Neil B. Hampson, MD

After 3 years of operation, the joint project between the UHMS and the US Centers for Disease Control and Prevention (CDC) to conduct online surveillance of cases of carbon monoxide (CO) poisoning treated with hyperbaric oxygen was completed in December 2011. Due to cutbacks in Federal funding for the CDC, financial support was not available for a fourth year. Furthermore, the pilot project had already achieved all of the goals established when it went online in August 2008, and more.

The main goal of the project was to determine whether teaming with a specialty medical society would provide the CDC a tool to acquire complimentary information about a health condition that their usual surveillance methods would not capture. The CDC collects epidemiologic data in an attempt to track trends in diseases and also to look for ways to develop more effective prevention programs. The fact that the project proposed by the UHMS involved online reporting of case information offered the additional possibility for near real‐time data acquisition, allowing the potential for intervention when an epidemic was identified.

From 2008‐2011, 64 UHMS affiliated hyperbaric facilities reported unidentifiable demographic, epidemiologic, and clinical data on 1,907 patients treated with HBO2 for CO poisoning in 42 states. This represents the first comprehensive collection of nationwide data on this group of patients. A paper has already been published by CDC and UHMS investigators that summarizes 1 year of data and discusses the potential that the information offers for improving poisoning prevention programs (1). Another paper is forthcoming in Undersea and HyperbaricMedicine summarizing the entire 3‐year data collection (2).

Rapid reporting with an online system did prove to offer the opportunity for intervention and poisoning prevention. After Hurricane Ike struck the coast of Texas in 2008, we were able to rapidly provide the CDC with information about the outbreak of CO poisonings that followed, such that they were able to intervene with appropriate public education resources to prevent further poisoning (3).

Such a large database containing information that was collected both systematically and prospectively has allowed us to answer existing some questions about CO poisoning. A few have included, "What percentage of HBO2‐treated patients are hospitalized?” (answer: 54%). "Why did people operate generators after Hurricane Ike?” (answer: Surprisingly, most did it to power video games and DVD players to entertain their children) (4). "Does the initial blood carboxyhemoglobin level correlate with the patient’s presenting symptoms?” (answer: No) (5).

Overall, the project was a success in all regards. The UHMS gained valuable visibility as the CDC showcased the program as an example of what can be achieved by teaming with a medical specialty society. Valuable information about CO poisoning in the US has been collected that will likely continue to yield new findings for some time to come. Revenue has flowed to the UHMS as the project has donated $20,000 in excess funds to the Society over the past few years.

It is probable that we will reactivate the system on ad hoc basis from time to time in the future. This will most likely occur if the CDC calls with a request for timely information about a specific event, such as a storm. In such a case, emails will be sent to UHMS members residing in a focused area of the country requesting case reporting for a short period of time.

Like many things that happen in the UHMS, none of this would have been possible without the enthusiastic volunteer cooperation of Society members who reported the cases online. I thank all of you who participated, and hope you enjoyed the coffee.

References:

1. Clower JH, Hampson NB, Iqbal S, Yip FY. Recipients of hyperbaric oxygen therapy for carbon monoxide poisoning and exposure circumstances. Am JEmerg Med 2011; Aug 18, epub ahead of print.
2. Hampson NB, Dunn SL, Yip FY, Clower JH, Weaver LK. The UHMS/CDC carbon monoxide poisoning surveillance system: Three year data. UnderseaHyperb Med 2012, in press.
3. Hampson N, Dunn S, Bronstein A, Fife C, Villanachi J, et al. Carbon monoxide exposures after Hurricane Ike – September 2008. MMWR 2009; 59:845‐847.
4. Fife CE, Smith L, Maus E, O’Malley E, Hampson NB. Dying to play video games: Carbon monoxide poisoning from electrical generators following hurricane Ike. Pediatrics; 2009 Jun;(6): e1035‐e1038.
5. Hampson NB, Dunn SL, Members of the UHMS/CDC CO Poisoning Surveillance Group. Symptoms of acute carbon monoxide poisoning do not correlate with the initial carboxyhemoglobin level. Undersea Hyperb Med 2012, in press