MMWR: Carbon Monoxide Exposures Related To Hurricane Sandy

# 6705

 

The CDC’s MMWR has a Notes From The Field report today on the the large number of CO exposures linked to the aftermath of hurricane Sandy in the North East.

 

It is such a common occurrence after a major storm – when power supplies are often disrupted - that I wrote about the risks twice during the past week (see here, and here).

 

Despite the warnings that go out every winter, and after every big storm, people without heat or light are often desperate enough to take chances. One such story from a couple of days ago produced tragic results:

 

Upstate couple found dead from apparent generator carbon monoxide poisoning

A generator used after Superstorm Sandy is believed to have killed an elderly couple. They were discovered Monday in Shokan, the husband in a basement and the wife at the bottom of stairs. It is believed they had been dead for at least two days.

By Charlie Wells / NEW YORK DAILY NEWS

 

Today’s MMWR cites more than 260 CO exposures (4 fatal, not including the 2 mentioned above) in the wake of Hurricane Sandy. 

 

 

Notes from the Field: Carbon Monoxide Exposures Reported to Poison Centers and Related to Hurricane Sandy — Northeastern United States, 2012

Weekly

November 9, 2012 / 61(44);905-905

Hurricane Sandy made landfall as a post-tropical cyclone along the coast of southern New Jersey on Monday, October 29, 2012. In the wake of Sandy, state and federal public health agencies have observed an increase in the number of exposures to carbon monoxide (CO) reported to poison centers. CO is imperceptible and can cause adverse health effects ranging from fatigue and headache to cardiorespiratory failure, coma, and death (1). CO poisoning is a leading cause of mortality and morbidity in post-disaster situations, when widespread power outages occur and risky behaviors, such as improper placement of generators and indoor use of charcoal grills, increase (2,3).

 

As of November 6, a total of 263 CO exposures related to Hurricane Sandy had been reported to poison centers in eight states: 80 in New York, 61 in New Jersey, 44 in Connecticut, 39 in Pennsylvania, 27 in West Virginia, eight in Virginia, three in Maryland, and one in Delaware. Four of the reported exposures, all in Pennsylvania, resulted from the use of a generator in a garage and were fatal. This likely is an underestimation of the total number of fatal cases; larger numbers of CO-related deaths have been reported in the media. Where symptom information was available (n = 182), the most frequently reported symptoms were headache (69 cases, 37.9%), nausea (44 cases, 24.2%), and dizziness (36 cases, 19.8%). For comparison, the total number of CO exposures reported to poison centers and related to Hurricane Irene during August 28–September 2, 2011, was 49.

 

CO exposures can be prevented by 1) placing generators as far from homes as possible, but also at a safe distance from any nearby dwellings; the recommended distance for generator placement outside a home is a minimum of 25 feet (7.6 m) (3); 2) never using a generator, grill, camp stove, or other gasoline or charcoal-burning device inside a home, basement, garage, or outside near an open window; 3) never heating homes with a gas oven or by burning charcoal; 4) ensuring that fuel-burning space heaters are properly vented; 5) installing a battery-operated or battery back-up CO alarm in the home; and 6) leaving the building and dialing 911 if a CO alarm sounds, if CO poisoning is supected, or if any person begins to feel dizzy, light-headed, or nauseous. More information about CO poisoning is available at http://www.cdc.gov/co/guidelines.htm. For suspected cases of CO poisoning and other exposures, persons should call their regional poison center at 1-800-222-1222.

 

 

The CDC offers the following basic advice regarding carbon monoxide:

 

Prevention Guidance

You Can Prevent Carbon Monoxide Exposure

• Do have your heating system, water heater and any other gas, oil, or coal burning appliances serviced by a qualified technician every year.
• Do install a battery-operated or battery back-up CO detector in your home and check or replace the battery when you change the time on your clocks each spring and fall. If the detector sounds leave your home immediately and call 911.
• Do seek prompt medical attention if you suspect CO poisoning and are feeling dizzy, light-headed, or nauseous.
• Don't use a generator, charcoal grill, camp stove, or other gasoline or charcoal-burning device inside your home, basement, or garage or near a window.
• Don't run a car or truck inside a garage attached to your house, even if you leave the door open.
• Don't burn anything in a stove or fireplace that isn't vented.
• Don't heat your house with a gas oven.

 

 

Having had a close call with CO poisoning myself due to a faulty furnace in a house I had just moved into, I now keep a CO detector in my house, along with a couple of smoke detectors. 

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NWS: Possible Coastal Storm Mid-Week

 

Source CDC

 

 

# 6694

 

As I mentioned on Thursday (see A Worrisome Mid-Week Forecast), computer models are increasingly indicating a coastal storm/Nor’easter for the Mid-Atlantic & New England states later this week.

 

Not only will this increase the misery factor for residents and rescue workers dealing with the aftermath of Sandy, for those without power or heat temperatures and wind chills may drop dangerously low.

 

This is the latest Hazardous Weather Outlook from the New York NWS, issued early this morning:

HAZARDOUS WEATHER OUTLOOK

NATIONAL WEATHER SERVICE NEW YORK NY
339 AM EST SUN NOV 4 2012

THIS HAZARDOUS WEATHER OUTLOOK IS FOR SOUTHERN CONNECTICUT...NORTHEAST NEW JERSEY AND SOUTHEAST NEW YORK.

.DAY ONE...TODAY AND TONIGHT.

TEMPERATURES TONIGHT ARE EXPECTED TO FALL INTO THE 20S AND 30S.

THOSE WITHOUT POWER SHOULD PLAN FOR ANOTHER COLD NIGHT.

.DAYS TWO THROUGH SEVEN...MONDAY THROUGH SATURDAY.

LOW TEMPERATURES MONDAY NIGHT ARE EXPECTED TO FALL INTO THE 20S.

THOSE WITHOUT POWER SHOULD BE PREPARED FOR ANOTHER COLD NIGHT.

THERE IS THE POTENTIAL FOR A COASTAL STORM TO IMPACT THE TRI-STATE REGION WEDNESDAY AND THURSDAY.

THIS STORM HAS THE POTENTIAL TO BRING STRONG GUSTY WINDS...RAIN/WINTRY PRECIPITATION...COASTAL FLOODING AND ADDITIONAL BEACH EROSION TO THE TRI-STATE AREA.

STAY TUNED FOR THE LATEST FORECASTS.

 

 

The 7 day forecast for Newark, NJ gives a pretty good idea of the expected progression of the weather.

 

The concern here isn’t just for the cold, for every year we get tragic reports of people who either started a house fire, or succumbed to Carbon Monoxide poisoning, while trying to heat their homes during a power outage.

 

The sources of CO are numerous; faulty furnaces, snow blocked car exhaust pipes, attempts to use generators inside the house or garage . . . and the use of CO producing emergency heat sources all contribute to the winter body count.

 

The CDC’s MMWR released a report in 2005 called Unintentional Non--Fire-Related Carbon Monoxide Exposures --- United States, 2001—2003 that stated:

 

During 2001--2003, an estimated 15,200 persons with confirmed or possible non--fire-related CO exposure were treated annually in hospital EDs. In addition, during 2001--2002, an average of 480 persons died annually from non--fire-related CO poisoning. Although males and females were equally likely to visit an ED for CO exposure, males were 2.3 times more likely to die from CO poisoning. Most (64%) of the nonfatal CO exposures occurred in homes. Efforts are needed to educate the public about preventing CO exposure.

 

The CDC maintains a webpage on Carbon Monoxide, which you can access here, and has this short video on what they call the `quiet killer’.

 

 

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Safety Issues After The Storm Passes

 

 

# 5526

 

 

Yesterday’s tornado and severe weather outbreak across the Mississippi Valley and Southland may well go into the record books, but as of now the full extent of the losses (human and property) haven’t been surveyed.

But what we do know is that it was – as predicted – very bad; scores are dead, hundreds injured, and hundreds of thousands affected by power outages.

 

 

The Storm Prediction Center in Norman, Oklahoma lists nearly 160 tornado reports, almost 300 wind reports, and 178 hail reports for yesterday. These are preliminary numbers, and each must be verified.  

 

The record was set on April 3rd, 1974 when over a 16 hour period 138 tornadoes swept across the Midwest killing more than 300 people.

 

April, 2011 – with more than 600 tornado sightings (preliminary) though Monday the 25th, is stacking up to be one of the worst months on record. 

 

The previous (confirmed) highest number was 267 confirmed – again during the infamous 1974 Super Outbreak.

 

But today is a day for cleanup and recovery, amid large scale power outages.  This is a dangerous time, during which additional deaths and injuries may occur.

 

So today, a review of some safety information for after the storm passes. 

 

Perhaps not something that people in the tornado damage zone will be reading today, but hopefully of use for those who may be hit tomorrow, or next month, or later in Hurricane season.

 

 

The Peachtree City, Georgia NOAA weather page has some useful information on after-storm cleanup, including dealing with repair contractors. 

 

This is just an excerpt, follow the link for a lot more:

 

Safety After the Storm

Here are just a few safety tips...

• Be aware of hazards from exposed nails and broken glass.
• Do not touch downed power lines or objects in contact with downed lines. Report electrical hazards to the police and the utility company.
• If it is dark when you are inspecting your home, use a flashlight rather than a candle or torch to avoid the risk of fire or explosion in a damaged home.
• If you see frayed wiring or sparks, or if there is an odor of something burning, you should immediately shut off the electrical system at the main circuit breaker if you have not done so already.
• If you smell gas or suspect a leak, turn off the main gas valve, open all windows, and leave the house immediately. Notify the gas company, the police or fire departments, or State Fire Marshal's office, and do not turn on the lights, light matches, smoke, or do anything that could cause a spark. Do not return to your house until you are told it is safe to do so.
• For more information, visit the Centers for Disease and Prevention. They have a wealth of information about what to do in the aftermath of all sorts of events - like tornadoes, floods, hurricanes, and many more.

 

 

The use of generators, and improvised cooking or heating indoors, often results in (preventable) Carbon Monoxide poisonings.  Each year hundreds of Americans are killed, and thousands affected, by CO poisoning.

 

In Carbon Monoxide: A Stealthy Killer I wrote in depth on the issue, but a few tips from the CDC include:

 

Prevention Guidelines

You Can Prevent Carbon Monoxide Exposure

• Do have your heating system, water heater and any other gas, oil, or coal burning appliances serviced by a qualified technician every year.
• Do install a battery-operated CO detector in your home and check or replace the battery when you change the time on your clocks each spring and fall. If the detector sounds leave your home immediately and call 911.
• Do seek prompt medical attention if you suspect CO poisoning and are feeling dizzy, light-headed, or nauseous.
• Don't use a generator, charcoal grill, camp stove, or other gasoline or charcoal-burning device inside your home, basement, or garage or near a window.
• Don't run a car or truck inside a garage attached to your house, even if you leave the door open.
• Don't burn anything in a stove or fireplace that isn't vented.
• Don't heat your house with a gas oven.

 

You’ll also find this useful CDC TV also has an excellent 3 minute video on CO poisoning from CDC TV , which you can watch here (dbl click image to view on Youtube).

 

 

 

Food safety after a power outage is another concern after the storm, something I covered last year in  USDA: Food Safety When The Power Goes Out.  

 

A few excerpts include:

 

The USDA maintains a Food Safety and Inspection website with a great deal of consumer information about how to protect your food supplies during an emergency, and how to tell when to discard food that may no longer be safe to consume.

 

First, an audio podcast (5 minutes).

 

Surviving a Power Outage: Don't Be in the Dark When it Comes to Food Safety (Jun 2, 2010; 4:45) | Script
FSIS Food Safety staff discusses tips on how to be food safe during a power outage.

 

The USDA also maintains a large repository of food safety information available to be read online, or downloaded as a pdf.

 

A Consumer's Guide to Food Safety: Severe Storms and Hurricanes

Note: This text-only version of the Guide has been optimized for accessibility. The illustrated PDF version (2.1MB) is recommended for printing.

 

 

Chainsaw accidents figure prominently after many weather-related disasters.  The CDC maintains a chainsaw safety webpage.  Excerpts follow:

 

Preventing Chain Saw Injuries During Tree Removal After a Disaster

 

Be aware of the risk of chain saw injury during tree removal

Each year, approximately 36,000 people are treated in hospital emergency departments for injuries from using chain saws. The potential risk of injury increases after hurricanes and other natural disasters, when chain saws are widely used to remove fallen or partially fallen trees and tree branches.

 

May and June are the peak months for Tornadoes in this country, and September is the peak of the Hurricane season.   Spring floods are sweeping downstream right now, affecting many communities.  

 

While it may seem as if the danger has passed once the clouds part, and the sun comes out, the truth is quite the opposite.

 

Now is a good time to follow these links and print out the information you may need - before the next big storm hits.

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Carbon Monoxide: A Stealthy Killer

 

 

# 5186

 

In my Kitchen, a few feet away from the only likely source of CO gas in my home (my gas stove), I keep a carbon monoxide detector.

 

I do so because nearly 15  years ago, in another state, my wife and I moved into an older home with a faulty heater, and we very nearly succumbed to CO poisoning that first winter because of it.

 

Luckily for us, the levels of CO were low enough not to be immediately fatal, but rather induced in us a chronic lethargy, constant headaches, and mind-numbing apathy.

 

At first, we simply thought we had the flu, or were having difficulty adjusting to our first mid-western winter,  or were allergic to something in our new home.

 

But the symptoms grew worse, and in desperation we finally installed CO alarms, which immediately began sounding.

 

We were slowly, but insidiously, being poisoned by low levels of Carbon Monoxide from a wood furnace that the previous owner had `modified’.

 

Two cold days later (no heat), repairs to the furnace were completed by a qualified technician at a cost of nearly $1000.

 

An expensive (and almost fatal) lesson.  But the constant headaches, and lethargy, went away with the CO.

 

The CO detector remains, however.

 

 

 

As a former paramedic – one who has seen CO poisoning more than once in the (dim and distant) past – you’d think that I would have been quicker to realize what the problem was. 

 

But that’s the problem with CO poisoning, it slowly robs you of your ability to think critically.  

 

Carbon Monoxide kills by binding to the blood’s hemoglobin at a rate many-fold faster than oxygen can.  It essentially crowds out life-essential oxygen from the blood, causing those exposed to slowly suffocate  . . . often completely unaware of what is happening to them.

 

 

 

Yesterday, the news wires carried the tragic report of 5 teenagers killed in a south Florida motel room from the exhaust of a car left idling in a parking garage below.

 

Florida: Exhaust Fumes Kill 5 Friends at Motel

By THE ASSOCIATED PRESS

Published: December 29, 2010

 

 

The sources of CO are numerous; faulty furnaces, snow blocked car exhaust pipes, attempts to use generators inside the house or garage . . . and the use of CO producing emergency heat sources all contribute to the winter body count.

 

The CDC’s MMWR released a report in 2005 called Unintentional Non--Fire-Related Carbon Monoxide Exposures --- United States, 2001—2003 that stated:

 

During 2001--2003, an estimated 15,200 persons with confirmed or possible non--fire-related CO exposure were treated annually in hospital EDs. In addition, during 2001--2002, an average of 480 persons died annually from non--fire-related CO poisoning. Although males and females were equally likely to visit an ED for CO exposure, males were 2.3 times more likely to die from CO poisoning. Most (64%) of the nonfatal CO exposures occurred in homes. Efforts are needed to educate the public about preventing CO exposure.

 

 

The CDC maintains a webpage on Carbon Monoxide, which you can access here.

 

CDC TV also has an excellent 3 minute video on CO poisoning, which you can watch here (dbl click image to view on Youtube).

 

 

 

 

Carbon Monoxide poisoning is a genuine, but preventable, risk.  If you don’t already have carbon monoxide detectors in your home, getting and installing some would make an excellent New Years resolution. 

 

Believe me, it’s a New Year’s resolution you can live with.

 

 

 

Note: I should mention I also have 2 smoke detectors in my home, as well. - MPC

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