Reports on Cases of Fatal Carbon Monoxide Poisoining due to Charcoal Grills Received by The Federal Institute For Risk Assessment in 2009: Background, Principal Measurements and Consideration as to Prevention

Objective: In the context of compulsory notification ofcases of poisoning, The Federal Institute For RiskAssessment (BfR) received eight reports of fatal casesof carbon monoxdide (CO) poisoning after indoor useof charcoal grills in 2009. Two cases resulted in verysevere neurological damage. CO is odourless, colourlessand non-irritant and therefore, does not produce anywarning effect for humans. The gas is lighter than airand readily absorbed through the lungs, which initiallyremains unnoticed. Insufficient ventilation in indoorenvironments will quickly result in lethal concentrationsof the toxic gas.Methods: The cases were investigatedand documented at BfR, and assessments of individualcases as well as an analysis of cases reported sofar under §16e Chemicals Act were performed. For abetter assessment of exposure, the Institute of the FireDepartment of Saxony-Anhalt (IdF) performed principalmeasurements of CO emissions from charcoal productsinside a fire container in the context of a researchproject of the Federal Land of Saxony-Anhalt.Results: In all cases, charcoal grills had been improperlyoperated indoors and probably also been used forheating. Examinations performed by IdF on thedynamics of the development of O2, CO and CO2 concentrationshave demonstrated the considerable riskposed by open fires in rooms lacking the necessaryventilation. Calculations of the absorbed toxic doseaccording to the Fractional Effective Dose (FED)model [Purser] have confirmed the fatal risk posed byindoor operation of charcoal grills. Very severe andlife-threatening poisoning may occur within 30minutes.Conclusion: Investigations into cases andevaluations of measurements have documented the riskposed by CO formation in indoor environments. Thecluster of fatal cases observed in the first half of 2009has indicated that, obviously, a part of the population isnot aware of the risk posed by indoor open fires. Eventhe use of embers as a source of heat in rooms maycause life-threatening poisoning. Open windows anddoors do not provide safety. In cases of moderate tosevere poisoning, persons affected will mostly exhibit acherry-red healthy skin colour. This may lead to misjudgementof the situation, particularly if alcohol hasbeen consumed.