Carbon Monoxide Poisoning in Ontario, Canada: Identifying Causes and at Risk Populations

Abstract

Carbon monoxide (CO) poisoning results in a substantial public health burden, a burden that is entirely preventable. In Ontario, if emergency services identify CO during a 911 response they will notify the Technical Standards and Safety Authority (TSSA), who then conduct a detailed site investigation. Ten years of investigation data (2007-2016) was examined to identify predictors of CO incidents and characteristics of individuals exposed, to ultimately help inform prevention strategies. Detailed information on 2,780 unique CO incidents and 374 individuals who were exposed to CO was assessed.Examining CO incidents by month, a seasonal trend was evident, with a higher occurrence of incidents in cold months (November to February). Across all age categories, incidents where an individual was exposed to CO occurred primarily in homes (private and multi-unit dwellings) versus commercial, institutional and industrial settings. Incidents peaked between 8:00am and noon and virtually all CO incidents between midnight and 7:00am were in homes. The most common cause of a CO incident was improper installation, operation, or maintenance of equipment.There were a total of 15 fatal injuries, 140 serious injuries (poisoning), and 191 minor injuries (nausea/dizziness, aches/pains). 68% of the injuries impacted working age adults (20-59 years), and injuries peaked at 40-49 years (6 per 100,000 population). Nausea and dizziness were the most common symptoms reported. Half of the fatal injuries involved older adults (>60 years) at home.In order to inform successful prevention strategies around CO poisoning, routine surveillance of CO incidents is needed to understand how these events occur and to identify the population at risk. TSSA data provide unique information to inform prevention efforts, such as public education on the importance of regular maintenance of fuel-burning appliances.