Transcript CO Poisoning Surveillance

Carbon Monoxide Related Drowning
Jane McCammon
Double Angel Foundation
CO Awareness Committee Chair
[email protected]
(303) 718-3799
Robert Baron, MD
ED Co-Director, Phoenix Banner Good Samaritan RMC
Medical Advisor, Glen Canyon National Recreation Area
Gratefully acknowledging Dr. Tim Flood’s contributions
NDPA 2006
DOUBLE ANGEL FOUNDATION®
www.doubleangel.org
Raising Awareness About the Dangers of Carbon Monoxide Poisoning on Boats
We only see what we look for,
and
we only look for what we know
McCammon & Baron NDPA 2006
Drowning and CO Overview
How do you know if CO was associated with the
drowning?
What CO concentrations cause death?
How many drownings are CO-related?
McCammon & Baron NDPA 2006
Drowning and CO Overview
How much CO is there around boats?
What type of boats are associated with COrelated drownings?
What is being done about prevention?
FOR MORE INFORMATION – go to
http://safetynet.smis.doi.gov/COhouseboats.htm
McCammon & Baron NDPA 2006
CO % in
Blood
Carboxyhemoglobin
Hemoglobin
At 50 -60%
Coma
and
Death
At 20-30%
Loss of
consciousness (LOC),
disorientation
CO
CO CO
CO
At about 10%
Headache,
nausea,
confusion
McCammon & Baron NDPA 2006
Lake Powell in Glen Canyon National
Recreation Area (GCNRA)
Lake Powell
Drownings at Lake Powell: 1994 -2004
• National Park Service records were used to identify
possible unintentional fatal drownings.
• Drowning as cause of death was confirmed through
ME/coroner reports and AZ Health Department.
• CO-relatedness was confirmed by COHb analyses
(range = 22% to 80%)
McCammon & Baron NDPA 2006
Drowning at Lake Powell 1994 - 2004
• 72 people drowned
12 (17%) of all Lake Powell drownings
were CO poisonings first
• 25 of the 72 drowned in boating accidents
12 (48%) boat-related drownings
were CO poisonings first
McCammon & Baron NDPA 2006
Philadelphia Inquirer:
Don Sapatkin
July18, 2003
“Based on an estimated 40% of boat-related
drownings at Lake Powell being CO-related,
there could be as many as 215 similar
drownings per year nationwide.”
McCammon & Baron NDPA 2006
How Many Boat-Related CO Poisonings?
607 poisonings in 33 states (99% occurred 1990 – 2004)
Severity: 122 people died / 128 lost consciousness (235 loc unknown)
Remember: Lake Powell data collection is the most extensive.
1
1
13
15
7
7
1
30
19*
1
45
Lake
Powell
176
(29%)
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22*
*Excludes
Lake
Powell
cases
2
1
5
20
6
3
5
10
29
4
1
15
44
30
2
2
3
4
12
1
17
Location
unspecified
39
January 2006
But How Many Poisonings?
Is it 607?
Lack of Recognition
Lack of Reporting
McCammon & Baron NDPA 2006
Outdoor Fatal Poisonings
Why wasn’t the extent of the problem
recognized earlier?
Because it’s unbelievable.
McCammon & Baron NDPA 2006
A sunny day on Chesapeake Bay
What’s wrong with this picture?
McCammon & Baron NDPA 2006
CO: 1 typical boat engine = ??? cars
188
Calculations by Paul Roberts, Sonoma Technology Inc.
Circumstances of Poisonings
McCammon & Baron NDPA 2006
McCammon & Baron NDPA 2006
What We Know about the “Death Zone”
Nationwide:
Guidelines – CO in Air
21 people poisoned
(parts of CO per million parts of air – ppm)
13 died
WHO limit for a 1587 clearing
Adults:
ropes
from or
minute
exposure
doing maintenance on props
Immediately
Children: playing
in the space
Dangerous to Life
1,200
and Health (IDLH)
COHb:
26 – 72 % within minutes of
exposure
Danger of death in
12,800
1-3 minutes
WHY?
CO :
Generator operating
30,000 ppm
(maximum)
Oxygen Deficient –
as low as 10%
CO :
Propulsion engines operating
60,000 ppm (maximum)
What We Know: Outside the “Death Zone”
Nationwide:
55 people poisoned
10 died
Example:
200 ppm53%
CO 10’
COHb
away
12 YO
playing for 30 minutes
disappeared from the platform:
drowned
7,000 – 10,000 ppm on the
swim platform
Why?
85,000 ppm CO measured where generator
exhaust leaves the boat
Ski Boats / Other Motorboats
Nationwide:
51 people poisoned on the swim platform
20 died
22 lost consciousness
Most recent drowning:
August 20, 2005
(Lake Tapps, WA)
McCammon & Baron NDPA 2006
Boats Underway:
Death Comes Quickly
COHb: Duration of Exposure
57%:
5 minutes
50%:
2 minutes
48%:
“in minutes”
61%:
20-25 minutes
56%:
10-15 minutes
64%, 62%,
53%, 41%,
etc.....
34 people poisoned on platforms of moving boats
17 died and 10 lost consciousness
Only 5 of these people were “teak surfing”
Most (19) were holding onto the platform while the
boat moved along slowly (5 mph or “idle speed”).
Boat Engine Idling - Not Moving
Example: Non-Fatal
Poisoning
Example: Fatal poisoning
COHb: 50 – 75%
89% COHb
2 YO unconscious
after 1 minute of
exposure
3 minute exposure
(based on 14%
measured after 2.5
hours O2 therapy)
McCammon & Baron NDPA 2006
12 people poisoned on platform of stationary
boat:
3 died and 8 lost consciousness
Guidelines – CO in Air
(parts of CO per million parts of air – ppm)
WHO limit for a 15minute exposure
87
Immediately Dangerous
to Life and Health (IDLH)
1,200
Danger of death in 1-3
minutes
12,800
McCammon & Baron NDPA 2006
Maximum CO Measured
on Platforms
Engine idling –
10,000 ppm
boat still
Boat moving at
26,700 ppm
10 mph
Cabin Cruisers
Of the known 147 cruiser-related poisonings:
124 people were inside the cabin / 26 died
15 people were outside the cabin / 3 died
Two 9 YO girls near the
generator exhaust for 10
minutes. The first girl
had difficulty responding
to parents when called in
for lunch.
Her COHb (measured
after 71 minutes of
oxygen therapy) – 15%
About 30 minutes later,
the second girl was
found on the bottom of
the lake. Her COHb
(autopsy) - 39%
Comparison of Swim Platform CO Concentration
Windy day
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No wind
Congested Boat Traffic – Lake Havasu
On Memorial Day, Independence Day, or Labor Day, there may be as
many as 700 boats in the Bridgewater Channel at any given time. If
each boat has only one engine, and only a third of the boats are
operating, exhaust is roughly equivalent to that of 40,000 automobiles.
What’s happening in your area?
12 people poisoned since 1997:
3 drownings / 5 LOC
Photo courtesy of the City of Lake Havasu
On six occasions during the summer of 2004, the Channel was
closed to incoming traffic after prolonged “Unhealthy”
conditions and CO levels in the “Hazardous” range.
So… What do we need to do?
Recognize it !
If the drowning was anywhere on or
near a boat with an engine, think CO
- and get a COHb
McCammon & Baron NDPA 2006
So - What do we need to do?
Report it !
Notify the appropriate agency (State Boating Law
Administrator, State Parks, State Fish and Game,
Sheriff, etc.) that the drowning was CO-related.
McCammon & Baron NDPA 2006
Prevent it !
Education
Controls
Legislation
DOUBLE ANGEL FOUNDATION®
www.doubleangel.org
Raising Awareness About the Dangers of Carbon Monoxide Poisoning on Boats