The 87th General Meeting Speaker Presentation
"Carbon Monoxide Mortality"
The following presentation was delivered at the 87th General Meeting Monday General Session, May 7, 2018. It has been edited for content and phrasing.
INTRODUCTION: Vincent Scarcella is the equipment breakdown risk control director for CNA Insurance. In this role he is responsible for risk control in the northeast zone. He manages compliance for jurisdictional inspections, and is a member of the National Board Committee on Qualifications for Inspection.
Mr. Scarcella's slide presentation can be accessed here.
MR. SCARCELLA: Last year I did a presentation on RCI-1, Rules for Commissioned Inspectors, and I ended that presentation with some comments about how all our inspectors carry personal meters, and how we were seeing incidents.
I went home and started doing some more research, and I looked at Bureau of Labor statistics, CDC, NFPA, and EPA. I started looking at all the data and some research papers on CO, and I found some surprises, and wanted to share them with you.
One of the first things that you might want to do if you are doing some research is go on the internet and search news and fatalities and carbon monoxide, and you are going to find some things that are tragedies. Often you will find that multiple family members perish. You will find old and young. You will find it all over the country.
There are some trends. Most of it is in habitation, and there is a reason for that. And we will look at some numbers that point that out. But the real thing that you notice when you start reading these articles, especially the last one that is mentioned there, these are people. And we are looking at statistics—we are engineers, and we are looking at numbers all the time. But this is really about the people that we protect and everything we do.
The last one on the list, a very young family from Arizona, and the striking thing is that a friend of theirs was with them the day before. She is a professional photographer, and there are some really beautiful pictures especially of the three- and four-year-olds. So it sticks with you.
When you start doing this research, you come to the quick realization that there is no consensus. We are all over the board with this.
ASHRAE has got a different number than the Congress of Government Industrial Hygienists. And then you have got NIOSH and OSHA, and OSHA changes their numbers. And the WHO just looks like they adopted everybody's numbers so that they could cover all the bases.
But seriously, what are you supposed to do? For guidance as jurisdictions, what do you do with this? Where do the meters go off at? Thirty?
MR. SCARCELLA: Thirty-five and seventy, is that right?
Now, here is the trick question, and this is about what can we do. In your homes, you all have detectors. Everybody has detectors. Why? Well, because it's code. What do they go off at?
MR. SCARCELLA: So you could be exposed. You have no idea. So this is what I want you to consider. You can go on the internet tonight, and you can buy a meter that has a digital readout. It costs about ten dollars more than the dummy one that's in the ceiling. Does anyone know what the U/L codes are? 2-17 and 20-34.
But the real thing is there is a lot of confusion, and we really didn't get a consensus on this.
So what is shocking about this one (slide)? In seven years, you doubled NFRs. This is when a fire department responds, it gets reported to NFRs. These are carbon monoxide non-fire-related incidents. You went from 40,000 responses in 2003 to 80,000 in seven years. Does anybody know why that is?
PARTICIPANT: The reporting structure.
MR. SCARCELLA: That's part of it. What else? More detectors, right? There are a lot more detectors out there. You've started putting it in construction codes. But yes, there is definitely different reporting. Good catch. I didn't expect somebody to get that.
MR. SCARCELLA: That came out of an NFPA study. This is CDC. They have this weekly. It's morbidity and mortality, and if you have to study a particular type of exposure, you can find some interesting stuff. This study was from 2014, and some of this information is from CPSC, Consumer Products Safety Council, and 5,000 deaths over ten years.
And that's pretty consistent. If you are looking across all of the sources of information, they go as low as 350 a year up to 600, but it might even be higher. And when you start looking at this data, you get that feeling that it could be. Twenty thousand visits to the emergency room, 4,000 hospitalizations. These are all non-fire-related, nonintentional.
And when you look at the data, only in 10% of the cases where you had fatalities were there carbon monoxide detectors present. And in those 10% of the cases, somebody was messing around with the detector. It may have been disabled. So it's a good rule of thumb to have them in there. You can save lives.
This one was pretty shocking. So CDC puts together the chart, and you have deaths per 100,000, but what was really striking is that the death rate for males is twice that of females. And I had to speak to Evelyn Carpenter, our IH person for our zone, and I spoke to an emergency room physician and a GP, and I said, “Why is there a difference?” It's that men are more likely to have already compromised pulmonary and respiratory systems, and they are less likely to pay attention to the symptoms. So that's what all three of them attributed it to.
This is not scientific. This is just our staff country-wide reporting into us. We get a report whenever there is an activation. If you go back to NFRs and the CDC, it's all about habitation, but then we only had one in the last six months.
But we had three in nursing homes and one in a hospital. Where are you going to find the greatest population with compromised pulmonary and respiratory systems? It's in the nursing home. They activated our alarms, but not theirs. So that was kind of disturbing.
The information here came from a study from Science Direct, and I don't agree with the conclusions. When I looked at the numbers, especially the responses and the CDC numbers, the study claims that there are about 6,600 people that are impacted cognitively by carbon monoxide. I think that number is way low. I wouldn't be surprised that it's actually ten times that.
The cost to society is 1.3 billion dollars. That's lost productivity, hospitalization, healthcare costs, everything. I really do think it may be a factor of ten. So it's a big cost.
What are the other costs?
Anybody ever been named in a complaint and had to defend? The costs to defend means you had to hire a lawyer, and that lawyer has to do an investigation, and you have to go through discovery, and there are all kinds of things that have to be done. You could have done nothing wrong, but you have blown a quarter of a million dollars. And judgments can average north of a million dollars. So that's the costs, some of the real tangible costs that we understand.
And we outfitted our people with meters, and what did we come up with on an annual basis? So we bought meters. We do training, and we do quarterly calibrations. For calibration and all the equipment, what did we come up with per annual? I think it was south of fifty bucks per staff.
A lot of these things you already do, right? We are experts at telling people how to maintain stuff. We do that all the time, thousands of times in a year. But not everybody insists that we look at the flue connections, right? It may be kind of controversial, but if I have a person that is standing there certifying a boiler and it has an obvious issue, then it's a very difficult position to defend, right? And it should be a difficult position to defend if there is a fatality. We insist that they look at the flue. We insist that they look at the fresh air intake, and I suggest that you do the same.
What else can we do? We have training. You guys probably have training too, for compliance-based entry. We add safety for any of the hazards the staff might face, and we include carbon monoxide in that.
By the way, those pictures on the right are all pictures taken by our inspectors for boilers that passed their last inspection, and the top one is completely corroded, and you can see where the windows are adjacent to the corrosion. There is a blockage in the second picture. And the bottom picture, you can't really see that well, but the hot water heater flue is completely disconnected.
We educate clients all the time, and CNA has probably educated 10,000 operators. We do a lot of that training, and we just added talk about CO in that training and insist on inspection of the flue connections. Some of that is a little repetitive for a reason.
But you can see the picture of an almost completely blocked chimney cleanout and not a great seal around where the flue enters the chimney. And I have no idea why we see the bottom picture. It looks like somebody took a hammer to the connection. And we actually have seen that more than once. Pretty strange.
Equipment user training, we do it. It's in our wheelhouse. Your staff does it every time they walk into a boiler room practically, right?
Change management—in some of the fatalities and in some of our experience, we have seen, especially when you are going from a fuel oil to a gas especially to a condensing unit, occasionally people have left galvanized in there, and you have predictable results.
Transfer of knowledge—there are some things that happen. I remember my first investigation into carbon monoxide poisoning, and the door to the room is pretty difficult to get open. So what do you have? You have negative pressure, right? It's kind of tough to run a boiler with negative pressure in a boiler room. And the fresh air intake for about a 1,400-horsepower boiler was about this big, and the spill switches were disconnected. And it took about how many minutes for me to figure that stuff out?
Instinctively the things that the people in this room know, somebody who just graduated college and has been in the field for a couple of years doesn't necessarily know. So it's our jobs at this point in our careers to make it a goal to pass along what we know—transfer knowledge.
Verify detection. And I highly suggest that you get the meters for your staff. I had a call from a jurisdiction recently and also had a call from a competitor both asking me what meter do you use, how do you do it, how does it work for you. And if you have a question, please give me a call. I can give you all the references for all the information that I have collected. It's dizzying. It's not light reading.
From a business standpoint, doing nothing is not a good strategy when it comes to this exposure. You have to be proactive on this one. Training your staff is right in the wheelhouse if you're already doing confined space and hazard identification that you have to do under OSHA. You can add it to your QC process which you have to do under RCI-1 already.
Supporting regulatory changes, going to our lobbyists and putting them into the mix are an important step that we should be making.
Right now today, does anybody know of a U/L-listed device that you can put into a boiler circuit to shut off a boiler if the carbon monoxide goes up? You wouldn't know about one. Actually, there is one in Europe. There is a European standard, but it costs more than a regular heating boiler to actually buy the whole system, so it's not doable.
But a lot of technicians are out there, and they are taking kitters and putting in a relay and some wiring and they are actually doing it. But that's not a U/L-listed device, and you are not complying with CSD-1 or NFPA-85.
So I am going to keep pushing. I did talk to AMBA, and I'm not done there. And I have had several communications with device manufacturers. Hopefully we can get something.
Chief, can you talk about your incident in the school?
MR. ROBBY TROUTT (CHIEF BOILER INSPECTOR OF TEXAS): Yes. So, Vinnie, first I want to say thank you so much for bringing this up and talking about it, being as passionate as you are about it, because for me this has really hit home.
Within the last three years I have conducted probably about seven different carbon monoxide incidents, one of which was at a school, where I got the pleasure of going up to the principal of the school and shaking his hand, because he literally saved the lives of 275 people that day.
What had happened is the boiler room was actually installed inside of a mechanical room with an air conditioner. The exhaust fan locked up, and the air handler sucked all the fumes of combustion into the school and just distributed it everywhere.
The principal noticed that two kids were vomiting violently at the same time, and he said something is wrong. The school had no carbon monoxide detectors. He called EMS. EMS walked in with personal carbon monoxide detectors, and they immediately went into alarm, and they evacuated the school. If that principal had not called EMS for those kids, 275 people would have had a really bad day.
When that happened, I immediately went to my executive office, and I told my executive office I'm not playing this game anymore. I want to buy personal carbon monoxide detectors for every one of my staff. I got them two weeks later.
That week one of my inspectors called me and said, “Rob, you just saved my life. “
I said, “What do you mean? “
He said, “I went into a mechanical room to do five boiler inspections. I would have been in there about three and a half, four hours. My personal carbon monoxide detector tapped at 900 parts per million.”
MR. SCARCELLA: That would have killed him, no doubt.
MR. TROUTT: So I made it mandatory that during inspections, my guys are to have their carbon monoxide detectors on their body, and they are actually required to report what the carbon monoxide level is in that mechanical room of every inspection they do. It's mandatory. If I catch them not doing that, I am going to write them up.
MR. SCARCELLA: Thank you.
So three weeks ago I was dealing with an issue. One of my guys was on an inspection. His name is Ben McKay in New York state, and he was reaching out with his detector, and I had to send this to Chief Sansone to take a picture of it. It went from 35 to 426 as he was taping it. It was the headquarters for a very large client. They were really happy with us that we found it the way we did, and of course we are getting boiler replacements really quick.
I asked John if he could make a comment about the one incident.
MR. JOHN ESCH (CHIEF BOILER INSPECTOR OF DELAWARE): We had an incident in Delaware about two years ago where we had four fatalities in one apartment complex. It took us two years to defend ourselves to get us out of a lawsuit. We have a whole staff of lawyers. I can't even tell you how much money it cost us.
We were sued by the building owner, whose maintenance staff installed water heaters in a boiler room when the boiler stack was falling off the boiler, and they could document that the guys were there, saw it, and did nothing about it. It fell off, hit the floor, ran for days, and killed four people.
MR. SCARCELLA: Change management. So when there is a change in the room, you have to be aware. Two years to defend.
We had another one with Chief Washington in a nursing home in northern New Jersey. How is this happening in a nursing home?
So I would hope that you take away from this personal detection devices. The single-gas units are cheap. The cost of the four-gas units is getting cheaper and even more convenient to carry around. I encourage you to get them.
But there is an even easier one. The installation of the one that I have installed in my last two homes actually just plug into the wall. So even I can install it without getting electrocuted, and my wife is not yelling about a hole I cut in the ceiling.
So please consider that, especially if you have young kids, young grandkids. If you see symptoms, let's eliminate that possibility of carbon monoxide impacting them cognitively. And if you have elderly parents, I would encourage you to go ahead and install the units with the digital readout.
MR. TROUTT: Vinnie, I have got one more thing for you.
So I want to share one other thing that's actively going on right now here in Texas. Well, actually two—okay, three.
Less than a month ago I was deposed. I was called in for a deposition for an apartment complex that an elderly gentleman had died in. EMS found him in front of his stove. They evacuated the entire apartment complex, and it was found to be a result of the boiler.
The flue stack had come completely disconnected inside the attic because there was no mechanical connection as by the design of the stack, the flue pipe. This is type V vent. It wasn't locked together. So I have got that going on right now.
Because of what happened in the Beaumont school that I told you about, I sent one of my deputies to every school in this city, Dallas, Texas. Out of every school he went to—and there are a lot of them here in Dallas—there were only five schools that he did not write violations on for carbon monoxide issues.
They were doing things such as taking a flue pipe—and the school had an actual chimney built into it for the incinerator and the heater from back in the old days. We are talking in the '70s, '60s, '50s.
What these people were doing was taking these incinerators out, taking these boilers out that are millions of BTU's and putting in sealed-combustion boilers, these high-efficiency boilers, or these boilers that are almost high efficiency, and they are dumping the fumes of combustion into the stack.
Anybody that knows anything about draft knows you are not going to heat that chimney up enough to be able to do that. So what's going to happen? All those fumes of combustion, they are going to turn back to condensate. The acid that's created, it's going to eat the mortar. So now not only do we have a problem with fumes of combustion getting into our school, we have a chimney that's going to fall on our kids.
MR. SCARCELLA: Thank you.