Improving Detection of CO Poisoning

The detection of carbon monoxide poisoning is a major public health issue. Improving the detection of carbon monoxide is crucial to prevent its often deadly consequences or long-term impacts on health.

There are two areas to consider concerning the detection of carbon monoxide.

Firstly, how carbon monoxide is detected in the home and/or built environment. Secondly, how carbon monoxide exposure is detected in a person/patient.

If you suspect you might have CO poisoning, please visit the NHS website immediately - Here

Carbon monoxide is a colourless, odourless gas that can be produced by incomplete combustion of fuels, such as gas, oil, and wood and poses a significant health risk.

The nature of carbon monoxide, combined with a lack of awareness of signs and symptoms of carbon monoxide exposure, means it is very difficult to detect.

In the built environment the detection of carbon monoxide is crucial for ensuring the safety of occupants. The most effective method for detecting it is to install CO alarms.

Please be aware, the requirements for the installation of CO alarms changed in 2022.

Find out more about the changes here.

Audible CO alarms are triggered when they detect a certain level of carbon monoxide in the air. They must be placed in the correct location (as recommended by the manufacturer) for example, near bedrooms, common living areas and appliances.

It's also essential that once the CO alarms are installed, they are tested regularly.

In some buildings, especially older ones or those in low-income areas, the absence of carbon monoxide detectors remains a significant issue.

Without alarms, individuals may not be alerted to the presence of dangerous levels of carbon monoxide, leading to a higher risk of poisoning.

The CO Research Trust is in full support of the requirement for CO alarms to be fitted alongside flued fixed combustion appliances, of any fuel type.

Read the Trust's response to the Welsh consultation on CO alarms here.

General awareness of the dangers of carbon monoxide poisoning is low. 

It therefore follows that poor awareness of the symptoms of carbon monoxide exposure is also a significant issue for homeowners and occupants.

However, this is a challenge for medical professionals, where a lack of awareness can lead to misdiagnosis. More on this below.

The symptoms of carbon monoxide poisoning can often mimic those of other illnesses, such as the flu. Headaches, dizziness, and nausea are non-specific and can easily be mistaken for other common ailments.


 

This can lead to a delay in recognizing the symptoms resulting from carbon monoxide exposure, potentially leading to a failure to take immediate action.

A delay in seeking medical attention further exacerbates the effects of carbon monoxide poisoning.

 

The diagnosis of carbon monoxide poisoning also poses a significant challenge for medical professionals as well.

The 2011 All-Party Parliamentary Carbon Monoxide Group (APPCOG) report highlighted the challenges faced by healthcare professionals in diagnosis and treatment. 

According to the Department of Health, every year in the UK, over 200 people go to hospital with suspected carbon monoxide poisoning, leading to around 40 deaths; however, relatively little is known about its epidemiology.


 

With this in mind, in 2016 the Trust funded a project carried out by the National Poisons Information Service (NPIS).

The survey sought to help gauge healthcare professionals’ awareness of carbon monoxide poisoning, following a pilot project.

Read more about the survey here.

Here Dr Euan Sandilands talks about the data collection and the key findings of the project.

Following on from this, a team working across St George’s, Epsom and St Helier University Hospitals, University of Surrey and Frimley Health Foundation Trust also carried out a patient study.

They sought to understand the number of patients presenting to emergency departments (EDs) with raised carboxyhaemoglobin (COHb) levels that could be caused by carbon monoxide exposure in the home or at work.


 

Over a 15-month period, the research aimed to reduce misdiagnosis so that patients could be treated appropriately and not sent back to the site of exposure before it is safe to do so.

As part of the research, all patients presenting at the hospital ED with specific symptoms such as chest pain, headache or seizures, completed a health questionnaire. 

For those patients with raised COHb levels whose answers suggest possible carbon monoxide poisoning, a registered gas engineer was sent to investigate the scene of the suspected exposure.


 

The findings of the study found evidence that emergency department patients with symptoms suggestive of carbon monoxide poisoning but no history of carbon monoxide exposure are at risk from poisoning. 

Here, project lead Professor Heather Jarman presents the findings of the study.

 

The findings suggest components of the carbon monoxide screening tool (used in the study) may be an indicator of carbon monoxide exposure over and above elevated COHb. 

Clinicians should have a high index of suspicion for carbon monoxide exposure so that this important diagnosis is not missed.

This supports the need for continued increased awareness of carbon monoxide symptoms among healthcare professionals.

Read more about this project here.