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The Case for Carbon Monoxide Protection

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Mecklenburg County requires in all homes. ... Connecticut, New Jersey, New York, Rhode Island, Texas (group homes/day care) ... to CO accumulations in homes ... – PowerPoint PPT presentation

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Title: The Case for Carbon Monoxide Protection


1
The Case for Carbon Monoxide Protection
  • Presented to the Code Technology Committee of the
    International Code Council
  • Detroit, Michigan
  • September 22, 2005

2
  • Wendy Gifford
  • Director, External Affairs, Invensys
  • Vice Chair, National Electrical Manufacturers
    Association Carbon Monoxide Section
  • Member, NFPA 720, Standard for the Installation
    of Household Carbon Monoxide Warning Equipment

3
Objective
  • To present the compelling evidence that will
    provide the Code Technology Committee the
    justification to mandate carbon monoxide
    protection in new and existing dwellings.

4
Committee Draft Recommendation
  • Not sufficient justification for mandating
    carbon monoxide protection.
  • Death and injury data
  • Cost/benefit calculation
  • Detector/standard questions

5
Injuries are significantAlarms offer effective
solution
  • Carbon monoxide poisoning causes 10,000 injuries
    a year.
  • Long term consequences
  • High societal costs.
  • Carbon monoxide alarms provide affordable,
    reliable protection appropriate to a building
    code.

6
Carbon Monoxide Causes Many Injuries
  • Carbon monoxide kills and injures more people
    than all other poisonings combined.
  • More than heroin

7
One third may go undiagnosed
  • Significant under reporting of CO deaths.
  • Misdiagnosis commonly occurs.
  • Many non-lethal exposures go undetected

8
Total injuries exceed 15,000 most in homes
  • 2001-2003 data Centers for Disease Control
  • Every year---
  • 15,200 people treated
  • 480 deaths
  • Majority (64) of non-fatal exposures occur in
    homes.

9
CPSC Nearly 200 died
  • 2002 Estimated 188 carbon monoxide poisoning
    deaths associated with the use of a consumer
    product
  • Excludes those in which source is a vehicle, even
    if in home

10
Decline in deaths may be artifact of statistics
  • Part of the decrease from the 1994-1998 average
    annual estimate of 200 . . . To an average of 141
    in 1999-2002 may be the result of . . . A new
    methodology.

11
Injuries vastly outnumber deaths
  • For every residential carbon monoxide death,
    there may be 51 injuries.
  • 9,728 annual injuries (CDC Data)
  • 188 deaths (CPSC Data)
  • 10,000 seek medical attention or miss work each
    year

12
Even these numbers may be underreported
  • Furnaces were the source in 46 of nonfatal CO
    poisonings
  • Only 10 of fatal poisonings.
  • This suggests that the role of home heating
    appliances is prominent in the large group of
    underreported nonfatal exposures.

13
CO poisoning affects the most vulnerable
  • Death rate highest among 65
  • Injury rate highest among children lt4
  • The fetus is particularly vulnerable.
  • Non-English speaking populations overrepresented

14
The effects are not always temporary or reversible
  • Significant after effects
  • Heart
  • Brain

15
Carbon monoxide injuries can affect the heart.
  • Nearly 40 of patients with moderate to severe
    carbon monoxide (CO) poisoning will have
    cardiovascular manifestations.

16
Neurological injuries can cause long term affects
  • Delayed neurological dysfunction (brain damage)
    occurs in 14 to 40 of serious cases.
  • Presents after patient appears recovered (2-40
    days)
  • Cognitive defects, memory impairment, learning
  • Difficulty moving
  • Personality changes

17
Can impact ability to work
  • One third of CO poisoning victims may have subtle
    but lasting memory deficits or personality
    changes.
  • In a 3-year follow-up of 63 CO poisoning
    survivors, Smith and Brandon found that 33
    showed evidence of personality deterioration and
    43 reported memory impairment.

18
Significant nerve damage can occur.
  • Parkinson's Disease
  • Persistent vegetative state
  • Agnosia,
  • inability to recognize and identify objects or
    people
  • Apraxia
  • Voluntary movement impaired

19
Nerve damage, continued.
  • Mental deterioration,
  • Urinary or fecal incontinence
  • Gait disturbance
  • Visual impairment/Blindness
  • Amnestic/confabulatory state
  • Psychosis

20
Hefty societal costs
  • Lost work time, productivity
  • Temporary
  • Permanent
  • Long term treatment
  • Health care costs
  • CPSC estimates gt630 million societal costs
    annually

21
Not having protection can be expensive legally
  • CARBON MONOXIDE CASE SETTLED FOR 30
    MILLIONSouth Florida Sun-Sentinel Fort
    Lauderdale, Fla. May 26, 2001 Akilah Johnson
    Staff Writer
  • Seven people who suffered brain damage after
    moving into or visiting the Terra Cotta Place
    Apartments will collect more than 30 million
    from complex owners and managers for failure to
    fix a water heater that was leaking carbon
    monoxide.

22
CO alarms are highly effective in reducing
exposure.
  • American Journal of Emergency Medicine study of
    911 calls
  • Persons with CO detectors were less likely to
    become symptomatic.
  • Only 13 symptomatic vs. 64 of those without
    alarms.

23
Mecklenburg County requires in all homes.
  • Ice storm power outage 161 people with
    confirmed CO exposure 1 death
  • 88 of the cases of symptomatic CO poisonings
    occurred in homes with no reported functioning CO
    alarm.
  • Mecklenburg County changed ordinance to require
    battery back up all homes

24
Alarms are already saving lives.
  • Any discussion of a decline in death rates should
    consider growth in home carbon monoxide alarm use
    since 1994.
  • Estimates 25-35 household penetration.

25
Current requirements
  • States
  • Alaska, Connecticut, New Jersey, New York, Rhode
    Island, Texas (group homes/day care), West
    Virginia, Utah, Vermont
  • Cities other AHJs
  • Chicago, New York City, and 30 others

26
(No Transcript)
27
Cost of compliance lower than assumed
  • Significantly below committee estimate of
    300-500.
  • Typically one per home
  • NFPA 720 One outside each separate sleeping
    area

28
Smoke/CO combo units eliminate extra labor
  • New construction (AC/DC)
  • Combo alarm 35-52
  • Incremental 15 over smoke alone
  • No incremental labor
  • Annual 6.15 (annual battery 5 year life)
  • Existing homes (battery)
  • CO alarm 20-42
  • Annual 11.40 (annual battery 5 year life)

29
UL Testing confirms reliability
  • Over five years, in home samples regularly tested
    to UL 2034 requirements in lab
  • Alarms have performed in an effective manor.
  • 2 alarms alerted consumers to CO accumulations in
    homes
  • In lab checking, 1 late alarmed 1 false
    positive.

30
CPSC Support
  • CPSC goal additional 20 reduction in deaths by
    2013
  • CPSC continues to recommend CO alarms
  • Tested alarms did not expose consumers to a
    significant health risk with one exception

31
Centers for Disease Control highlights the role
of alarms
  • Yes, people can prevent carbon monoxide
    poisoning by taking some simple precautions,
    including making sure that
  • carbon monoxide detectors are properly installed
    and maintained in homes, houseboats, workplaces,
    and other appropriate places

32
Standards development for CO alarms similar to
smoke alarms
  • ANSI UL 2034, carbon monoxide standard
  • Three major changes in first 12 years of
    standard.
  • UL 217, smoke alarm standard
  • Half a dozen changes in first 12 years after
    alarms were first required in residences.
    Meanwhile, lives were saved.
  • Dont wait for the perfect standard.

33
CO protection is appropriate to a minimum standard
  • UL 2034 life safety standard, not health standard
  • Allows levels far in excess of agency
    recommendations for outdoor air and the
    workplace.

34
Comparative CO limits
  • Environmental Protection Agency
  • Outdoor air 9 ppm/8 hours 35 ppm/1 hour
  • ICC IMC
  • Parking garage 25 ppm/1 hour requires
    ventilation
  • American Conference of Governmental Industrial
    Hygienists
  • 25 ppm/8 hours
  • National Institute for Occupational Safety and
    Health
  • 35 ppm/8 hours
  • Occupational Safety and Health Administration
  • 50 ppm/8 hours
  • UL 2034 ignore 30 ppm/30 days 70 ppm/1 hour

35
  • The least we can do is offer some protection in
    the home where the most vulnerable population
    spends the most time.

36
Not for profit organizational support
  • American Lung Association
  • Home Safety Council
  • National Safe Kids Campaign
  • Residential Fire Safety Institute

37
Evidence is compelling.
  • Residential carbon monoxide deaths and injuries
    are a major problem.
  • Long term implications and societal costs are
    significant.
  • We have the tool right now to protect lives.

38
Conclusion
  • The Code Technology Committee has the
    opportunity to lead.
  • We ask you to recommend carbon monoxide
    protection for dwelling units and start saving
    lives.

39
References
  • Choi, S. Delayed neurologic sequelae in carbon
    monoxide intoxication, JAMA Archives of
    Neurology, Vol 40, No 7, July 1983
  • Krenzelok, EP, Carbon Monoxide, the silent
    killer with an audible solution, American
    Journal of Emergency Medicine 14 (5) 484-486 SEP
    1996
  • Lavonas, Ed., MD, et. Al, Use of Carbon Monoxide
    Alarms to Prevent Poisonings During a Power
    Outage---North Carolina, December 2002, Journal
    of the American Medical Association
    (20042911691-1692) and MMWR (200453189-192)
  • Shochat, Guy, MD, Assistant Clinical Professor of
    Medicine, Division of Emergency Medicine,
    University of California at San Francisco Medical
    Center, and Lucchesi, Michael, MD, Chair,
    Associate Professor, Department of Emergency
    Medicine, State University of New York at
    Brooklyn, Toxicity, Carbon Monoxide, August
    19, 2004, emedicine.com

40
  • Tomaszewski, Christian, MD, Carolinas Medical
    Center, Charlotte, North Carolina Department of
    Emergency Medicine, University of North Carolina
    at Chapel Hill School of Medicine, Carbon
    monoxide poisoning Early awareness and
    intervention can save lives Postgraduate
    Medicine, Vol 105, No 1, January 1999.
  • Carbon monoxide poisoning Early awareness and
    intervention can save lives. Christian
    Tomaszewski, MD, VOL 105 / NO 1 / JANUARY 1999 /
    POSTGRADUATE MEDICINE
  • Varon J, Marik PE Carbon Monoxide Poisoning. The
    Internet Journal of Emergency and Intensive Care
    Medicine 1997 Vol1 N2 http//www.ispub.com/journ
    als/IJEICM/Vol1N2/CO.htm

41
  • Carbon Monoxide Poisoning Often Cardiotoxic
    Reuters Health Information 2005. (Dr. Timothy
    Henry, Minneapolis Heart Institute Foundation
    study, reported in the Journal of the American
    College of Cardiology.
  • Unintentional NonFire-Related Carbon Monoxide
    Exposures United Staes, 2001-2003, Centers for
    Disease Control, MMWR Weekly, January 21, 2005
  • Non-Fire Carbon Monoxide Deaths Associated with
    the Use of Consumer Products, 2002 Annual
    Estimates consumer Product Safety Commission.
  • Carbon Monoxide Alarm Field Study, December
    2004, Underwriters Laboratories
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