Policy Development for Carbon Monoxide Poisoning Reporting in North Carolina

BACKGROUND: Carbon monoxide (CO) poisoning is a public health concern that contributes to more than 50,000 emergency department (ED) visits and 430 deaths annually in the US. Recent high profile CO-related deaths have highlighted the public health impact of CO exposures in North Carolina.  During 2012─2014, we estimated, using our statewide syndromic surveillance system, an average of 354 CO poisoning related visits to EDs per-year (range 254-460).  Given this potential illness burden, the North Carolina Division of Public Health (NC DPH) is planning to propose a rule amendment to make occupational CO poisoning a mandatory reportable condition in an effort to describe incidence, identify common sources, and monitor morbidity and mortality trends. If the rule is successfully amended, the next step will be to propose a statute to make non-occupational CO poisoning reportable, as well.

METHODS: In order to make CO poisoning a reportable condition, a standard case-definition and reporting criteria must be established.  Commonly, healthcare providers report incidents to the Carolinas Poison Center (CPC); we plan to establish a data feed to receive weekly case data from the CPC.  However, CPC data likely reflects only a portion of true case events.  As a result NC DPH will engage local health departments and healthcare providers in the reporting requirements and will continue to develop relationships with fire departments and first responders to obtain information about all suspect cases.   

RESULTS: At least 10 states have already implemented CO poisoning as reportable condition. Two of these states, Florida and Tennessee, have been able to identify the sources of exposure and populations at risk for each of the cases. They were able to target their outreach messages more effectively and receive information in a timelier manner.   

CONCLUSIONS: Implementing mandatory CO poisoning reporting will allow NC DPH to obtain the same type of information (exposure sites, sources, and high risk populations) and increase awareness and knowledge of CO poisoning among vulnerable populations, improve communication with healthcare facilities, establish partnerships with other agencies and ultimately reduce the number of CO incidents in the state.