The Case for Carbon
Monoxide Protection
Presented to the Code Technology
Committee of the International
Code Council
Detroit, Michigan
September 22, 2005

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
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Objective

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To present the compelling evidence
that will provide the Code Technology
Committee the justification to mandate
carbon monoxide protection in new
and existing dwellings.
Committee Draft
Recommendation

Not “sufficient justification” for
mandating carbon monoxide
protection.
Death and injury data
 Cost/benefit calculation
 Detector/standard questions

4
Injuries are significant;
Alarms offer effective solution

Carbon monoxide poisoning causes
10,000 injuries a year.
Long term consequences
 High societal costs.


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Carbon monoxide alarms provide
affordable, reliable protection
appropriate to a building code.
Carbon Monoxide Causes
Many Injuries

Carbon monoxide kills and injures
more people than all other poisonings
combined.

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More than heroin
One third may go
undiagnosed
“Significant under reporting of CO
deaths.”
 “Misdiagnosis commonly occurs.”
 “Many non-lethal exposures go
undetected”

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Total injuries exceed 15,000;
most in homes

2001-2003 data Centers for Disease
Control
Every year-- 15,200 people treated
 480 deaths

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Majority (64%) of non-fatal exposures
occur in homes.
CPSC: Nearly 200 died

2002: Estimated 188 carbon
monoxide poisoning deaths
associated with the use of a consumer
product

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Excludes those in which source is a
vehicle, even if in home
Decline in deaths may be
artifact of statistics

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“Part of the decrease from the 19941998 average annual estimate of 200
. . . To an average of 141 in 19992002 may be the result of . . . A new
methodology.”
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)


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10,000 seek medical attention or miss
work each year
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.”

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CO poisoning affects the
most vulnerable
Death rate highest among 65+
 Injury rate highest among children <4
 The fetus is particularly vulnerable.
 Non-English speaking populations
overrepresented
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The effects are not always
temporary or reversible

Significant after effects
Heart
 Brain

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Carbon monoxide injuries
can affect the heart.

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Nearly 40% of patients with moderate to
severe carbon monoxide (CO) poisoning
will have cardiovascular manifestations.
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

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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.
Significant nerve damage
can occur.



Parkinson's Disease
Persistent vegetative state
Agnosia,


Apraxia
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inability to recognize and identify objects or
people
Voluntary movement impaired
Nerve damage, continued.
Mental deterioration,
 Urinary or fecal incontinence
 Gait disturbance

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Visual impairment/Blindness
Amnestic/confabulatory state
Psychosis
Hefty societal costs

Lost work time, productivity
Temporary
 Permanent

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Long term treatment
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Health care costs
CPSC estimates >$630 million
societal costs annually
Not having protection can be
expensive legally
CARBON MONOXIDE CASE SETTLED FOR
$30 MILLION
South 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.
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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.

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Estimates 25-35% household
penetration.
Current requirements

States


Cities & other AHJs
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Alaska, Connecticut, New Jersey,
New York, Rhode Island, Texas (group
homes/day care), West Virginia, Utah,
Vermont
Chicago, New York City, and 30 others
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Cost of compliance lower
than assumed
Significantly below committee
estimate of $300-$500.
 Typically one per home

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NFPA 720: One outside each
separate sleeping area
Smoke/CO combo units
eliminate extra labor

New construction (AC/DC):



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Existing homes (battery)

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Combo alarm = $35-$52
Incremental = $15 over smoke alone
No incremental labor
Annual $6.15 (annual battery + 5 year life)
CO alarm $20-$42
Annual $11.40 (annual battery + 5 year life)
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.
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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
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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:
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“carbon monoxide detectors are
properly installed and maintained in
homes, houseboats, workplaces, and
other appropriate places;”
Standards development for CO
alarms similar to smoke alarms

ANSI UL 2034, carbon monoxide standard


UL 217, smoke alarm standard

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Three major changes in first 12 years of
standard.
Half a dozen changes in first 12 years after
alarms were first required in residences.
Meanwhile, lives were saved.
Don’t wait for the “perfect” standard.
CO protection is appropriate
to a minimum standard

UL 2034 life safety standard, not
health standard
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Allows levels far in excess of agency
recommendations for outdoor air and
the workplace.
Comparative CO limits

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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.
Not for profit organizational
support
American Lung Association
 Home Safety Council
 National Safe Kids Campaign
 Residential Fire Safety Institute

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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.
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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.
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References
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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
(2004;291:1691-1692) and MMWR (2004;53:189-192)
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/journals/IJEICM/Vol1N2/CO.htm
 “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 Non—Fire-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
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