March and April 2008 -- Carbon Monoxide - The Silent Killer PARTS 1 & 2

A family of five travels from Charleston to Buckhannon to Grandma's for the Thanksgiving holiday. Dad is driving, extremely drowsy, while his wife and three young children drift off to sleep. When he stops for a bathroom break and to refuel, he has difficulty rousing the family, and the youngest child is unresponsive.

An older couple, retired from daily employment, follows a "set your clock by" routine. After breakfast each day, the gentlemen drives down to the shop now run by other family members, where he spends his morning sharing stories and dispensing life's wisdom and advice. When Pop hasn't arrived by 9:45 and no one answers the ringing phone, the realization occurs that something is very, very wrong.

A mother and two children move into a small, two-bedroom rental home in the fall. The gas furnace is loud, the exhaust ductwork leaks water during the heating season, and an explosive "POW!" punctuates the home every time the furnace shuts off. The mom experiences constant nausea, headaches, joint pains, extreme fatigue and more starting the first night in the house.

Not all of these stories end happily ever after. In varying degrees, each person fell victim to carbon monoxide, aka CO or CO1, poisoning. The very sad truth is, all of these exposures were preventable.

The following symptoms can be signs of other illnesses, so CO poisoning can be difficult to diagnose properly. Headache, dizziness, flu-like symptoms, fatigue, shortness of breath, dizziness, chest pain, nausea, vomiting, abdominal pain, drowsiness, visual changes, hallucinations, confusion, agitation, depression, fainting, memory problems, walking/coordination problems, seizure and death are some of the signposts of CO poisoning.

Not all people experience all symptoms, as exposure time and CO levels (in parts per million [ppm]) vary, as do size, weight, age and health of each person. For the same reasons, prognosis is difficult to predict: Even with proper treatment, some people suffer long-term brain damage resulting in various complications (i.e., severe memory loss, difficulty thinking, etc.). Severe exposure can result in death.

CO forms when organic compounds burn. The most common sources include motor vehicle exhaust, smoke from fires, engine fumes and non-electric heaters and furnaces. Malfunctioning or obstructed furnace exhaust systems are frequently associated with CO poisoning.

Sources of CO in and around the home include gas water heaters and furnaces, kerosene space heaters, propane heaters and stoves, gasoline and diesel powered equipment (including generators, concrete saws, chain saws, lawn mowers, etc.), any boat with an engine, motor vehicles, spray paint, solvents, degreasers, and paint removers.

High risk exposures include riding in the back of enclosed pickup trucks (children are at particularly high risk); using alternative heating sources during power outages; working indoors with combustion engines or combustible gases. Risks associated with boating include swimming near or under the stern or swim-step of a boat with the engine running; back drafting when a boat is operated at a high bow angle; mooring next to a boat that is running a generator or engine; improper boat ventilation.

Install detectors. Safety commissions report that while 93% of homes have at least one smoke alarm on the premises, only 15% contain CO alarms. CO alarms or detectors work much like smoke detectors with audible alarms. The smartest choice is a model equipped with both the audible alarm and an LED readout that measures and records the highest level of CO and

the family in the rental home installed a CO detector with an LED, ran the furnace for about an hour each morning just to take the chill off the house. The first day, the LED showed 27 ppm. The second day the reading was 29 ppm. On the third day, the reading stood at 31 ppm - at 30 ppm exposure, evacuation of the premises is in order, as is a call to emergency services.

Purchase detectors at hardware and department stores. Prices start around $20. Both plug in the wall and battery operated alarms are available. Detectors with LED readout start around $30. Combination smoke and CO detectors cost about $45. Replace batteries and test existing detectors, both smoke and CO, at least twice a year, during Daylight Savings Time clock changes in spring and fall. Put it on the calendar.

Be safe. Never burn charcoal indoors, not even in the fireplace. Never use a charcoal or barbecue grill indoors.

Never leave the car, mower, snow blower, 4-wheeler, etc., running in an attached garage, even with the door open.

Never run gas-powered equipment or engines in confined areas such as basements or garages.Don’t use catalytic (portable flameless chemical) heaters inside the home, camper or cabin.

Never patch a vent pipe with tape or gum.

Never use a gas range or oven for heating during power outages or use a portable gas camp stove indoors.

Never use a generator inside the home, basement or garage, and never run a generator near a window, door or vent of any kind.

NEVER burn in a stove or fireplace that isn't vented.

Inspect for Hazards. Whether the home is owned or rented, the house's heating system, chimney, and flue all require inspection and cleaning by a qualified technician annually. To ensure proper ventilation, keep chimneys clear of debris such as bird and squirrel nests, sticks, leaves and other residue. Furnaces, gas fireplaces, gas ovens, ranges, cook tops, and water heaters require inspection of pilot lights and for adequate ventilation. ALWAYS use a qualified technician to make repairs on heating systems and appliances. Check exhaust flues or ducts to appliances such as water heaters, ranges and clothes dryers to make sure they are not blocked or sealed shut. Heavy snowfall or even brush and leaves can pile against building foundations and limit exhaust flow.

All gas appliances must be properly vented so that CO will not build up in your home, cabin or camper. Exhaust ductwork or vent pipes to fuel appliances should never be perfectly level. Vent pipes must elevate slightly as they go toward outdoors to prevent CO and other toxic gases from leaking around ill-fitting joints on the pipes. Vent pipes must be clean, fitted snugly together and slightly uphill to vent properly. If ductwork is rusting, pitted, loose at the joints, or leaking vapor or moisture, shut appliance off and immediate repair or replace damaged parts and pieces.

Last month, we discussed common sources of carbon monoxide (CO) emissions and ways to avoid CO poisoning. The National Institute of Occupational Safety and Health states that the US Environmental Protection Agency (EPA) established an outdoor CO air quality federal standard of 9 parts per million (ppm) for an 8-hour exposure and 25 ppm for a 1-hour exposure. The Consumer Product Safety Commission recommends that long-term exposures to CO indoors be limited to less than 15 ppm for an 8-hour exposure and 25 ppm for a 1-hour exposure.

What does this mean? Depending on usage patterns and exposure, product-specific recommendations for CO may vary. Tolerance levels vary among individuals, also. For instance, the family in the rental unit was exposed to CO for 16 months at levels exceeding 30 ppm, and while the children exhibited recurring CO symptoms including fatigue, headaches, depression and agitation, these symptoms evaporated while away from the unit each weekend. The mother still deals with physical, cognitive, sensory and motor impairments not present prior to CO exposure.

Immediate measures to take to help those afflicted with CO poisoning include vacating the premises; move the victim to fresh air immediately. If that is not possible, turn off all combustion appliances and open all windows and doors. Call emergency services if unconsciousness has occurred. Take or transport victim to a hospital emergency room as quickly as possible. A simple blood test can determine if CO poisoning is the culprit.

Oxygen treatment may be necessary to rid the victim's system of CO. The woman mentioned above underwent a month-long nighttime oxygen regimen. Severe cases may require multiple oxygen treatments in a hyperbaric chamber.

What do you do if your CO detector alarm goes off? Turn off all combustion appliances and vacate the premises. To determine the cause of the CO, call a qualified heating contractor. The same family's gas company told them that the company only checked for gas leaks, not CO. Do not run faulty appliances or vehicles until tested and repaired/replaced by QUALIFIED personnel. Do install and maintain detectors. If you routinely feel vaguely ill, headachy or nauseous in the same building or vehicle, be very suspicious and check ALL combustion appliances and/or exhaust and heating systems.

The family overcome by CO emissions while on a holiday road trip was treated at a local hospital. The youngest child, unconscious on arrival, required a longer hospitalization but eventually recovered completely along with the rest of the family.

A cracked furnace block caused severe CO emissions in the home of the retired couple mentioned in last month's column. They did not survive.