Question of the Week

July 10, 2006


Carbon monoxide is a "colorless, odorless, highly poisonous gas, CO, formed by the incomplete combustion of carbon or a carbonaceous material, such as gasoline."

Carbon monoxide (CO) detectors are becoming more common, but even those who already have detectors in their homes may be unaware of other places that CO can be found.

"On June 1, 2002, a family of two adults and three children (two boys aged 4 and 12 years and a girl aged 2 years) and three friends went to a lake in Georgia to water ski. The ski boat was placed in an idling position while one parent put on a ski vest. During this time, the girl climbed over the back of the boat onto the swim platform (a wooden platform attached to the stern a few inches above the surface of the water) and lay in a prone position to push back and kick the water. In <1 minute, she became unconscious and unresponsive. The girl's father ... performed rescue breathing; after 15--20 assisted ventilations, the child resumed unassisted breathing. Local emergency medical services (EMS) personnel were notified. ... During the initial resuscitation of the girl, her youngest brother was removed from the swim platform and watched by friends during his sister's transport to the hospital. Several hours after being removed from the water, he complained of severe headache, vomited, and fell asleep. He was transported to the hospital for evaluation. Approximately 4 hours after exposure, his COHb level was 10.1% [normal: <5.0%]. Back calculations of COHb levels estimated that the boy's COHb level was 18%--21% immediately after exposure. Both children were transported to another hospital, admitted to the pediatric intensive care unit, and treated with 100% oxygen. They were discharged the following day."

In this case the children were outdoors (where people often think they are safe from accumulating CO). In actuality...

"Carbon monoxide (CO) can harm and even kill you inside or outside your boat!
Did you also know:
* CO symptoms are similar to seasickness or alcohol intoxication?
* CO can affect you whether you're underway, moored, or anchored?
* You cannot see, smell, or taste CO?
* CO can make you sick in seconds. In high enough concentrations, even a few breaths can be fatal?
Most important of all, did you know carbon monoxide poisonings are preventable?"

"...[C]arbon monoxide poisonings are preventable..."

When boating, "Some Simple Precautions can be taken to avoid exposure to CO:
* Avoid known locations where the gas can be present.
* Have regular maintenance done on your engine and exhaust system by a trained technician.
* Install a CO detector ...
* Open hatches and keep fresh air circulating throughout the boat ...
* Turn off the engine or generator when people swim near the boat. ...
* Be aware that if a passenger has the symptoms of seasickness it could be CO poisoning and they should immediately be moved to fresh air.
* Get a vessel safety check."

Even those who are not around motor boats still need to be aware of CO.

"Carbon monoxide gas is produced when fossil fuel burns incompletely because of insufficient oxygen. During incomplete combustion, the carbon and hydrogen combine to form carbon dioxide, water, heat, and deadly carbon monoxide. In properly installed and maintained appliances gas burns clean and produces only small amounts of carbon monoxide. Anything which disrupts the burning process or results in a shortage of oxygen can increase carbon monoxide production. Wood, coal, and charcoal fires always produce carbon monoxide, as do gasoline engines."

"Wood, coal, and charcoal fires always produce carbon monoxide, as do gasoline engines." It is important to be careful when burning such fuels outside; bringing such combustion inside can be even more dangerous.

"On the afternoon of March 14, 1999, a 51-year-old man, his 10-year-old son, a 9-year-old boy, and a 7-year-old girl were found dead inside a zipped-up, 10-foot by 14-foot, two-room tent at their campsite in southeast Georgia (a pet dog also died). A propane gas stove, still burning, was found inside the tent; the stove apparently had been brought inside to provide warmth. The occupants had died during the night."

Whether camping out or staying home, it is important to remember that some things were not meant for indoor use.

"When electricity goes out during a hurricane or ice storm, people often turn to gasoline-powered generators for power, use charcoal or gas grills for cooking, or use kerosene heaters for warmth. But many people do not realize that those generators, grills and heaters can create dangerous--and deadly--carbon monoxide gas if used in enclosed areas. ... In an enclosed space, CO can build up to deadly levels without anyone noticing it. High levels of CO can kill people in minutes if they do not immediately get fresh air."

It's summer. While some people are boating and camping, others are in the midst of another storm season.

"The four major hurricanes that struck Florida during August 13--September 25, 2004, produced electric power outages in several million homes. After the hurricanes, the Consumer Product Safety Commission (CPSC) investigated six deaths in Florida attributed to carbon monoxide (CO) poisoning (CPSC, unpublished data, 2004). The Florida Department of Health and CDC analyzed demographic and CO exposure data from these fatal poisoning cases and from nonfatal poisoning cases among 167 persons treated at 10 hospitals, including two with hyperbaric oxygen (HBO2) chambers. ... The majority of nonfatal poisonings occurred overnight, with patients waking in the early morning with symptoms. ... Medical records indicated that patients typically used generators to power refrigerators, fans, and air conditioners while sleeping. Similar exposure patterns and types of powered appliances were reported among the five incidents with fatalities."

Whether inside or out, camping, or cleaning up after a storm, it is important to know the dangers well enough to avoid them.

"It is most important to be sure combustion equipment is maintained and properly adjusted.  Vehicular use should be carefully managed adjacent to buildings and in vocational programs.  Additional ventilation can be used as a temporary measure when high levels of CO are expected for short periods of time.
* Keep gas appliances properly adjusted.
* Consider purchasing a vented space heater when replacing an unvented one.
* Use proper fuel in kerosene space heaters.
* Install and use an exhaust fan vented to outdoors over gas stoves.
* Open flues when fireplaces are in use.
* Choose properly sized wood stoves that are certified to meet EPA emission standards. Make certain that doors on all wood stoves fit tightly.
* Have a trained professional inspect, clean, and tune-up central heating system (furnaces, flues, and chimneys) annually. Repair any leaks promptly.
* Do not idle the car inside garage."

Questions of the Week:
When are you in situations where carbon monoxide is present? When might these levels get high enough to be dangerous? How can you reduce the chances of CO levels getting too high? How do you know if the amount of CO in the air is reaching dangerously high levels? What should you do if you suspect that someone might have CO poisoning?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

Health Community Coordinator
Access Excellence @ the National Health Museum

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