January 2009 Preventing Carbon Monoxide Poisoning Information for Older Adults and Their Caregivers o you know that from being absorbed into the carbon monoxide body, which can damage tissues (CO) is the most and result in death.3 common cause of Dpoisoning death in the United What Are the States? Unintentional CO poisonings are responsible for Symptoms of CO about 500 deaths and 15,000 Poisoning? visits to emergency rooms For most people, the first Fact Fact Sheet annually. Older adults over signs of exposure to low 65 years of age are especially concentrations of CO vulnerable to unintentional include mild headache and CO poisoning due to their breathlessness upon moderate high frequency of pre-existing exercise. Continued or acute Everyone is at medical conditions.1 While CO exposure can lead to flu-like risk of being alarms can save lives, fewer symptoms including more than one third of American severe headaches, dizziness, poisoned by carbon homes have them installed.2 tiredness, nausea, confusion, monoxide exposure. irritability, and impaired judgment, memory and Older adults What Is Carbon coordination.4 CO is called the Monoxide (CO)? with pre-existing “silent killer” because if these CO is an odorless, colorless early signs are ignored, a person conditions, such gas that can cause illness and may lose consciousness and be as chronic heart death. It is produced whenever unable to escape the danger. any fuel such as natural gas, disease, anemia, propane, gasoline, oil, kerosene, You May Be Symptom or respiratory wood or charcoal is burned. Devices that produce CO include Free and Still Exposed problems, are even cars, boats, gasoline engines, to Unsafe CO Levels more susceptible stoves and heating systems. CO Breathing low concentrations of from these sources can build up CO may not result in obvious to the effects of this in enclosed or semi-enclosed symptoms of CO poisoning, odorless, colorless spaces. When people inhale yet exposure to low levels CO, the toxic gas enters the of CO can cause long-term gas. bloodstream and blocks oxygen health damage, even after the CO source is removed. These health effects victims and 40% of black victims became include long-term neurological damage such as poisoned as a result of indoor burning of learning and memory impairments, emotional charcoal briquettes.10 and personality effects, and sensory and motor disorders.5 If You Experience Symptoms You Think Could Be from CO Who Is at Risk from CO Poisoning: Poisoning? n Get fresh air immediately. Open doors and People of all ages are at risk for CO poisoning. windows and turn off stoves, ovens, heaters Persons living with chronic heart disease, and similar appliances and leave the house. anemia, or respiratory problems are more n susceptible to its effects.6 Older adults more Call a poison center immediately at 1-800- frequently have these pre-existing conditions, 222-1222. The poison experts there will let which lower their tolerance and increase the you know if you need to seek further medical risk of a fatal exposure.7 CO poisoning can attention. also be highly dangerous for unborn children, greatly increasing the risk of fetal death and To Prevent CO Poisoning, developmental disorders.8, 9 Remember I CAN B: More Common among Minorities n Install CO alarms near sleeping areas. n Check heating systems and fuel-burning A study conducted in Washington State among appliances annually. minority populations showed that Hispanic populations had a four times greater risk and n Avoid the use of non-vented combustion black populations had a three times greater appliances. risk than white populations for CO poisoning. n Never burn fuels indoors except in devices The most common source of CO poisoning such as stoves or furnaces that are made for among those populations was burning charcoal safe use. briquettes. Approximately 66% of Hispanic n Be Attentive to possible symptoms of CO poisoning. Other Tips for Preventing CO Poisoning: Red n Keep gas appliances properly adjusted. Blood n Consider purchasing a vented space heater Cell Oxygen when replacing a non-vented one. n Use proper fuel in kerosene space heaters. n Install and use an exhaust fan vented to the outdoors over gas stoves. n Open flues when using the fireplace. Carbon n Choose properly-sized wood stoves that are Oxygen Oxygen Monoxide certified to meet EPA emission standards. (vital to life) (deadly fumes) Ensure wood stove doors fit tightly. n Have your heating system and chimney inspected and cleaned by a qualified technician annually. n Make sure all interior fuel-burning appliances are in good condition and have proper How to Tell the Difference ventilation. between CO Poisoning n Never idle the car in the garage, even if the garage door is open to the outside. and the Flu n Use portable generators outside and far Since many of the symptoms of away from buildings. Never use portable CO poisoning are similar to those generators on balconies or near doors, vents of the flu, you may not think that or windows. Never use portable generators CO poisoning could be the cause. near to where you sleep or your family Symptoms could be the result of sleeps. CO poisoning when: n Never use a charcoal grill indoors, even in a n You feel better when you are fireplace. away from your home. n Propane heaters or heaters using other n More than one person in the home fuels placed in enclosed hunting and fishing gets sick at the same time (it shanties, should be vented to the outside. usually takes several days for the n Never heat your home with a gas oven. flu to pass from person to person). n Family members who are most affected spend the most time in Carbon Monoxide Alarms the home. n Symptoms occur or get worse shortly after turning on a fuel- burning device or running a vehicle in an attached garage. n Indoor pets also appear ill, exhibiting symptoms such as drowsiness and lethargy (human flu viruses are not transmitted to battery operated pets). electric plug-in wall/ceiling unit n Generalized aching, low-grade fever, or swollen lymph nodes (these are typical of a cold CO Alarms or flu).12 Half of all unintentional CO poisoning deaths could be prevented with the use of CO alarms. Alarms should be Underwriters Laboratories (UL) approved and are generally available at local hardware stores.11 The cost is minimal Don’t let buying a CO alarm lull you into a and in view of the possibility that it may save false sense of security. CO alarms should only the lives of you and your family it is a bargain. be considered a back-up for proper use and Install a CO alarm on every floor of your home maintenance of your fuel-burning appliances. and within hearing range of each sleeping area. CO alarms are not designed for low-level CO Carefully follow manufacturers’ instructions for monitoring and there have been questions their placement, use, and maintenance. Unlike about whether CO alarm standards are smoke alarms, CO alarms may expire after protective enough, especially for sensitive groups several years. such as older adults.13 4 The U.S. Environmental Protection Agency (EPA), Indoor Aging Adults and Environmental Environments Division (6607J) Office of Air and Radiation, Health Issues “Protect Your Family and Yourself from Carbon Monoxide Poisoning,” October 1996. http://www.epa.gov/iaq/pubs/ EPA’s Aging Initiative is working to protect the coftsht.html health of older adults from environmental 5 Delayed Neuropathology after Carbon Monoxide hazards through risk management and Poisoning Is Immune-Mediated, Stephen R. Thom, Veena prevention strategies, education and research. M. Bhopale, Donald Fisher, Jie Zhang, Phyllis Gimotty and Robert E. Forster, Proceedings of the National Academy of For more information about EPA’s Aging Sciences of the United States of America, Vol. 101, No. 37 Initiative, visit www.epa.gov/aging (Sep. 14, 2004), pp. 13660-13665. Printed copies of this fact sheet can be ordered EPA. 2000. Air Quality Criteria for Carbon Monoxide. at: http://www.epa.gov/aging/resources/ U.S.EPA, National Center for Environmental Assessment. June, 2000. EPA 600/P-99/001F. factsheets/order.htm 6 Centers for Disease Control and Prevention (CDC), National Center for Environmental Health, “Carbon Additional Resources Monoxide Poisoning: Questions and Answers,” July 2006. http://www.cdc.gov/co/faqs.htm Your Local Poison Center 7 CPSC. 2004. Non-Fire Carbon Monoxide Deaths n 1-800-222-1222 Associated with the Use of Consumer Products: 2001 Annual Estimates. U.S. Consumer Product Safety n Internet: www.aapcc.org Commission, Division of Hazard Analysis, May 13, 2004. 8 Raub, J. A., M. MathieuNolf, N. B. Hampson, and S. U.S. Environmental Protection Agency R. Thom. Carbon Monoxide Poisoning - a Public Health Carbon Monoxide Perspective. TOXICOLOGY (145):1-14, (2000).) http://www.epa.gov/iaq/co.html 9 Liu, S. Krewski, D., Shi, Y, Chen, Y, and R.T. Burnett. 2003. Association between gaseous ambient air pollutants CDC and adverse pregnancy outcomes in Vancouver, Canada. Environmental Health Perspectives. 111:1773-1778. Carbon Monoxide 10 Ralston, J.D. and N.B. Hampson. 2000. Incidence of http://www.cdc.gov/co/ severe unintentional carbon monoxide poisoning differs across racial/ethnic categories. Public Health Reports. Consumer Product Safety Commission 115:46-51. U.S. Department of Health and Human Services. Home Heating Equipment Safety 11 Yoon, S., Macdonald, S., Parrish, G. 1998. Deaths from unintentional carbon monoxide poisoning and potential for www.cpsc.gov/cpscpub/pubs/heatpubs.html prevention with carbon monoxide detectors. JAMA. 279(9): 685-687 Carbon Monoxide Alarms 12 U.S.