American Academy of Emergency Medicine

Safely Heating Your Home This Holiday Season — Do You Know the Risks of Carbon Monoxide?

Dec 03, 2012 - The first day of winter is near, and again, it comes time to think about keeping our homes warm. While we look for methods to keep ourselves toasty indoors, it’s important to know the steps to safely heat our houses. We’ve often heard about fire-hazards around the holidays, but there is another home-heating concern to keep in mind — carbon monoxide. Incorrectly using some heating devices can lead to illness or even death from carbon monoxide poisoning.

Carbon monoxide is a colorless and odorless gas that is released into the air when various fuels are burned, including: wood, charcoal, kerosene, or propane. Internal combustion engines found in cars or portable generators also produce carbon monoxide. These poisonings peak in the winter months from poorly ventilated fires, stoves, portable space heaters, gas water heaters and auto exhaust, which are responsible for the majority of cases.

Over 300 deaths each year are caused by carbon monoxide, and it sends thousands more patients to our nation’s emergency departments with serious poisonings.

According to Dr. Michael Pulia, MD FAAEM, Assistant Professor of EM, University of Wisconsin School of Medicine and Public Health, these deaths are preventable. "In my experience, cases of carbon monoxide poisoning are so heartbreaking because it can affect entire families and is completely preventable with adequate education and safety measures. Educating the public and physicians is critical because these efforts have the potential to make a huge impact on public health by reducing the number of patients harmed by this substance.”

Since it is among the most common causes of unintentional, poisoning-related deaths, this gas has often been referred to as “the silent killer.” Carbon monoxide causes harm to the body by preventing oxygen from binding with red blood cells. Red blood cells normally carry oxygen throughout the body, however, when carbon monoxide interferes, less oxygen is sent throughout the body. Vital organs that rely on lots of blood, such as the heart and the brain, can be negatively impacted. Carbon monoxide also causes long lasting damage to cells which can lead to chronic immunologic and inflammatory problems.

By reviewing the safety precautions below, you can minimize the impact of this toxic agent and keep yourself and your family healthy this winter.

The first part of any good carbon monoxide safety plan is preparation and prevention.

1. Purchase a detector and check the batteries. The US Consumer Product Protection Agency (CPPA) recommends the installation of battery-operated carbon monoxide detectors outside each separate sleeping area of your home.  

2. Service your heating equipment. Be sure to have your home heating systems serviced by trained professionals annually to check that the equipment is running properly.

3. Use correct heating equipment. The CPPA advises to never use the following indoors: portable generators, charcoal grills, or a fireplace with a closed damper. Indoor appliances such as a gas range or oven should also not be used for heating. Instead use approved home heating devices, such as space heaters. Always follow the manufacturers instructions, monitor children and pets near these devices, and do not leave them unattended.

With these safety steps the risk of carbon monoxide poisoning will be significantly lowered, but it is still critical to understand the symptoms of exposure to this gas.  

Often mistaken for the flu, exposure is characterized by headaches, nausea, dizziness, and shortness of breath. In higher level exposures, symptoms can progress to confusion, loss of coordination, vomiting, coma, and death. One helpful way to determine if it is ongoing poisoning versus the flu is to look at the health of others in your household. If the flu-like symptoms are present among multiple individuals in the same family — without the hallmark fever of a viral infection — consider the presence of carbon monoxide.

What to Do If You Suspect Carbon Monoxide Exposure
The first step in any suspected exposure is to get outside immediately and call 911. Once in the emergency department, physicians will begin by determining the level of your exposure, and then administer highly concentrated oxygen to help reduce the duration of carbon monoxide activity.  

Depending on the severity of the exposure more extensive treatment may be required.  It is our goal as emergency physicians to not only to be experts in how to treat this condition, but also play an active role in educating the public and help eliminate preventable cases of carbon monoxide poisonings. By staying informed, you can help yourself and your family stay safe this holiday season.


The American Academy of Emergency Medicine (AAEM) is the specialty society in emergency medicine today. As an organization, it believes achievement of board certification represents the only acceptable method of attaining recognition as a specialist in emergency medicine. The Journal of Emergency Medicine is the society’s official journal, and AAEM holds an annual Scientific Assembly.
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