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.