A Review of Disaster-Related Carbon Monoxide Poisoning: Surveillance,Epidemiology, and Opportunities for Prevention

Objectives. We conducted a systematic literature review to better understand aspects of disaster-related carbon monoxide (CO) poisoning surveillance and determine potentially effective prevention strategies.Methods. This review included information from 28 journal articles on disaster-related CO poisoning cases occurring between 1991 and 2009 in the United States.Results. We identified 362 incidents and 1888 disaster-related CO poisoning cases, including 75 fatalities. Fatalities occurred primarily among persons who were aged 18 years or older (88%) and male (79%). Hispanics and Asians accounted for 20% and 14% of fatal cases and 21% and 7% of nonfatal cases, respectively. Generators were the primary exposure source for 83% of fatal and 54% of nonfatal cases; 67% of these fatal cases were caused by indoor generator placement. Charcoal grills were a major source of exposure during winter storms. Most fatalities (94%) occurred at home. Nearly 89% of fatal and 53% of nonfatal cases occurred within 3 days of disaster onset.Conclusions. Public health prevention efforts could benefit from emphasizing predisaster risk communication and tailoring interventions for racial, ethnic, and linguistic minorities. These findings highlight the need for surveillance and CO-related information as components of disaster preparedness, response, and prevention.Carbon monoxide (CO) poisoning is a leading cause of poisoning in the United States. Unintentional, non–fire-related (UNFR) CO poisoning results in more than 20 000 emergency department (ED) visits, more than 2000 hospitalizations, and nearly 450 deaths annually.1–3 Health effects of CO exposure can range from viral-like symptoms such as fatigue, dizziness, headache, confusion, and nausea to more severe symptoms such as disorientation, unconsciousness, long-term neurologic disabilities, coma, cardiorespiratory failure, and death.1,4–6 CO is a colorless, odorless, and tasteless nonirritant gas that is imperceptible to human senses.7 Furthermore, CO exposure is often underdiagnosed or misdiagnosed as a result of the nonspecificity of the clinical effects.8,9 Both of these factors make exposure to CO a serious health concern because individuals can be severely or fatally poisoned before even realizing that they have been exposed. UNFR carbon monoxide exposure occurs year-round, with a usual seasonal peak during the winter season, and has been reported to be a leading cause of mortality and morbidity in postdisaster situations when engagement in high-risk behaviors is more common (e.g., improper placement of generators, use of charcoal grills indoors).1,2,10 Power outages during disasters or postdisaster cleanup and recovery have been found to be primarily responsible for a large number of fatal and nonfatal disaster-related CO exposures.10 It is important to identify and characterize high-risk populations and circumstances leading to disaster-related CO exposures to better target public health interventions and health messaging.For this study, we reviewed disaster-related CO poisoning articles in scientific journals that included cases occurring between 1991 and 2009 in the United States. The objective was to better understand the aspects of disaster-related CO poisoning surveillance, characterize the populations at risk, and determine potentially effective prevention strategies.     

Recipients of hyperbaric oxygen treatment for carbon monoxide poisoning and exposure circumstances

Background

Unintentional carbon monoxide poisoning is preventable. Severe cases are often referred for hyperbaric oxygen treatment. To guide prevention efforts and treatment practices, this study provides some of the most detailed current information about patients with carbon monoxide poisoning who have been treated at hyperbaric facilities across the United States and the circumstances surrounding their exposures. This study can help improve efforts to prevent carbon monoxide poisoning and enhance treatment practices.

Methods

From August 2008 to January 2010, nonidentifiable, patient-level data were reported by 87 hyperbaric facilities in 39 states via an online reporting system. This reporting system was developed collaboratively by the Undersea and Hyperbaric Medical Society and the Centers for Disease Control and Prevention.

Results

Among the 864 patients reported to receive hyperbaric oxygen treatment for unintentional, non–fire-related, carbon monoxide poisoning, most of the patients were white men aged between 18 and 44 years. Only 10% of patients reported the presence of a carbon monoxide alarm at their exposure location, and 75% reported being part of a group exposure. Nineteen patients (2%) reported a prior carbon monoxide exposure. About half (55%) of the patients treated were discharged after treatment; 41% were hospitalized.

Conclusions

The findings in this report expand the knowledge about patients with carbon monoxide poisoning. These results suggest that prevention efforts, such as educating the public about using carbon monoxide alarms and targeting the most at-risk populations, may help reduce the number of exposures, the number of persons with chronic cognitive sequelae, and the resulting burden on the health care system.     

CNS intravascular large cell lymphoma in a patient with autoimmune hemolytic anemia

Intravascular large cell lymphoma (IVLCL) is a rare disease characterized by proliferation of malignant lymphocytes within the small blood vessel lumens. The association of IVLCL with autoimmune hemolytic anemia (AIHA) has been described in a single case report, but the true prevalence of this co‐occurrence is not known because of declining autopsy rates. Here, we report a case of a 41‐year‐old woman who carried a diagnosis of AIHA for 2 years, with repeated hemolytic episodes that were initially well controlled with immunomodulatory treatment. At her last presentation, the patient developed rapidly progressive neurologic symptoms and leukoencephalopathy on MRI; she died 4 weeks later with a clinical impression of thrombotic microangiopathy, a known complication of AIHA. At autopsy, the brain showed widespread platelet thrombi and intraparenchymal hemorrhages characteristic of this disorder. In addition, there was evidence of a clinically unsuspected IVLCL, most likely of B‐cell lineage. This case illustrates a potential association between IVLCL and AIHA, highlights the need for broad differential diagnosis in cases with atypical disease presentation or progression, and underlines the importance of autopsy in establishing the full cause of morbidity and mortality.