Winter Watch: Deadly Dangers of Carbon Monoxide

by David Roesel, M.D.

This article originally appeared in a newsletter from Wise Patient Internal Medicine and has been reprinted under an agreement.

In late December 2005, a massive storm struck the Pacific Northwest. What was later dubbed the "Hanukkah Eve windstorm" devastated the region with hurricane-force gusts reaching up to 70 mph and some of Seattle's heaviest rainfall on record. The storm caused hundreds of millions of dollars in damage and led the governor to declare a state of emergency in 17 counties. Power was knocked out for millions of residents, in some cases for as many as 11 days. And the night after the storm, a cold front plunged temperatures to below freezing.

I was working at the Harborview Emergency Room that evening, and in addition to caring for the usual mix of patients as well as some injured from the storm, medic units began bringing in entire families who were suffering from the same symptoms: bad headaches, lethargy, nausea, severe fatigue. Many were immigrant families. We learned that in an effort to keep warm, people had resorted to burning charcoal stoves indoors for heat. Others ran gasoline generators in closed garages to try and power appliances. In all of these cases, the culprit behind their symptoms was an invisible but highly poisonous gas: carbon monoxide (CO).

In the aftermath of the storm, hundreds of people required treatment for CO poisoning, and sadly eight people died. In response to this public health crisis, The Seattle Times devoted its front page to notices in six languages — English, Russian, Vietnamese, Chinese, Spanish, and Somali — cautioning residents against burning charcoal indoors.

Unfortunately, CO continues to be the leading cause of poisoning death in the United States. More than 400 Americans die annually from unintentional CO poisoning not associated with fires and over 100,000 people need to seek care in the emergency room. Just last month, two students at Evergreen State College were hospitalized and one was found dead in an apartment after a contractor working nearby heard carbon monoxide alarms going off and went to investigate.

We can't see or smell or taste carbon monoxide but it is produced any time fossil fuels are burned. It is highly poisonous and can kill a person within minutes by avidly binding to hemoglobin in red blood cells, which impairs the blood's ability to carry oxygen. With low-level exposure, the organs most dependent on oxygen, particularly our brain, heart, and liver, start to have trouble functioning. With exposure to higher concentrations of the gas, they cease to function. Even breathing very low levels of CO for prolonged periods of time can lead to symptoms such as sleep disturbances, impaired memory and concentration, and vision problems.

CO can build up quickly to unsafe levels in enclosed spaces where things are burning. One of the most common causes is gas or kerosene-powered space heaters. Other examples include motor vehicle engines idling in garages, charcoal grills being used in carports, unvented gas ranges, poorly maintained fireplaces, faulty heating systems, and campers using stoves inside tents. But there have even been cases of poisoning from warehouse workers driving propane-fueled forklifts, the resurfacing machines at ice skating rinks, people swimming near boat exhaust, and children riding in the back of pickup trucks. Infants, elderly individuals, and those with pre-existing respiratory conditions are particularly vulnerable, and household pets are also at risk.

The initial symptoms of CO poisoning are vague and can resemble a flu-like illness: headaches, dizziness, fatigue, nausea. With worsening exposure, individuals can experience confusion, impaired coordination, chest pain, and rapid heart rate. More severe poisoning can result in seizures, coma, and death. There are tragic cases where people go to sleep without any symptoms where CO is being produced, but never wake up.

Fortunately, CO detectors are now available! These alarm when CO levels get to dangerous levels, and are now required in most residences in Washington State. Be sure you have one on every level of your home, particularly near sleeping areas. Check the batteries every six months. If you don't have one, go out now and get one, or order online! It can save a life. If your alarm persistently goes off, move to fresh air, and call 911. Tell them your alarm is going off, and don't return to the building until it has been determined safe to do so.

Other important things you can do to prevent carbon monoxide poisoning:

• If you have a gas, oil, or coal-burning heating system, have it inspected and serviced annually by a qualified technician.
• Never idle a car in a garage, even if the garage door is open.
• Never use a charcoal grill, hibachi, or camping stove inside a home, tent, or camper.
• If you use a fireplace or wood stove, make sure that the chimneys and flues are in good condition and not blocked.
• Never burn charcoal indoors, even in a fireplace
• Never run a portable generator indoors or in a garage.
• Never use a gas range or oven to heat your home.
• Never sleep in a room while using an unvented gas or kerosene heater.

Stay warm and stay safe this winter!

📸 Featured Image: Photo via Zigmar Stein/Shutterstock.com