The CO+ Impact was a thorough review of existing research and regulation relating to carbon monoxide (CO) in the UK and elsewhere. It considered not only the medical side of research, but also in correlation with the chemical/physical effects.

The research looked at how people are affected by CO in a variety of environments and to what degree. These included environments associated with leisure activities including boats, caravans and tents, as well as in the home, specific working environments and public spaces.

The outcome of this research is a report identifying gaps in research and understanding, as well as the development of systems for defining the impact of CO, and monitoring its effects in the UK in defined environments.


  • Due to the potentially high impact of chronic CO exposure, research should be conducted into chronic low-level CO poisoning, its symptoms, its potential link to other common chronic conditions, and on-going neurological sequelae.
  • More research into the levels of CO present in the home environment must be conducted to aid in the understanding of current numbers of low level occult exposures.
  • Studies using CO poisoning thresholds and categorising exposures should reconsider their definitions and exclusions to prevent missing data.
  • Current CO alarm standards should reconsider evaluating their threshold CO concentrations for activation to keep up with WHO guidelines, research on low-level poisonings and knowledge on susceptible groups.
  • More research is needed into the numbers of individuals affected by CO whilst staying in alternate/temporary domestic/leisure environments such as hotels, tents, caravans or boats.
  • The figures obtained from statistics should be coupled with data on travel rates and the types of CO incidents, to determine the true impact of CO in leisure environments. From this, more successful and directed advice can be provided on actions to take, to at-risk groups, when in these settings.
  • Specific risks identified in leisure environments should be investigated, and safer ways of burning carbon-based fuels in such spaces developed.
  • More research should be conducted into the effects of increased airtightness on the plethora of toxins present in the domestic environment and their impact on the health of occupants.
  • Studies should be implemented to research the impact of increased airtightness in homes, on the levels of CO for both chronic low-level concentrations and high-level acute CO leaks. This should be linked to the health impacts on the occupants for corresponding concentrations.
  • Further research should be provisioned to find methods to reduce the burden of indoor pollutants on occupants, such as recommendations on activities and ventilation to reduce emissions and concentrations of pollutants.
  • The work of indoor air scientists should feed more regularly into policy in order to protect the public from pollutants produced indoors.
  • Studies that claim to be researching the number of deaths by preventable CO poisoning should attempt to accurately define their sample.
  • Non-fire related CO deaths should not be used as a blanket term for preventable CO deaths as it is misleading and excludes preventable cases.
  • Research in ICD code data utilisation should be conducted; specifically which fire codes are most often coupled with CO code data, and how ‘anecdotal’ or ‘media’ evidence would be coded by different individuals.
  • ICD-11 should attempt to include more CO codes like ICD-9, as ICD-10 is lacking, or should allow for more combination codes.
  • All data sets on CO poisoning incidents should be collated and reviewed for more definitive suggestions of numbers of individuals affected.
  • Considering the difference in inclusion criteria for the pre-existing data sets, any missing data should also be collected; relevant proposals should be drawn for their inclusion by currently included institutions or new organisations to undertake the work.
  • Groups and charities that have unique access to victims of CO poisoning should be encouraged to collect more detailed qualitative information, to be added to the collaborative data set.
  • Whilst laws and regulations governing CO alarms should be harmonised throughout the United Kingdom, in the meantime, there should be an interactive repository for the laws on CO alarm installation in the UK, which is easily accessible and informative for the public.
  • Alarm manufacturers should continue to make installation guides simple for the public to use effectively, and primarily to encourage their use.
  • There should be alarm standards for an alarm/system between domestic and industrial for smaller occupational premises.
  • If the optimal position for a CO alarm is on average a foot below ceiling height, then CO alarms should be drop-tested from an equal height to this.
  • There should be one advice line for CO such as 111 for the NHS.
  • Gas inspectors who are already required to ask about whether an individual has a CO alarm (without any legal connotations), should be able to install a CO alarm to optimal positioning and offer this as a service to those without an alarm.
  • A system dynamics study should be conducted to determine the current invested agencies in CO poisoning prevention, and coordinate them and their impacts.
  • The study should engage with the current groups on CO to determine how they interact and impact each other and themes surrounding CO in order to create an agency map. The agency map should be used to facilitate the inclusion of groups at meetings etc. and drive with direction and ease, research and policy in specific themes on CO.

Final Report

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6 Month Progress Report

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12 Month Progress Report

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12 Month Review Presentation

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