The Case for Carbon Monoxide Protection

1
The Case for Carbon Monoxide Protection

• Presented to the Code Technology Committee of the
  International Code Council
• Detroit, Michigan
• September 22, 2005

2

• Wendy Gifford
• Director, External Affairs, Invensys
• Vice Chair, National Electrical Manufacturers
  Association Carbon Monoxide Section
• Member, NFPA 720, Standard for the Installation
  of Household Carbon Monoxide Warning Equipment

3
Objective

• To present the compelling evidence that will
  provide the Code Technology Committee the
  justification to mandate carbon monoxide
  protection in new and existing dwellings.

4
Committee Draft Recommendation

• Not sufficient justification for mandating
  carbon monoxide protection.
• Death and injury data
• Cost/benefit calculation
• Detector/standard questions

5
Injuries are significantAlarms offer effective
solution

• Carbon monoxide poisoning causes 10,000 injuries
  a year.
• Long term consequences
• High societal costs.
• Carbon monoxide alarms provide affordable,
  reliable protection appropriate to a building
  code.

6
Carbon Monoxide Causes Many Injuries

• Carbon monoxide kills and injures more people
  than all other poisonings combined.
• More than heroin

7
One third may go undiagnosed

• Significant under reporting of CO deaths.
• Misdiagnosis commonly occurs.
• Many non-lethal exposures go undetected

8
Total injuries exceed 15,000 most in homes

• 2001-2003 data Centers for Disease Control
• Every year---
• 15,200 people treated
• 480 deaths
• Majority (64) of non-fatal exposures occur in
  homes.

9
CPSC Nearly 200 died

• 2002 Estimated 188 carbon monoxide poisoning
  deaths associated with the use of a consumer
  product
• Excludes those in which source is a vehicle, even
  if in home

10
Decline in deaths may be artifact of statistics

• Part of the decrease from the 1994-1998 average
  annual estimate of 200 . . . To an average of 141
  in 1999-2002 may be the result of . . . A new
  methodology.

11
Injuries vastly outnumber deaths

• For every residential carbon monoxide death,
  there may be 51 injuries.
• 9,728 annual injuries (CDC Data)
• 188 deaths (CPSC Data)
• 10,000 seek medical attention or miss work each
  year

12
Even these numbers may be underreported

• Furnaces were the source in 46 of nonfatal CO
  poisonings
• Only 10 of fatal poisonings.
• This suggests that the role of home heating
  appliances is prominent in the large group of
  underreported nonfatal exposures.

13
CO poisoning affects the most vulnerable

• Death rate highest among 65
• Injury rate highest among children lt4
• The fetus is particularly vulnerable.
• Non-English speaking populations overrepresented

14
The effects are not always temporary or reversible

• Significant after effects
• Heart
• Brain

15
Carbon monoxide injuries can affect the heart.

• Nearly 40 of patients with moderate to severe
  carbon monoxide (CO) poisoning will have
  cardiovascular manifestations.

16
Neurological injuries can cause long term affects

• Delayed neurological dysfunction (brain damage)
  occurs in 14 to 40 of serious cases.
• Presents after patient appears recovered (2-40
  days)
• Cognitive defects, memory impairment, learning
• Difficulty moving
• Personality changes

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Can impact ability to work

• One third of CO poisoning victims may have subtle
  but lasting memory deficits or personality
  changes.
• In a 3-year follow-up of 63 CO poisoning
  survivors, Smith and Brandon found that 33
  showed evidence of personality deterioration and
  43 reported memory impairment.

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Significant nerve damage can occur.

• Parkinson's Disease
• Persistent vegetative state
• Agnosia,
• inability to recognize and identify objects or
  people
• Apraxia
• Voluntary movement impaired

19
Nerve damage, continued.

• Mental deterioration,
• Urinary or fecal incontinence
• Gait disturbance
• Visual impairment/Blindness
• Amnestic/confabulatory state
• Psychosis

20
Hefty societal costs

• Lost work time, productivity
• Temporary
• Permanent
• Long term treatment
• Health care costs
• CPSC estimates gt630 million societal costs
  annually

21
Not having protection can be expensive legally

• CARBON MONOXIDE CASE SETTLED FOR 30
  MILLIONSouth Florida Sun-Sentinel Fort
  Lauderdale, Fla. May 26, 2001 Akilah Johnson
  Staff Writer
• Seven people who suffered brain damage after
  moving into or visiting the Terra Cotta Place
  Apartments will collect more than 30 million
  from complex owners and managers for failure to
  fix a water heater that was leaking carbon
  monoxide.

22
CO alarms are highly effective in reducing
exposure.

• American Journal of Emergency Medicine study of
  911 calls
• Persons with CO detectors were less likely to
  become symptomatic.
• Only 13 symptomatic vs. 64 of those without
  alarms.

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Mecklenburg County requires in all homes.

• Ice storm power outage 161 people with
  confirmed CO exposure 1 death
• 88 of the cases of symptomatic CO poisonings
  occurred in homes with no reported functioning CO
  alarm.
• Mecklenburg County changed ordinance to require
  battery back up all homes

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Alarms are already saving lives.

• Any discussion of a decline in death rates should
  consider growth in home carbon monoxide alarm use
  since 1994.
• Estimates 25-35 household penetration.

25
Current requirements

• States
• Alaska, Connecticut, New Jersey, New York, Rhode
  Island, Texas (group homes/day care), West
  Virginia, Utah, Vermont
• Cities other AHJs
• Chicago, New York City, and 30 others

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(No Transcript)
27
Cost of compliance lower than assumed

• Significantly below committee estimate of
  300-500.
• Typically one per home
• NFPA 720 One outside each separate sleeping
  area

28
Smoke/CO combo units eliminate extra labor

• New construction (AC/DC)
• Combo alarm 35-52
• Incremental 15 over smoke alone
• No incremental labor
• Annual 6.15 (annual battery 5 year life)
• Existing homes (battery)
• CO alarm 20-42
• Annual 11.40 (annual battery 5 year life)

29
UL Testing confirms reliability

• Over five years, in home samples regularly tested
  to UL 2034 requirements in lab
• Alarms have performed in an effective manor.
• 2 alarms alerted consumers to CO accumulations in
  homes
• In lab checking, 1 late alarmed 1 false
  positive.

30
CPSC Support

• CPSC goal additional 20 reduction in deaths by
  2013
• CPSC continues to recommend CO alarms
• Tested alarms did not expose consumers to a
  significant health risk with one exception

31
Centers for Disease Control highlights the role
of alarms

• Yes, people can prevent carbon monoxide
  poisoning by taking some simple precautions,
  including making sure that
• carbon monoxide detectors are properly installed
  and maintained in homes, houseboats, workplaces,
  and other appropriate places

32
Standards development for CO alarms similar to
smoke alarms

• ANSI UL 2034, carbon monoxide standard
• Three major changes in first 12 years of
  standard.
• UL 217, smoke alarm standard
• Half a dozen changes in first 12 years after
  alarms were first required in residences.
  Meanwhile, lives were saved.
• Dont wait for the perfect standard.

33
CO protection is appropriate to a minimum standard

• UL 2034 life safety standard, not health standard
• Allows levels far in excess of agency
  recommendations for outdoor air and the
  workplace.

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Comparative CO limits

• Environmental Protection Agency
• Outdoor air 9 ppm/8 hours 35 ppm/1 hour
• ICC IMC
• Parking garage 25 ppm/1 hour requires
  ventilation
• American Conference of Governmental Industrial
  Hygienists
• 25 ppm/8 hours
• National Institute for Occupational Safety and
  Health
• 35 ppm/8 hours
• Occupational Safety and Health Administration
• 50 ppm/8 hours
• UL 2034 ignore 30 ppm/30 days 70 ppm/1 hour

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• The least we can do is offer some protection in
  the home where the most vulnerable population
  spends the most time.

36
Not for profit organizational support

• American Lung Association
• Home Safety Council
• National Safe Kids Campaign
• Residential Fire Safety Institute

37
Evidence is compelling.

• Residential carbon monoxide deaths and injuries
  are a major problem.
• Long term implications and societal costs are
  significant.
• We have the tool right now to protect lives.

38
Conclusion

• The Code Technology Committee has the
  opportunity to lead.
• We ask you to recommend carbon monoxide
  protection for dwelling units and start saving
  lives.

39
References

• Choi, S. Delayed neurologic sequelae in carbon
  monoxide intoxication, JAMA Archives of
  Neurology, Vol 40, No 7, July 1983
• Krenzelok, EP, Carbon Monoxide, the silent
  killer with an audible solution, American
  Journal of Emergency Medicine 14 (5) 484-486 SEP
  1996
• Lavonas, Ed., MD, et. Al, Use of Carbon Monoxide
  Alarms to Prevent Poisonings During a Power
  Outage---North Carolina, December 2002, Journal
  of the American Medical Association
  (20042911691-1692) and MMWR (200453189-192)
• Shochat, Guy, MD, Assistant Clinical Professor of
  Medicine, Division of Emergency Medicine,
  University of California at San Francisco Medical
  Center, and Lucchesi, Michael, MD, Chair,
  Associate Professor, Department of Emergency
  Medicine, State University of New York at
  Brooklyn, Toxicity, Carbon Monoxide, August
  19, 2004, emedicine.com

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• Tomaszewski, Christian, MD, Carolinas Medical
  Center, Charlotte, North Carolina Department of
  Emergency Medicine, University of North Carolina
  at Chapel Hill School of Medicine, Carbon
  monoxide poisoning Early awareness and
  intervention can save lives Postgraduate
  Medicine, Vol 105, No 1, January 1999.
• Carbon monoxide poisoning Early awareness and
  intervention can save lives. Christian
  Tomaszewski, MD, VOL 105 / NO 1 / JANUARY 1999 /
  POSTGRADUATE MEDICINE
• Varon J, Marik PE Carbon Monoxide Poisoning. The
  Internet Journal of Emergency and Intensive Care
  Medicine 1997 Vol1 N2 http//www.ispub.com/journ
  als/IJEICM/Vol1N2/CO.htm

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• Carbon Monoxide Poisoning Often Cardiotoxic
  Reuters Health Information 2005. (Dr. Timothy
  Henry, Minneapolis Heart Institute Foundation
  study, reported in the Journal of the American
  College of Cardiology.
• Unintentional NonFire-Related Carbon Monoxide
  Exposures United Staes, 2001-2003, Centers for
  Disease Control, MMWR Weekly, January 21, 2005
• Non-Fire Carbon Monoxide Deaths Associated with
  the Use of Consumer Products, 2002 Annual
  Estimates consumer Product Safety Commission.
• Carbon Monoxide Alarm Field Study, December
  2004, Underwriters Laboratories