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Are Carbon Monoxide (CO) Detector Regulations Saving Lives? Data to Quell the Controversy

Submitted by lesenochek on Mon, 05/23/2011 - 00:54

Are Carbon Monoxide (CO) Detector Regulations Saving Lives? Data to Quell the Controversy

By Mark K. Goldstein, Ph.D.

The data presented below show that Carbon monoxide (CO) alarms are proven to save lives. Regulations to require CO detectors can help prevent death and injuries, and they make sense economically. As long as we continue to use fossil fuels, we will continue to have CO accidents of various types.  Although increased awareness and improved technology has reduced fatalities, CO poisoning continues to be the leading cause of poisoning death (1).  Widespread, CO injuries and health effects are major causes of suffering and economic loss (1-15). 

A look at the evidence of some sample studies indicated the widespread nature of CO health impacts.  Michael Dolan at the University of Kentucky Medical Center, found that 23.6% of those diagnosed by emergency room doctors with the flu actually had CO poisoning (16).  Dr. Paul Heckerling, University of Illinois hospital in Chicago, found 15% of those with headaches had CO poisoning (17).  According to Cobb and Etzel, of the CDC, 56,133 CO fatalities occurred over a 10-year period from 1979 to 1988.  About 15,000 deaths were fire related, 11,547 motor vehicle related and 5,000 residential appliance related (1). Dr. Michael Dolan has stated that these numbers on death certificates are grossly underestimated because CO is often misdiagnosed (16, 25).  For example, a few years ago an elderly man died from CO in San Diego, but doctors assumed it was a heart attack and so stated the death certificate; however, during the funeral his son and his family nearly died from CO in the same house.   A few months ago, a similar dual poisoning accident happened in Japan; however, this time the son was also killed by CO.

The number of non-fatal accidents in homes is 10 times the number of fatal accidents, according to Clifton et al.  Clifton et al clearly shows that fatality rates prove that CO regulations are saving lives.  Death Rates as defined by Clifton, for cities with detector regulations like Chicago and St. Louis are 0.4 and 0.6, respectively.  While cities without regulations such as Los Angeles, Dallas, New Orleans, Detroit and Atlanta are between 15.0 and 25.0.   Case Death Rates were calculated as the ratio of the number of deaths in CO exposed people and the total number of CO exposed people during the time period of the study multiplied by 100 (19).

The typical cost of a CO alarm is about $30.  Detectors will last for 7 years.  The cost is $4.30 per year.  This is very cheap insurance for society when you consider all the alternative costs. 

Some of those opposing CO alarms, e. g., GRI, devised a bogus 5% relative humidity (RH) test (20).   GRI knows that when appliances produce 1100 ppm CO, at least 200 water molecules are emitted for just one CO molecule. Therefore CO accidents occur at high humidity. Why are these “Gas Industry Experts” opposing CO detectors based on a test conducted at 5% RH? Was it to kill the CO requirement in 62.2P ASHRAE ’s Ventilation Standard? 

CO has been a major problem in the gas industries for over a century.  It is much better now than 50 years ago.  But as energy costs rise and people tighten up their residences and businesses things will get much worse without CO alarms. There are many important CO studies referenced in the EPA CO Report, e.g., Dr. Edward Coops (former US Surgeon General) concluded that up to 50,000 non-smokers die from passive smoking and that CO is a major factor (13). Human exposures to CO levels from combustion appliances are generally an order of magnitude greater than from passive smoking, which kills 50,000 per year (13).  Hundreds of thousands and perhaps millions of people are exposed to CO levels above 70 ppm from the misuse of cooking equipment and other combustion processes (7).

The Carbon Monoxide Health and Safety Association (COSHA) estimated the medical cost of CO accidents at about $5.4 Billion per year.  Combining medical cost, lost productivity as well as lost wages amounts to a staggering $88 Billion over 10 years.  The cost of equipping every home with two CO alarms was estimated at $6 billion over 10 years, saving $82 billion (7).  In cost to society, CO deaths are but the tip of the iceberg, non-lethal exposures created significant brain damage, cardiovascular and other vital organ problems.  According to a study by COSHA, the cost per heart attack was $44,000 per death and $60,000 per year for survivors (7). We have not included all the cost of suffering from death or injuries.  We still have not even begun to deal with the value of a human life.  How do you value your life, your children or your parents?  I won’t try to address the cost of suffering and confusion for those that are brain damaged. We are counting only costs associated with injuries, deaths and lost earnings.

CO poisoning comes from many sources such as appliance misuse and malfunctions, fires and engines. Errors in installation and maintenance can often cause moderate levels of CO for years before a serious incident brings victims to the hospital.  This long-term exposure leads to unnecessary cost and tremendous human suffering, from cardiovascular and other impairments.

Although moderate CO levels create enough symptoms for a doctor to diagnose the problem, they generally don’t (16,17). Therefore accidents can result in accumulated damage for years.  CO poisoning in pregnant women will cause the baby to be brain-impaired (13).  These children will end up frustrated and often turn to gangs, violence or end up on welfare. This is a very high cost to society, which we all must pay for the lack of CO regulations.

There are millions of poor housing units that give the occupants free gas for cooking (18).  Sounds like a generous idea. The price may be included in the rents, but it causes untold damage to millions of unborn children. The poor mothers in government housing figure out they can reduce their electric heating bills by running their ovens all the time. In one study, conducted by Columbia School of Public Health in New York, 20% to 30% of the homes surveyed misused their gas oven in this way. In 10 generations, America will really feel the impact, if we fail to do what is morally right now (21-24).

Stopping the damage to millions of unborn children is a good start.  CO detector regulation is the best way to accomplish the task.  I know there are lots of good people within the industry.  It is time for them to speak up!  The government and other regulators are too often influenced by powerful industry with deep pockets and bogus testing.  ASHRAE needs to consider the independent data from the medical industry that show CO detectors are working in the real world (Clifton et al, American Journal of Emergency Medicine Vol. 19, No. 2, March 2001). City officials stated that Chicago’s regulations has saved more than 50 lives from CO directly attributed to the CO requirement about 2 years after the requirement’s effective date. 

Cities with CO detector regulations have very low rates of fatalities (average about 0.5); most cities without have much higher rates (greater than 10 times those regulated) (19).  Guess what! CO detector regulations are saving many lives.  ASHRAE should take the lead to require CO detectors, before millions more will be exposed to damaging levels of CO, destroying their intelligence, robbing their health and/or killing them.


1. Cobb N. and Etzel .R. A., Unintentional carbon monoxide-related deaths in the United States, 1979 1988. JAMA 1991; 266, 659-663.

2. Hampson NB, Norkool DM. “Carbon monoxide poisoning in Children Riding in the back of pickup trucks”, JAMA 1992; 267, 538-540.

3. CDC, Carbon monoxide poisonings associated with snow-obstructed vehicle exhaustsystems – Philadelphia and New York City, January 1996. MMWR 1996; 45:1-3.

4. Moolenaar RL, Etzel RA, and Parrish RG. Unintentional deaths from carbon monoxide poisoning in New Mexico, 1980 to 1988: a comparison of medical examiner and national mortality data. West J Med 1995; 163, 431-434.

5. Cook M, Simon PA, and Hoffman RE. Unintentional carbon monoxide poisoning in Colorado, 1986 through 1991. Am. J. Public Health 1995; 85, 988-690.

6.  Railroad Commission of Texas, Alternative Energy division, LP-Gas Operations, Richard L. Gilbert, Accident Report ID# 10-LP-135.

7.  COSHA “Poisonings in the USA”, La Jolla, California, Carbon Monoxide Safety and Health Association (COSHA), 1997.

8.  Liangzhu Wang and Steven J. Emmerich, NIST Technical Note 1637, “Modeling the Effects of Outdoor Gasoline Powered Generators Use on Indoor Carbon Monoxide Exposures”, Building Environmental Div., US Department of Commerce, NIST, August 2009.  

9. Ilano AL and Raffin TA. Management of Carbon Monoxide Poisoning, Chest 1990; 97:165-169.

10.CDC, Unintentional Carbon Monoxide Poisoning Following a Winter Storm, Washington, January 1993. MMWR 1993;42:109-111.

11.Ed Krenzelok, PharmD.  Krenzelokis currently the Director of the Pittsburgh Poison Center at Children's Hospital of Pittsburgh and the Director of the Schools of Pharmacy & Medicine, University of Pittsburgh (July2000 private communication).

12. Lara A. Gundel, Michael G. Apte and Albert R. Nematollahi, Carbon Monoxide Detector; “Technology Comparison: Report to Various Gases” Lawrence Berkeley National Laboratory Report LBNL-40556 July 1998.

13. US EPA “Air Quality Criteria for Carbon Monoxide” June 2000 (EPA 600/P- 99/001F).

14. National Highway Traffic Safety Administration (NHTSA), 1996 December Research Report

15.  California Air Resources Board (CARB), “Measuring Concentrations of Selected Air Pollutants Inside California Vehicles”, Contract No. 95-339 Final Report Dec. 1998.

16.  Michael Dolan, MD, Annuals of Emergency Medicine, 1987, 16, 782-786.

17. Paul Heckerling, MD, America Journal of Emergency Medicine, 1987, 5 No. 3, 201-204.

18.   Inge Goldstein, Leslie R. Andrews, Diane Hartel, “Assessment of Human Exposure to Nitrogen Dioxide, Carbon Monoxide, and Respirable Particulates in New York Inner- city Residences", Columbia University School of Public Health (1988).

19.   Jack C. Clifton II, MD, Jerrold Blair Leiken, MD, Daniel O. Hryhorczuk, MD, MPH and Edward P. Krenzelok, PharmD., “Surveillance for Carbon Monoxide Poisoning Using National Media Clipping Service” Presented at the North American Congress of Clinical Toxicology, San Diego, CA, Sept. 1999 and Am. Jr. of Emerg. Med Vol.19 No. 2, 106-108, March 2001

20. GRI (GTI) CO Alarm Reliability: Field Experiments, Laboratory Testing and   Certification Standards, Presented at 2001 ASHRAE Winter Meeting, Atlanta, GA.

21.   Goldstein I. F, Hartel D, Weinstein A.  Andrews L R, Indoor Air Pollution Exposures of Inner-city Residents, Environmental Intl 12:211-220, 1986.  

22.   Goldstein IF, Andrews LR.  Peak exposures to Nitrogen Dioxide and Study: Designed to Detect their Acute Health Effects.  Environment Intl 13:285-291, 1987.

23. Bodian C, Andrews H, Goldstein I. F., “Variability in Nitrogen Dioxide Readings Within and between New York Inner-city Apartments”, Environ Intl 5; 1-6:483-488, 1989.

24.  Michael. C. Dolan, Canadian Medical Association Journal Vol 133, Sept. 1, 1985, 382-398.

25.  Sebastian Moffet, “Backdrafting Woes”, Canadian Mortgage and Housing    Corporation, Progressive Builder November 1986.

26. Matthew V. Hnatov, Incidence, Deaths and In-Depth Investigations Associated with non-Fire Carbon Monoxide from Engine-Driven Generators and Other Engine-Driven Tools, 1999-2006, US CPSC, Washington DC 20207, October 10, 2007

27. ESI report Project number 32726T, James L. Daughenbaugh, September 2010.

28. Mike Tolson, Carbon Monoxide Suspected in Trail Rider’s Death, Houston            Chronicle Feb 23, 2009

29. American Medical Equestrian Association News, Asphyxiation in Horse Trailers, Nov. 1994, Vol IV, Number 4.

30. US Senate Committee on Commerce, and Transportation, Press Release, Contact Jena Longo, Democratic Deputy Communications Director (202 224-7824), Hearing Summary- Carbon Monoxide Poisoning the Alarm on a Silent Killer, 12/17/09.

31. Private Communication Hiroki Sasaki Tokyo Japan Jan. 2008.    

32.  Chairmen Ann Brown, US Consumer Product Safety Commission, Press    Release    #96-189, Sept 20, 1996, Washington DC 20207

33. CPSC, Carbon Monoxide Poisoning: President Urges Americans To Be Alert To A Senseless Killer, Sept 1993, Release 93-109, Washington DC 20207

34. Office of State Fire Marshall, State Of Vermont, Fire Safety News, Nov. 2007.

35. CDC, Carbon Monoxide Poisonings after Two Major Hurricanes - Alabama and Texas, August - October 2005. Morbidity and Mortality Weekly Report (MMWR), United States Centers for Disease Control and Prevention: 4. (2006)

36. Walton, G. N. and W. S. Dols. 2005. CONTAMW 2.4 User Guide and Program Documentation. NISTIR 7251. Gaithersburg, MD, USA, National Institute of Standards and Technology: 286.

37. Wang, L. 2007. Coupling of Multi-zone and CFD Programs for Building Airflow and Contaminant Transport Simulations. Mechanical Engineering. West Lafayette, IN, Purdue University. PhD: 271

38. M. C. Dolan, Carbon Monoxide Poisoning, The Canadian Medical Association Journal Vol 133 September 1985

39. New York Times, NY/Region, May 25, 1995

40. Vivan S. Toy, New York times, NY/Region, June 1, 1995