Lindell K. Weaver, MD at Intermountain Health, talks about how to protect yourself from carbon monoxide poisoning.
Interview conducted by Ivanhoe Broadcast News in 2023.
What do people need to know about carbon monoxide?
Weaver: Sure. as the temperature drops in the fall, as it always does, of course, then we’re going to be shutting doors, closing up garages, operating equipment inside. But more comparingly what we do when it gets cold, we turn on the heat. And every year when people are turning on their heating systems, we, unfortunately, in fact, the word is inundated really, we get more and more calls about carbon monoxide poisoning and we end up treating more patients with carbon monoxide poisoning. Sometimes it’s a whole family. It could be a woman who’s pregnant with small children and elderly and so forth. We’ve treated as many as over 20 patients at one time in the past from one event. And so what to do about that, prevent it. The treatment is often ineffective. And even when we treat people, including with the hyperbaric oxygen in this chamber behind me, sometimes people still have problems afterwards. So it’s important to prevent poisoning. How do we prevent poisoning? Everybody should have their heating system inspected by qualified technician every year because you just never know. A bird may have built a nest, wind may have blown something and broken something. The unit might be older and it may have broken inside, whatever. These are all explanations and things that we’ve seen and treated patients who were poisoned. So have it inspected by a qualified person and then of course do sensible things. Don’t operate internal combustion engines, motors inside enclosed spaces. Don’t run a car inside a garage. If you have a keyless ignition, be sure it’s off. Unfortunately, we’ve treated and are aware of many patients now who mostly keyless ignition have left the car running and it has poisoned them or sometimes even their neighbors. So just keep your wits about you here. Don’t do pressure washing inside, don’t bring a generator inside, don’t cut concrete inside. We’ve treated two concrete cutting patients in the last two weeks. I think our total now is up to over 100 patients. They come at all times of year, of course, because they have a job to do. They need to cut concrete with a gas powered saw. Another strategy, of course, is carbon monoxide alarms and carbon monoxide detectors. This is a carbon monoxide alarm. These are available online or almost anywhere. They’re hardware stores, what have you. They sell for about 20, $25 each. And they will protect from serious poisoning, but they won’t protect from carbon monoxide exposure, which can be harmful to some, let’s say it’s a pregnant woman. This alarm would protect from serious damage, but maybe not permanent damage to the baby. This is one of many different designs. I’m not endorsing any particular company, but this alarm is low level. It will go off at five or 10 parts per million. It takes 70 parts per million before this one will sound. So low level alarms are very nice. Personally, I also travel with one. So not just winter time, but I travel with one and carry it with me and my luggage to protect from, heaven forbid, carbon monoxide poisoning that might happen at a hotel or something.
Let’s talk about that, something people don’t think about like hotels or Airbnbs.
Weaver: Right. And I’m sure some people watching this may be aware of a recent death of two relatively young people down near Cabo San Lucas in Mexico. I don’t know for sure it was carbon monoxide poisoning, but I’ve heard some news outlets mention it was likely carbon monoxide poisoning. But I think we all know about the three individuals who died while staying at the Sandals resorts in the Caribbean that was carbon monoxide poisoning. I don’t know exactly what the cause was, but on the other hand, had they had this, presumably they wouldn’t have been hurt. They certainly wouldn’t have died. Then you may say, gee, how come the hotel industry, the hospitality industry don’t install these in every room? I have no idea why. I mean, it must be a money thing because they don’t. I mean some do and some are required by law to have carbon monoxide detection, but in many jurisdictions they are not. So I don’t know. It’s pretty simple. You better carry your own because you just don’t know that the hotel or the motel or the resort may have a carbon monoxide protection strategy. And as I’m sure you are aware, this gas, carbon monoxide, we cannot detect it. We don’t smell it. We can’t taste it. We can’t feel it. It can be percolating along and the next thing we know we’re sick or maybe even unconscious or can even die. That’s why it’s called the silent killer because it’s silent. And indeed, people can and have died. Therefore, prevention is critically important.
What would be a cause at a hotel for carbon monoxide leak in the room?
Weaver: When you look at this, and this is something actually I’ve published about, so we’ve analyzed this to some degree, the major source is boilers. But boilers heat hot water and boilers use a lot of energy. Therefore, they produce a lot of exhaust and by so doing a fair amount of carbon monoxide. And it’s usually a problem with the boiler. Either the boiler somehow was in disrepair or was old or the ventilation system somehow broke and released exhaust products into the hotel. And then you say, wait a minute, the boiler is over here in this area heating hot water for a pool. How did the carbon monoxide get into the occupancy areas? And it sure can. Carbon-monoxide can go through dry wall very easily. It can move through crevices and little holes and where people have put conduit or pipes in the structure. So indeed, people often have been poisoned in sometimes quite a distance remote from the poisoning or the carbon monoxide source.
Could this potentially be a problem on cruise ships?
Weaver: Good question. That I don’t know, I would assume. What drives a cruise ship? It’s an internal combustion engine, consuming some carbon based fuel. If there were a leak in that exhaust system, yeah of course, it could happen. I’m not aware that it’s happened, but at least hypothetically, yeah it makes sense that it could happen.
So, your advice, really, is that when you travel, always travel with one of these, right?
Weaver: Exactly. I travel- well, I don’t travel with this model, but I have another one similar to it. I have- so what do I do? I’ve got a couple of these kind, residential carbon monoxide alarms located through the house, and then I’ve got a couple of the low level alarms. I actually have one in my bedroom, and I have one just parked in my suitcase, my carry on, so I don’t forget it, and it’s a lower level device, so I have both. How long do these things last? Probably at least five years, if not longer. So it’s really not that much money in the big scheme of things to just carry one because you can’t trust wherever you’re going to have one. Maybe they do, maybe they don’t.
And if there’s a poisoning, I guess, talk about part of the treatment.
Weaver: Sure. Well, to treat poisoning, first off, is it poisoning? The individual if they’re sick, they need to call 911. In some jurisdictions, the emergency medical people have a monitor where they can slip it on your finger and sometimes it can detect carbon monoxide. But if the person is sick, they should go to a hospital. Most hospitals, unless they’re quite small, can measure carbon monoxide in the blood nowadays. And if they’re truly poisoned, well, you get out of the environment that’s sensible, and you get treated with oxygen. And in some cases, we use oxygen in a chamber, like behind me, in a much higher dose. What does this do? It gets rid of carbon monoxide out of the body, but it also blocks some of the downstream bad things that carbon monoxide has or can trigger, mostly with inflammation in the brain.
A lot of people think of carbon monoxide poisoning and dying, but sometimes, really, you’ll just suffer some really bad lasting effects, right?
Weaver: Well, so if you look at the people who have been poisoned, 30-45% of that group of people are going to have long term problems with their brain, much like a concussion, headaches, dizziness, sleep problems, irritability, things of that sort. Sometimes these problems are permanent. Often they don’t respond terrifically well to therapy so you’re back to prevention. Let’s not get poisoned in the first place.
So is there anything else you want to add that I didn’t ask?
Weaver: Now, just be wary about poisoning because I mean for example, let’s say you have a room or something and you need to use some industrial equipment inside. You need to polish the floor, you need to cut concrete or something and you have a carbon monoxide producing engine. So I’ve seen people set up a fan and they’ll open a window, but that doesn’t really do it. It takes a fair amount of ventilation, moving through the space to clear out carbon monoxide. And so what should a person do in that situation? Use electric tools if they can. If they have to run them with a generator, be sure the generator is outside. The number of people poisoned by generators in the United States is just way too high, even to this day.
That is very good. Can you talk about the symptoms?
Weaver: Yes. Sure. So symptoms from carbon monoxide poisoning. Well, let’s start in the extreme, if the dose is really really high, there are no symptoms. The person will lose consciousness and die within minutes of time. Now that’s really high levels, which we don’t see fortunately, very often. So with lower levels, the patients that I treat, the symptoms, the person has symptoms. Of course, they didn’t die and what are those symptoms? Headache is the most common, dizziness, nausea, sometimes vomiting. Children vomit more often than adults, young children in particular often have seizures. Seizures in adults is quite unusual. People don’t feel well, they know something’s wrong, can’t quite put their finger on it. They often are not thinking clearly, their thinking is slower. They just feel like they’re sick, like the flu, but not quite. Muscles sometimes are sore, but not always and people are weak, tired, just want to go lay down. When does poisoning happen? If you think about it, from furnaces and things, usually at night because it’s cold, that’s when the furnace is on. Where is the individual? Often in bed, often they’ll be sick, they’ll get out of bed, and then they’ll lose consciousness as a consequence of getting up from bed or they just stay in bed and if the poisoning continues, well often, unfortunately they may die and they’re found in bed.
In a hotel room, but more importantly, in like a rental property, where is the ideal place that someone should place one of these, say, a family of five is using a three bedroom rental property, they have one of those, where do they put it?
Weaver: Good question. So if you have a- let’s say, okay- let’s talk about where to put carbon monoxide detection systems, be the alarms. Now, if the carbon monoxide alarm is connected with, it’s a combination alarm with a smoke detector. And they exist, you have smoke and carbon monoxide in one system. Those need to go up high on a ceiling because of smoke. But if you have carbon monoxide alarms that are separate from that, they do not have to go on the ceiling. The notion that carbon monoxide rises because it’s a little bit lighter than air is inaccurate. It is lighter than air, but it doesn’t rise, gases don’t behave this way. It distributes through the space. So where do you put it? Put it on a bedside counter top. So if you have one alarm, and you have a rental property, put it in a bedroom, preferably the adult bedroom, close enough that if it goes off, it will awaken you or instead of one, maybe get a couple of them, so put them in different places in the place that you’re renting. And which one do you get? Well, the residential alarms, again, these are going to go off when an adult’s blood level has about 10% carbon monoxide in it. Personally, I think that’s too high. But these will prevent probably serious harm, they certainly will prevent death. But I suggest traveling with really a low level alarm, something like this. There’s quite a number of them out there on the market and they’ll go off at 10 or 20 parts per million. And usually they’re smaller and things of that sort or carry one of each like I’d shared with you. I’ve got both at my house.
END OF INTERVIEW
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