Carbon monoxide poisoning at motels, hotels, and resorts

Analyzing the national fire incident reporting system to identify carbon monoxide incidents in the U.S. lodging industry

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NFIRS data identified 3405 CO incidents in the U.S. lodging industry.

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Lodging industry CO incidents occur at far greater rates than previously realized.

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There is a larger public health risk associated with lodging industry CO exposure.

Carbon Monoxide (CO) poisonings in the U.S. lodging industry have become a regular occurrence, however there is no current mandatory national reporting, tracking, or surveillance mechanism for CO incidents in the U.S. lodging industry. As such, the problem is largely invisible. The objective of this study was to utilize the National Fire Incident Reporting System (NFIRS) data to better understand the public health risk from Carbon Monoxide (CO) incidents in the U.S. lodging industry. The NFIRS datasets for years 1999 through 2018 were assessed to identify CO incidents occurring at U.S. hotels and motels. The results of the analysis identified 3405 incidents. Incidents were strongly correlated with increased fire department participation in NFIRS (R = 0.82). The number and frequency of CO incidents in the U.S. lodging industry are underreported. Previous efforts relying on news media identified only 10% of the incidents reported in the NFIRS data. This indicates a greater public health risk associated with CO exposure in the U.S. lodging industry than previously realized.

Aspects Regarding Safety and Security in Hotels: Romanian Experience

This study investigates safety and security from the perspective of Romanian tourists by assessing the level of importance that tourists give to safety and security depending on the level of classification of the services they experienced and the generation to which they belong. We used a quantitative research method in the form of a questionnaire and analysed eight dimensions of safety and security: detectors, emergency preparedness, medical preparedness, staff security, guestroom security, pool and beach security, hotel access control, and cyber security. We identified the differences between tourists’ perception of safety and security depending on the level of classification of accommodation services and on generation.

Effectiveness of Hyperbaric Oxygenation Versus Normobaric Oxygenation Therapy in Carbon Monoxide Poisoning: A Systematic Review

Carbon monoxide (CO) is a gas product of combustion, considered highly poisonous. Prolonged CO exposure is responsible for more than half of fatal poisonings and is also one of the leading causes of poisoning in Western countries. We aimed to compare the effectiveness of therapy with hyperbaric oxygen (HBO) versus normobaric oxygen (NBO) in the setting of carbon monoxide poisoning (COP). We independently searched the National Library of Medicine's Medline (PubMed™), ScienceDirect™, and Scielo™ for any relevant studies published from 1989 to 2017, using the following keywords: hyperbaric therapy, hyperbaric oxygenation, normobaric therapy, carbon monoxide poisoning, carboxyhemoglobin, Haldane effect. We analyzed the studies that suggested the effectiveness of HBO or NBO. Also, we searched for studies related to COP; including history, epidemiology (risk factors, incidence, demographics), pathophysiology, clinical manifestations, diagnosis, and treatment. Sixty-eight articles were found, sixteen of which dealt with either HBO or NBO or both. Twelve suggested HBO as the treatment of choice in COP; four studies indicated that NBO was an adequate treatment due to its cost-effectiveness and availability in the emergency department (ED). HBO has been shown in several studies to be effective in moderate to high-risk COP situations, being the therapy of choice to avoid sequelae, especially neurologically. NBO can be considered as a reasonable alternative due to its cost-effectiveness. The availability and understanding of different therapeutic interventions are critical in the management of patients with COP in ED and the Critical Care unit.

Carbon monoxide poisonings in hotels and motels: The problem silently continues

Carbon monoxide poisoning remains common in the United States. One component of effective prevention involves identification of scenarios in which poisoning occurs to guide development of appropriate interventions. This study was conducted to determine the significance of the problem of carbon monoxide poisoning occurring in US hotels, motels and resorts. This is a population-based case series of guests staying at US hotels, motels, and resorts from 2005 to 2018. Details of incidents and individuals poisoned with carbon monoxide were collected from online searches and professional experience of the authors. Data extracted included number of incidents and individuals poisoned, age of those poisoned, outcomes, source of carbon monoxide, and lodging type. From January 1, 2005 to December 31, 2018, 905 guests were poisoned in 115 identified incidents, including 22 fatalities. Children represented 16% of those poisoned and 27% of fatalities. Type of lodgings were hotels, motels, and resorts of all classes and located in a majority of states. Most poisonings were caused by natural gas fueled appliances and could likely have been prevented by an in-room carbon monoxide alarm. To reduce morbidity and mortality from unintentional CO poisoning in lodging facilities, government should mandate installation of in-room CO alarms, similar to the current requirement for smoke alarms.

Carbon monoxide poisoning and death in a large enclosed ventilated area

A 55-year-old man with a medical history of tobacco use suddenly collapsed while power washing an empty indoor pool in a hotel. The decedent was transported to the local hospital where he was pronounced. A postmortem examination revealed atherosclerotic heart disease and bilateral pulmonary edema and congestion. A postmortem blood carbon monoxide (CO) level was 27% saturation, and a CO performed on hospital admission blood was 49% saturation. CO poisoning is a common cause of toxicological morbidity and mortality in the United States. The circumstances most often occur in an enclosed environment and may be intentional or unintentional. CO poisoning has been reported in open, well-ventilated spaces, but rarely results in death. A warning label was present on the engine clearly stating the dangers of CO emission. However, there was a false sense of security due to the large size of the pool room and the presence of industrial blowers that were being used for ventilation.

Practice recommendations in the diagnosis, management, and prevention of carbon monoxide poisoning

Carbon monoxide (CO) poisoning is common in modern society, resulting in significant morbidity and mortality in the United States annually. Over the past two decades, sufficient information has been published about carbon monoxide poisoning in the medical literature to draw firm conclusions about many aspects of the pathophysiology, diagnosis, and clinical management of the syndrome, along with evidence-based recommendations for optimal clinical practice. This article provides clinical practice guidance to the pulmonary and critical care community regarding the diagnosis, management, and prevention of acute CO poisoning. The article represents the consensus opinion of four recognized content experts in the field. Supporting data were drawn from the published, peer-reviewed literature on CO poisoning, placing emphasis on selecting studies that most closely mirror clinical practice.

Public health surveillance and knowing about health in the context of growing sources of health data

The past decade has brought substantial changes in how data related to a community's health are collected, stored, and used to inform decisions about health interventions. Despite these changes, the purpose of public health surveillance has remained constant for more than a century. Public health surveillance is the ongoing, systematic collection, analysis, and interpretation of health-related data with the a priori purpose of preventing or controlling disease or injury, or of identifying unusual events of public health importance, followed by the dissemination and use of information for public health action. Surveillance is an important and necessary contributor to knowledge of a community's health. The public health system is responsible for ensuring that public health surveillance is conducted with appropriate practices and safeguards in order to maintain the public's trust.

Carbon monoxide poisoning in Jerusalem: epidemiology and risk factors

OBJECTIVES

To describe the epidemiology of carbon monoxide (CO) poisoning in Jerusalem and identify risk factors for such poisoning.

DESIGN

A retrospective descriptive analysis of patients with CO poisoning who presented to the Hadassah hospitals in Jerusalem from 1994 to 2006.

PATIENTS

All patients with suspected CO poisoning were examined and those with confirmed cases [carboxyhemoglobin (COHb) level >5%] were included. Sources of exposure, seasonal variation, and demographic characteristics were analyzed.

RESULTS

There were 292 patients (49% males) with 40 family clusters that accounted for 149 patients (51%); 230 patients (79%) presented during the winter months. All but one had unintentional CO intoxication. The main sources of exposure were faulty gas heaters (n = 135), fire (n = 102), and other residential heating systems (n = 40). The estimated annual incidence of CO poisoning decreased from 6.45 per 100,000 in 1994-2000 to 3.53 per 100,000 in 2001-2006. High-risk intoxication (COHb level >25%) occurred in 84 patients (29%). Factors associated with severe intoxication were male gender, individual patients (compared with those in clusters), and faulty gas heaters (compared with other sources).

CONCLUSIONS

Males exposed to CO may have a more severe intoxication. The lower risk in patients presenting in clusters could be explained by the assumption that severe presentation in one patient alerts the others who are less severely affected. The implementation of safer standards for residential heating systems and CO detectors together with the public education may explain the decline in the incidence of CO poisoning.