Zero Carbon Monoxide Morbidity has to be Demanded
No one seems to quite get that the zero carbon monoxide has to be the goal. I spent the day in a meeting in the U.S. Consumer Products Safety Commissions hearing room, listening to a strategy aimed at stopping carbon monoxide emissions when they hit 400 ppm. It was claimed by industry representative that the goal of the CPSC is to eliminate deaths from carbon monoxide. The Niles Quality Inn and Suites carbon monoxide poisoning is the best proof that just eliminating deaths isn’t enough. The measured levels in the Niles Quality Inn and Suites were only twice what this industry trade group was setting as a stop the presses standard, at 800 ppm.
Zero carbon monoxide is the goal. The CPSC aims are not just to eliminate the 750 deaths from portable electric generators but also the injuries to the 25,000 who survived.
Our hearts go out not just to the child who died, but the other five children who spent the weekend in the hospital. Those children may face months, years or even a lifetime of struggles. Carbon monoxide poisoning is not a binary outcome. There is a world of disability between death and survival. With carboxyhemoglobin levels in the survivors which likely approached 40%, we can anticipate that recovery will not be complete. 40% of those with carboxyhemoglobin levels above 10% are likely to have permanent neuropsychiatric problems.
What is meant by permanent neuropsychiatric problems? It means problems with thinking, memory concentration. It also means material changes in behavior. With children, neurobehavioral problems means a regression in maturity with a 14 year old acting more like a 9 year old. Mood problems can be even more severe. In the dozens of middle school children we represent we see severe mood swings, even psychiatric hospitalizations. The risk of self harm is never far from many parents mind.
The sneaky part of the changes post carbon monoxide poisoning include changes in the neurological system, including ways in which the eyes, the balance system and other sensory and motor problems. Other organ damage, especially with levels as high as we saw in the Quality Inn and Suites carbon monoxide poisoning, are likely. All survivors should have their heart and lung function monitored closely.
Then there is the matter of the delayed onset, or in this case, more likely relapse of symptoms. The focus over the last few days has been in getting the oxygen levels back to normal, as absence of oxygen can damage cells. But even though oxygen levels are restored in the blood, the body is just beginning its battle with the poison that is carbon monoxide. Sometimes the cure to kill the poison results in immunological responses that make the cell damage worse.
All this because the hotel did not have a carbon monoxide detector in the pool area. Carbon monoxide detectors don’t warn unless they are where the people are when they are getting exposed. With levels at 150 ppm in other parts of the hotel, others may have gotten poisoned as well. If the carbon monoxide exposures stayed above 100 for any length of time, many others could have long term problems as well.
As I said today in Bethesda, it is not just about the deaths. It is all about all the disability found in the survivors. We must have a goal of zero carbon monoxide.
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