1 The Dangers of Carbon Monoxide Poisoning A joint hearing of the Senate Transportation and Housing Committee and the Assembly Housing and Community Development Committee Peggy Jenkins, Manager Indoor Exposure Assessment Section California Air Resources Board November 27, 2007 Informational Hearing

2 Colorless, odorless, tasteless gas Produced by incomplete combustion Sources of indoor CO –Vehicle exhaust –Gas and propane appliances –Woodstoves, fireplaces –Kerosene heaters –Cigarettes, cigars –Candles, incense Carbon Monoxide (CO) Basics

3 Health Effects of Carbon Monoxide CO binds strongly with hemoglobin. Result: Decreased motor skills Reduced mental sharpness, difficulty concentrating Flu-like symptoms (headache, lethargy) Angina (heart pain) Dizziness, nausea Long-term neurologic effects At high levels: Unconsciousness Death

4 CO Standards and Guidelines Averaging Time California 1 AAQS (ARB) National AAQS (US EPA) ARB Indoor Air Quality Guideline 3 8 hour9 ppm 2 9 ppm 1 hour20 ppm35 ppm20 ppm 1.CAAQS: 2.ppm = parts per million 3.Guideline no. 2, Combustion Pollutants in Your Home, and the Supplement to Guideline no. 2:

5 Annual California CO Poisonings Accidental Deaths Emergency Room Visits and Hospitalizations 2 Hundreds to Thousands of Illnesses 2 1.Extrapolated from Girman et al., Causes of Unintentional Deaths from Carbon Monoxide Poisonings in California. West J Med 168(3): , a study of 10 years of California death certificates, Also, current DPH mortality statistics. 2.ARB-DPH staff estimates, based on several references, including Hampson and Weaver, 2007; Mah, 2000; Waldman, 1996; Cook et al., 1995; Kirkpatrick, 1987; CDC, 1982.

6 Sources of CO in Accidental CO Deaths in California 1 ( ) Percent 1.Girman et al., Causes of Unintentional Deaths from Carbon Monoxide Poisonings in California. West J Med 168(3):

7 Percent of Combustion Appliance CO Deaths in California 1 1.Girman et al., Final Report: Causes of Unintentional Deaths from Carbon Monoxide Poisonings in California. Table 6. For years 1979–1988. Propane (24%) Natural Gas (75%) Percent

8 Who is at Risk Children, heart disease patients most at risk Those with anemia, pulmonary disease, pregnant women and their unborn babies also at risk Men and African Americans involved disproportionately to their population percents Users of sources in winter season (winter highest rate of episodes and deaths) Those with older vehicles and appliances

9 Common Indoor Causes Poor appliance maintenance (up to 27% of gas homes 1 ) Improper installation (up to 27% of gas homes 1 ) Improper use of appliances  gas range or oven to heat home (6.5% of gas homes 1 )  charcoal grill inside house  kerosene heater inside home Appliance leakage or backdrafting Idling vehicle in garage 1. Wilson et al., 1993, California Residential Indoor Air Quality Study, final report.

10 Combustion appliances the primary source of CO poisonings Substantial health risk despite attention to issue and some use of CO alarms –Known, documented deaths –Large number of non-fatal impacts –Increasing concern for low level, chronic exposures and long-term impacts Summary