Carbon Monoxide Related Drowning

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Carbon Monoxide Related Drowning

• Jane McCammon
• Double Angel Foundation
• CO Awareness Committee Chair
• jmccammon_at_earthlink.net
• [phone]
• Robert Baron, MD
• ED Co-Director, Phoenix Banner Good Samaritan
  RMC
• Medical Advisor, Glen Canyon National
  Recreation Area

NDPA 2006
Gratefully acknowledging Dr. Tim Floods
contributions
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DOUBLE ANGEL FOUNDATIONwww.doubleangel.org
Raising Awareness About the Dangers of Carbon
Monoxide Poisoning on Boats
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• We only see what we look for,
• and
• we only look for what we know

McCammon Baron NDPA 2006
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Drowning and CO Overview

• How do you know if CO was associated with the
  drowning?
• What CO concentrations cause death?
• How many drownings are CO-related?

McCammon Baron NDPA 2006
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Drowning and CO Overview

• How much CO is there around boats?
• What type of boats are associated with CO-related
  drownings?
• What is being done about prevention?

FOR MORE INFORMATION go to http//safetynet.smis
.doi.gov/COhouseboats.htm
McCammon Baron NDPA 2006
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CO in Blood
Carboxyhemoglobin
Hemoglobin
At 50 -60 Coma and Death
At 20-30 Loss of conscious-ness (LOC),
disorientation
CO
CO
CO
CO

At about 10 Headache, nausea, confusion
McCammon Baron NDPA 2006
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Lake Powell in Glen Canyon National Recreation
Area (GCNRA)
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Lake Powell
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Drownings at Lake Powell 1994 -2004

• National Park Service records were used to
  identify possible unintentional fatal drownings.
• Drowning as cause of death was confirmed through
  ME/coroner reports and AZ Health Department.
• CO-relatedness was confirmed by COHb analyses
  (range 22 to 80)

McCammon Baron NDPA 2006
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Drowning at Lake Powell 1994 - 2004

• 72 people drowned

12 (17) of all Lake Powell drownings were CO
poisonings first

• 25 of the 72 drowned in boating accidents

12 (48) boat-related drownings were CO
poisonings first
McCammon Baron NDPA 2006
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Philadelphia Inquirer Don Sapatkin July18, 2003

• Based on an estimated 40 of boat-related
  drownings at Lake Powell being CO-related, there
  could be as many as 215 similar drownings per
  year nationwide.

McCammon Baron NDPA 2006
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How Many Boat-Related CO Poisonings?
607 poisonings in 33 states (99 occurred 1990
2004)
Severity 122 people died / 128 lost
consciousness (235 loc unknown)
Remember Lake Powell data collection is the
most extensive.
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1
1
15
7
7
3
1
4
1
6
3
2
15
30
19
1
5
1
5
44
45
30
10
29
2
Lake Powell 176 (29)
2
22
4
12
Location unspecified 39
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1
Excludes Lake Powell cases
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January 2006
McCammon Baron NPDA 2006
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But How Many Poisonings?
Is it 607?
Lack of Recognition
Lack of Reporting
McCammon Baron NDPA 2006
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Outdoor Fatal Poisonings

• Why wasnt the extent of the problem recognized
  earlier?
• Because its unbelievable.

McCammon Baron NDPA 2006
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A sunny day on Chesapeake Bay
Whats wrong with this picture?
McCammon Baron NDPA 2006
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CO 1 typical boat engine ??? cars
188
Calculations by Paul Roberts, Sonoma Technology
Inc.
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Circumstances of Poisonings
McCammon Baron NDPA 2006
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McCammon Baron NDPA 2006
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What We Know about the Death Zone
Guidelines CO in Air (parts of CO per million parts of air ppm) Guidelines CO in Air (parts of CO per million parts of air ppm)
87 WHO limit for a 15-minute exposure
1,200 Immediately Dangerous to Life and Health (IDLH)
12,800 Danger of death in 1-3 minutes
Nationwide 21 people poisoned 13 died Adults
clearing ropes from or doing maintenance on
props Children playing in the space COHb 26
72 within minutes of exposure WHY?
CO Generator operating 30,000 ppm (maximum)

Oxygen Deficient as low as 10
CO Propulsion engines operating 60,000 ppm
(maximum)
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What We Know Outside the Death Zone
Nationwide 55 people poisoned 10 died
Example 53 COHb 12 YO playing for 30
minutes disappeared from the platform drowned
Why?

200 ppm CO 10 away
7,000 10,000 ppm on the swim platform
85,000 ppm CO measured where generator exhaust
leaves the boat
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Ski Boats / Other Motorboats
Nationwide 51 people poisoned on the swim
platform 20 died 22 lost consciousness
Most recent drowning August 20, 2005 (Lake
Tapps, WA)
McCammon Baron NDPA 2006
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(No Transcript)
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Boats Underway Death Comes Quickly COHb
Duration of Exposure 57 5
minutes 50 2 minutes 48 in
minutes 61 20-25 minutes 56 10-15
minutes 64, 62, 53, 41, etc.....
34 people poisoned on platforms of moving boats
17 died and 10 lost consciousness Only 5 of
these people were teak surfing Most (19) were
holding onto the platform while the boat moved
along slowly (5 mph or idle speed).
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Boat Engine Idling - Not Moving
Example Non-Fatal Poisoning COHb 50 75 2 YO
unconscious after 1 minute of exposure (based on
14 measured after 2.5 hours O2 therapy)

Example Fatal poisoning 89 COHb 3 minute
exposure
12 people poisoned on platform of stationary
boat 3 died and 8 lost
consciousness
McCammon Baron NDPA 2006
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Guidelines CO in Air (parts of CO per million parts of air ppm) Guidelines CO in Air (parts of CO per million parts of air ppm)
WHO limit for a 15-minute exposure 87
Immediately Dangerous to Life and Health (IDLH) 1,200
Danger of death in 1-3 minutes 12,800
Maximum CO Measured on Platforms Maximum CO Measured on Platforms
Engine idling boat still 10,000 ppm
Boat moving at 10 mph 26,700 ppm
McCammon Baron NDPA 2006
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Cabin Cruisers
Of the known 147 cruiser-related poisonings 124
people were inside the cabin / 26 died 15 people
were outside the cabin / 3 died
Two 9 YO girls near the generator exhaust for 10
minutes. The first girl had difficulty
responding to parents when called in for lunch.
Her COHb (measured after 71 minutes of oxygen
therapy) 15
About 30 minutes later, the second girl was
found on the bottom of the lake. Her COHb
(autopsy) - 39
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Comparison of Swim Platform CO Concentration
Windy day
No wind
McCammon Baron NDPA 2006
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Congested Boat Traffic Lake Havasu
On Memorial Day, Independence Day, or Labor Day,
there may be as many as 700 boats in the
Bridgewater Channel at any given time. If each
boat has only one engine, and only a third of the
boats are operating, exhaust is roughly
equivalent to that of 40,000 automobiles.
Whats happening in your area?
12 people poisoned since 1997 3 drownings / 5
LOC
Photo courtesy of the City of Lake Havasu
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On six occasions during the summer of 2004, the
Channel was closed to incoming traffic after
prolonged Unhealthy conditions and CO levels in
the Hazardous range.
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So What do we need to do?

• Recognize it !
• If the drowning was anywhere on or near a boat
  with an engine, think CO - and get a COHb

McCammon Baron NDPA 2006
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So - What do we need to do?

• Report it !
• Notify the appropriate agency (State Boating Law
  Administrator, State Parks, State Fish and Game,
  Sheriff, etc.) that the drowning was CO-related.

McCammon Baron NDPA 2006
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Prevent it !
Education
Controls
Legislation
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DOUBLE ANGEL FOUNDATIONwww.doubleangel.org
Raising Awareness About the Dangers of Carbon
Monoxide Poisoning on Boats