December 06 Carbon Monoxide Poisoning Epidemic

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December 06 Carbon Monoxide Poisoning Epidemic

• Sean Akamine
• March 7, 2007

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Overview

• Carbon Monoxide
• Symptoms
• The Storm
• The Epidemic
• Other epidemics
• Lessons
• Recommendations

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Carbon Monoxide

• Colorless
• Odorless
• Tasteless
• By-product of many things we use daily
• Cars
• Gas powered appliances
• Charcoal

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Carbon Monoxide cont

• Mechanism of Toxicity
• Binding of CO to Hb inhibits oxygen transport to
  tissues in Mb it decreases oxygen storing
  capacity
• Affinity of CO for Mb is 200 times greater than
  oxygen
• CO binds to cytochromes in the mitochondria used
  in ATP synthesis
• Normal COHb levels
• Non-smoker 3
• Smoker 5-10

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Symptoms

• Mild HA, N/V, dyspnea, disorientation, confusion
• Moderate severe HA, tachycardia, tachypnea,
  syncope
• Severe seizure, coma, dysrhythmia, hypotension,
  respiratory failure, death

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Timeline December 14, 2006

• December 14, 2006
• Seattle Times, has the potential to be a
  memorable storm
• At 7pm storm hits western Washington
• Night temperature near freezing
• CO poisoning rare
• December 15, 2006
• Over 1 million without power
• Night-time temperatures near freezing
• CO poisoning present
• Still no major reports aimed at prevention

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Timeline cont.

• December 16, 2006
• Peak of CO poisoning epidemic
• 533,000 still without power
• Night-time temperature near freezing
• December 18, 2006
• 7 deaths attributed to CO poisoning

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CO Sources

• Staying warm was a big issue
• Charcoal
• Gas-powered generator
• Difference between ethnicity and CO source

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CO Sources

• Charcoal
• Immigrants are used to using charcoal
• Breathable dwellings
• Only see heat waves no smoke
• Insufficient heat conduction to effectively use a
  fireplace
• Generator
• Bad placement
• In garage next to furnace
• Under porch
• Right next to house

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Maine Ice Storm, 1998

• 600,000 lost power up to 2 weeks
• 400 cases of CO poisoning from 42 incidents
• 71 generators
• 26 space heaters
• 5 charcoal
• Peak of epidemic day 3
• Typically presenting at night

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North Carolina, 2002

• 1 million without power
• 28 generators
• 72 charcoal
• Peak of epidemic day 2
• Typically presenting at night

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Aug. - Sept. 04 Florida

• 4 hurricanes in a row
• Mass power outages
• 6 deaths due to CO poisoning
• CO poisonings peak on day 2
• Typically presenting in the morning
• Climate differences
• People were using generators to power their air
  conditioners
• Placement near air conditioner intake

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Lessons

• Power loss ? indirect CO poisonings
• CO poisonings have predictable epidemiology
• There is a window of time 2-3 days
• Sources of CO are related to type of storm/climate

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What should we do?

• Get educated
• Populations at risk?
• Seasonal epidemics
• When what time is it usually presented?
• CO detectors