January 2009
Everyone is at
risk of being
poisoned by carbon
monoxide exposure.
Older adults
with pre-existing
conditionsf such
as chronic heart
disease, anemia,
or respiratory
problems, are even
more susceptible
to the effects of this
odorless, colorless
gas.
                        Preventing Carbon
                        Monoxide  Poisoning
                        Information for Older Adults and
                        Their Caregivers

        Do you know that
        carbon monoxide
        (CO) is the most
        common cause of
poisoning death in the United
States? Unintentional CO
poisonings are responsible for
about 500 deaths and 15,000
visits to emergency rooms
annually. Older adults over
65 years of age are especially
vulnerable to unintentional
CO poisoning due to their
high frequency of pre-existing
medical conditions.1 While CO
alarms can save lives, fewer
than one third of American
homes have them installed.2


What Is Carbon
Monoxide (CO)?
CO is an odorless, colorless
gas that can cause illness and
death. It is produced whenever
any fuel such as natural gas,
propane, gasoline, oil, kerosene,
wood or charcoal is burned.
Devices that produce CO include
cars, boats, gasoline engines,
stoves and heating systems. CO
from these sources can build up
in enclosed or semi-enclosed
spaces. When people inhale
CO, the toxic gas enters the
bloodstream and blocks oxygen
from being absorbed into the
body, which can damage tissues
and result in death.3

What Are the
Symptoms of CO
Poisoning?
For most people, the first
signs of exposure to low
concentrations of CO
include mild headache and
breathlessness upon moderate
exercise. Continued or acute
exposure can lead to flu-like
symptoms including more
severe headaches, dizziness,
tiredness, nausea, confusion,
irritability, and impaired
judgment, memory and
coordination.4 CO is called the
"silent killer" because if these
early signs are ignored, a person
may lose consciousness and be
unable to escape the danger.

You May Be Symptom
Free and Still Exposed
to Unsafe CO Levels
Breathing low concentrations of
CO may not result in obvious
symptoms of CO poisoning,
yet exposure to low levels
of CO can cause long-term
health damage, even after the

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CO source is removed. These health effects
include long-term neurological damage such as
learning and memory impairments, emotional
and personality effects, and sensory and motor
disorders.5

Who Is at  Risk  from CO
Poisoning?
People of all ages are at risk for CO poisoning.
Persons living with chronic heart disease,
anemia, or respiratory problems are more
susceptible to its effects.6 Older adults more
frequently have these pre-existing conditions,
which lower their tolerance and increase the
risk of a fatal exposure.7 CO poisoning can
also be highly dangerous for unborn children,
greatly increasing the  risk of fetal death and
developmental disorders.8 9

More Common  among Minorities
A study conducted in  Washington State among
minority populations showed that Hispanic
populations had  a four times greater risk and
black populations had a three times greater risk
than white populations for CO poisoning. In
addition, 67% of Hispanic populations and 40%
of black populations became poisoned due to
the indoor burning of charcoal briquettes.10
             Red
            Blood
             Cell
f Oxygen 1
                 Carbon
               Monoxide  [Oxygen
               (deadly fumes)
If You Experience Symptoms
You Think Could Be from CO
Poisoning:
 Get fresh air immediately. Open doors and
   windows and turn off stoves, ovens, heaters
   and similar appliances and leave the house.
 Call a poison center immediately at 1-800-
   222-1222. The poison experts there will let
   you know if you need to seek further medical
   attention.

To Prevent  CO Poisoning,
Remember I CAN B:
 Install CO alarms near sleeping areas.
 Check heating systems and fuel-burning
   appliances annually.
 Avoid the use of non-vented combustion
   appliances.
 Never burn fuels indoors except in devices
   such as stoves or furnaces that are made for
   safe use.
   Be Attentive to possible symptoms of CO
   poisoning.

Other Tips  for Preventing CO
Poisoning:
 Keep gas appliances properly adjusted.
 Consider purchasing a vented space heater
   when replacing a non-vented one.
   Use proper fuel in kerosene space heaters.
   Install and use an exhaust fan vented to the
   outdoors over gas stoves.
   Open flues when using the fireplace.
   Choose properly-sized wood stoves that are
   certified to meet  EPA emission standards.
   Ensure wood stove doors fit tightly.
   Have your heating system and chimney
   inspected  and cleaned by a qualified
   technician annually.
   Make sure all interior  fuel-burning appliances
   are in good condition and  have proper
   ventilation.

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 Never idle the car in the garage, even if the
   garage door is open to the outside.
 Use portable generators outside and far
   away from buildings. Never use portable
   generators on balconies or near doors, vents
   or windows. Never use portable generators
   near to where you sleep or your family
   sleeps.
 Never use a charcoal grill indoors, even in a
   fireplace.
 Propane heaters or heaters using other
   fuels placed in enclosed hunting and fishing
   shanties, should be vented to the outside.
 Never heat your home with a gas oven.

CO Alarms
Half of all unintentional CO poisoning deaths
could be prevented with the use of CO alarms.
Alarms should be Underwriters  Laboratories
(UL) approved and are generally available at
       arbon Monoxide Alarms
     electric plug-in
battery operated
wall/ceiling unit
local hardware stores." The cost is minimal
and in view of the possibility that  it may save
the lives of you and your family it  is a bargain.
Install a CO alarm on every floor of your home
and within hearing range of each  sleeping area.
Carefully follow manufacturers'  instructions for
their placement, use, and maintenance. Unlike
smoke alarms, CO alarms may expire after
several years.

Don't let buying a CO alarm lull you into a
false sense of security. CO alarms  should only
be considered a back-up for proper use and
Since many of the symptoms of
CO poisoning are similar to those
of the flu, you may not think that
CO poisoning could be the cause.
Symptoms could be the result of CO
poisoning when:

 You feel better when you are
   away from your home.
 More than one person  in the
   home gets sick at the same time
   (it usually takes several days for
   the flu to pass from person to
   person).
 Family members who are most
   affected spend the most time in
   the home.
 Symptoms occur or get worse
   shortly after turning on a fuel-
   burning device or running a
   vehicle  in an attached garage.
 Indoor pets also appear ill,
   exhibiting symptoms such as
   drowsiness and lethargy (human
   flu viruses  are not transmitted to
   pets).
 Generalized aching, low-grade
   fever, or swollen lymph nodes
   (these are  typical of a cold
   or flu).12
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                        maintenance of your fuel-burning appliances.
                        CO alarms are not designed for low-level CO
                        monitoring and  there have been questions
                        about whether CO alarm standards are
                        protective enough, especially for sensitive groups
                        such as older adults.13

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Aging Adults and Environmental
Health Issues
EPA's Aging Initiative is working to protect the
health of older adults from environmental
hazards through risk management and
prevention strategies, education and research.
For more information about EPA's Aging
Initiative, visit www.epa.gov/aging
Printed copies of this fact sheet can be ordered
at: http://www.epa.gov/aging/resources/
factsheets/order.htm

Additional Resources

Your Local Poison Center
 1-800-222-1222
 Internet: www.aapcc.org

U.S. Environmental Protection Agency
Carbon Monoxide
http://www.epa.gov/iaq/co.html

CDC
Carbon Monoxide
http ://www.cdc.gov/co/

Consumer Product Safety Commission
Home Heating Equipment Safety
www.cpsc.gov/cpscpub/pubs/heatpubs.html

Carbon Monoxide Alarms
www.cpsc.gov/cpscpub/prerel/prhtml01/
01069.html

Portable Generators
www.cpsc.gov/cpscpub/pubs/portgen.html

Endnotes
1  Centers for Disease Control and Policy. Carbon
Monoxide-Related Deaths - United States, 1999-2004.
Morbidity and Mortality Weekly Report. December 21, 2007;
56(50):! 309-12.
2 Home Safety Council. Unintentional Home Injury in the
United States. State of Home Safety: 2004 Edition, http://
www.homesafetycouncil.org./state_of_home_safety/
sohs_2004_p017.pdf.
3 (CDC), National Center for Environmental Health,
"Carbon Monoxide Poisoning: Questions and Answers," July
2006. http://www.cdc.gov/co/faqs.htm
4 The U.S. Environmental Protection Agency (EPA), Indoor
Environments Division (6607J) Office of Air and Radiation,
"Protect Your Family and Yourself from Carbon Monoxide
Poisoning," October 1996. http://www.epa.gov/iaq/pubs/
coftshthtml
5 Delayed Neuropathology after Carbon Monoxide
Poisoning Is Immune-Mediated, Stephen R. Thorn, Veena
M. Bhopale, Donald Fisher, Jie Zhang, Phyllis Gimotty and
Robert E. Forster, Proceedings of the National Academy of
Sciences of the United States of America, Vol. 101, No. 37
(Sep. 14, 2004), pp. 13660-13665.
EPA. 2000. Air Quality Criteria for Carbon Monoxide.
U.S.EPA, National Center for Environmental Assessment.
June, 2000. EPA 600/P-99/001 F.
6 Centers for Disease Control and Prevention (CDC),
National Center for Environmental Health, "Carbon
Monoxide Poisoning: Questions and Answers," July 2006.
http://www.cdc.gov/co/faqs.htm
7 CPSC. 2004. Non-Fire Carbon Monoxide Deaths
Associated with the Use of Consumer Products: 2001
Annual Estimates. U.S. Consumer Product Safety
Commission, Division of Hazard Analysis, May 13, 2004.
8 Raub, J. A., M. MathieuNolf, N. B. Hampson, and S.
R. Thorn. Carbon Monoxide Poisoning - a Public Health
Perspective. TOXICOLOGY (145):1-14, (2000).)
9 Liu, S. Krewski, D., Shi, Y, Chen, Y, and R.T. Burnett.
2003. Association between gaseous ambient air pollutants
and adverse pregnancy outcomes in Vancouver, Canada.
Environmental Health Perspectives.  111:1773-1778.
10 Ralston, J.D. and N.B. Hampson. 2000. Incidence of
severe unintentional carbon monoxide poisoning  differs
across racial/ethnic categories. Public Health Reports.
115:46-51. U.S. Department of Health and Human Services.
11  Yoon, S., Macdonald, S., Parrish, G. 1998. Deaths from
unintentional carbon monoxide poisoning and potential for
prevention with carbon monoxide detectors. JAMA. 279(9):
685-687
12 U.S. Department of Housing and Urban Development.
Healthy Homes Issues: Carbon Monoxide, Healthy homes
Initiative Background Information, December 2005. http://
www.healthyhomestraining.org/Documents/HUD/HUD_CO_
Brief.pdf.
13 The Minnesota Department of Health, Environmental
Health Services Division, "Carbon Monoxide (CO)  Poisoning
In Your Home," April 2007. http://www.health.state.mn.us/
divs/eh/indoorair/co/index.html
 Publication Number EPA 100-F-09-001

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