January 2009

       Preventing Carbon
       Monoxide Poisoning
       Information for Older Adults and
       Their Caregivers
Everyone is at
risk of being
poisoned by
carbon monoxide
Older adults
with pre-existing
conditions, such
as chronic heart
disease, anemia,
or respiratory
problems, are even
more susceptible
to the effects of
this odorless, color-
less gas.
      Do you know that carbon monoxide (CO) is the
      most common cause of poisoning death in
      the United States? Unintentional CO poison-
ings 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 fre-
quency 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 ill-
ness 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 peo-
ple inhale CO, the toxic gas enters the bloodstream
and blocks oxygen from being absorbed into the
body, which can damage tissues  and result in

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 expo-
sure can lead to flu-like symptoms
including more severe headaches,
dizziness, tiredness, nausea, confu-
sion, irritability, and impaired judg-
ment, memory and coordination.4
CO is called the "silent killer"
because if these early signs are
ignored, a person may lose con-
sciousness 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 symp-
toms of CO poisoning, yet exposure
to low levels  of CO can cause long-
term health damage, even after the
CO source is  removed. These health
effects include long-term neurologi-
cal damage such as learning and
memory impairments, emotional
and personality effects, and sensory
and motor disorders.5
           How to Tell the Difference between
                 CO Poisoning and the Flu
  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
  • Family members who are most affected spend the most time in
    the home.
  • Symptoms occur or get worse shortly after turning on a fuel-burn-
    ing device or running a vehicle in an attached garage.
  • Indoor pets also appear ill, exhibiting symptoms such as drowsi-
    ness 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

Who Is at Risk from CO
People of all ages are at risk for CO
poisoning. Persons living with
chronic heart disease, anemia, or
respiratory problems are more sus-
ceptible 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 poi-
soning can also be highly danger-
ous for unborn children, greatly
increasing the risk of fetal death
and developmental disorders.8'9

More Common among
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 poi-
soned due to the indoor burning of
charcoal briquettes.10

If You Experience Symptoms
You Think Could Be from CO
• Get fresh air immediately. Open
  doors and windows and turn off
            (deadly fumes)
  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. 14

To Prevent CO Poisoning
Remember I CAN B:
• Install CO alarms near sleeping
• 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 fur-
  naces that are made for safe use.
• Be Attentive to possible symp-
  toms of CO poisoning.

Other Tips for Preventing CO
• Keep gas appliances properly
• 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
• Open flues when using the fire-
• 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
• Make sure all interior fuel-burn-
  ing appliances are in good condi-
  tion and have proper ventilation.
• 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
     Carbon Monoxide Alarms
    electric plug-in
battery operated
wall/ceiling uni
CO Alarms
Half of all unintentional CO poison-
ing deaths could be prevented with
the use of CO alarms.  Alarms
should be Underwriters
Laboratories (UL) approved and are
generally available at local hard-
ware stores.11  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 man-

ufacturers' 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 mainte-
nance of your fuel-burning appli-
ances. 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

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 pre-
vention strategies, education and
research. For more information
about EPA's Aging Initiative, visit

Printed copies of this fact sheet can
be ordered at:
Additional Resources

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

U.S. Environmental  Protection
Carbon Monoxide:

Carbon Monoxide:

Consumer Product Safety
Home Heating Equipment Safety:

Carbon Monoxide Alarms:

Portable Generators:


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):1309-12.

2  Home Safety Council. Unintentional Home Injury in the United States.
State of Home Safety: 2004 Edition.
http ://www. h o m esaf etyco u n ci I .o rg./state_of_h o m e_saf ety/

3  (CDC), National Center for Environmental Health, "Carbon Monoxide
Poisoning: Questions and Answers," July 2006.

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.

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-99/001F.

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 unintention-
al carbon monoxide poisoning differs across racial/ethnic categories. Public
Health Reports. 115:46-51. U.S. Department of Health and Human

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.

13  The Minnesota Department of Health,  Environmental Health Services
Division, "Carbon Monoxide (CO) Poisoning In Your Home," April 2007.