Carbon monoxide (CO) is the dominant gas in fire smoke toxic ity. In many cases, according to Babrauskas [1], carbon monoxide, carbon diox ide and the depletion of oxygen are the only toxic agents of consequence. The problems of CO have been studied [2] at the U.S. National Institute of Standards and Technology, and the views of Babrauskas would be based on such work.
While acknowledging this view, this paper concentrates on the suggested dominant role of carbon monoxide. The views expressed recognise that this is not a novel problem. Rather, the paper attempts to bring together two, quite sep arate, discussions of the medical and fire science literature.
Babrauskas, V. et al. "A methodology for obtaining and using toxic potency data for fire hazard analysis," Fire Safety J., 1998, 31:345-358.
2.
Pitts, W.M. "Long-range plan for a research project on carbon monoxide production and prediction," NISTIR 89-4185, Gaithersburg, National Institute for Standards & Technology, 1989 .
3.
Douglas, C.G. , Haldane, J.S. and Haldane, J.B.S. "The laws of combination of haemoglobin with carbon monoxide and oxygen," J Physiol., 1912, 44:275-304.
4.
Vieregge, P. et al. "Subacute sequelae of carbon monoxide poisoning," Ann. Emerg. Med. , 1985,14:1163-1167.
5.
Choi, I.S. "Delayed neurologic sequelae in carbon monoxide intoxication," Arch. Neurol., 40, July, pp. 433-435.
6.
Mathieu, D. et al. "Acute carbon monoxide poisoning—Risk of late sequelae and treatment by hyperbaric oxygen," Clin. Toxicol., 1985, 23(4-6):315-324.
7.
Min, S.K. "A brain syndrome associated with delayed neuropsychiatric sequelae following acute carbon monoxide intoxication," Acta. Psychiatr. Scand., 1986,73:80-86.
8.
Smith, J.S. and Brandon, S. "Morbidity from acute carbon monoxide poisoning at three-year follow-up ," Br. J. Med., 1973, 1:318-321.
9.
Lugaresi, A. et al. "'Akinesia' following carbon monoxide poisoning," Eur. Neurol., 1990, 30:167-169.
10.
Klawans, H.L. et al. "A pure Parkinson syndrome following acute carbon monoxide intoxication," Arch. Neurol., 1982, 39:302-304.
11.
Jaeckle, R.S. and Nasrallah, H.A. "Major depression and carbon monoxide-induced Parkinsonism: Diagnosis axial tomography and response to L-dopa," J. Nerv. Ment. Disease, 1985, 173(8):503-508.
12.
Ringle, S.P. and Klawens, H.L. "Carbon monoxide-induced Parkinsonism ," J. Neurol. Sci., 1977,16:245-251.
13.
Sawa, G.M. et al. "Delayed encephalopathy following carbon monoxide intoxication ," Can. J. Neurol. Sci., 1981, 8:77-79.
Werner, B., et al. "Two cases of acute carbon monoxide poisoning with delayed neurological sequelae after a "free" interval," Clin. Toxicol, 1985, 23:249-265.
18.
Ginsberg, R. and Romano, J. "Carbon monoxide encephalopathy: Need for appropriate treatment," Am. J. Psychiatry, 1976, 133(3):317-320.
19.
In Fire Safety of Upholstered Furniture—The final report on the CBUF research programme, Ed. Bjorn Sundstrom, European Commission Measurement and Testing Report, EUR 16477EN Section 3.1.1, p. 61.
20.
Sainrat, A. et al. "Research of critical levels in terms of people's health due to the fire effluent production from combustion of upholstered furniture," DGCCRF, 1995.
21.
Draft for Development DD240:Part 1:1997—Fire safety engineering in buildings: Part 1, Guide to the application of fire safety engineering principles, British Standards Institution, London.
22.
ISO/PD TR 13387—Fire Safety Engineering. Part 1—The application of performance concepts to design objectives; Part 2—Design fire scenarios and design fires; Part 3—Assessment and verification of mathematical fire models; Part 4—Initiation and development of fire and generation of fire effluent ; Part 5—Movement of fire effluent; Part 6—Structural response and fire spread beyond the enclosure of origin; Part 7—Detection, activation and suppression; Part 8—Life safety: occupant behaviour, location and condition. British Standards Institution, London.
23.
Seager, D. and Welch, L. "Carbon monoxide controversies: Neuropsychologic testing, mechanism of toxicity, and hyperbaric oxygen," Annals Emerg. Med., 1994, 24(2):242-248.
24.
Tibbles, M.P. and Perrotta, P.L. "Treatment of carbon monoxide poisoning : Critical review of human outcome studies comparing normobaric oxygen with hyperbaric oxygen," Annals Emerg. Med., 1994 , 24(2):269-276.
25.
Garland, H. and Pearce, J. "Neurological complications of carbon monoxide poisoning," Q. J. Med., 1967 , 36:445-455.
26.
Thom, S.R. et al. "Delayed neuropsychologic sequelae after carbon monoxide poisoning: Prevention by treatment with hyperbaric oxygen," Annals Emerg. Med., 1995, 25(4):474-480.
27.
Olson, K.R. "Hyperbaric oxygen for carbon monoxide poisoning: Does it really work," Annals Emerg. Med., 1995, 25(4):535-536.
28.
Remick, R.A. and Miles, J.E. "Carbon monoxide poisoning: Neurologic and psychiatric sequelae," Can. Med. Assoc. J., 1997, 117:654-657.
29.
Ginsberg, M.D. and Ramano, J. "Carbon monoxide encephalopathy: Need for appropriate treatment," Am. J. Psychiatry, 1976, 133:317-320.
30.
Vieregge, P. et al. "Carbon monoxide poisoning: Clinical, neurophysiological and brain imaging observations in acute disease and follow-up ," J. Neurol., 1989, 236:478-481.
31.
Hardy, K.R. and Rhom, M.D. "Patholophysiology and treatment of carbon monoxide poisoning," Clin. Toxicol., 1994, 32(6):613-629.
32.
Pulst, S.-M. et al. "Carbon monoxide poisoning with feathers of Gilles de la Tourette's syndrome," Arch. Neurol., 1983, 40:443-444.
33.
Norkool, D.M. et al. "Treatment of acute carbon monoxide poisoning with hyperbaric: A review of 115 cases,"Ann. Emer. Med., 1985, 14:1168-1171.
34.
Norris, C.R. et al. "Delayed carbon monoxide encephalopathy: Clinical and research implications," J. Clin. Psychiatry, 1982, 43(7):294-295.
35.
Jefferson, W.J. "Subtle neuropsychiatric sequelae of carbon monoxide intoxication: Two case reports," Am. J. Psychiatry , 1976, 1133(8):961-964.
36.
Shillito, F.H. et al. "The problem of nervous and mental sequelae in carbon monoxide poisoning," JAMA, 1936, 106(9):669-674.
37.
Levasseur, L. et al. "Effects of mode of inhalation of carbon monoxide and of normobaric oxygen administration on carbon monoxide elimination from the blood," Hum. Experim. Toxicol., 1996 , 15:898-903.
38.
Hantson, P. et al. "Early complications and value of initial clinical and paraclinical observations in victims of smoke inhalation without burns," Chest, 1997, 111(3):671-675.
39.
Walker, A.R. "Emergency department management of house fire burns and carbon monoxide poisoning in children," Paediatrics , 1996, 8:239-242.
40.
Moisan, T.C. "Prolonged asthma after smoke inhalation: A report of three cases and a review of previous reports," J. Occ. Med., 1991, 33(4):458-461.
41.
Touger, M. et al. "Relationship between venous and arterial carboxyhaemoglobin levels in patients with suspected carbon monoxide poisoning," Ann. Emer. Med., 1995, 25(4):481-483.
42.
Cramlet, S.H. et al. "Ventricular function following acute carbon monoxide exposure," J. Appl. Physiol., 1975, 59(3):482-486.
43.
Allred, E.N. et al. "Short-term effects of carbon monoxide exposure on the exercise performance of subjects with coronary artery disease ," N. Eng. J. Med., 1989, 321(21):1427-1432.
44.
Kinsella, J. et al. "Increased airways reactivity after smoke inhalation," Lancet, 1991, 337:595-597.
45.
Marius-Nunez, A.L. "Myocardial infarction with normal coronary arteries after acute exposure to carbon monoxide," Chest, 1990, 97(2):491-494.
46.
Remick, R.A. and Miles, J.E. "Carbon monoxide poisoning: Neurologic and psychiatric sequelae," CMA J., 1977, Sept. 17, 117:654-657.
47.
Anderson, R.F. et al. "Myocardial toxicity from carbon monoxide poisoning," Annals Int. Med., 1967, 67(6):1172-1182.
48.
Ginsberg, M.D. and Myers, R.E. "Experimental carbon monoxide encephalopathy in the primate: II—Clinical aspects, neuropathology and physiological correlation," Arch. Neurol., 1974, 30:209-216.
49.
Lapresle, J. and Fardeau, M. "The central nervous system and carbon monoxide poisoning II: Anatomical study of brain lesions following intoxication with carbon monoxide," Brain Res., 1967, 24:31-74.
50.
Bour, H. et al. "The central nervous system and carbon monoxide poisoning I. Clinical data with reference to 20 fatal cases," Prog. Brain Res., 1967, 24:1-30.
51.
Krenzelok, E.P. et al. "Carbon monoxide ... The silent killer with an audible solution," Am. J. Emer. Med., Sept. 1996, 14(5):484-486.
52.
Pruitt, B.A. et al. "Evaluation and management of patients with inhalation injury ," J. Trauma, 1990, Supp. 30(12):63-68.
53.
Hart, K. et al. "Neurological manifestations of carbon monoxide poisoning," Postgrad. Med. J., 1988, 64:213-216.
54.
Hartman, D. In Neuropsychological toxicology: Identification and assessment of human neurotoxic syndrome, New York, Pegram Press, 1988, pp. 244-253.
55.
Messier, L.D. and Mayers, R. "A neuropsychological screening battery for emergency assessment of carbon monoxide-poisoned patients," J. Clin. Psych., 1991, 47:675-684.
56.
Robkin, M.A. "Carbon monoxide and the embryo," Int. J. Dev. Biol., 1997.
57.
Ruszkiewicz, A. et al. "Unusual presentation of death due to carbon monoxide poisoning," Am. J. Forensic Med. Pathol. , 1997, June 18, (2):181-184.
58.
Ramos, V. et al. "Simultaneous death of twins," Am. J. Forensic Med. Pathol., 1997, Mar. 18 (1):75-78.
59.
Piantadosi, C.A. et al. "Apoptosis and delayed neuronal damage after carbon monoxide poisoning in the rat," Exp. Neurol. , 1997, Sept. 14, (1):103-114.
60.
Illum, F. "Calcification of basal ganglia following carbon monoxide poisoning ," Neuradiology, 1980, 18:312-314.
61.
Kim, K.S. et al. "Acute carbon monoxide poisoning: Computed tomography of the brain," AJNR, 1980, 1:399-402.
62.
Sawada, Y. et al. "Computed tomography as an indication of long-term outcome after carbon monoxide poisoning," Lancet, 1980, 1:782-784.
63.
Sawada, Y. et al. "Correlation of pathological findings with computed tomography findings after carbon monoxide poisoning," New Eng. J. Med. , 1983, 308:1926.
64.
Smith, J.S. et al. "Akinetic mutism with recovery after repeated carbon monoxide poisoning," Psychol. Med., 1971, 1:172-177.
65.
Smith, J.S. and Mellick, R.S. "Neuropsychiatric relapse following acute carbon monoxide poisoning—The contribution of electro-convulsive therapy ," Med. J. Aust., 1975, 12:465-468.
66.
Pentschew, A. "Kohlenoxydvergiftung," in Handbuch der Siellen Patholgischen Anatomie und Histologie, Lubarsch, O., Henke, F. and Roessel, R. (Eds.), Berlin , Springer-Verlag, 1958, Vol. 13, No. 2B, pp. 2107-2149,2440-2449.
67.
Brown, D.B. et al. "Severe carbon monoxide poisoning in the paediatric patient : A case report," Aviat. Space Environ. Med., 1996, 67(3):262-265.
68.
Raskin, N. and Mullaney, O.C. "The mental and neurological sequelae of carbon monoxide asphyxia in a case observed for fiteeen years," J. Nerv. Ment. Disorder , 1940, 92:640-649.
69.
Martindale, L.G. "Carbon monoxide poisoning. The rest of the story," J. Emerg. Med., 1989, 15(2):Part 1:101-104.
70.
Roberts, J.R. et al. "Successful heart transplantation from a victim of carbon monoxide poisoning," Annals Emerg. Med. , 1995, 26(5):652-655.
71.
Levit, F. "Skin discomfort as a presenting sign of carbon monoxide poisoning ," J. Am. Acad. Dermatol., 1995, 32:671.
Jerrett, J.G. and Steffens, D.C. "Carbon monoxide-related organic mood disorder successfully treated with ECT," J. Clin. Psychiatry , 1995, 56(7):232-233.
74.
Finck, P.A. "Exposure to carbon monoxide; review of the literature and 567 autopsies," Mil. Med. Dec., 1966, 1513-1539.
75.
Fire Statistics—United Kingdom. Published annually by the Home Office, Research and Statistics Department, Lunar House, 40 Wellesley Road, Croydon CRO 9YD, United Kingdom.
