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It is probably just the perception from what makes the national news, but Pennsylvania seems to be the hardest hit this winter for Carbon Monoxide poisoning. The latest story to make news on Carbon monoxide exposure takes place in Altoona, PA, where a family of 5 was treated for exposure. The family was exposed to a CO level of 500 ppm, as opposed to what is considered a safe level of 9 ppm. That is more than 50 times a safe level. For more on this story, click here.

One of the disturbing parts to the story is that the the carbon monoxide levels were so high, that the smoke detectors were going off. Smoke detectors are not designed to detect even lethal levels of carbon monoxide, as it is not have the type of substance that leaves a tangible particulate in the air, which is what sets off smoke detectors.

Again, as always, I would remind everyone that a clean bill of health from hospital officials on the day of exposure, does not assure that there may not be long term health consequences. This is especially true with small children and older people. This family had a three year old and a two year old. Carbon monoxide exposure can cause a delay neurological symptoms DNS, which can appear 2 to 40 days after the exposure. For more information on DNS, click here.

As all eyes in the political spectrum turned to Ohio, and the plight of Youngstown is on every politician’s tongue, a man from nearby Vienna, Ohio quietly dies from carbon monoxide poisoning. In the wake of his death, paramedics put out a call for increased use of CO detectors.

The victim in this case was an aging man. The culprit an aging furnace. The combination, which happens so often with our elderly, is potentially lethal. The older the furnace, the more likely there could be a problem. The older the person, the more likely that where CO typically strikes first, the heart, will be adversely affected.

Check on your parents, check on your shut in friends. See to it that they have CO detectors, and make sure that they have had periodic maintenance on their furnaces.

This winter of 2008, there have been two well publicized mass shootings in my part time home state of Illinois, and many more mass killings from Carbon Monoxide. Even the election cycle news had to take a pause for the Northern Illinois tragedy. Nary a peep, except in the local media, about Carbon Monoxide’s rampages.
The first string of cases, was so predictable, I almost blame myself for not having found a bigger mountain top to have raised my cry of alarm: household generators. Any time there is a flame, and it is in an unventilated place, there will be a risk of CO exposure. Well the last few weeks has seen many storms. With storms, comes power outages. With power outages, comes the use of portable electric generators. My father spent his life designing such generators. Electric generators, when used properly, should not be a serious risk. But they were never intended to be set up in the kitchen, to operate the microwave.
More severe weather is sweeping across the nation this week. I fear that will be more power outages, more death from this silent killer. If you are in the business of selling portable generators, I believe you must include a CO detector with each purchase. That should be the law. I am sure the good businessmen who sell them warn people, but you can buy the little portable units almost anywhere now, and the corporate executives at Home Depot or Walmart, ought to just package the CO detector right with the product.
For more information on the dangers of portable generators, click here: http://www.usfa.dhs.gov/citizens/all_citizens/co/generator.shtm
Here are the basic rules to avoid CO exposure when using a portable generator:
Always use generators outdoors.
Keep generator exhaust away from air that flows into a building. But also make sure it is away from windows, doore and vents. The venting part can be critical. Many of the tragic stories we have heard this winter was from indirect exposure because an engine source (like a generator) was too close to an air intake vent.
Garages, basements, crawl spaces, are not OUTDOORS.
Follow manufacturer’s instructions. This presumes you can still find the instructions. Hopefully they are printed right on the generator itself. If not, look them up online. Keep in mind that exhaust that can get into your living area can kill you.
Use CO detectors, and make sure they are working, that the batteries are replaced when needed. Remember that smoke detectors, are not CO detectors. You can have CO exposure with no smell of smoke and without a smoke detector going off.

Winter Heart Attack – The Hidden Impact of Carbon Monoxide

I have coined a term, “winter heart attack”, to describe what I believe to be a large number of carbon monoxide related cardiac arrests and heart attacks, that are caused by carbon monoxide poisoning. It is likely that in many of these cases the true triggering phenomenon – carbon monoxide poisoning – is never identified.

The term “Winter Headache” has long been used to describe the situation of getting headaches in the winter flu season, not because of a virus, but because of carbon monoxide exposure. For the same reasons that carbon monoxide is grossly undiagnosed in winter headache, I believe it is undiagnosed in winter heart attack. See http://codamage.com/carbon_monoxide_poisoning/carbon_monoxide_unexplained_heart_attacks.html

A recent study by researchers at the Rhode Island Hospital provides further backup to my hypothesis that carbon monoxide poisoning is a much bigger culprit in heart problems during the winter than diagnosed.
See http://www.sciencecodex.com/carbon_monoxide_may_cause_long_lasting_heart_damage

The common thinking about the mechanism of Carbon Monoxide Poisoning is oxygen deprivation (hypoxia). SinceCarbon Monoxide interferes with the blood’s capacity to carry oxygen, insufficient oxygen reaches the bodies organs, including the heart, causing damage. But according to this study published in the January issue of Academic Emergency Medicine, CO also causes a more toxic damage to the heart muscle, not related to oxygen deprivation. This can not only cause a heart attack, but could also cause long term damage.

Perhaps there is a cart and the horse issue here. I have been saying that Winter Heart Attack, is misdiagnosed, because no doctor thinks to look for a complex diagnosis, when someone with known heart disease has a heart attack. But the carbon monoxide may actually have created the defect as well.

“These findings suggest that heart damage caused by carbon monoxide may have long-lasting effects even after its been eliminated from the blood, making the diagnosis of carbon monoxide poisoning even more critical,” said lead author Selim Suner, M.D., M.S., director of emergency preparedness and disaster medicine at Rhode Island Hospital.

“While this research puts us one step in the right direction, there is still much more we need to know about the underlying mechanisms if we hope to someday develop targeted treatments,” added Suner, who’s also an associate professor of emergency medicine, surgery and engineering at The Warren Alpert Medical School of Brown University.

The study is the first to show that Carbon Monoxide’s effect on heart muscle is unrelated to oxygen deprivation in the recovery phase, even when all CO is out of the system.

THIS MEANS WE MUST LOOK CLOSER, LOOK AT MORE THAN JUST THE BRAIN, WHEN THERE IS A KNOWN CARBON MONOXIDE EXPOSURE.

I realize that I am a lawyer, one of those people who are always accused of drumming up lawsuits. But our civil justice system is about compensating individuals for all of the damages wrongfully caused by others, even the damages missed by others. What this study is telling us is that Carbon Monoxide poisoning cannot only cause death, heart attack, brain damage, but it can also cause additional permanent heart damage in those who survive, ultimately shortening life expectancy.

Every day there is another story about a group of people who were hospitalized for CO poisoning. Every day, those people are treated and released, with a seemingly clean bill of health. If they hired a lawyer, the lawyer would likely be scratching his head, trying to determine why this particular case merited any real effort. The lesson of this Rhode Island Hospital study, of the delayed effects theme I have repeated often on here, is that don’t judge the extent of damage from CO poisoning, based upon the 24 hour window.

Carbon monoxide poisoning is called the great mimicker for a reason. It acts like flu at first. It can put on the veil of so many other diseases, heart disease, dementia, headache – because it is a toxin, let loose in the blood stream capable of damaging any part of the body. We must think about all of the places this toxin could cause damage. We must think about the possibility that Carbon Monoxide could be the culprit, when someone reports symptoms consistent with simple diagnosis, but are coming from an environment with the risk of Carbon Monoxide poisoning.

As I think of what that means, it means all situations, especially in the winter. So how could that practically be included in the standard medical diagnosis: Would it be so hard to start all inquiries with: do you have a carbon monoxide detector in your living space? In some places like Chicago, it is the law.

The temperature is plummeting in the upper midwest, and the number of carbon monoxide poisoning cases is skyrocketing. This time it was Libertyville, IL. One man dead. The culprit, a malfunctioning hot water boiler for a car wash, in an enclosed space. That is a lethal combinations: a stressed boiler, a small room. No carbon monoxide detector installed. For complete details see http://www.pioneerlocal.com/libertyville/news/764884,li-pjohnson-012908-s1.article

In theory, all fires (and a boiler, a furnace, a hot water heater, a fireplace, an engine are all fires) should occur in the open air where all fumes, including carbon monoxide will be dispersed below critical levels. Of course, the practicalities of civilized society is to bring the comforts of fire, indoors. Thus, comes the science and engineering of assuring complete combustion, which eliminates the risk of CO creation, and the science and engineering of complete ventilation of the exhaust of our controlled fires. But when science and engineering get translated into actual products and buildings, that must be designed, produced and maintained, there is always a risk of a break down, and the poison gas killing.

Engineers must always be on the watch for modifications of their designs and products, which could turn a well thought out design deadly. Maintenance people must always keep in mind the deadly nature of fire risk. Human occupants, must always remember to make sure their are carbon monoxide detectors to immediately warn of danger.

CARBON MONOXIDE POISONING SHOULD NEVER HAPPEN. SOMEONE WAS NEGLIGENT WHEN IT DID. Landlords, building owners must install carbon monoxide protectors to make sure that when all else fails, the potential victims of carbon monoxide, can get out in time.

Two more days, two more dead, and one in critical condition: The bodies of two Chickasaw, Alabama residents were removed from a home after apparently being poisoned by carbon monoxide. Click here for the breaking news.

It is three days since my last rant about hotels and carbon monoxide detectors, and once again 17 more people are hospitalized with dangerous carbon monoxide levels at a hotel. A hotel which is part of a national chain, a chain that does not require carbon monoxide detectors in each room. Comfort Suites. But this time it wasn’t comfort, it was nausea, headache and breathing problems that warned guests to call for help. Thank god they did. Click here for the excellent TV new story on this event in Jeffersontown, KY.

How can the hotel industry continue to ignore this risk? Do they breath a collective sigh of relief when no one, or as in the case of the Allentown, PA tragedy, only one person dies? CARBON MONOXIDE DETECTORS SHOULD BE MANDATORY IN ALL GUEST ROOMS. In Allentown, fire officials said a “tarp on the south side of the building likely forced the carbon monoxide from the hotel’s hot water heaters and recirculating the poisonous gas into the first-floor rooms and basement of the hotel.” See news story at http://www.msnbc.msn.com/id/22733907/

The hotel industry is a ripe place for CO poisoning, especially since when something goes wrong, so many are at risk. 17 people in Jeffersontown,KY, ten people in Allentown, PA, including one fatality. Click here for information on hotel exposures.

Even the hotel industries trade association acknowledges the risks, but nothing is done. The argument is that it would cost $100 million dollars to put detectors in each room in the United States. The lawsuits could add up to more, not to mention the cost in human lives. Click here for information on what states have regulations with respect to CO detectors in hotels.

Again, we remind everyone that a discharge with a clean bill of health does not guard against future problems, because of the delayed neurological symptoms that can occur. Click here for more information on DNS.

It has been a few days since our last blog and two more news stories have hit the national news about carbon monoxide poisoning. The first involved what seems to be good news, the second tragedy. Both may have far more tragic results than appears at present. The good news story involves a family of six in Anchorage, Alaska, who hit a snow bank when the driver succumbed to carbon monoxide poisoning. All lived. The tragic story involves a case of hotel negligence in Allentown, PA where one died and nine were sickened by carbon monoxide exposure.

While it doesn’t now appear to be what happened here, the Anchorage story highlights a serious risk this time of year: keeping a car running when it isn’t moving in hopes of staying warm. Any time car exhaust is not properly vented, there is some risk of carbon monoxide exposure. Of course, if you are sitting in a car in severe cold, the need may exist to keep the engine running to avoid freezing to death. But if something could obstruct the tailpipe, such as the snow, the moderate risk of danger and could become potentially catastrophic. Click here for the latest on the Anchorage story.

The Allentown, Pennsylvania story is all too familiar. A hotel does something stupid with the maintenance or design of their HVAC system, fumes go the wrong place, and a building full of people are at risk. In this case, workers doing construction on the outside of the hotel had erected a plastic tent-like canopy near the spot where the heaters were vented. http://ap.google.com/article/ALeqM5gH8Dl-4pgpAT5njFHZuEQVlCzLjwD8U8I1MO1

Making the hotel exposure cases even more outrageous, hotels refuse to put carbon monoxide protectors in each room. Only four states currently require carbon monoxide detectors in hotels, and none in each room. A recent study showed that only 11% of hotel chains that had had a carbon monoxide poisoning incident, had put in CO detectors, in each room, AFTER THE EXPOSURE. Such foolish risking of human lives must stop.

Perhaps even more troubling about these two incidents, is that the good fortune of the 15 survivors, may be an illusion. Carbon monoxide poisoning comes with it the risk of something called Delayed Neurological Sequelae, or DNS. Despite the apparent full recovery at the time of discharge from the hospital, the CO gases continue to attack the brain. Behavioral and neurologic deficits can arise or worsen two to 40 days after the exposure. Often times a patient is discharged from the hospital after initial evaluation, to have a severe relapse of symptoms, from this escalating pathology. The toxic effects of CO poisoning continue to attack the neurological system and particularly the brain, for many weeks after the initial exposure. This syndrome can materialize as almost any neurological or behavioral symptom, including memory loss, confusion, seizures, urinary incontinence, loss of bowel function, disorientation, hallucinations, psychosis and balance and dizziness. Click here for more information on DNS.

We don’t know what discharge warnings were given to these 15 individuals, but in our opinion, they should be required to follow up periodically with experts in CO exposure and have a repeat MRI done, at least once, to see if they have any signs of DNS. This is particularly true if the CO exposure caused a loss of consciousness, which it appeared to do in each case. As said in the Anchorage Daily New Story: “When officers arrived, the six occupants were either unconscious or unresponsive.” That is not the time to treat at the scene and send on their way. It is time to begin a careful monitoring to fully assess and possibly head off, the severe neurological attack that may lie in wait.

According to a new study by the federal Centers for Disease Control and Prevention, the first month of the year is the worst for carbon monoxide poisoning. At least two people die each day from carbon-monoxide poisoning in January—three times the fatality rate recorded in August and July.

Fatalities were highest among men and senior citizens: Men because they are engaged in more high-risk behaviors such as working with fuel-burning tools or appliances and seniors because they are likely to mistake the symptoms of CO poisoning (headaches, charcoal-burning device inside the home, basement or garage or outside the home near a window.

Related reading:
Read Consumer Reports full report on CO and smoke detectors, including an interactive diagram of where to place them in your home. http://www.consumerreports.org/cro/home-garden/home-improvement/home-security/carbon-monoxide-alarms/co-alarms-905/overview/index.htm

Three Dead in Providence, Rhode Island

It seems every day, there is another story of a someone dying of carbon monoxide poisoning. Today the blame was a faulty boiler in Providence, Rhode Island. As too often is the case, carbon monoxide poisoning wasn’t the first concern – foul play was.
http://www.projo.com/news/content/Death_Folo_01-09-08_458HQ0N_v27.287d59c.html

But improperly installing a boiler, as was the official explanation here, can have as bad of results as foul play. This is the time of year that you need to run your furnaces long and hard. Insist on proper safety checks and install a carbon monoxide detector, and make sure it is working properly.

Faulty boilers are one of the chief culprits in this deadly time of year. http://minnesota.publicradio.org/display/web/2008/01/01/carbonmono/?rsssource=1