Boat-Related Carbon Monoxide Poisoning

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Robert Baron, MD presents about Boat-Related Carbon Monoxide Poisoning at the International Boating and Water Safety Summit (March 2012).

Robert Baron, MD presents about Boat-Related Carbon Monoxide Poisoning at the International Boating and Water Safety Summit (March 2012).

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  • 1. Boat-Related Carbon Monoxide Poisoning Robert Baron, MD Medical Advisor, Glen Canyon National Recreation Area Director of Quality and Risk, Emrgency Professional Services, Phoenix, AZ Special Thanks to: Jane McCammon, NIOSH Retired 16th International Boating and Water Safety Summit San Diego, CA March 6, 2012
  • 2. We only see what we look for,We only see what we look for, andand we only look for what we knowwe only look for what we know McCammon & Baron Nov 2009
  • 3. NIOSH Disclaimer Disclaimer: The findings and conclusions in this presentation have not been formally disseminated by the National Institute for Occupational Safety and Health and should not be construed to represent any agency determination or policy • Disclaimer: Mention of any company or product does not • constitute endorsement by CDC, NIOSH
  • 4. Contributors: • US Coast Guard: Phil Cappel and his team at the Recreation Product Assurance Division past and present • NIOSH: Jane McCammon, Kevin Dunn, Alberto Garcia and all of the NIOSH staff past and present • National Park Service: Steve Luckesen, Sara Newman, Kerry Haut, Brian O’Dea and their administrators and staff past and present. • US Department of the Interior: Tim Radtke • McCuneWright, LLP: Richard McCune
  • 5. For a copy of this presentation please send requests to: erfpmd1@cox.net
  • 6. CO Overview How big of a problem is this?How big of a problem is this? What are the high risk areas on a boat?What are the high risk areas on a boat? What needs to be done?What needs to be done? What has been done?What has been done?McCammon & Baron Nov 2009
  • 7. CO % in Blood At about 10% Headache, nausea, confusion At 20-30% Loss of conscious- ness (LOC), disorientation At 50 -60% Coma and Death CO CO CO CO HemoglobinCarboxyhemoglobin
  • 8. After exposure ends, how long does CO remain in the blood?* After exposure ends, how long does CO remain in the blood?* • In room air, after exposure ends, COHb will decrease by half every 2 - 6 hours. • Oxygen therapy reduces that time to 1 - 2 hours. • Hyperbaric oxygen therapy reduces it to 20 minutes *Half-life varies widely by individual and activity level*Half-life varies widely by individual and activity level CO CO CO CO
  • 9. How Many Boat-Related CO Poisonings?How Many Boat-Related CO Poisonings? 879 poisonings in 39 states (96% occurred 1990 – 2009)879 poisonings in 39 states (96% occurred 1990 – 2009) 160 people died160 people died *Excludes Lake Powell cases 14 8 62 8 31 37* 31* 16 20 24 6 21 5 1 12 14 56 7 7 44 2 8 38 15 23 1 20 6 3 Location unspecified 92 Lake Powell 211 (24% of the total) 1 Nov 2009 Remember: Lake Powell data collection is the most extensive.Remember: Lake Powell data collection is the most extensive. 1 8 2 6 3 2 1 7 4 9
  • 10. Lack of Recognition Lack of Reporting But How Many Poisonings? Is it 879? McCammon & Baron Nov 2009
  • 11. Drowning and CO at Lake Powell: 1994 - 2004 12 (48%) of the 25 boat-related drownings12 (48%) of the 25 boat-related drownings were CO poisonings firstwere CO poisonings first McCammon & Baron Nov 2009
  • 12. National Estimate ? 1997 – 2005:1997 – 2005: Drownings off of boats = 4676*Drownings off of boats = 4676* *Based on US Coast Guard Boating Accident Report Database If 48% of those were CO-related …..If 48% of those were CO-related ….. 250 per year nationwide.250 per year nationwide. McCammon & Baron Nov 2009
  • 13. Outdoor Fatal Poisonings Why wasn’t the extent of the problemWhy wasn’t the extent of the problem recognized earlier?recognized earlier? Because it’s unbelievable.Because it’s unbelievable. McCammon & Baron Nov 2009
  • 14. A sunny day on Chesapeake Bay What’s wrong with this picture?What’s wrong with this picture?
  • 15. Cabin Cruisers—Station Wagon Effect • The use of the canopy top increases the station wagon effect. – Often, boaters leave the back panel(s) completely or partially unzipped, which will cause exhaust fumes to funnel directly into the cockpit
  • 16. Dixey Boys Arizona Republic Newspaper August 4, 2000 Divers Find Bodies of Brothers in Lake “Divers recovered the bodies of two brothers who drowned while swimming at Lake Powell. The brothers, 10 and 7, from Parker, Colorado were swimming at the rear of a houseboat Wednesday night … when they disappeared.” COHb: 59 and 52% after a brief exposure in the “Death Zone”
  • 17. Circumstances of Poisonings - Houseboats McCammon & Baron Nov 2009
  • 18. Inside the “Death Zone”
  • 19. Inside the “Death Zone” Children playfully enter the area. Adults enter to clear fouled propellers or to do maintenance. Resulting COHb : 26 – 72 % within minutes of exposure WHY?
  • 20. Inside the “Death Zone” CO : Propulsion engines operating 60,000 ppm (maximum) Guidelines – CO in Air (parts of CO per million parts of air – ppm) 87 WHO limit for a 15- minute exposure 1200 Immediately Dangerous to Life and Health (IDLH) Oxygen Deficient – as low as 10% CO : Generator operating 30,000 ppm (maximum)
  • 21. CO: 1 typical boat engine = ??? cars 188 Calculations by Paul Roberts, Sonoma Technology Inc.
  • 22. Outside the “Death Zone” 7,000 – 10,000 ppm CO on the swim platform 200 ppm CO 10 feet away Why?
  • 23. Pleasurecraft (ski boats, cabin cruisers, etc.)
  • 24. 26,700 ppm CO –boat moving26,700 ppm CO –boat moving Poisonings Resulting in Death/Drowning COHb: Minutes Exposed 57% 1 56% <1 56% 5 50% 1 - 2 48% 10-15 41% <1 67, 64, 64, 41, 39% in “minutes” Why? 10,000 ppm CO –boat stopped10,000 ppm CO –boat stopped Death Comes QuicklyDeath Comes Quickly
  • 25. It’s not just teak surfing! Example:Example: Saguaro Lake , AZ 2008Saguaro Lake , AZ 2008 22 year old male was sitting on the back deck of boat while the motor was at idle. Witnesses state he lost consciousness and fell into water. Bystanders pulled him from the water, at which point he was unresponsive. After they performed chest compressions for 2 minutes, he regained consciousness, sat up, spoke a few words and then again lost consciousness. His carbon monoxide reading was 45% upon transport. O2 saturation was 92%. Incident Information - Medical Transport Record
  • 26. Showers in a Toxic Environment “Preheat your wetsuit, warm up after a cool swim or wash sand and dirt from your feet and decks.” To use it, you have to be on the swim platform while the engines are running. 4 YO on the swim platform playing with the shower stopped breathing after less than 15 minutes. (COHb 2.2 % - 4 half- lives later) 4 children in various locations on a canopy-enclosed cabin cruiser. All found unconscious 45 minutes after last being seen; 1 died. (COHb = 47%) McCammon & Baron Nov 2009
  • 27. Cabin Cruisers Deaths and poisonings occur both inside and outside the cabin. By far, most cabin cruiser associated deaths occur inside the cabin. McCammon & Baron Nov 2009
  • 28. Cabin Cruisers Deaths and poisonings outside the cabin - Why? 41,600 ppm CO measured at the generator exhaust terminus 570 ppm CO 10 feet away
  • 29. Comparison of Swim Platform CO Concentration Windy day No wind
  • 30. 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.
  • 31. Congested Boat Traffic – Lake Havasu NIOSH found that over half of Lake Havasu City public safety workers in the Bridgewater Channel were overexposed to CO during 2003 Memorial Day weekend….. …And, more than half of the public safety workers in the Bridgewater Channel reported post-shift symptoms consistent with CO poisoning (headache, fatigue, weakness, visual disturbances, dizziness) on days with highest CO exposures.
  • 32. So… what needs to be done at the scene?So… what needs to be done at the scene? 1. Recognition1. Recognition • If a victim was anywhere on or near aIf a victim was anywhere on or near a boat with an engine, think CO.boat with an engine, think CO. • If a victim has a headache, nausea,If a victim has a headache, nausea, vomiting or loss of consciousness,vomiting or loss of consciousness, think CO.think CO. • Pitfalls: delay in COHb and/or normalPitfalls: delay in COHb and/or normal
  • 33. 2. Treatment2. Treatment a. Extrication / scene safetya. Extrication / scene safety b. 100% oxygenb. 100% oxygen So… what needs to be done at the scene?So… what needs to be done at the scene?
  • 34. Transport patients for further evaluation and treatment, including consideration of hyperbaric therapy, if they experienced: • LOC or • 1st COHb >25% or • Persistent abnormal mental status or • Abnormal cerebellar function at time of exam or • Cardiovascular disfunction (chest pain, arrhythmias, hypotension) associated with the poisoning or • If the patient is pregnant
  • 35. So - What do we need to do? 3. Report it3. Report it This is the key to prevention,This is the key to prevention, because if it doesn’t get counted, it didn’t happen.because if it doesn’t get counted, it didn’t happen. Notify the appropriate agencyNotify the appropriate agency (Sheriff, Boating Law Administrator, State Parks, State(Sheriff, Boating Law Administrator, State Parks, State Fish and Game, etc.)Fish and Game, etc.)
  • 36. It is time to redirect efforts from collecting examples of poisonings to prevention of poisonings.
  • 37. Prevent it ! Engineering controlsEngineering controls EducationEducation Legislation/Legislation/RegulationRegulation
  • 38. Education • Coast Guard Auxiliary offers boating safety class at Delta College • Published: Sunday, March 04, 2012, 10:30 AM • FRANKENLUST TWP. — The Coast Guard Auxiliary is offering a boating safety class at Delta College on March 10. • Topics include: • Boating Problems - Hypothermia; boating accidents and rescues; man overboard recovery; capsizing; running aground; river hazards; strainers: emergency radio calls; engine problems; equipment failures; carbon monoxide (CO); other boating and PWC problems.
  • 39. Dangerous 'teak surfing' prohibited in Nevada, California Jeff Munson September 29, 2004 SOUTH LAKE TAHOE - A dangerous boat activity called teak surfing will be banned by the Nevada Department of Wildlife and made illegal in the state of California. The Nevada ban and California law, to take effect next year, are intended to save lives after a series of accidents and fatalities over the past decade, officials said Tuesday. On May 28, 2003, an 11-year-old El Dorado Hills boy died behind the boat his father was driving at Folsom Lake. An autopsy revealed Anthony Farr had 63 percent of his bloodstream filled with carbon monoxide, which was emitted from the boat's engine into the boys lungs as he surfed hanging onto the step at the back of the boat. "Had I known this was dangerous, had I heard of the dangers of doing this, I would never have put my son or myself at risk," said Mike Farr, Anthony's father, who convinced Sacramento lawmakers to support the legislation. The Nevada ban on teak surfing was agreed to Sept. 12 by the Board of Wildlife commissioners, the body that regulates boating safety in the Silver State. "We are extremely pleased the Wildlife Commission has stepped up to address this very serious issues," said Fred Messmann, the boating law administrator for Nevada. "We have had a hard time quantifying the exact number of deaths each year because of this activity, but the specific examples show how dangerous teak surfing can be." KATU 2 News - Portland, Oregon www.katu.com Come 2006, teak surfing will be illegal in Oregon - SALEM, Ore. - A summertime water sport popular with teens and young adults will become illegal in Oregon beginning in 2006. Teak surfing, also known as platform dragging, is when a person hangs onto the rear of the boat to be pulled through the water until the boat's wake builds enough to allow body surfing. Senate Bill 56, which Gov. Ted Kulongoski is expected to sign, would make teak surfing illegal. There are a number of dangers associated with teak surfing. An obvious danger is the swimmer's proximity to the boat propeller. Another not so obvious danger is carbon monoxide poisoning. In addition to these dangers, teak surfing is usually done without a life jacket because it inhibits body surfing. (Copyright 2005 by The Associated Press. All Rights Reserved.) Legislation
  • 40. Regulation: Monitoring Air quality, Lake Havasu
  • 41. ABYC STANDARDS • ABYC Standard A-24 requires a CO detection system to be installed on all boats with an enclosed accommodation compartment(s) and a gasoline generator or an inboard gasoline propulsion engine. • ABYC Standard P-1 now includes a section on the installation of a vertical stack exhaust system for houseboats.
  • 42. National Park Service Memorandum January 30, 2012 This memorandum outlines new requirements for concession boat rental and marina operations to help control the potential for carbon monoxide (CO) poisoning • Retrofit all houseboats with vertical stack exhaust systems • Convert outboard, stern drive/inboards and generators to catalyzed low CO emitting units • Concessioner must provide signs about the dangers of CO and how to prevent poisoning on vessels and around the marina. • CO poisoning must be addressed in all motor boat safety briefings
  • 43. • Comprehensive EPA and CARB regulations affecting all marine engines. • As of January 1, 2011 marine engine manufacturers could no longer legally sell non- catalyzed engines in the United States unless the company had built up EPA clean-air credits. – A company must roughly sell five catalyzed engines to get enough credit to sell one non-catalyzed engine. • Spark-ignition marine generators • Stern-drive and inboard engines • Outboard and PWC Regulatory actions
  • 44. Vertical Stacks:Vertical Stacks: Moving Generator Exhaust to a Safer LocationMoving Generator Exhaust to a Safer Location
  • 45. Generator Exhaust Configurations--Stack Removable stack for easier transport (Sampled on center of swim platform) Time, (Hours:Min:Sec) 10:30:00 10:40:00 10:50:00 11:00:00 11:10:00 CarbonMonoxideConcentration,ppm 0 200 400 600 800 1000 1200 1400 With Stack Without Stack Generator On Main Engines & Gen. On (NIOSH Ceiling = 200 ppm)
  • 46. Low CO Emission Generators • Westerbeke Safe- COTM Generator – 14-kW and 20-kW generators evaluated • Kohler Generator Testing – 15-kW Generator evaluated Catalyst
  • 47. Houseboat Generator • Stack reduced CO concentrations on lower rear deck by 50% (vs. side) and 99% (vs. rear exhaust) – The dry stack is a simple and effective control that has performed well under multiple evaluations. • The Westerbeke Safe-COTM and Kohler generators resulted in low CO emissions – CO concentrations reduced by 99% from exhaust
  • 48. Control at the Source – Inboard Engines “It’s the right thing to do,” ….
  • 49. Ski Boats—Propulsion Engines • At idle, the Indmar new catalytic technology resulted in an average 92% reduction of CO emissions (measured directly into the exhaust opening) 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 10,000 11,000 12,000 13,000 14,000 15,000 0 20 40 60 80 100 120 140 Time (sec) COConcentrations(ppm) NO-CAT CAT SKI Boat With/Without CatalystSKI Boat With/Without Catalyst
  • 50. Propulsion engines NIOSH researchers worked with various engine manufacturers to assist in evaluation and development of low-CO marine propulsion engines that are now on the market.
  • 51. Prevent it ! Engineering controlsEngineering controls EducationEducation Legislation/Legislation/RegulationRegulation
  • 52. Those who contributed the most,Those who contributed the most, the victims and their familiesthe victims and their families • The Double Angel Foundation http://www.doubleangel.org • The CO Action Group http://www.coactiongroup.org/index.html • Ken Kidder Memorial Fund • The families of Stacy Beckett, Anthony Farr, Mark Tostado, Joel Martin, Kathryn Reese, Jena Jones, Chad Ethington, Skip Bauer and over one hundred more……
  • 53. Prevention through Public Awareness One example of many:
  • 54. We only see what we look for, and we only look for what we know Now you know it so let’s prevent it!