Until now, doctors believed most of the victims were generating electricity to keep lights, air conditioners and refrigerators running. But now it appears that a substantial number were using the generators to power video games.
Of 12 separate poisoning incidents in the Houston area in the wake of Hurricane Ike, which left two million people without power in September 2008, five resulted from the use of generators for video games, Caroline Fife, M.D., of the University of Texas Health Science Center in Houston, and colleagues reported.
Overall, 21 children and 17 adults were poisoned. A three-year-old died, and the others had symptoms ranging from nausea, vomiting, dizziness, and headache to chest pain, loss of consciousness, and coma, the researchers reported in the June issue of Pediatrics.
"This is the first study to suggest that generators are commonly used immediately after a large-scale power outage to power entertainment electronics for children," they said.
A spokeswoman for the U.S. Consumer Products Safety Commission (CPSC) said, regardless of the appliances being powered, generators should never be used indoors, even with ventilation.
"Operating a generator inside your home produces poisonous levels of carbon monoxide equal to that of hundreds of cars running inside your home," she said.
These levels can linger for hours, even after the generator has shut off, she said.
The researchers called for "additional public education about carbon monoxide risk . . . perhaps directed at older children and teenagers through the schools in regions susceptible to hurricanes."
About 50,000 people suffer carbon monoxide poisoning in the U.S. each year. The most common cause is the use of charcoal indoors for heating and cooking, followed by electrical generators.
After Hurricane Ike, staff members at Memorial Hermann Hospital-Texas Medical Center treated or triaged by phone 37 cases of carbon monoxide poisoning from the Houston area, excluding the one death. All were related to the use of gas-powered electrical generators.
Eleven of the 12 incidents occurred because the generators were used either in an attached garage or inside the home. The placement of the generator for the twelfth incident was unknown.
Of the nine incidents for which the reason for generator use could be determined, powering video games and/or watching movies was responsible for five. Food refrigeration was listed for only two.
Just over half (54%) of the patients were younger than 18, and the five video game incidents accounted for three-quarters of the pediatric poisoning.
Dr. Fife and colleagues noted that previous studies have shown that carbon monoxide detectors, which are effective for secondary prevention of poisoning, are absent in most incidents.
But, they said, "even if a home has a carbon monoxide alarm, a generator should never be used indoors."
Recommendations state that a generator should be used no closer than 50 feet from a house, but the continuing problem of carbon monoxide poisoning shows that the public has not been sufficiently informed of the risks, they said.
Since May 14, 2007, the CPSC has required all new or imported generators to carry a label warning that using a generator indoors can "kill you in minutes."
But, the researchers noted that generators manufactured before that date carry no such warning.
To help raise awareness of the dangers after Hurricane Ike, hospital staff members conducted numerous interviews with local media and enlisted the help of AT&T to send warnings by text message.
"Other measures currently being considered to reduce generator-related carbon monoxide poisoning include generator weatherization so that owners are more willing to leave them outdoors, installation of catalytic converters, and incorporation of carbon monoxide monitors on generators, which would shut off the device if ambient carbon monoxide measurements rose above a predetermined level," the researchers said.
In addition to those strategies, the CPSC is considering theft deterrence and noise reduction measures to encourage the outdoor use of generators.
|Partial funding for the study was provided by the CDC and by the Edward H. Morgan Chair in Pulmonary and Critical Care Medicine.
Zalman S. Agus, MD Emeritus Professor
University of Pennsylvania School of Medicine and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner