The Case for Carbon Monoxide Protection

Presented to the Code Technology Committee of the International Code Council

Detroit, MichiganSeptember 22, 2005

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Wendy GiffordDirector, External Affairs, InvensysVice 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

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

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Committee Draft Recommendation

Not “sufficient justification” for mandating carbon monoxide protection.Death and injury dataCost/benefit calculationDetector/standard questions

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Injuries are significant;Alarms offer effective solution

Carbon monoxide poisoning causes 10,000 injuries a year.Long term consequencesHigh societal costs.

Carbon monoxide alarms provide affordable, reliable protection appropriate to a building code.

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Carbon Monoxide Causes Many Injuries

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

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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 ControlEvery year---15,200 people treated480 deaths

Majority (64%) of non-fatal exposures occur in homes.

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CPSC: Nearly 200 died

2002: Estimated 188 carbon monoxide poisoning deaths associated with the use of a consumer productExcludes those in which source is a

vehicle, even if in home

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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.”

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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

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Even these numbers may be underreported

Furnaces were the source in 46% of nonfatal CO poisoningsOnly 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 <4The fetus is particularly vulnerable.Non-English speaking populations

overrepresented

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The effects are not always temporary or reversible

Significant after effectsHeartBrain

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Carbon monoxide injuries can affect the heart. Nearly 40% of patients with moderate to

severe carbon monoxide (CO) poisoning will have cardiovascular manifestations.

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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, learningDifficulty movingPersonality 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

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Nerve damage, continued.

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

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Hefty societal costs

Lost work time, productivityTemporaryPermanent

Long term treatmentHealth care costs

CPSC estimates >$630 million societal costs annually

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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.

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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 death88% 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.

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Current requirements

StatesAlaska, Connecticut, New Jersey,

New York, Rhode Island, Texas (group homes/day care), West Virginia, Utah, Vermont

Cities & other AHJsChicago, 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 homeNFPA 720: One outside each

separate sleeping area

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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)

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UL Testing confirms reliability

Over five years, in home samples regularly tested to UL 2034 requirements in labAlarms “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 2013CPSC continues to recommend CO

alarmsTested 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: “carbon monoxide detectors are

properly installed and maintained in homes, houseboats, workplaces, and other appropriate places;”

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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.

Don’t wait for the “perfect” standard.

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CO protection is appropriate to a minimum standard

UL 2034 life safety standard, not health standardAllows 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.

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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

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

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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 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