Carbon Monoxide Poisoning in Schools
Carbon Monoxide Poisoning in Schools, Again
In 2013 it was the Montezuma Creek Elementary School in Montezuma Creek, Utah where 40 children suffered an exposure to carbon monoxide in school. In 2014 it was the North Mac middle school in Girard, IL. http://fox2now.com/2014/09/15/school-evacuated-for-carbon-monoxide-leak/
On October 30, 2015, it was the Prussing Elementary School in Chicago where more than 70 children were poisoned. See http://chicagocarbonmonoxide.com/prussing-elementary-in-chicago-evacuated-for-carbon-monoxide-poisoning/
In all three cases, the headlines were about how much worse it could have been but it is imperative that everyone exposed to carbon monoxide in schools get a thorough diagnostic work up and treatment. Carbon monoxide in schools can kill. But more relevantly in these three cases, carbon monoxide poisoning can disable. When it strikes a school, the resulting disability can put a big whole in a community as parents and teachers try to understand why so many children are suddenly different.
Carbon monoxide can injure any cell in the human body, is hardest on internal organs and when it causes brain damage, can cause lasting effects that can cause permanent change in the way a person thinks, feels, behaves and moves. Damage to other organs can effect heart, liver and lungs and even cause intestinal problems.
When school children are treated and released after an incident like this, everyone rightfully breaths a sigh of relief that no one dies. But what is not recognized is that carbon monoxide damage actually gets worse over the first month or two after a poisoning event and anyone who tested positive for carbon monoxide in his or her blood, needs ongoing treatment and evaluation.
In most cases, the survivor of a carbon monoxide poisoning gets oxygen for a short while, is sent home and assumes they are lucky to have survived such a scare. But that is not the whole story.
Risk of DNS in the School Carbon Monoxide Poisoning
One of the most troubling aspects of carbon monoxide poisoning is the delayed onset of Neurological symptoms, called delayed neurological sequelae or DNS. Delayed neurological sequelae involves an elongated process of brain damage. Neurologic and behavioral deficits can arise or worsen for up to 40 days after the exposure. In most cases of non-catastrophic injuries the patient is discharged from the hospital but has a relapse of symptoms, from the intensifying pathology. The toxic effects of carbon monoxide poisoning continue to attack the nervous system, especially the brain, for many weeks after the initial exposure. The syndrome of DNS (Delayed Neurological Sequelae) can manifest itself as in neurological or behavioral symptoms, including confusion, memory loss , seizures, urinary or bowel incontinence, disorientation, psychosis, hallucinations and balance and dizziness problems.
With these treatment possibilities, it is critical that the potential for Delayed Neurological Sequelae in all carbon monoxide exposure cases be evaluated. The risk factors for DNS go up in a patient who was unconscious. It is likely that the prevalence of Delayed Neurological Sequelae is significantly understated, as the studies that have looked at neuropsychological testing measures, versus strictly clinical manifestations, the percentage of those with DNS climbs to nearly 50%.
What to Watch for in a Child after Carbon Monoxide Poisoning in Schools
The problem in assessing the symptoms of carbon monoxide poisoning in a school population is that the most significant symptoms in children are likely to be behavioral and mood problems. But since children’s behavior changes so much during developmental years, it is easy to attribute mood and behavior problems to childhood or adolescence. Thus, it is often only in the best behaved children, that parents make the connection between the carbon monoxide poisoning event and the change in behavior. But carbon monoxide poisoning does not just strike the well behaved. It is likely to have more severe impact on those whose behavior wasn’t stellar before. Yet, even in the A students, the mood problems can cause severe depression and worse.
It is essential that all survivors of carbon monoxide are monitored and counseled about what may lie ahead. With children, that is even more critical.