Carbon Monoxide: The Case for Environmental Public Health Surveillance

Carbon monoxide is a common, potentially lethal gas produced by the incomplete combustion of fossil fuels such as natural or liquefied petroleum gas, oil, wood, and coal.It is one of the oldest documented toxicants.Mortality and morbidity from acute, unintentional, non-fire-related carbon monoxide poisoning is a substantial, but often unrecognized, public health problem in the United States.(Intentional and fire-related carbon monoxide poisoning have other public health pathways for surveillance, prevention, and control; these events are, therefore, not addressed in this article.)It is estimated that each year in the United States at least 15,200 individuals seek medical attention in an emergency department or miss at least one day of work due to carbon monoxide poisoning. 1However, this estimate does not account for the full burden of illness; the toxic effects of carbon monoxide exposure are nonspecific and easily misdiagnosed.Symptoms may include headache, dizziness and nausea, and-at higher levels of exposure-disorientation, unconsciousness, and death.The estimate also does not account for those directly admitted to a hospital, those presenting to other types of outpatient clinics, who call poison control centers, who do not seek care, or those who die immediately from carbon monoxide exposure and receive no medical care.Carbon monoxide poisoning occurs both as the result of routine domestic, occupational, and recreational activities, and in the wake of large-scale disasters such as those caused by hurricanes, 2,3 floods, 4 and winter storms. 5,6It is almost entirely preventable by the correct installation, maintenance, and operation of devices that may emit carbon monoxide, combined with the appropriate use of carbon monoxide detectors (also called carbon monoxide alarms).It has been estimated that carbon monoxide detectors could prevent at least half of all deaths attributable to nondisaster-related carbon monoxide poisoning. 7In 2004, six states (Alaska, Delaware, Florida, Maine, Mississippi, and Montana)