hurricane passes. They suggest people to follow local flood watches, warnings, and instructions. When driving follow the maxim, turn around don’t drown. Avoid driving through flooded areas especially when the water is fast moving. As little as six inches of water can cause the driver to lose control of the vehicle.

In addition, the CDC recommends people don’t walk through or swim in flood water. It can contain electrical, chemical and disease hazards. This means people trapped in flooded areas need to keep wounds as clean as possible washing them with soap and water. Don’t drink flood water or any fresh water source that may have been contaminated by runoff.

During the period of a power outage, the CDC recommends people use gas-powered generators, gas grills or other gas-powered devices outdoors. These things can emit CO that is odorless and tasteless gas. In addition, if you are using these things use a battery powered CO detector. Also, don’t connect your generator to your homes electrical circuits without the approved automatic-interrupt devices. Otherwise, it can hurt the power company workers who are trying to restore their electricity. They lastly caution to never touch fallen power lines remembering not to walk or drive through water that has a fallen line in it. The other concern is the CDC highly recommends using battery-powered flashlights and lanterns rather than candles or gas lanterns/torches because of both fire risk and CO risk (CDC, 2018).

Severe weather events such as summer hurricanes, tornados, and winter storms often result in widespread and prolonged power outages, interrupting essential household heating. Power loss can also compromise food storage and home cooling devices. Faced with this people may turn to dangerous remedies to compensate for the loss of power. Sadly poison control and hospital ERs continue to see surges in generator-associated CO poisonings during and after major storms, despite mandated warnings labels and public health advisories.

In many CO poisoning, tragedies result with entire families affected, some fatally. CO is often referred to as a silent killer because it is odorless, tasteless, colorless toxic gas. It is made when any appliance that burns wood, coal or fuel (oil, gas, propane, kerosene) malfunctioning or poorly vented. Unfortunately, early symptoms of CO poisoning are often mistaken for those of the flu including a headache, nausea, sleepiness, dizziness, and confusion.

In severe instances, it can cause coma, heart attack, and death. Be very suspicious if symptoms occur shortly after using the furnace or generator especially if multiple family members become sick at the same time or symptoms improve once they are outside the home or building. Babies, children, and older adults are particularly susceptible to CO poisoning. In an effort to make sure CO doesn’t cause problems in the home there are steps that can be taken to reduce this.

Make sure that all furnaces, chimneys, wood stoves, and heaters are checked regularly and are in good repair. Never use grills or gasoline powered equipment indoors or in a garage. When faced with power outages gasoline powered generators should only be used outdoors and away from vents or windows. Also, they should be at least 25 feet from the house. Don’t use gas ovens to health the home and most importantly, install CO monitors in the home making sure they have fresh working batteries. If you think CO is in your home, you may attempt to air out the home, shut off heating system and call 911 (Henretig, 2018).

CO is a colorless and non-irritating gas and is a common lethal toxicant. Adverse health effects associated with CO exposure range from subtle cardiovascular and respiratory effects to neuropsychiatric presentations or even death. The pattern of CO poisoning has also changed in other Asian countries, with an increase in the incidence of charcoal-burning related suicide.

In addition to a high mortality rate, CO poisoning may lead to persistent neurological sequelae. Neurological outcomes were the primary points of interest in the study and were found it did not improve after hospitalizations. In China and Taiwan, charcoal-burning suicides accounted for 18.4% of suicide-related deaths. Intentional CO poisoning group had significantly more history of psychiatric issues, smoking habit, drinking behavior, unemployment, living alone, older age, and loss of consciousness from longer duration of CO exposure.

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Results revealed mortality related to charcoal-burning suicide was significantly associated with overall suicide mortality in Taiwan. The study also found several clinical and demographic predictors associated with neurological issues and myocardial injury. The study also found a change in brain CT but because it was such a small number of people it is uncertain what conclusions can be drawn.

Tissue hypoxia is the major outcome of CO poisoning. Hypobaric oxygen therapy was considered as an important treatment, but the study felt the efficacy of the hypobaric oxygen in CO-poisoned people was controversial. Predictors of neurological outcomes of CO poisoning may help clinicians to predict outcomes of patients with CO poisoning and then direct appropriate treatments (Lin, 2018).

Carbon monoxide (CO) poisonings affect 50,000 people a year in the US. It runs the gamut from headaches and dizziness to coma and death with a mortality rate ranging from 1%-3%. CO is a colorless, gas and is usually formed from incomplete combustion of carbon compounds; sources include fuel, engine exhaust, and faulty furnaces. It is so deadly because CO competes for binding to hemoglobin reducing the ability of the blood to carry oxygen. Many patients are found unconscious or severely ill making it impossible to obtain a medical history.

Survivors of CO poisoning often suffer from long-term neuro-cognitive sequelae related to brain injury. Symptoms of this include impaired memory, cognitive dysfunction, depression, anxiety, and motor deficits. Current therapy includes time spent in a hypobaric chamber to assist the body with a faster transfer rate of CO from oxygen. About 50% to 75% of related injuries from fires have some component of CO poisoning.

Because of power outages caused by hurricanes, tornados, or winter storms, it has prompted a campaign about the invisible killer as related to use of gas-powered generators or grill that is not properly ventilated. Beyond public awareness and public safety efforts, however, there is still an unmet clinical need for better therapies for the most common of human poisonings. Further developments may include therapies that enhance CO dissociation from hemoglobin in red blood cells and antidotes that could possibly be administered immediately on site (Rose, 2018).

Work Cited
CDC Priority Message. (2018). Stay safe after Hurricane Florence: Center for Disease Control and Prevention. https://www.cdc.gov/disasters/hurricanes/hurricane-florence.html

Henretig, F.M. et al. (2018). Predictable, preventable, and deadly: Epidemic carbon monoxide (CO) poisoning after storms. American Journal of Public Health,108(10). Doi:10.2105/AJPH.2018.304619

Issa, A. et al. (2018). Deaths related to hurricane Irma-FL, GA, and NC September 4-October 10, 2017. MMWR-Morbidity and Mortality Weekly Report,67(30). Centers for Disease Control and Prevention. Doi:10.15585/mmwr.mm6730a5

Lin, M-S. et al. (2018). Myocardial injury was associated with neurological sequelae [outcome] of acute CO poisoning in Taiwan. Journal of Chinese Medical Association,81(8). https://doi.org/10.1016/jcma.2017.12.006

Rose, J.J. et al. (2017). Carbon monoxide poisoning: Pathogenesis, management, and future directions of therapy. American Journal of Respiratory and Critical Care Medicine,195(5). American Thoracic Society Journals. https://doi.org/10.1164/rccm.201606-1275CI

Smith, J. et al. (2018. Catastrophic hurricanes and public health dangers: Lessons learned. Journal of Public Health and Emergency,2(7). Doi:10.21037/jphe.2018.01.04

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Comments

I grew up on a farm and we heated it with a crushed coal furnace. I remember being awakened by a high pitched alarm that was coming from our carbon monoxide detector. My brother helped me get my two girls out of the building and into the cars in the drive (it was middle of winter) and then returned to the house to open the vents on the furnace. We had to stay outside until the monitor stopped making noise.