During the cold winter months, there are many factors that can affect how our bodies lose heat. We previously spoke about hypothermia and frostbite. We touched base on these two topics in our blog about Cold Weather Dangers and How to Avoid Them. During extremely cold weather it is also important to beware of the dangers that can be presented by carbon monoxide. Here are some cold weather tips in relation to that topic.

Carbon Monoxide (referred to as CO) is an odorless, colorless gas that is found in combustion fumes from any device that is producing a flame; this becomes a problem when it does so in an enclosed or partially-enclosed area. Stoves, gasoline-powered engines, generators, wood-burning stoves and even gas ranges can produce carbon monoxide gas. Exposure to high concentrations of this gas can cause very serious and sudden symptoms that can rapidly progress to death – if such an exposure continues.

The main mechanism by which CO causes problems and poisoning is that CO binds to red blood cells more quickly and avidly than does oxygen. As a result, there is less opportunity for oxygen to bind to the red blood cells. As the concentration of oxygen in the bloodstream is lowered, cells throughout the body can become injured and, in the case of severe CO poisoning, die.

Early Symptoms of CO exposure and poisoning include:

• The onset of a headache
• Sometimes dizziness
• Weakness
• Nausea and vomiting
• A quick progression to confusion

In some instances, a person may even experience chest pain- particularly if they have pre-existing heart or lung disease. One of the problems with CO exposure is that if a person is sleeping, has been drinking alcohol or using other substances that can alter awareness, they can die from CO poisoning before they ever experience any symptoms!

Signs You and Your Loved Ones May Have Been Exposed to High Levels of CO:

Any family where everyone suddenly has the simultaneous, rapid onset of symptoms that seems like the flu should be highly suspicious for CO exposure. If CO poisoning is suspected, one needs to be evaluated right away. The environment they were in needs to be ventilated as soon as possible – by professionals who can test for and deal with CO build-up. In most situations, this means the local fire department.

Some people are very sensitive to CO and experience mild symptoms at very low concentrations. An example would be getting a headache while in heavy, stop-and-go traffic on a hot day or while driving stop-and-go in a long underground tunnel.

How do I prevent CO poisoning?

The first and foremost way is to make sure a CO detector is installed (and properly functioning!) in your house/apartment. In the case of a power outage, never, and I repeat, never use a gas range or an open oven to heat your apartment/house! If you have a garage attached to your home, never leave the car running or idling in it, since CO can “seep” into your home. You should never run a generator or any gasoline-powered device in a garage, under a window, near a door or anywhere where the exhaust gases can enter into a home. Make sure that you identify a device that specifically states it is approved for use inside a home before using it as a supplemental source of heat. If you do lose power, don’t use a fireplace that hasn’t been ignited in years, or has not been properly inspected and cleaned.

These rules also apply to a car; don’t sit in a parked car with the heater running for a prolonged period of time. You should also have your vehicle’s exhaust system checked in the fall to make sure there are no leaks (we tend to keep windows closed in the winter rather than in the warmer seasons). Even the smallest leak in an exhaust system can cause CO gas to build up in a stationary vehicle.

Cold weather safety tips from the Massachusetts Emergency Management Agency (MEMA)

• Make sure you always have a well-stocked Winter Home Emergency Supply Kit that includes flashlights, portable radio, extra batteries, a first aid kit, bottled water, non-perishable food, a manual can opener, as well as extra heavy blankets.
• Ensure you have sufficient heating fuel, as well as emergency heating equipment in case you lose electricity. Remember that unvented kerosene heaters are illegal in Massachusetts.
• When utilizing alternate heating sources such as your fireplace, wood stove, or space heater, take the necessary safety precautions.  Keep the heat sources three feet away from anything that can catch fire. Turn off space heaters when going to bed or leaving the house.
• Keep a fire extinguisher handy; ensuring everyone knows how to use it properly. Test smoke alarms and carbon monoxide (CO) detectors.
• If you lose your heat during a storm, seal off unused rooms by stuffing towels in the cracks under the doors. At night, cover windows with extra blankets or sheets.
• Make sure your car is properly winterized.  Keep the gas tank at least half-full.  Carry a Winter Emergency Car Kit in the trunk including blankets, extra clothing, flashlight with spare batteries, a can and waterproof matches (to melt snow for drinking water), non-perishable foods, windshield scraper, shovel, sand, towrope and jumper cables.

Above all, use common sense, and respect the strength and unpredictability of Mother Nature.

Henry R. Vaillancourt  MD, MPH, a Truesdale Health member and specialist in Public Health and Prevention.