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55 METCALFE STREET, SUITE 700 | OTTAWA, ON K1P 6L5 | CANADA | TEL: 613.260.1424 | FAX: 613.260.1443
DRAFT REPORT
Benchmarking Risk of Injury and Death from TSSA-
Regulated Activities against Other Jurisdictions
Prepared for: TSSA
7 August 2015
Benchmarking Risk of Injury and Death from TSSA-Regulated Activities against Other Jurisdictions
7 AUGUST 2015 II
Contents 1. Introduction .............................................................................................................................................. 3
1.1 Report Structure ................................................................................................................................. 3
1.2 Considerations for Data Interpretation .............................................................................................. 4
2. Methods .................................................................................................................................................... 4
2.1 Development, Augmentation, and Refinement of Search Terms ....................................................... 4
2.2 Review of the Academic Literature ..................................................................................................... 4
2.3 Broad Web-based Research ................................................................................................................ 5
2.4 Organization-specific Searches ........................................................................................................... 5
3. Results ....................................................................................................................................................... 5
3.1 Elevating Devices ................................................................................................................................ 5
3.2 Amusement Devices ........................................................................................................................... 7
3.3 Ski Lifts .............................................................................................................................................. 11
3.4 Boilers and Pressure Vessels ............................................................................................................. 12
3.5 Carbon Monoxide Poisoning (Fuels) ................................................................................................. 13
4. Discussion ................................................................................................................................................ 18
4.1 Regulatory Variation ......................................................................................................................... 18
4.2 Performance Reporting Variation ..................................................................................................... 19
4.3 Usefulness of Performance Benchmarking ....................................................................................... 20
References .................................................................................................................................................. 21
Appendix A - Relevant search terms. .......................................................................................................... 25
Appendix B - List of organizations with mandates similar to that of TSSA ................................................. 26
Appendix C - Population estimates for jurisdictions of relevance .............................................................. 28
Appendix D - Studies of injuries/deaths from carbon monoxide poisoning ............................................... 32
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1. Introduction
As an adjunct to its Annual Public Safety Performance Report (ASPR), the Technical Standards and Safety
Authority (TSSA) is interested in improving its understanding of its performance in managing risks to the
public relative to similarly mandated organizations in other jurisdictions. This report describes TSSA
public safety incident data in the context of incidents reported by other similar organizations. In most
respects, the report is similar to a previous report (RSI, 2014), except for the more extensive analysis of
carbon monoxide poisonings included in this report. The purpose or replicating the prior analysis is to
maintain a complete discussion in a single report that is updated annually.
The ongoing exercise has three main objectives:
1. To update findings from a previous report (RSI, 2014) summarizing international statistics regarding injury and death associated with TSSA-regulated activities, in order to provide ongoing context for analysis of cross-jurisdictional variation in regulatory and reporting requirements.
2. To facilitate dialogue with regulators in other jurisdictions on public safety and risk management regarding the collection of data and its interpretation to support improvements in the safety of regulated technological systems.
3. To assist with the communication of the level of risk faced by the Ontario public.
This report is not intended as a comment on the success or failure in risk management by the TSSA or by any other institution. The levels of risk cited or estimated in this report should not be used to infer or imply the tolerability of current levels of risk from various sources and activities. Rather, this report seeks to compare safety levels across international jurisdictions in order to provide insight for a broader discussion centered on variability in regulatory and performance reporting requirements. While the focus is on international comparisons, incident data from the British Columbia Safety Authority (BCSA), perhaps the organization most similar to the TSSA, are also included for comparison.
1.1 Report Structure
The remainder of this section includes a discussion of important considerations in understanding and interpreting the data presented. Section 2 describes the project approach and methods. Section 3 provides tables summarizing risks from TSSA-regulated sectors and making comparisons with similar risks in international jurisdictions. Subsections 3.1 to 3.4 update previously summarized data (RSI 2014) regarding performance in technology sectors related to elevating and amusement devises, ski lifts, boiler and pressure vessels. Compared to the previous report (RSI, 2014), the current report provides more information on injuries and deaths associated with carbon monoxide poisoning. Carbon monoxide poisoning statistics are summarized in subsection 3.5. Section 4 discusses cross-jurisdictional variability in regulatory and reporting requirements, which may help explain the observed disparities and inform the process for TSSA performance benchmarking in the future. Section 5 provides key messages and conclusions.
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1.2 Considerations for Data Interpretation
This report summarizes and reviews information from international jurisdictions on injuries associated with technologies that are regulated by the TSSA. As previously described, comparability of these data to TSSA’s data is limited due to substantial variations in the characteristics of the data including the following:
Differing populations covered by injury and fatality data, including entire jurisdictional populations, hidden tourist population inflow, subpopulations that are engaged in the activity (e.g. amusement park attendees), or populations that are the focus of a specific statistical report (e.g. children);
sources of data, such as national fatality records, or estimations made from actual numbers from a sample of reporting centers (e.g., the CPSC NEISS);
regulatory data for jurisdictions with different regulatory categories, numbers of devices, and performance metrics;
definitions of injuries that are captured;
definitions of causal factors;
the time period included in the numbers reported; and
expression of the denominator value and units in incidence rates, for example in units of per million general population per year, or a subpopulation of device users, or occupational group, or the number of passenger miles.
Recognition of these constraints informs a discussion of the limitations of benchmarking efforts, and the possibility of standardizing reporting formats among jurisdictions who are interested in collecting and sharing more comparable data to improve safety in all jurisdictions.
2. Methods
The following steps have been taken to ensure a systematic approach to the search for information.
2.1 Development, Augmentation, and Refinement of Search Terms
Initial search terms and phrases were selected based on our understanding of the TSSA’s mandates and general knowledge regarding the types of regulatory and performance information required to conduct an appropriate analysis. As the research progressed, the search strategy was refined. Appendix A provides a list of main and partnered search terms and phrases used in identifying relevant regulatory and performance information.
2.2 Review of the Academic Literature
Peer-reviewed literature was searched using Web of Science, Pubmed, Google Scholar, and Medline as the primary bibliographic databases With the exception of data on carbon monoxide poisoning, this approach did not prove very successful, given that most information is released through private or public regulatory institutions, rather than independent academic research publications.
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2.3 Broad Web-based Research
The academic literature search was supplemented with a review of the grey literature, identified by inputting the search terms listed in Appendix A into the Google Search Engine. This helped to identify a broader array of references as well as further key organizations with mandates similar to the TSSA.
2.4 Organization-specific Searches
Appendix B identifies key organizations with mandates similar to that of the TSSA that were researched independently of the broad web search.
3. Results
For the purposes of this analysis, risk summaries are provided for Elevating Devices, Ski Lifts, Amusement Devices, Boilers and Pressure Vessels, and Fuels. For the fuels program, the focus in this report is on injuries from exposure to carbon monoxide (CO), as this causes the greatest number of injuries. Data on Boilers and Pressure Vessels involve mainly occupational risks. Exposure to CO can occur in occupational and non-occupational settings. All other comparisons are focused on the risk to the public rather than on occupational risks associated with these technologies. Estimates of relevant populations by jurisdiction and year, used to calculate injury and fatality rates, are included in Appendix C.
No international organization was identified with a mandate identical to that of the TSSA. The British Columbia Safety Authority (BCSA) regulates a very similar set of activities and is considered the best regulatory comparator. While its data is included for comparison in the summary tables, the BCSA is not included in the discussion due to the international focus of this report. Key data sources included the United States Consumer Product Safety Commission (CPSC) and its National Electronic Injury Surveillance System (NEISS) and the European Lift Association, which presents data on elevating device injury across the European Union.
3.1 Elevating Devices
Obtaining data on injury and fatality risks associated with elevators and escalators is difficult, and not all information available is from regulatory agencies. A further challenge is that many organizations may not distinguish between risks from different types of elevating devices or may only be concerned with a certain type (e.g., elevators but not escalators). This can make performance benchmarking complicated and obscure proper comparisons
Key findings for risks associated with elevators and escalators in international jurisdictions are listed in Tables 1A and 1B, respectively. Cells left blank do not indicate a value of zero, but rather that information was not reported. Most European data was obtained from a single presentation by the European Lift Association, where little information was available on the reporting process or definition of “injury.” This differs from the TSSA and BCSA distinction between permanent and non-permanent (or major and minor) injuries. While for the purposes of this report these categories have been combined into a single “injury” total, it should be noted that non-permanent injuries (such as superficial injuries like scrapes and bruises) make up the majority of this figure. Meanwhile, for example, the substantial difference in the United Kingdom 2002 and 2011 injury rate suggests the possibility that the ELA reporting process may produce statistics that underestimate the risk.
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Table 1A Injuries and deaths associated with elevators
Jurisdiction, Year (Reference) Injuries Deaths Rate (Per 1M pop/yr)
Ontario, 2015 (TSSA) 127 0 9.77 injuries
Ontario, 2014 (TSSA) 189 0 14.54 injuries
British Columbia, 2014 (BCSA, 2014a) 62 (see page 8)
01 13.39 injuries
British Columbia, 2013 (BCSA, 2014) (all elevating devices)
38 0 8.29 injuries
United Kingdom 2001 (HASS & LASS, 2002; hospital visits)
1,722 29.07 injuries
United Kingdom, 2011 (ELA, 2013) 141 2.2 injuries
Unites States, 2014 (CPSC NEISS)2 10,969 34.40 injuries
United States, 2013 (CPSC NEISS) 11,172 36.19 injuries
United States 1992-2009 (McCann, 2013) 89 (deaths to passengers while
at work)
0.016 deaths (while at work)3
United States 1997 to June 2010 (McCann, 2013)
91 (deaths to passengers while
not at work)
0.016 deaths (while not at
work)4
United States 1992-2003 (McCann & Zaleski, 2006; excludes 176 work-related deaths occurring outside of the elevator)
68 (deaths to passengers while
at work)
0.02 deaths (while at work)
United States 1997-2006 (McCann & Zaleski, 2006)
56 (deaths to passengers while
not at work
0.02 deaths (while not at
work)
Belgium, 2011 (ELA, 2013) 13 1.3 injuries
Czech Republic, 2010 (ELA, 2013) 2 0.2 injuries
Denmark, 2010 (ELA, 2013) 1 1 0.2 injuries 0.2 deaths
Finland, 2010 (ELA, 2013) 39 7.3 injuries
France, 2011 (ELA, 2013) 270 4.1 injuries
Germany, 2011 (ELA, 2013) 65 2 0.8 injuries 0.025 deaths
Hungary, 2010 (ELA, 2013) 1 0.1 injuries
Italy, 2010 (ELA, 2013) 99 1.6 injuries
Luxembourg, 2009 (ELA, 2013) 1 2 injuries
Norway, 2011 (ELA, 2013) 2 0.4 injuries
Romania, 2010 (ELA, 2013) 11 2 0.5 injuries
1 All severe cases were related to railway incidents (page 8); it can be inferred that there were no fatalities related to elevator incidents 2 National injury estimate: http://www.cpsc.gov/cgibin/NEISSQuery/PerformEstimates.aspx. The code for “Elevators or other lifts (excl. escalators, hoists, jacks, forklifts and automotive lifts)” is 1889 (see NEISS Coding Manual at http://www.cpsc.gov//Global/Neiss_prod/completemanual.pdf) 3 The population number (292,390,920) was obtained by averaging over 2000-2009. 4 The population number (294,012,918) was obtained by averaging over 2000-2010.
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0.09 deaths
Switzerland, 2011 (ELA, 2013) 27 3.5 injuries
Tehran, 1999-2003 (Khaji and Ghodsi, 2014)
63 (“serious injury”)
15 1.73 serious injuries
0.41 deaths5
Greece, 1998–2010 (Zarikas et al., 2013) 52 (34 non-fatal)6
18 0.44 injuries (0.29 non-fatal)
0.15 deaths7
Table 1B Injuries and deaths associated with escalators
Jurisdiction, Year (Reference) Injuries Deaths Rate (Per 1M pop/yr)
Ontario, 2015 (TSSA) 382 0 29.38 injuries
Ontario, 2014 (TSSA) 438 0 33.69 injuries
United States, 2003 (O’Neil et al., 2008) 7,300 24.9 injuries
United States, 1997-June 2010 (McCann, 2013)
39 (deaths to passengers while
not at work)
0.01 deaths8
United States, 2006 (McCann & Zaleski, 2006) 24 0.01 deaths
Unites States, 2014 (CPSC NEISS) 12,7749 40.1 injuries
United States, 2013 (CPSC NEISS) 12,260 39.72 injuries
United Kingdom 2001 (HASS & LASS, 2002) 3,157 53.30 injuries
Switzerland, 2000-2010 (Schminke et al., 2012)
173 2.02 injuries
3.2 Amusement Devices
Benchmarking of amusement devices also presented certain challenges. Primarily, TSSA regulates fixed and traveling rides, including inflatable rides, water slides, go-carts, and ski lifts; this does not appear to reflect the mandate of some international jurisdictions. In the United States, for example, there is federal oversight only for mobile site rides, and none for fixed-site amusement devices (Mikol, 2007). Even though oversight for mobile site rides is conducted by the CPSC, it regulates such a broad set of technologies that little focus can be put on amusement device safety regulations. This can make comparison of the TSSA and CPSC and their associated statistics problematic. State law regulates injury surveillance and dictates the type of information collected, which allows the International Association of Amusements Parks and Attractions to track injury data. However, the outcomes of this surveillance are not released to the public (Mikol, 2007). Most information uncovered discusses amusement device injury in the context of medical case studies, with little data regarding annual incidence and overall risk. European data is presented in a report from the European Commission Directorate-General for Health and Consumer Protection (2005)
5 The population number (7,278,182.5) was obtained by averaging 1996 and 2006 census data (6,758,845 and 7,797,520, respectively). http://www.citypopulation.de/php/iran-tehrancity.php 6 Data from table 7 of the publication: (NIN-no injury; LET-fatal injury) 7 The population number (10,677,920) was obtained by averaging population numbers over 2000-2010 8 The population number (294,012,918) was obtained by averaging over 2000-2010 9 National injury estimate: http://www.cpsc.gov/cgibin/NEISSQuery/PerformEstimates.aspx. The code for escalators is 1890 (see NEISS Coding Manual at http://www.cpsc.gov//Global/Neiss_prod/completemanual.pdf)
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derived from the European Union Public Health Information Network (EUPHIN) database, which tracks emergency room visits resulting from incidents at “Amusement Parks”, including circuses, Tivoli, zoos, animal parks, fairgrounds, and holiday recreation centers. Since the EUPHIN project ended in 2002, this information is somewhat out of date. Table 2 summarizes data on injuries and deaths on amusement rides in Ontario, British Columbia, the United States, and some European countries.
Table 2 Injuries and deaths associated with amusement devices
Jurisdiction, Year (Reference) Injuries Deaths Rate (Per 1M pop/yr)
Ontario, 2015 (TSSA) 519 0 39.92 injuries
Ontario, 2014 (TSSA) 477 0 36.69 injuries
British Columbia, 2014 (BCSA, 2014a10) 11 2.38 injuries
British Columbia, 2013 (BCSA, 2014) 12 0 2.62 injuries
United States, 2006 (CPSC 417 rides) 17,767 59.5 injuries
United States, 2011 (Safety Council, 2011) 1,204 3.86 injuries
Unites States, 2014 (CPSC NEISS) 27,91711 87.55 injuries
United States, 2013 (CPSC NEISS) 27,054 86.19 injuries
United States, 2010 (Woodcock, 2014; analysis based on data from NEISS)
13,770 (reviewed and
revised national estimate)12
44.35 injuries
United States, 2013 (IAAPA, 201413)
1,356 (attendance-
based estimate) 1,221
(ridership-based estimate)
4.7 (per 1M attendance) 0.9 (per 1M
patron-rides)
United States, 2012 (IAAPA, 2014) 1,424 (attendance-
based estimate) 1,347
(ridership-based estimate)
4.6 injuries per 1M attendance 0.9 injuries per 1M patron-rides
United States, 2011 (IAAPA, 2014) 1,204 (attendance-
based estimate)
4.3 injuries per 1M attendance 0.8 injuries per
1M patron-rides
10 page 8 at http://safetyauthority.ca/sites/default/files/sos_2014.pdf 11 National injury estimate: http://www.cpsc.gov/cgibin/NEISSQuery/PerformEstimates.aspx. The code for “Amusement attractions (incl. rides)” is 1293 (see NEISS Coding Manual at http://www.cpsc.gov//Global/Neiss_prod/completemanual.pdf) 12 746 records in the probability sample (used as the basis for the national estimate) were reviewed and 270 were excluded; 476 records were used as the basis of the revised estimate. 13 Fixed-site amusement ride injuries. Data from the IAAPA survey that included amusement and theme parks, tourist attractions, and family entertainment centers.
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1,415 (ridership-based
estimate)
United States, 2010 (IAAPA, 2014) 1,299 (attendance-
based estimate) 1,207
(ridership-based estimate)
4.4 injuries per 1M attendance 0.7 injuries per
1M patron-rides
United States, 2009 (IAAPA, 2014) 1,181 (attendance-
based estimate) 1,086
(ridership-based estimate)
4.4 injuries per 1M attendance 0.6 injuries per
1M patron-rides
United States, 2008 (IAAPA, 2014) 1,523 (attendance-
based estimate) 1,343
(ridership-based estimate)
4.7 injuries per 1M attendance 0.8 injuries per
1M patron-rides
United States, 2007 (IAAPA, 2014) 1,664 (attendance-
based estimate) 1,309
(ridership-based estimate)
4.6 injuries per 1M attendance) 0.7 injuries per
1M patron-rides
United States, 2006 (IAAPA, 2014) 1,797 (attendance-
based estimate) 1,546
(ridership-based estimate)
6.6 injuries per 1M attendance) 0.9 injuries per
1M patron-rides
United States, 2005 (IAAPA, 2014) 1,783 (attendance-
based estimate) 1,713
(ridership-based estimate)
5.2 injuries per 1M attendance 0.9 injuries per
1M patron-rides
United States, 2004 (IAAPA, 2014) 1,637 (attendance-
based estimate) 1,648
(ridership-based estimate)
5.2 injuries per 1M attendance) 0.9 injuries per
1M patron-rides
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United States, 2003 (IAAPA, 2014) 2,044 (attendance-
based estimate) 1,954
(ridership-based estimate)
7.0 injuries per 1M attendance) 1.0 injuries per
1M patron-rides)
United States, 2013 (CPSC, 2015) 17,377 (estimated
number of ED-treated injuries
for inflatable amusements)
55.15 injuries
United States, 2012 (CPSC, 2015) 18,841 (same as above)
60.03 injuries
United States, 2011 (CPSC, 2015) 14,492 46.27 injuries
United States, 2010 (CPSC, 2015) 13,470 43.42 injuries
United States, 2009 (CPSC, 2015) 10,554 34.35 injuries
United States, 2008 (CPSC, 2015) 7,470 24.59 injuries
United States, 2007 (CPSC, 2015) 8,348 27.72 injuries
United States, 2006 (CPSC, 2015) 5,938 19.90 injuries
United States, 2005 (CPSC, 2015) 5,371 18.16 injuries
United States, 2004 (CPSC, 2015) 6,101 20.82 injuries
United States, 2003 (CPSC, 2015) 5,311 18.29 injuries
United States, January 2003 to December 2013 (CPSC, 2015)
12 (reported deaths)
0.0036 deaths14
United States, 2011 (International Association of Amusement Parks and
Attractions, 2011)
1415 (61 hospitalizations)
4.58 injuries
Canada, 1990-2009 (McFaull and Keays, 2013)
674 (CHIRPP surveillance
data on injuries associated with
inflatable amusement structures)
Not calculated15
Austria, 2001 (DG for Health and Consumers, 2005)
240 29.99 injuries
Belgium, 2001 (DG for Health and Consumers, 2005)
1,880 188 injuries
Denmark, 2001 (DG for Health and Consumers, 2005)
1,250 234.52 injuries
Finland, 2001 (DG for Health and Consumers, 2005)
340 65.75 injuries
14 The population number (303,828,782) was obtained by averaging over 2003-2013 15 CHIRPP is not population-based; data are collected from all 11 pediatric and 4 general hospitals across Canada
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France, 2001 (DG for Health and Consumers, 2005)
960 16.34 injuries
Germany, 2001 (DG for Health and Consumers, 2005)
5,400 65.72 injuries
Greece, 2001 (DG for Health and Consumers, 2005)
1,180 111.8 injuries
Ireland, 2001 (DG for Health and Consumers, 2005)
180 47.66 injuries
Italy, 2001 (DG for Health and Consumers, 2005)
720 12.48 injuries
Luxembourg, 2001 (DG for Health and Consumers, 2005)
30 68.85 injuries
Netherlands, 2001 (DG for Health and Consumers, 2005)
625 39.4 injuries
Portugal, 2001 (DG for Health and Consumers, 2005)
2,400 235.34 injuries
Spain, 2001 (DG for Health and Consumers, 2005)
110 2.77 injuries
United Kingdom, 2001 (DG for Health and Consumers, 2005)
2,860 47.97 injuries
3.3 Ski Lifts
Data on ski lift risk in international jurisdictions was perhaps the most difficult to find. Academic data dealt almost exclusively with the risks associated with skiing and snowboarding, with little consideration of those arising from the lifts. Most data on ski lift risk is anecdotal in nature, with no mention of annual statistics. The few identified publications dealing with injury and fatality figures rely on long-term trends, as the yearly number of incidents is too low to be used directly. Further, data for most of the United States was difficult to acquire, as passengers falling out of chairlifts – one of the key sources of ski lift injury – is not usually recorded by state regulatory agencies; Colorado is one exception, being required to report falls resulting in injury to the Colorado Passenger Tramway Board (NSAA, 2012). As an example of how many injuries might be excluded by neglecting falls from chairlifts, 227 falls resulting in injury were recorded over an 11-season period in Colorado; 196 (86%) of these were attributed to skier error (NSAA, 2012). That other states might overlook these incidents could call into question state and national estimates for risk associated with ski lifts. Table 3 shows available data on injuries and deaths associated with ski lifts.
Table 3. Injuries and deaths associated with ski lifts.
Jurisdiction, Year (Reference) Injuries Deaths Rate (Per 1M pop/yr)
Ontario, 2015 (TSSA) 49 0 3.77 injuries
Ontario, 2014 (TSSA) 65 0 5.00 injuries
British Columbia, 2009 to June 2014 (BCSA, 2014a)
1116 0 0.44 injuries17
16 Table 7.1-1 on p. 48 17 The population number (4,500,175) was obtained by averaging across 2009-2013
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Deropement incidents on passenger ropeways
British Columbia, 2013 (BCSA, 2014) “Passenger ropeways”:
includes tramways, gondolas, chairlifts, rope tows and passenger conveyors
27 5.89 injuries
Unites States, 2014 (CPSC NEISS) 817+ (sample count) 18
United States 1973-Oct 2014 (NSAA, 2014)19
0.293 (average annual # of passenger fatalities)20
0.001 deaths21
United States 1973-2012 (NSAA, 2012) 0.33 0.001 deaths
New Zealand 2000-2005 (Smartt & Chalmers, 2009; injuries resulting in
hospitalization)
44 (7.33/year) 1.78 injuries
Colorado 2001-2012 (injuries from falls from lifts) (NSAA, 2012)
227(18.92/year) 3.97 injuries
3.4 Boilers and Pressure Vessels
Injuries associated with these devices occur mostly in occupational settings. As members of the public are not usually in the plants containing the boilers and pressure vessels, their exposure is limited. Data on injuries and deaths from incidents with boilers and pressure vessels are summarized in Table 4. . Note that rates are not calculated as numbers reported cover very different population sizes.
Table 4. Injuries and deaths associated with boilers and pressure vessels.
Jurisdiction, Year (Reference) Injuries Deaths Rate (Per 1M pop/yr)
Ontario, 2015 (TSSA) 0 0 0 injuries
Ontario, 2014 (TSSA) 0 0 0 injuries
British Columbia, 2014 (BCSA, 2014a) (includes boiler, pressure vessel, and
refrigeration incidents)
022 0
18 Sample count from: http://www.cpsc.gov/cgibin/NEISSQuery/PerformEstimates.aspx. The code for ski lifts is 3283 (see NEISS Coding Manual at http://www.cpsc.gov//Global/Neiss_prod/completemanual.pdf). NEISS Injury data are gathered from emergency departments of 100 hospitals selected as a probability sample of over 5000 hospitals with emergency departments. Numbers for injuries associated with ski lifts were not extrapolated to give a national estimate 19 NSAA Ski Lift Safety Fact Sheet. October 31, 2014. http://www.nsaa.org/media/214677/Lift_Safety_Fact_Sheet_10_31_14.pdf 20 12 injuries during a 41-year period 21 The population number (298,307,193.5) was obtained by averaging over 2000-2013 22 The four injuries reported in 2014 were from exposure to ammonia in refrigeration (see pages 8 and 22)
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British Columbia, 2013 (BCSA, 2014) (includes boiler, pressure vessel, and
refrigeration incidents)
22 0
Unites States, 2014 (CPSC NEISS) 36+ (sample count) 23
United States 2013 (CPSC NEISS) 26+24
3.5 Carbon Monoxide Poisoning (Fuels)
Carbon monoxide (CO) is a colourless and odourless gas that results from incomplete combustion of
fuels (e.g., natural gas, gasoline, oil, wood, coal). People can be exposed to CO in a domestic
settings and at work from furnaces, cooking appliances, water heaters, space heaters, boilers,
motor vehicles, generators and other tools or equipment that burn fuel. During winter months, the
use of heaters increases. If not functioning or ventilated properly, heaters can release high amounts
of CO. CO binds to hemoglobin at a rate 200-250 times greater than oxygen and significantly
reduces the oxygen-carrying capacity of blood. Exposure to relatively small amounts of CO in the air
can disrupt oxygen transport in the body and cause tissue hypoxia (inadequate oxygen supply). At
low CO concentrations, signs and symptoms of intoxication (headache, dizziness, and nausea) are
nonspecific and can be attributed to other causes. At very high concentrations, CO poisoning results
in unconsciousness and death (CDC, 2005; de Juniac et al., 2012; Henn et al., 2013). Children,
pregnant women, and people with pre-existing diseases, such as ischemic heart disease or chronic
obstructive pulmonary disease, are at higher risk of a severe outcome (Harduat-Morano and
Watkins, 2011).
TSSA's Fuels Safety Program regulates the transportation, storage, handling and use of natural gas,
propane, butane, hydrogen, digester gas, landfill gas, fuel oil, gasoline, and diesel25. Information on
CO poisonings associated with these fuels was, therefore, of primary interest. However, we also
included data on all unintentional non-fire related poisonings as a group, even though a fraction of
unintentional non-fire-related poisoning cases may be associated with burning of solid fuels (e.g.,
coal, wood).
As risk factors for CO poisoning change over time, only data for 2000 and later years were collected. Publications that include earlier data were disregarded. If a publication contains recent data and data for earlier periods, both were extracted into the Appendix D table.
The following reports were excluded:
23 Sample count from: http://www.cpsc.gov/cgibin/NEISSQuery/PerformEstimates.aspx. The code for boilers is 308 (see NEISS Coding Manual at http://www.cpsc.gov//Global/Neiss_prod/completemanual.pdf). NEISS Injury data are gathered from emergency departments of 100 hospitals selected as a probability sample of over 5000 hospitals with emergency departments. Numbers for injuries associated with boilers were not extrapolated to give a national estimate 24 As with all NEISS Injury data are gathered from emergency departments of 100 hospitals selected as a probability sample of over 5000 hospitals with emergency departments. Numbers were not extrapolated to give a national estimate 25 Information from Technical Standards & Safety Authority (TSSA) at https://www.tssa.org/regulated/fuels/Default.aspx
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intentional CO poisonings or poisonings of unknown intent;
fire-related poisonings or poisonings with unknown relatedness to fire;
CO poisonings during power outages related to natural disasters;
Jurisdiction associated with the poisoning is not sufficiently clear to allow for an estimate of the source population such that rate calculations are not possible.
Data on injuries and deaths from CO poisoning are summarized in Table 5. More details can be
found in Appendix D. Identified articles include data on injuries/deaths from CO poisoning
associated with the use of gas, petrol26/diesel, oil, and with the use of consumer products.
However, in most analyzes, all unintentional non-fire-related CO poisonings were combined. The
contribution of poisonings associated with burning of solid fuel is unknown in these cases. The
contribution of CO poisonings from solid fuels may change over time and differ from population to
population. According to data from the UK (Co-Gas Safety, 2012), 30% of deaths (average) from
unintentional CO poisoning in 1995-2012 were related to burning of solid fuel. There appears to be
a trend towards a decrease in the proportion of deaths from CO poisonings associated with solid
fuel. In the US (CPSC 2014a), the estimated number of carbon monoxide deaths associated with the
use of consumer products was 156 for the period 2009-2011. Of these, only 13 (8%) were from
burning solid fuel and 6 (4%) were from burning unspecified fuel.
Some reports include a very detailed breakdown of cases by type of device/fuel used. It was not possible to extract data at this level of details.
Table 5. Annual rates of injuries and deaths from CO poisoning27
Jurisdiction Year Rate (per 1M per year) Reference
Injury Death
Incident associated with gas
Ontario, 2015 (TSSA)
2015 2.56 0.21 TSSA, 2015
Ontario, 2014 TSSA
2014 2.79 0.24 TSSA, 2014
British Columbia 2013 3.27 (non-fatal) 0.87 BC Safety Authority, 2014
British Columbia 2007-2013 3.53 (non-fata) 0.29 BC Safety Authority, 2014a
UK28 2010-2011 No data 0.29 Co-Gas Safety, 2013
UK 29 1996-2007 No data 0.3530 de Juniac et al., 2012
Great Britain 2012-2013 5.05 0.1531 Cross Government Group on Gas Safety and Carbon Monoxide (CO) Awareness Annual Report 2013-2014
26 “Gasoline” in the U.S. 27 This table includes data for the most recent year for which it is believed the data are fairly complete. More information (injuries and deaths by year, season, gender, age, circumstances etc.) can be found in Appendix D 28 Data for mains and portable gas combined 29 Data for liquefied petroleum gas and mains gas combined 30 Population average for 2000-2007 (60,141,183) was used for calculation of rates. 31 The population estimate for 2012 was used to calculate rates.
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Jurisdiction Year Rate (per 1M per year) Reference
Injury Death
US32 2009-2011 No data 0.18 Consumer Product Safety Commission (CPSC), 2014a
Incident associated with oil
UK 2010-2011 No data 0 Co-Gas Safety, 2013
US 2009-2011 No data 0.006 Consumer Product Safety Commission (CPSC), 2014a
UK 1996-2007 No data 0.00433 de Juniac et al., 2012
Incident associated with petrol/diesel
UK 2010-2011 No data 0.06 Co-Gas Safety, 2013
US 2009-2011 No data 0.22 Consumer Product Safety Commission (CPSC), 2014a
Incident associated with generators and other engine-driven tools
US 2004-2013 No data 0.34 Consumer Product Safety Commission (CPSC), 2014c
US 1999-2012 No data 0.2434 Consumer Product Safety Commission (CPSC), 2013
Unintentional non-fire related poisonings
UK 2007 No data 0.46 de Juniac et al., 2012
England and Wales 2012 No data 0.4435 Fisher et al., 2014
England 2001-2010 4.9 (hospitalizations)36
No data Ghosh et al., 2015
US 2004-2006 70 (ED visits) 6 (hospitalizations)37
No data Centers for Disease Control and Prevention (CDC), 2008
US 2001-2003 (injuries) 2001-2002 (deaths)
52.7 (ED visits) 5.8 (hospitalizations)
1.738 CDC, 2005
US 1999-2004 No data 1.5339 CDC, 2007
US 2005 14.240 (hospitalizations)
No data Iqbal et al., 2010
US 2007 71 (ED visits) 8 (hospitalizations41
No data Iqbal et al., 2012ab
2009 No data 1.4342
32 Data for natural, liquid petroleum and unspecified gas combined 33 Population average for 2000-2007 (60,141,183) was used for calculation of rates 34 Population average over 2000-2012 35 Rate calculated by the study authors 36 Rate calculated by the study authors 37 Rates calculated by the study authors 38 Rates calculated by the study authors 39 Rate calculated by the study authors 40 Rate calculated by the study authors 41 Rates calculated by the study authors 42 Rate calculated by the study author
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Jurisdiction Year Rate (per 1M per year) Reference
Injury Death
US, Minnesota 2007 64.4 (ED visits) 5.4 (hospitalizations)
1.743 Minnesota Environmental Public Health Tracking, 2009
US, Florida 2005-2007 (ED visits) 1999-2007 (hospitalizations and deaths)
14.2 (ED visits) 3.2 (hospitalizations)
1.544 Harduar-Morano and Watkins, 2011
US, Maine 2000-2003 (ED visits) 1999-2003 (hospitalizations and deaths)
86 (ED visits) 7 (hospitalizations)45
2 deaths were identified; rate not calculated
Graber and Smith 2007
US, Michigan 2013 No data 2.63 Michigan Department of Health and Human Services, 2015
Iran, Tabriz 2007-2009 346 28 Dianat and Nazari 2011
Iran, East Azerbaijan province
2003-2008 171 19 Nazari et al., 2010
Non-fire related occupational fatalities
U.S. 1992-2008 No data 0.17 per 1M full-time equivalent workers per year46
Henn et al., 2013
Unintentional non-fire related exposures (poison control center calls)
US 2000-2009 23.247 CDC, 2011
US, Minnesota 2007 103.648 Minnesota Environmental Public Health Tracking, 2009
As discussed in several publications, in particular by Ghosh et al., 2015, the number of cases of CO
poisoning may be underestimated as a result of:
misdiagnosis due to the nonspecific symptoms;
non-confirmation of diagnosis on hospital records and death certificates due to lack of awareness of CO poisoning by clinicians;
short half-life of CO in blood (4-6 h); confirming CO exposure is difficult if blood testing was delayed.
43 Rates calculated by study authors 44 Rates calculated by study authors 45 Rates calculated by study authors 46 Rate calculated by study authors 47 Rate calculated by study authors 48 Rate calculated by study authors
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Estimates based on hospital administrative records are limited to exposures treated within the
health-care system. Cases managed at the site of exposure and not treated at a health-care facility
cannot be identified from these sources (CDC 2011).
On the other hand, there exist a possibility of overestimating the number of unintentional
poisonings: exclusion of injuries/deaths related to self-harm may not be complete due to
underreporting of self-harm (Cross Government Group on Gas Safety and Carbon Monoxide
Awareness, 2014).
Time trends observed in the data, especially increases seen in more recent years compared with
previous years, should be interpreted with caution. Although reasons are not clear, improved
reporting or better case ascertainment might account for apparent increases (Minnesota
Environmental Public Health Tracking, 2009).
There are significant constraints on the comparability of collected data. The characteristics that may
differ among data sets include:
Different sources of information on CO poisoning: media reports, data on emergency department (ED) visits or hospitalizations from hospitals or other public health databases, data on CO exposures from poison centers. Analyses of hospital admissions characterize more severe poisonings than those based on ED visits. Data from poison centers include individuals treated at a health-care facility and those who did not seek medical care. According to CDC (2011), 45% of CO exposures reported to the National Poison Data System (NPDS) in 2000-2009 were managed at the site of exposure. These would not have been identified through health care records. The sources of information on CO poisoning are described in Figure 1 (copied from Iqbal et al., 2012).
Population distribution by age and gender. Generally, there are more CO exposures and more emergency department visits among females but the rates of hospitalization and death are higher in males (Harduar-Morano and Watkins, 2011; Iqbal et al., 2012a). Reasons for these differences are unclear. Males may be exposed to higher CO levels or more vulnerable to CO than women (Fisher et al., 2014). Older individuals tend to be more frequently hospitalized for CO poisoning.
Populations of different ethnicity and/or socio-economic status differ in terms of heating and cooking practices and risk factors for CO poisoning (Ghosh et al., 2015)
Region-specific risk factors (Harduar-Morano and Watkins, 2011)
Possible inter-population differences in accuracy of diagnosis, recording and coding of morbidity and mortality data (Ghosh et al., 2015)
Analyses based on actual numbers of injuries/deaths or estimates based on a population sample (e.g., CDC, publications).
Column “Injuries” in the table may or may not include fatal cases. In some studies, fatalities are excluded from the number of injuries (e.g., BC Safety Authority, 2013; Cross Government Group on Gas Safety and Carbon Monoxide Avareness, 2014; Harduar-Morano and Watkins, 2011; CDC, 2005, 2008). In other studies, it was not possible to separate fatal
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from non-fatal poisonings, and the number in the column includes both (Ghosh et al., 2015). In some cases it is unclear whether the reported numbers of hospitalizations/emergency department visits include fatal cases (e.g., Minnesota Environmental Public Health Tracking, 2009). The US National Poison Data System (NPDS) reports data on CO exposures regardless of whether or not any health effect was observed (e.g., CDC, 2011).
Figure 1. Diagram copied from Figure 2 of Iqbal et al., 2012 representing the national surveillance framework for unintentional, non-fire-related CO poisoning in the United States
4. Discussion
The summary tables show broad variation in jurisdictional safety performance. Potential reasons for this variations are discussed below. Two likely sources of variation are differences in regulatory and performance reporting requirements, as these can affect both the safety of TSSA-mandated technologies as well as the quality and transparency of safety data. This section will examine key distinctions arising in these areas, concluding with a discussion of the usefulness of benchmarking exercises in light of the potential confounding factors.
4.1 Regulatory Variation
One of the key sources of variation relates to inspection requirements for TSSA-regulated technologies. Inspection intervals, for example, are often not specified in regulatory documents, including the Technical Standards and Safety Act. This creates the potential for broad variation in the periodicity of inspection, which can impact the safety of these technologies. Some jurisdictions, such as the New York City Department of Buildings Elevator Division (2011), specify that inspections
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must be performed and filed between January 1st and December 31st of each calendar year, subject to penalties and fines. It is difficult, however, to ascertain the impact of such requirements.
Further, there are certain subtle differences in some jurisdictions that are not discussed in publicly available, sector-specific regulatory documents. In New York City, for example, all wheelchair lifts in residential and/or commercial properties are required to perform annual inspection. Residential properties are not required to submit the inspection/test results to the Elevator Division, but building owners must keep and be able to produce upon request a lift maintenance log. Meanwhile, wheelchair lifts in commercial properties are required to submit to the Elevator Division the inspection/test results (New York City Department of Buildings Elevator Division, 2011, page 18). It is difficult to ascertain whether such distinctions exist in other jurisdictions as they are often not discussed.
Difficulties in comparing regulatory regimes are greater in the European Union, due to an umbrella Directive that still allows cross-jurisdictional variation. The European Lift Directive approximates the laws of the Members States and covers legal requirements for lift design, installation, and inspection. However, the Member States of the EU implement the Directive in their national laws, in some cases with subtle changes that may have important implications for lift safety. Such a possibility has yet to be explored in research.
In summary, no jurisdiction was found that had a regulatory mandate identical to that of TSSA. As a result, efforts were made to identify analogous organizations. This produced a list of organizations that were mandated to ensure the safety of at least one technology for which TSSA is responsible (elevating devices, amusement devices, or ski lifts). Further challenges relate to subtle variations in regulatory requirements which have not been sufficiently studied to allow comment on their impact. In light of such variation, it is difficult to conduct a robust benchmarking exercise, as confounding factors and uncertainty limit the confidence with which the apparent variations in safety performance can be attributed to regulatory requirements.
4.2 Performance Reporting Variation
Differences in performance reporting requirements represent another key confounding factor in this benchmarking exercise. In this regard, the TSSA tends to surpass its jurisdictional counterparts. The TSSA Chief Safety and Risk Officer is mandated to prepare an annual report, in addition to any reports that may be requested by the Board of Directors; all of these reports are made publicly available. Such requirements support regular monitoring of TSSA-mandated technology safety performance, as well as public transparency. Many analogous organizations, particularly those in South America and most of Asia, have no such requirements, which explains the absence of performance data from those countries.
Further, among those jurisdictions that do publicly report performance data, there is a wide variation in the type of data collected and how it is presented, making comparisons difficult. Norway, for example, monitors deaths from Accidental Falls and Other Accidents, but does not seem to specify how many of those injuries are due to elevating devices, ski lifts, or amusement devices. At the same time, the United States Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System (NEISS) tracks injuries from a range of technologies, including those mandated by TSSA. However, national estimates are based on injury data from a small sample of hospitals, meaning figures are subject to uncertainty and are reliant on the need for hospitalization. The International Association of Amusement Parks and Attractions, responsible for
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annual surveillance of amusement ride-related injury in the United States, does not release the outcomes of their surveillance for public scrutiny (Mikol, 2007). Further, state law regulates injury surveillance and dictates the type of information that is collected, so data collection can vary anywhere from the state to individual park level. For these reasons, it is difficult to draw conclusions regarding the implications of TSSA injury statistics in relation to other jurisdictions, as it is unknown whether they are ultimately measuring the same phenomena. An expectation that they are not measuring the same phenomena may be the best choice of a default assumption.
TSSA performance data are also more detailed than those from most other organizations. This is due to the annual surveillance, monitoring, and evaluation being conducted, as well as due to categorization of injury data into “permanent injury” and “non-permanent injury”. This allows a measure of injury severity in the case of an accident, which appears to be absent from most other jurisdictional performance reporting. The same is true for reporting on incident causality, as very few international jurisdictions participate in or publish the results of this type of analysis. Those few that do include some data on causes of injury, such as the National Ski Areas Association, often limit their reporting by concluding that the majority of incidents are the result of user error, and provide little or no information or analysis beyond this. Perhaps most important, though, is the exclusion of injuries from certain types of technologies; most notably the exclusion by some agencies of injuries arising from escalators, focusing solely on those from elevators, which are much more rare. Such a difference will contribute to lowering the apparent elevating device injury rates dramatically compared to those of TSSA, which monitors and reports injuries from both sources.
In sum, jurisdictions continue to have such a wide variety of requirements and protocols for performance monitoring, evaluation, and reporting that it is difficult to ascertain whether differences observed in the summary statistics are the result of regulatory variation or of different performance reporting practices. This key confounding variable makes it very difficult to draw meaningful conclusions about the cause of differential injury rates in various jurisdictions.
4.3 Usefulness of Performance Benchmarking
The previous discussion would suggest that there are certain challenges and confounding variables inherent in any benchmarking exercise in this field which make it very difficult to draw meaningful conclusions from the findings. There are too many regulatory variations to control for measuring the impact of one key approach, and performance-reporting protocols differ substantially across jurisdictions. Further, very few organizations keep robust, publicly available annual injury statistics, as evident by the lack of new information since the previous ASPR report. In light of this, a key recommendation arising from this report is to develop a stronger cross-jurisdictional collaboration and associated technical infrastructure in order to facilitate inter-jurisdictional communication and harmonization.
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Appendix A - Relevant search terms.
Main Search Term/Phrase Partnered Search Term(s)
Elevat* device, elevator, escalator, lift And accident, death, fatal*, motalit*, morbidit*, injur*, incident,
And surveillance, data, stat*, monitor*, safety
Amusement rides, amusement parks, amusement attractions
And (as above)
Ski lift, chairlift And (as above)
Boiler, pressur* vessel* And (as above)
Fuel, carbon monoxide, gas And (as above)
Carbon monoxide poisoning/statistics and numerical data [MeSH Terms]
--
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Appendix B - List of organizations with mandates similar to that of TSSA
Organization Name Jurisdiction Mandate of Interest
Consumer Product Safety Commission
United States Elevating devices and amusement rides
New York City Department of Buildings Elevator Division
New York City, USA Elevating devices
Illinois Office of the State Fire Marshal
Illinois, USA Elevating devices
European Lift Directive Members of the European Union
Elevating devices
European Lift Association Members of the European Union
Elevating devices
Lift and Escalator Industry Association
United Kingdom Elevating devices
Health and Safety Executive United Kingdom Elevating devices
Safety Assessment Federation United Kingdom Elevating devices
Japan Elevator Association Japan Elevating devices
Korean Elevator Safety Institute
South Korea Elevating devices
Lift and Elevator Contractors and Manufacturers
Association
Singapore Elevating devices
Saferparks.org United States Amusement devices
International Association of Amusement Parks and
Attractions
United States Amusement devices
Bureau of Fair Rides Inspection Florida, USA Amusement devices
Rideaccidents.com United States Amusement devices
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European Union Public Health Information Network
Member States of the European Union
Amusement devices
National Ski Areas Association United States Ski lifts
Colorado Passenger Tramway Board
Colorado, USA Ski lifts
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Appendix C - Population estimates for jurisdictions of relevance
Jurisdiction, Year Population Source
Ontario, 2013 13,538,000 Link
Austria, 2001 8,032,857 Link
Belgium, 2001 10,258,760 Link
Belgium, 2010 10,423,490 Link
British Columbia, 2013 4,581,978 Link
British Columbia, 2014 4,631,302 Link
British Columbia, 2009-2013 (average)
4,500,175 Link
British Columbia, 2007-2013 (average)
4,448,753 Link
Colorado, USA, 2001-2012 (average)
4,763,742 Link
Czech Republic, 2010 10,201,710 Link
Denmark, 2001 5,352,815 Link
Denmark, 2010 5,515,575 Link
Finland, 2001 5,175,783 Link
Finland, 2010 5,255,068 Link
France, 2001 59,551,230 Link
France, 2011 65,312,250 Link
Germany, 2001 83,029,540 Link
Germany, 2011 81,471,830 Link
Great Britain (England, Scotland and Wales), 2012
61,881,400 Link
Greece, 2001 10,623,840 Link
Benchmarking Risk of Injury and Death from TSSA-Regulated Activities against Other Jurisdictions
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Greece, 2000-2010 (average) 10,677,920 Link
Hungary, 2010 9,992,339 Link
Iran, Tabriz 1,580,000 Population estimate from the publication (Dianat and
Nazari 2011)
Iran, East Azerbaijan province 3,600,000 Population estimate from the publication (Nazari et al.,
2010)
Ireland, 2001 3,840,838 Link
Luxembourg, 2001 442,972 Link
Luxembourg, 2009 491,775 Link
Michigan, 2013 9,895,622 Link
Netherlands, 2001 15,981,470 Link
New Zealand, 2000-2005 (average)
3,928752 Link
Norway, 2011 4,691,849 Link
Portugal, 2001 10,066,250 Link
Romania, 2010 21,959,280 Link
Spain, 2001 40,038,000 Link
Switzerland, 2000-2010 (average)
7,454,048 Link
Switzerland, 2011 7,639,961 Link
Tehran, 1996 and 2006 census data (average)
7,278,182.5 Link
United Kingdom, 2001 59,647,790 Link
United Kingdom, 2011 62,698,360 Link
United Kingdom, 2007 60,776,240 Link
Benchmarking Risk of Injury and Death from TSSA-Regulated Activities against Other Jurisdictions
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United Kingdom, 2010-2011 (average)
62,523,405 Link
United Kingdom, 2000-2007 (average)
60,141,183 Link
United States, 2003 290,342,600 Link
United States, 2004 293,027,600 Link
United States, 2005 295,734,100 Link
United States, 2006 298,444,200 Link
United States, 2007 301,139,900 Link
United States, 2008 303,824,600 Link
United States, 2009 307,212,100 Link
United States, 2010 310,232,900 Link
United States, 2011 313,232,000 Link
United States, 2012 313,847,500 Link
United States, 2013 315,079,109 Link
United States, 2014 318,881,992 Link
United States, 2000-2009 (average)
292,390,920 Link
United States, 2000-2010 (average)
294,012,918 Link
United States, 2003-2013 (average)
303,828,782 Link
United States 2004-2013 305,177,401 Link
United states, 2000-2012 (average)
297,017,046 Link
United States, 2000-2013 (average)
298,307,194 Link
Benchmarking Risk of Injury and Death from TSSA-Regulated Activities against Other Jurisdictions
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United States, 2009-2011 (average)
309,305,333 Tables B1-B5 at: Link
United States, 2004-2012 304,077,211 Link
Wales, 2012 3,100,000 Link
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Appendix D - Studies of injuries/deaths from carbon monoxide poisoning
Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
British Columbia
BC Safety Authority, 2014
2013 Gas-related incidents
15 (major non-fatal) 4 Major non-fatal injuries: 3.27
Deaths: 0.87
Dara from table A-3 Gas Incidents at http://www.safetyauthority.ca/sites/default/files/state_of_safety_2013_728_28may2014.pdf
Population estimates: http://www.bcstats.gov.bc.ca/StatisticsBySubject/Demography/PopulationEstimates.aspx
Data for the 6-year period (2007-2012) were also analyzed; these data are not extracted here because they are part of the 2007-2013 data below.
British Columbia
BC Safety Authority, 2014a
2007-2013 Gas-related incidents
110 (non-fatal) 9 Non-fatal injuries: 3.53
Deaths: 0.29
See pages 31-33 and table A4-1 at http://safetyauthority.ca/sites/default/files/sos_2014.pdf
Population estimates: as above (4,448,753 averaged over 2007-2013)
“Carbon monoxide incident investigations represent 62 of the 426 gas related incidents investigated by BCSA’s safety officers.”
62 incidents 49
By source of CO50
49 One incident may involve more than one person 50 “Some investigations identified multiple appliances that may have produced CO, yet did not confirm which was most likely the CO source; therefore, the total number of appliances exceeds the number of events.”
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
Furnace: confirmed CO source-23, possible CO source – 6
Water heater: confirmed -11, possible – 5
Boiler: confirmed -11, possible -3
Fireplace: confirmed -3, possible -1
Stove or range: confirmed -1 possible-3
Heating unit: confirmed 2, possible -1
Air handling unit confirmed -2, possible -1
Refrigerator: confirmed-3
Generator: confirmed – 1
Lantern: possible -1
Investigated incidents by location
Residential: 51 (single-family-38, multi-family-10, non-primary e.g., cabin -3)
Non-residential: 11 (commercial -7, converted trailer – 2, camperized van – 1, industrial -1)
By causes and contributing factors:
Ventilation and inability to vent combustion products -20
Service, maintenance and/or equipment replacement – 11
Equipment or component failure -9
Installation issues -8
Investigations were inconclusive – 5
Unqualified persons performing regulated work – 4
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
Unsafe use of equipment -3
Poor air-gas ratio -4
Wind creating a downdraft -1
UK
Co-Gas Safety, 2013
1999/200051 Gas Mains No data 17 0.29 Data on deaths: http://www.co-gassafety.co.uk/downloads/2013/Statistics%20Sheet%20for%20press%20pack%20page%2013%20onwards%20for%20Kadee.pdf
Population estimates are available from 2000 to 2012: http://www.indexmundi.com/g/g.aspx?v=21&c=uk&l=en
Population estimates for 2000 were used to calculate rates for 1999/2000
Deaths related to CO poisoning from use of solid fuel are also reported. These numbers range from 3 in 2003-2004 to 19 in 2000-2001
As discussed by de Juniac et al., 2012 (see below), data in the Co-Gas Safety database “are primarily compiled from a ‘cuttings and media’ service and the database is an incomplete record of all deaths.”
Gas Portable No data 10 0.17
Petrol52/diesel No data 4 0.07
Oil No data 0 0
2000/01 Gas Mains No data 18 0.31
Gas Portable No data 5 0.08
Petrol/diesel No data 3 0.05
Oil No data 0 0
2001/02 Gas Mains No data 6 0.10
Gas Portable No data 6 0.10
Petrol/diesel No data 6 0.10
Oil No data 0 0
2002/03 Gas Mains No data 12 0.20
Gas Portable No data 7 0.12
Petrol/diesel No data 4 0.07
Oil No data 0 0
2003/04 Gas Mains No data 10 0.17
Gas Portable No data 8 0.13
Petrol/diesel No data 2 0.03
Oil No data 0 0
51 Year from 1 April to 31 March 52 “Gasoline” in the U.S.
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
2004/05 Gas Mains No data 13 0.22
Gas Portable No data 2 0.03
Petrol/diesel No data 2 0.03
Oil No data 0 0
2005/06 Gas Mains No data 9 0.15
Gas Portable No data 8 0.13
Petrol/diesel No data 2 0.03
Oil No data 0 0
2006/07 Gas Mains No data 10 0.16
Gas Portable No data 3 0.05
Petrol/diesel No data 8 0.13
Oil No data 0 0
2007/08 Gas Mains No data 12 0.20
Gas Portable No data 5 0.08
Petrol/diesel No data 7 0.11
Oil No data 1 0.02
2008/09 Gas Mains No data 14 0.23
Gas Portable No data 5 0.08
Petrol/diesel No data 2 0.03
Oil No data 1 0.02
2009/10 Gas Mains No data 8 0.13
Gas Portable No data 4 0.06
Petrol/diesel No data 8 0.13
Oil No data 1 0.02
2010/11 Gas Mains No data 12 0.19
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
Gas Portable No data 6 0.10
Petrol/diesel No data 4 0.06
Oil No data 0 0
2011/1253 Gas Mains No data 1 0.02
Gas Portable No data 1 0.02
Petrol/diesel No data 3 0.05
Oil No data 0 0
Great Britain (England, Scotland and Wales)
Cross Government Group on Gas Safety and Carbon Monoxide (CO) Awareness Annual Report 2013-2014
Report date: November 2014
2009/2010 Supply and use of flammable gas
292 (non-fatal) 9 4.87 non-fatal injuries/0.15 deaths
Data on CO poisoning injuries/deaths: http://www.hse.gov.uk/Gas/domestic/cross-government-group-1314.pdf
Source of information on injuries/deaths: RIDDOR - Reporting of Injuries, Diseases and Dangerous Occurrences Regulations. “The Regulations apply to events, which arise out of or in connection with work activities covered by the Health & Safety at Work etc Act 1974. The Regulations require gas conveyors and LPG suppliers to report incidents where someone has died, lost consciousness, or been taken to hospital for treatment to an injury where gas is likely to be a cause.”
2009/2010 and 2010/2011: Population estimate of Northern Ireland (approximated as 1,814, 000) was
2010/2011 368 (non-fatal) 13 6.06 injuries/0.21 deaths
2011/2012 226 (non-fatal) 3 3.66 injuries/0.05 deaths
2012/2013 313 (non-fatal) 9 5.05 injuries/0.15 deaths
2013/201454 316 (non-fatal) 3 5.11 injuries/0.05 deaths
53 Fewer cases than in the previous years; data may be incomplete. 54 Data may be incomplete
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
subtracted from the UK population estimates.
UK estimates: http://www.indexmundi.com/g/g.aspx?v=21&c=uk&l=en
Northern Ireland estimate: http://www.ons.gov.uk/ons/dcp171778_320900.pdf
2011/2012, 2012/2013 and 2013/2014: population estimates of Great Britain from http://www.ons.gov.uk/ons/dcp171778_320900.pdf
The mean values of the 2009-2010, 2010-2011, 2011-2012 population estimates were used to calculate rates. The population estimate for 2012 was used to calculate rates for 2012/13 and 2013/14
UK
de Juniac et al., 2012
1996 Unintentional, non-fire related
No data 74 http://www.ncbi.nlm.nih.gov/pubmed/22175228
Population estimates: http://www.indexmundi.com/g/g.aspx?v=21&c=uk&l=en
In this article, numbers of deaths obtained from Co-Gas Safety Society database are reported by year (similar to the data extracted from the Co-Gas Statistics above), month, age, type of fuel, source, housing type.
1997 No data 43
1998 No data 56
1999 No data 48
2000 No data 48 0.81
2001 No data 30 0.50
2002 No data 22 0.37
2003 No data 28 0.47
2004 No data 23 0.38
2005 No data 22 0.36
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
2006 No data 40 0.66 The study “did not attempt to estimate absolute rates, instead it focusses on patterns within the sample.”
The authors concluded:
- The number of unintentional non-fire related deaths fell between 1996 and 2000 and then stabilized.
- A ‘November spike’ in boiler-related deaths was evident between 1996 and 2000 but not in later years.
- “…while nearly 40% of fatalities came from mains gas appliances, non-gas fuel sources posed a more serious relative public health risk, with a risk of CO death about 10 times higher than that for gas-fuel appliances.
As discussed by the authors, data in the Co-Gas Safety database “are primarily compiled from a ‘cuttings and media’ service and the database is an incomplete record of all deaths.”
Bias can be introduced by inconsistency in cause of death coding.
Data “may be biased towards cases with greater media impact, such those involving the very young, the elderly, or those incidents involving multiple deaths”. This “could have caused an overrepresentation of certain appliances or sources.”
2007 No data 28 0.46
1996-2007 No data Total: 462 (100%)
By type of fuel
LPG55 76 (16.5%)
Mains gas: 177 (38.3%)
Oil: 3 (0.6%)
Paraffin 4 (0.9%) Petrol/diesel: 52 (11.3%)
Solid: 146 (31.6%)
Unknown: 4 (0.9%)
By source
Boilers: 130 (28.1%)
Heaters: 131 (28.4%)
Gas-fires: 41 (8.9%)
Cooker: 58 (12.6%)
The mean population estimate for 2000-2007 (60141182.5) was used for calculation of rates.
Average annual rates over the 12-year period
Total: 0.64
By fuel type
LPG: 0.11
Mains gas: 0.25
Oil: 0.004
Paraffin: 0.006
Petrol/diesel: 0.07
Solid: 0.2
Unknown: 0.006
By source:
Boilers: 0.18
Heaters: 0.18
Gas-fires: 0.06
Cooker: 0.08
Engine: 0.04
Other: 0.10
55 Liquefied petroleum gas
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
Engine: 30 (6.5%)
Other: 72 (15.6%)
Mean age at death: 55 years;
<15 years: 5%
>65 years: 39%
Also, “inaccuracies may not have been stable over time and could differ between UK regions.”
England and Wales
Fisher et al., 2014.
1979 Unintentional non-fire-related
No data 166 (56%)56 3.37 http://www.ncbi.nlm.nih.gov/pubmed/24533843
Rates calculated by the study authors.
Source of data for analyses by Fisher et al., 2014: mortality data provided by coroners in England and Wales.
“Despite some fluctuation from year to year, there was a steady decline in the annual number of such deaths between 1979 and 2012.”
81% and 92% of deaths in males and in females, respectively, occurred at the home address of the deceased.
Males were overrepresented in age groups 10-19, 20-39, 40-64 years with similar numbers of males and females in age groups <1, 1-9, 65-79 and 80+years
Limitations discussed by the authors:
1980 No data 118 (65%) 2.39
1981 No data 153 (66%) 3.10
1982 No data 136 (59%) 2.75
1983 No data 95 (57%) 1.92
1984 No data 73 (62%) 1.47
1985 No data 106 (60%) 2.13
1986 No data 118 (59%) 2.37
1987 No data 68 (60%) 1.36
1988 No data 83 (61%) 1.66
1989 No data 58 (59%) 1.16
1990 No data 61 (66%) 1.21
1991 No data 66 (67%) 1.31
1992 No data 65 (66%) 1.28
1993 No data 81 (65%) 1.60
1994 No data 69 (59%) 1.36
56 % male
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
1995 No data 58 (62%) 1.14 - Detailed data on the place of death or the precise location of a death (e.g., garage, boat etc.), the source of CO (e.g., piped gas appliance, coal or wood-burning fi re, etc.) were not available.
- Deaths in a workplace could not be differentiated other than “not at a private
residential address”.
1996 No data 63 (56%) 1.23
1997 No data 53 (58%) 1.03
1998 No data 41 (71%) 0.80
1999 No data 47 (64%) 0.91
2000 No data 48 (69%) 0.92
2001 No data 59 (75%) 1.13
2002 No data 46 (78%) 0.87
2003 No data 36 (75%) 0.68
2004 No data 34 (82%) 0.64
2005 No data 22 (82%) 0.41
2006 No data 41 (68%) 0.76
2007 No data 47 (72%) 0.86
2008 No data 39 (79%) 0.71
2009 No data 39 (74%) 0.71
2010 No data 32 (84%) 0.57
2011 No data 34 (65%) 0.61
2012 No data 25 (76%) 0.44
England
Ghosh et al., 2015
2001-2010 Accidental (unintentional) non-fire-related
Hospital admissions: 2463 over 10 years; 53% were male
“HES data were not linked with mortality data so we do not know how many individuals died from CO poisoning.”
Average annual rate of hospital admissions: 4.9 (calculated by the study authors).
The rates were higher in colder winter months. There was a pattern of increasing admissions with increasing
http://jpubhealth.oxfordjournals.org/content/early/2015/03/27/pubmed.fdv026.long
Source of data: Hospital Episode Statistics (HES) inpatient data for England between 2001 and 2010
“Due to the non-specific symptoms of CO poisoning, the number of hospital admissions in HES is likely to be underestimated. In addition, many
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
deprivation. The highest rate was seen in the oldest age group (80+ years) and second highest in the youngest age group
(<10 years)57.
individuals with symptoms of non-acute CO poisoning may present first at primary care services rather than as a hospital admission leading to an underestimation of the risk of CO poisoning when using HES only.”
USA
Centers for Disease Control and Prevention (CDC), 2008
2004-2006 Unintentional, Non--Fire-Related
Non-fatal injuries
Total: 20,636
Male: 9,770
Female: 10,866
Treated and released: 18,646
Hospitalized/Transferred: 1,695
Age (years)
0-4: 2,344
5-9: 1,407
10-14: 1,577
15-24: 3,341
25-34: 4,183
35-44: 2,775
45-54: 2,229
55-64: 1,444
≥65: 1,328
Exposure status
No data ED visits
Total: 70 per 1M (95% CI: 51-88)
Male: 67 (50-84)
Female 72 (50-94)
Treated and released: 63 (95% CI: 46-80)
Hospitalized/Transferred: 6 (3-9)
Age (years)
0-4: 116 (77-154)
5-9: 72 (38-105)
10-14: 76 (33-118)
15-24: 79 (57-101)
25-34: 104 (65-143)
35-44: 63 (42-84)
45-54: 52 (34-71)
55-64: 48 (29-66)
≥65: 36 (23-49)
http://www.ncbi.nlm.nih.gov/pubmed/18716581
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5733a2.htm#tab1
Data from the National Electronic Injury Surveillance System -- All Injury Program (NEISS-AIP) database. The database “includes data on all types and causes of injuries treated in U.S. hospital EDs”.
Estimates are based on data for ED visits to the 63 NEISS-AIP sample hospitals.
57 These data are presented in a graph.
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
CO poisoning: 14,127 (68.5%)
CO exposure: 6,320 (30.6%)
Possible CO exposure: 189 (0.9%)
Season
Winter: 8,538 (41.4%)
Spring: 4,175 (20.2%)
Summer: 3,474 (16.8%)
Fall: 4,448 (21.6%)
Location of incident
Residence: 15,030 (72.8%)
Workplace: 2,769 (13.4%)
Other: 1,162 (5.6%)
Unknown: 1,674 (8.1%)
Rates by exposure status, season and location of incident are not reported.
USA
Centers for Disease Control and Prevention (CDC), 2005
Non-fatal exposures: 2001-2003
Deaths: 2001-2002
Unintentional, non-fire-related
Non-fatal exposures
ED visits
Total: 15,200
Male: 7,874
Total: 480
Male: 344
Female: 137
Age (years)
0-4: 9
Non-fatal exposures
ED visits
Total: 52.7 (38.3-67.2)
Male: 55.6 (40.0-71.2)
Female: 50.0 (34.0-65.9)
http://www.ncbi.nlm.nih.gov/pubmed/15660017
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5402a2.htm
Rates calculated by the study authors.
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
Female: 7,326
Treated and released: 13,202
Hospitalized/Transferred: 1,676
Age (years)
0-4: 1,596
5-14: 2,352
15-24: 2,478
25-34: 2,750
35-44: 2,358
45-54: 1,669
55-64: 918
≥65: 1,079
Exposure status58:
Possible exposure: 6%
Exposure: 41.9%)
Poisoning: 52.1%
CO source59
Furnace (oil, gas and unspecified): 18.5%
Motor vehicle: 9.1%
5-14: 19
15-24: 58
25-34: 57
35-44: 92
45-54: 79
55-64: 53
≥65: 113
Treated and released: 45.8 (33.5-58.1)
Hospitalized/Transferred: 5.8 (2.7-9.0)
Age (years)
0-4: 81.5 (44.7-118.3)
5-14: 57.3 (36.7-78.0)
15-24: 61.1 (41.7-80.4)
25-34: 69.0 (46.9-91.1)
35-44: 52.6 (36.0-69.2)
45-54: 41.7 (25.6-57.8)
55-64: 34.5 (19.7-49.3)
≥65: not calculated
Deaths
Total over 2 years: 1.7 (1.6-1.8)
Male: 2.4 (2.3-2.6)
Female: 0.9 (0.8-1.0)
Age (years)
0-4: 0.5 (0.2-0.7)
5-14: 0.5 (0.3-0.6)
15-24: 1.4 (1.2-1.7)
25-34: 1.4 (1.2-1.7)
35-44: 2.0 (1.7-2.3)
Data on emergency department (ED) visits from the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP) and 2001--2002 death certificate data from the National Vital Statistics System (NVSS).
Data are drawn from a nationally representative subsample of 66 of 100 NEISS hospitals that were selected as a stratified probability sample of hospitals in the United States and its territories.
58 Based on 778 cases reported by NEISS-AP 59 Based on 778 cases reported by NEISS-AP
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
Stove/Gas range: 4.9%
Gas line leak: 4.9%
Gas water heater: 4.2%
Generators: 2.2%
Space heater: 1.9%
Machinery: 1.5%
Other: 9.3%
Unknown: 42.8%
45-54: 2.0 (1.7-2.3)
55-64: 2.0 (1.6-2.4)
≥65: 3.2 (2.0-3.6)
USA
Centers for Disease Control and Prevention (CDC), 2007
1999-2004 Unintentional, non-fire-related
No data 439 (annual average number)
National 6-year average annual rate: 1.53 (95% CI: 1.47-1.59)
Males: 2.41 (95% CI: 2.30-2.52)
Females: 0.74 (95% CI: 0.68-0.79)
White, non-Hispanic: 1.54 (1.48-1.61)
Black, non-Hispanic: 1.64 (1.45-1.83)
Other, non-Hispanic: 1.01 (0.80-1.22)
Hispanic: 1.31 (1.14-1.48)
http://www.ncbi.nlm.nih.gov/pubmed/18097342
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5650a1.htm
(see tables)
Mortality rates were calculated by the study authors on the basis of death certificate data obtained from the National Vital Statistics System (NVSS).
USA
Centers for Disease Control
2000-2009 Unintentional, non-fire-related CO exposures
Total of 68,316 for 2000-2009; no data by year.
Numbers of cases of CO exposure for
235 for 2000-2009; no data by year
All CO exposures: annual average 23.2; range: 19.7--25.3
http://www.ncbi.nlm.nih.gov/pubmed/21814164
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6030a2.htm
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
and Prevention (CDC), 2011
2000-2009 are reported by gender, age, region, exposure site and outcome.
CO exposures most frequently occurred between November and February (53.5%)
By gender: female (50.3%), male (44.3%)
By age (years): ≤17 (27.7%), 18-44 (20.4%), 45-64 (11.4%), ≥65 (6.2%)
By exposure cite: residence (77.65%), workplace (12.0%), public area (3.8%), school (3.0%), other (4.7%).
By outcome: death (0.3%), major effect60 (1.5%), moderate effect61 (15.1%), minor
Transported to a health-care facility: range 11.1-14.3 per year
Managed on-site: range 8.6-14.0 per year
Rates calculated by the study authors
Data from the National Poison Data System (NPDS) were used “to characterize reported unintentional, non-fire-related CO exposures, including those that were managed at the site of exposure and were not treated at a health-care facility.”
“NPDS is a near real-time, comprehensive poisoning surveillance system that collects data on calls regarding poison exposure placed to any of the U.S. poison centers.”
"Women and children are the most commonly exposed, but deaths from CO exposure more often occur among men.”
60 Definition: “Exposure symptoms were life-threatening or resulted in significant residual disability or disfigurement” 61 Definition: “Exposure symptoms were pronounced, prolonged, or systemic and usually required some form of treatment”
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
effect62 (50.1%), no effect (33.0%)
Minnesota
Minnesota Environmental Public Health Tracking
Report date: December 2009
Unintentional non-fire-related
Hospitalizations http://www.health.state.mn.us/divs/hpcd/tracking/pubs/coreport.pdf
Rates calculated by the study authors
Source of data on hospitalizations, emergency department visits and deaths: Minnesota Department of Health’s Injury and Violence Prevention Unit
Data on CO exposure calls: the Minnesota Poison Control System
“ED visits may result in treatment and release, or in hospitalization or death. ED visits that result in hospitalizations are counted as inpatient hospitalization cases and do not appear in the ED visit dataset.”
“PCC calls may represent CO exposure events that may not otherwise be captured in hospital discharge data or ED data. They may include events where CO exposure was detected but did not result in symptoms, where symptoms were mild and did not require follow-up in a healthcare facility, and where the event resulted in symptoms but the patient refused to seek medical treatment. However, PCC call data are highly reliant on the knowledge, attitudes, and practices
2000 31 6.3
2001 29 5.8
2002 29 5.8
2003 41 8.1
2004 42 8.3
2005 25 4.9
2006 39 7.6
2007 28 5.4
2003-2007 Average annual rates
By age (years)
0-17: 1.7 (95% CI: 0.9-3.1)
18-34: 6.1 (4.3-8.5)
35-64: 6.5 (5.1-8.3)
65+: 19.6 (15.0-25.2)
By gender
Male: 9.6 (7.9-11.3)
Female: 4.1 (3.1-5.4)
ED visits
2000 247 50.1
2001 249 50.0
2002 222 44.3
62 Definition: “Exposure symptoms were minimally noticeable”
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
2003 211 41.8 by local residents around the use of poison control centers.”
Some conclusions from the report:
“− Unintentional, non-fire related CO hospitalizations occur at a higher rate in older populations (65 years of age and older). In contrast, emergency department visits resulting from unintentional, non-fire related CO poisonings occur at a higher rate in younger populations (under age 65).
− Males had higher rates of unintentional, non-fire related CO hospitalizations and deaths compared with females. The emergency department visit rates were similar for males and females.
− In Minnesota, unintentional, non-fire related CO poisoning rates follow seasonal patterns, with greater hospitalizations, emergency department visits, and calls to the poison center occurring in the fall and winter months.”
2004 259 51.0
2005 242 47.4
2006 215 41.8
2007 334 64.4
2003-2007 Average annual years
By age (years):
0-17: 52.6 (95% CI: 46.9-28.2)
18-34: 70.8 (64.0-77.6)
35-64: 43.7 (39.6-47.7)
65+: 20.9 (16.2-26.7)
By gender:
Male: 51.6 (47.7-55.6)
Female: 47.1 (43.3-50.8)
Deaths
2000 16 3.2
2001 20 4.0
2002 19 3.8
2003 15 3.0
2004 14 2.8
2005 10 2.0
2006 13 2.5
2007 9 1.7
2003-2007 Annual average rates
By age (years):
Benchmarking Risk of Injury and Death from TSSA-Regulated Activities against Other Jurisdictions
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
0-17: 1.7 (0.9-3.1)
18-34: 2.4 (1.3-4.0)
35-64: 2.8 (1.9-4.1)
65+: 2.3 (0.9-4.6)
By gender:
Male: 3.9 (2.9-5.1)
Female: 0.9 (0.5-1.6)
Poison Control Center CO Exposure Calls
2002 275 54.8
2003 262 51.9
2004 303 59.7
2005 286 56.0
2006 215 41.8
2007 537 103.6
Florida
Harduar-Morano and Watkins, 2011
2005-2007 Unintentional non-fire-related
Emergency department visits: 260.3 (annual average number)
The cause and situation known for 91% of cases. Of these, 31% were “from a known source…such as generators, industrial kilns, and blast furnces; 21%
Total: 14.2 (95% CI: 13.2-15.1)
By gender
Male: 13.9 (12.5-15.3)
Female:14.4 (13.0-15.8)
By race
White: 11.9 (10.9-12.9)
Black: 24.3 (2.11-2.75)
Other: 14.4 (8.4-20.5)
By ethnicity
Non-Hispanic: 14.5 (13.4-15.7)
http://www.ncbi.nlm.nih.gov/pubmed/21387954
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056037/
Rates calculated by the study authors
Morbidity data were obtained from the Florida Agency for Health Care Administration (AHCA), which collects data on all patients treated in non-federal Florida hospitals or EDs.
Death certificate data were obtained from the Florida Department of Health Bureau of Vital Statistics database.
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
from motor vehicle exhaust fumes.
There was no difference in exposure situation by race. Place recorded for 27% of cases. Of these, 50% occurred at home, 15% in industrial locations.
Hispanic: 12.0 (10.0-14.1)
By age (years):
0-14: 15.0 (12.6-17.4)
15-24: 15.7 (12.8-18.6)
25-34: 24.8 (21.0-28.6)
35-44: 19.2 (16.1-22.3)
45-54: 13.3 (10.7-15.9)
55-64: 7.2 (5.1-9.2)
65-74: 6.3 (4.0-8.6)
75-84: 5.4 (3.0-7.8)
≥85: 4.5 (0.9-8.2)
Individuals who died in the hospital or ED were excluded from motbidity analyses.
“Information related to the intent and mechanism of injury is required before an injury-related death certificate is issued, making this a more complete record for the purposes of poisoning intent and mechanisms…. ED [emergency department] and hospitalization data are medical-billings data collected for administrative purposes and often do not contain the intent or mechanism of the injury, as it is not required for reimbursement or treatment.”
“It was not possible to estimate the magnitude of the morbidity underestimation.”
The frequency of CO poisonong was highest in 2004-2005, the years in which many hurricanes and related widespread power outages occurred. However, the overall demographic pattern was similar.
A large number of poisonings occurred during winter months and during the hurricane season in the fall.
It was not possible to estimate the frequency of CO poisoning due directly to hurricanes, tropical storms, or cleanup efforts.
“Severe CO poisoning resulting in hospitalization or death in Florida affects
1999-2007 Hospitalizations: 54.8 (annual average number)
The cause and situation recorded for 88% of cases. Of these, 30% were related to motor vehicle exhaust fumes and 33% were related to a known source such as generators, industrial kilns, and blast furnaces.
White people were more likely than nonwhite people to have CO poisoning
Total: 3.2(95% CI: 2.9-3.5)
By gender
Male: 3.8 (3.3-4.2)
Female: 2.6 (2.3-3.0)
By race
White: 2.9 (2.6-3.2)
Black: 4.5 (3.7-5.3)
Other: 3.3 (1.5-5.1)
By ethnicity
Non-Hispanic: 3.3 (2.9-3.6)
Hispanic: 2.7 (2.0-3.3)
By age (years):
0-14: 2.0 (1.5-2.6)
15-24: 2.5 (1.8-3.2)
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
related to motor vehicle exhaust. Nonwhite people were more likely than white people to be exposed to CO via the burning of domestic fuels.
The place was recorded for 31% of cases. Of these, 70% occurred within the home and 9% at an industrial location.
25-34: 1.7 (1.1-2.3)
35-44: 3.7 (2.9-4.4)
45-54: 4.2 (3.3-5.1)
55-64: 3.9 (3.0-4.9)
65-74: 3.3 (2.3-4.2)
75-84: 5.6 (4.2-7.1)
≥85: 4.6 (2.3-6.8)
males more often than females, while acute CO poisoning cases (those treated in the ED) are more prevalent among females than males. The hospitalization and fatality rates are much higher for the elderly (≥75 years of age) than for other age groups. This may be because elderly patients are more likely to mistake their symptoms for other conditions, such as influenza-like illness or fatigue, leading to more severe CO poisoning cases, or because of the higher prevalence of other underlying medical conditions in this age group.
1999-2007 Fatalities: 25.6 (annual average number).
Cause and situation recorded for 82% of deaths. Of these, 35% were caused by a vehicle left running in an enclosed space; vehicle exhaust fumes were listed as the cause for an additional 34%
Total: 1.5 (1.3-1.7)
By gender
Male:1.9 (1.6-2.2)
Female: 1.1 (0.8-1.3)
By race
White: 1.6 (1.4-1.8)
Black: 0.9 (0.6-1.3)
Other: 1.5 (0.3-2.7)
By ethnicity
Non-Hispanic: 1.5 (1.3-1.7)
Hispanic: 1.3 (0.9-1.7)
By age (years):
0-14: 0.6 (0.3-0.9)
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
of deaths. Generator-related exposure: 12%; heating home with a grill, gas oven or space heater: 8%.
White people were more likely than nonwhite people to be exposed to exhaust fumes.
Place: 77% occurred in the home.
15-24: 1.0 (0.6-1.5)
25-34: 1.1 (0.7-1.6)
35-44: 1.4 (0.9-1.9)
45-54: 1.7 (1.1-2.2)
55-64: 1.14 (0.9-2.0)
65-74: 1.9 (1.1-2.6)
75-84: 3.3 (2.2-4.5)
≥85: 6.3 (3.7-8.9)
USA, Maine
Graber and Smith 2007
Outpatient and impatient: 1999-2003
ED visits: 2000-2003
Deaths: 1999-2003
Unintentional non-fire-related
Outpatient
Total: 693
Male: 380
Female: 313
Age (years)
0-17: 140
18-34: 233
35-64: 290
≥65: 30
Inpatient
Total: 47
2 deaths were identified
Outpatient
Total: 108 (95% CI: 100-116)
Male: 115 (110-134)
Female: 95 (85-106)
Age (years)
0-17: 96 (81-113)
18-34: 174 (153-198)
35-64: 108 (96-121)
≥65: 33 (23-46)
Inpatient
http://www.ncbi.nlm.nih.gov/pubmed/17357356
http://www.ncbi.nlm.nih.gov/pubmed/17357356
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1820438/
Morbidity data from three Maine hospital records datasets housed by the Maine Health Data Organization (MHDO): inpatient (IP), ED, and outpatient (OP)
Maine death certificate file
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
Male: 33
Female: 14
Age (years)
0-17: 0
18-34: 9
35-64: 25
≥65: 13
ED visits
Total: 442
Male: 247
Female: 195
Age (years)
0-17: 77
18-34: 151
35-64: 190
≥65: 24
Total: 7 (6-10)
Male: 14 (8-15)
Female: 4 (3-7)
Age (years)
0-17: no cases
18-34: 7 (3-13)
35-64: 9 (6-14)
≥65: 14 (8-24)
ED visits
Total: 86 (78-94)
Male: 93 (82-106)
Female: 78 (68-89)
Age (years)
0-17: 66 (51-83)
18-34: 141 (120-165)
35-64: 87 (76-101)
≥65: 32 (22-48)
USA, Michigan
Michigan Department of Health and Human Services
http://www.michigan.gov/mdch/0,1607,7-132-54783_54784_54787---,00.html
2009 Unintentional non-fire related
Unclear, how many injuries were fire-unrelated
17 (from a generator -7, from a vehicle -5, from a furnace or a water heater – 2, from a space heater -2, from a charcoal grill -1)
1.72
Estimated population: 9,901,591
http://www.oem.msu.edu/userfiles/file/Annual%20Reports/CarbonMonoxide/CO2009AnnualReportUpdate.pdf
Sources of information: Michigan Poison Control Center (PCC), Michigan hospitals, and death certificates.
Of 41 reported deaths, 17 were non-fire related
1,050 individuals were unintentionally poisoned by CO; it is not clear how many of
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
them were fire-related. 108 were work-related.
97 individuals with sufficient information to assign NAICS codes are listed by industry sector.
Source of exposure (occupational and non-occupational): unknown -30.6%, furnace/water heater – 26.1%, generator-4.5%, fire-8.7%, other-6.8%, portable grill -1.6%, power machinery – 4.8%, space heater – 3.2%, stove -3.7%, vehicle-8.6%, wood stove – 1.0%.
Population estimates: http://www.michigan.gov/cgi/0,4548,7-158-54534-291725--,00.html
2010 12 1.22
Estimated population: 9,876,149
http://www.oem.msu.edu/userfiles/file/Annual%20Reports/CarbonMonoxide/2010CO_AnnualReport_8.22.14.pdf
Sources of information: Michigan Poison Control Center (PCC), Michigan hospitals, and death certificates.
Of 25 reported deaths, 12 were non-fire-related
Reports of unintentional CO poisoning were received on 985 individuals; it is not clear how many of them were fire-related. 118 were poisoned at work (number of fire-related is not reported).
98 individuals with sufficient information to assign NAICS codes are listed by industry sector.
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
Source of exposure (occupational and non-occupational): unknown – 27.8%; forklift -1.1%, boat – 0.8%, small engine – 1.8%, other power machinery – 3.17%, vehicle -8.6%, stove -3.3%, space heater – 3.0%, furnace/water heater – 26.3%, generator – 4.8%, portable grill/heater – 0.9%, fire -9.6%, wood stove – 1.5%, other -7.1%.
Population estimates: http://www.michigan.gov/cgi/0,4548,7-158-54534---,00.html
2011 15 (from a generator -6, from a vehicle -3, from a propane-fueled device -2 small engine-1, stove – 1, source unknown -2)
1.52
Estimated population: 9,874,589
http://www.oem.msu.edu/userfiles/file/Annual%20Reports/CarbonMonoxide/2011CO_AnnualReport_8.22.14.pdf
Sources of information: Michigan Poison Control Center (PCC), Michigan hospitals, and death certificates
Of 22 reported deaths, 15 were non-fire-related.
Reports of unintentional CO poisoning were received on 934 individuals; it is not clear how many of them were fire-related. 163 were exposed at work (the number of fire-related occupational cases is not reported)
137 individuals with sufficient information to assign NAICS codes are listed by industry sector.
Source of exposure (occupational and non-occupational): unknown – 23.6%; forklift -3%, boat – 0.3%, small engine – 0.7%,
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
other power machinery – 1.7%, vehicle -10.3%, train – 1.3%, stove -2.5%, space heater – 3.4%, furnace/water heater – 23%, generator – 10.5%, portable grill/heater – 2.5%, fire -7.1%, wood stove – 0.4%, other -9.7%.
Population estimates: http://www.michigan.gov/cgi/0,4548,7-158-54534---,00.html
2012 17 1.72
Estimated population: 9,882,519
http://www.michigan.gov/documents/mdch/2012_report_version_8_475712_7.pdf
Sources of information: Michigan Poison Control Center (PCC), Michigan hospitals, and death certificates
Of 22 reported deaths, 17 were non-fire-related.
Reports of unintentional CO poisoning were received on 765 individuals; it is not clear how many of them were fire-related.
Exposure source was known for 497 individuals. Of them: Furnace/Water Heater-22.7%, vehicle -14.9%, fire-14.5%, generator-13.7%, other-10.91%, stove -5.2%, portable grill- 4.6%, space heater -4.2%, small engine -2.2%, forklift-1.8%, woodstove -1.8%, natural gas-1.6, boat -1%, power machinery/other 0.8%.
Population estimates: http://www.michigan.gov/cgi/0,4548,7-158-54534---,00.html
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
2013 26 2.63
Estimated population: 9,895,622
http://www.michigan.gov/documents/mdch/2013_Annual_Report_of_Carbon_Monoxide_Poisoning_in_Michigan_484733_7.pdf
Sources of information: Michigan Poison Control Center (PCC), Michigan hospitals, and death certificates
Of 34 reported deaths, 26 were non-fire-related
Reports of unintentional CO poisoning were received on 823 individuals; it is not clear how many were fire-related
Exposure source was known for 465 individuals. Of them: Furnace/Water Heater -21.7%, generator -19.6%, vehicle – 14.6%, fire-12.5%, power machinery/other -8.2%, other -7.3%, space heater – 6.7%, stove- 5.2%, woodstove – 1.5%, forklift – 1.1%, portable grill- 0.9%, boat -0.4%, small engine – 0.4%
Population estimates: http://www.michigan.gov/cgi/0,4548,7-158-54534---,00.html
U.S.
Consumer Product Safety Commission (CPSC), 2014a
1981 Estimated non-fire carbon monoxide deaths associated with the use of consumer products
No data 311 1.355 “Non-Fire Carbon Monoxide Deaths Associated with the Use of Consumer Products 2011 Annual Estimates” at: http://www.cpsc.gov//Global/Research-and-Statistics/Injury-Statistics/Carbon-Monoxide-Posioning/NonFireCarbonMonoxideDeaths
1982 No data 340 1.402
1983 No data 323 1.338
1984 No data 275 1.247
1985 No data 284 1.119
1986 No data 240 1.049
Benchmarking Risk of Injury and Death from TSSA-Regulated Activities against Other Jurisdictions
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
Report date: September 2014
1987 No data 232 0.977 AssociatedwiththeUseofConsumerProducts2011AnnualEstimatesSept2014.pdf
“The national estimates presented in this report are based on death certificate records obtained from 50 states, the District of Columbia, and New York City directly, augmented by information collected in CPSC's In-Depth Investigations (IDis), and to a lesser extent, news articles and medical examiners' reports contained in the CPSC Injury or Potential Injury Incident (IPII) database.”
“Data collection was only partially complete for 2011, and estimates for this year may change in the future when additional data become available”.
U.S. population estimates and mortality rates are presented in tables B.1 –B5 on pp. 37 -41
More detailed information on deaths by type of consumer product and type of fuel can be found in tables 1 and 2 of the report. Only annual average numbers (2009-2011) for selected products/types of fuel are extracted into this table. Information on numbers of deaths by month of the year, age, ethnicity and other variables can be found in other tables of the report.
1988 No data 238 1.044
1989 No data 296 1.049
1990 No data 243 1.053
1991 No data 250 0.927
1992 No data 211 0.877
1993 No data 214 0.831
1994 No data 223 0.808
1995 No data 201 0.802
1996 No data 217 0.740
1997 No data 180 0.705
1998 No data 180 0.566
1999 No data 108 0.509
2000 No data 138 0.434
2001 No data 121 0.515
2002 No data 181 0.527
2003 No data 153 0.576
2004 No data 168 0.581
2005 No data 190 0.606
2006 No data 180 0.621
2007 No data 186 0.601
2008 No data 178 0.548
2009 No data 148 0.523
2010 No data 159 0.503
2011 No data 160 Not calculated
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
2001 Estimated non-fire CO deaths associated with generators
No data 20 0.095
2002 No data 42 0.129
2003 No data 49 0.152
2004 No data 41 0.20263
2005 No data 88 0.241
2006 No data 85 0.269
2007 No data 68 0.220
2008 No data 76 0.202
2009 No data 64 0.196
2010 No data 42 0.179
2011 No data 60 Not calculated
2001 Estimated non-fire CO deaths associated with generators and other engine-driven tools
No data 22 0.17
2002 No data 52 0.151
2003 No data 56 0.188
2004 No data 56 0.24364
2005 No data 102 0.295
2006 No data 104 0.318
2007 No data 79 0.262
2008 No data 83 0.237
2009 No data 76 0.231
2010 No data 56 0.218
2011 No data 70 Not calculated
63 Based on the number of deaths (41) and population estimate (293,046,000) the rate is 0.140. 64 Based on the number of deaths (56) and population estimate (293,046,000) the rate is 0.191
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
By consumer product
2009-2011 (annual average numbers)
Furnaces (incl. boilers)
No data 22 (14%65)
Of these, 11 (7%) on natural gas, 2 (1%) on liquid petroleum and 5 (3%) on unspecified gas
0.07
Average annual population estimate for 2009-2011 (tables B1-B5 of the publication): 309305333
Portable heaters No data 13 (8%). Of these, 12 8%) on liquid petroleum gas
0.04
Wall/floor furnaces
No data 4 (3%) 0.01
Room/Space heaters
No data 5 (3%) 0.02
Engine-driven tools
No data 67 (43%). Of these, 55 (35%) were generators and 12 (8%) were other engine-driven tools.
0.22
By fuel type
Natural gas No data 19 (12%)66 0.06
65 Of the total annual average of 156 66 Of the total annual average of 156
Benchmarking Risk of Injury and Death from TSSA-Regulated Activities against Other Jurisdictions
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
2009-2011 (annual average numbers)
Liquid Petroleum (LP) Gas
No data 27 (17%) 0.09
Unspecified gas No data 10 (6%) 0.03
Gasoline67-Fueled Products
No data 67 (43%) 0.22
Oil-Fueled Products
No data 2 (1%) 0.006
Diesel-Fueled Products
No data ? (<1%)
By location
Home No data 117 (75%)68 0.38
Temporary shelter
No data 17 (11%) 0.05
Vehicles (including boats)
No data 9 (6%) 0.03
By gender
Male 113 (72%) 0.37
Female 42 (27%) 0.14
U.S.
Consumer Product Safety Commission (CPSC), 2014b
Report date: January 2014
Estimates for each year from 1980-to 2010 and average annual estimates for 2008-2010
Non-Fire Carbon Monoxide Deaths Associated with the Use of Consumer Products
No data Numbers of deaths by year, by type of product and fuel are presented in way similar to the report
“Non-Fire Carbon Monoxide Deaths Associated with the Use of Consumer Products 2010 Annual Estimates” at: http://www.cpsc.gov//Global/Research-and-Statistics/Injury-Statistics/Carbon-Monoxide-Posioning/2010NonFireCODeathsFINAL.pdf
67 “Petrol” in the U.K. 68 Of the total annual average of 156
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
summarized above. Period covered: 1980-2010
This report is of similar structure and content as the one summarized above. Estimates for each year from 1980 to 2010 and annual averages for 2008-2010 are presented.
U.S.
Consumer Product Safety Commission (CPSC), 2012
December 2012
Estimates for each year from 1980-to 2009 and average annual estimates for 2007-2009
Non-Fire Carbon Monoxide Deaths Associated with the Use of Consumer Products
No data Numbers of deaths by year, by type of product and fuel are presented in way similar to the report summarized above. Period covered: 1980-2009
“Non-Fire Carbon Monoxide Deaths Associated with the Use of Consumer Products 2009 Annual Estimates” at: http://www.cpsc.gov//PageFiles/136146/co12.pdf
This report is of similar structure and content as the one summarized above. Estimates for each year from 1980 to 2009 and annual averages for 2007-2009 are presented.
U.S.
Consumer Product Safety Commission (CPSC), 2014c
Report date: June 2014
2004-201369 Engine-Driven Generators and Other Engine-Driven Tools
No data Total engine-driven tools: 808.
By product
Generators -657 (portable -650, fixed -5, welder used as a generator – 2)
Other engine-driven tools -
Total: 0.29
Generators: 0.24
Other engine-driven tools: 0.04
Include in the summary table
Multiple products: 0.02
“Incidents, Deaths, and In-Depth Investigations Associated with Non-Fire Carbon Monoxide from Engine-Driven Generators and Other Engine-Driven Tools, 2004–2013” at: https://www.cpsc.gov/Global/Research-and-Statistics/Technical-Reports/Home/Portable-Generators/GeneratorsandOEDTFatalities-2014-FINAL.pdf
69 “In this report, the two most recent years, 2012 and 2013, are identified as being incomplete because the numbers for these years most likely will increase in future reports.”
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
103 (Lawn mowers-54; power washer/sprayer11; snow blower – 10; all-terrain vehicle – 8; welder – 4; water pump – 5; concrete saw -2; air compressor – 2; one death associated with each of the following: paint sprayer, snowmobile, go-cart, tiller, small engine of unknown use, edger, stump grinder)
Multiple fuel-burning consumer products -48
By year
Detailed information by type of product, year, season, age, gender, ethnicity, location, reason for use and other variables can be found in the tables of the report
Population numbers (averaged over 2004-2012): http://www.indexmundi.com/g/g.aspx?v=21&c=us&l=en
2004 62 0.21
2005 116 0.39
2006 109 0.37
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
2007 82 0.27
2008 102 0.34
2009 76 0.25
2010 57 0.18
2011 108 0.34
2012 4970 0.16
2013 4771 0.15
U.S.
Consumer Product Safety Commission (CPSC), 2013
Report date: August 2013
1999-201272 Engine-Driven Generators and Other Engine-Driven Tools
No data Total engine-driven tools: 931 (generators- 739, other tools- 126, multiple products -66)
0.24 “Incidents, Deaths, and In-Depth Investigations Associated with Non-Fire Carbon Monoxide from Engine-Driven Generators and Other Engine-Driven Tools, 1999–2012” at: http://www.cpsc.gov/Global/Research-and-Statistics/Injury-Statistics/Carbon-Monoxide-Posioning/GeneratorsAndOEDTFatalities2013FINAL.pdf
Data by product type and year are not extracted because it is overlapping with the information from the CPSC 2014 report summarized above
Detailed information by type of product, year, season, age, gender, ethnicity, location, reason for use and other variables can be found in the tables of the report.
70 Incomplete data 71 Incomplete data 72 “In this report, the two most recent years, 2011 and 2012, are identified as being incomplete because these figures most likely will change in future reports.”
Benchmarking Risk of Injury and Death from TSSA-Regulated Activities against Other Jurisdictions
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
USA
Iqbal et al., 2012a
1993 Unintentional, non-fire-related
Hospitalizations: 15 Hospitalization rates by year from figure 3 of the publication
http://www.ncbi.nlm.nih.gov/pubmed/22942466
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407848/
Public Health Rep. 2012 Sep-Oct; 127(5): 486–496
Data sources: death certificate data from the National Vital Statistics System (NVSS); emergency department visit and hospitalization data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Emergency Department Sample and Nationwide Inpatient Sample
Population estimate as of July 1, 2009 (307,006,550) from http://www.census.gov/popest/data/state/totals/2009/tables/NST-EST2009-01.csv See “Annual Population Estimates at: http://www.census.gov/popest/data/historical/2000s/vintage_2009/index.html
1994 Hospitalizations: 15
1995 Hospitalizations: 15
1996 Hospitalizations: 15
1997 Hospitalizations: 11
1998 Hospitalizations: 12
1999 Hospitalizations: 9
2000 Hospitalizations: 8
2001 Hospitalizations: 7
2002 Hospitalizations: 7
2003 Hospitalizations: 7
2004 Hospitalizations: 7
2005 Hospitalizations: 7
2006 Hospitalizations: 8
2007 Hospitalizations: 2,302
ED visits: 21,304
Hospitalizations: 8
ED visits: 71
2009 439 1.43
USA
Iqbal et al., 2012b
2007 Unintentional, non–fire-related
ED visits
Total: 21,304
Men: 9,879
Women: 11,426
Age (years)
0-17: 5,587
No data ED visits
Total: 71 (95% CI: 64-77)
Men: 67 (60-73)
Women: 75 (67-83)
Age (years)
0-17: 76 (66-86)
http://www.ncbi.nlm.nih.gov/pubmed/21570230
Am J Emerg Med. 2012 Jun;30(5):657-64
Rates calculated by the study authors.
Data from Nationwide Inpatient Sample (NIS) and Nationwide Emergency
Benchmarking Risk of Injury and Death from TSSA-Regulated Activities against Other Jurisdictions
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
18-44: 9,879
45-64: 4,259
65-84: 1,367
≥85: 212
Place of occurrence:
Residential: 61%
Occupational: 10.8%
Recreational: 0.7%
Motor-vehicle-related: 1.5%
Public buildings: 3.9%
Other: 22.1%
Season: the highsst numbers during winter months.
Outcome
Treated and released: 18,466
Admitted: 1,652
Transferred: 556
Died in ED: 46
Not admitted, unknown: 584
Hospitalizations
Total: 2,302
18-44: 87 (79-96)
45-64: 56 (50-62)
65-84: 42 (36-48)
≥85: 41 (28-55)
Hospitalizations
Total: 8 (6-9)
Men: 9 (6-11)
Women: 7 (5-8)
Age (years)
0-17: 3 (1-4)
18-44: 6 (4-8)
45-64: 12 (9-15)
65-84: 14 (10-18)
≥85: 18 (9-27)
Department Sample (NEDS) data from the Hospitalization Cost and Utilization Project (HCUP)
Cases were classified into confirmed, probable and suspected on the basis of ICD-9 CM codes. Only confirmed cases were analyzed.
Of 21,304 ED visits, 46 died in ED.
Data on deaths among hospitalized patients were not available.
Benchmarking Risk of Injury and Death from TSSA-Regulated Activities against Other Jurisdictions
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
Men: 1,306
Women: 992
Age (years)
0-17: 182
18-44: 664
45-64: 903
65-84: 457
≥85: 92
Place of occurrence:
Residential: 63%
Occupational: 9.5%
Recreational: 0.5%
Motor-vehicle-related: 1.3%
Public buildings: 4.1%
Other: 21.6%
Season: the highsst numbers during winter months.
Iqbal et al., 2010
2005 Hospitalizations
Total: 4,216
Male: 2,525
Female: 1,682
Age (years)
<1: no data
1-17: 341
No data Total: 14.2 (95% CI: 13.8-14.7)
Male: 17.3 (16.6-18.0)
Female: 11.2 (10.6-11.7)
Age (years)
<1: no data
1-17: 4.9 (4.4-5.4)
http://www.ncbi.nlm.nih.gov/pubmed/20433037
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848267/
Public Health Rep. 2010 May-Jun;125(3):423-32.
Rates calculated by the study authors
Benchmarking Risk of Injury and Death from TSSA-Regulated Activities against Other Jurisdictions
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
18-44: 1,442
45-64: 1,499
65-84: 745
≥85: 155
18-44: 12.7 (12.1-13.4)
45-64: 20.6 (19.5-21.6)
65-84: 23.5 (21.8-25.2)
≥85: 30.4 (25.6-35.2)
Data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS)
Cases were classified into confirmed, probable and suspected on the basis of ICD-9 CM codes. Only confirmed cases were analyzed.
USA
Henn et al., 2013
1992–2008 Occupational non fire-related carbon monoxide fatalities
No data Total: 374
By National Occupational Research Agenda (NORA) sector
Agriculture, Forestry, & Fishing: 47
Construction: 94
Health Care & Social Assistance: 6
Manufacturing: 37
Mining, Oil & Gas Extraction: 17
Services, including public safety: 114
Rates per 1M full-time equivalent workers per year (1FTE=2,000 hr worked per year)
Total: 0.17
By National Occupational Research Agenda (NORA) sector
Agriculture, Forestry, & Fishing: 0.87
Construction: 0.59
Health Care & Social Assistance: 0.02
Manufacturing: 0.11
Mining, Oil & Gas Extraction: 1.35
Services, including public safety: 0.13
Transportation,Warehousing, & Utilities: 0.16
Wholesale & Retail Trade: 0.08
http://www.ncbi.nlm.nih.gov/pubmed/23868822
Rates calculated by the study authors
Source of data on work-related fatalities due to CO poisoning:
- the Census of Fatality and Occupational Injury (CFOI) database;
- Integrated Management Information System (IMIS) of the Occupational Safety and Health Administration (OSHA)
The number of full-time equivalent workers was obtained from the Bureau of Labor Statistics (BLS) Current Population Survey (CPS) from 1992 through 2008.
Benchmarking Risk of Injury and Death from TSSA-Regulated Activities against Other Jurisdictions
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
Transportation,Warehousing, & Utilities: 20
Wholesale & Retail Trade: 33
Unknown: 6
Top10 Occupational CO Fatality Rates by Industry Reported in BLS’ CFOI
Fishing, hunting, and trapping: 9
Automotive repair and maintenance: 33
Mining and support activities for mining: 10
Oil and gas extraction: 7
Iron and steel mills and steel product mfg: 9
Unknown: not calculated
Top10 Occupational CO Fatality Rates by Industry Reported in BLS’ CFOI
Fishing, hunting, and trapping: 7.96
Automotive repair and maintenance: 1.51
Mining and support activities for mining: 1.35
Oil and gas extraction: 1.35
Iron and steel mills and steel product mfg: 1.17
Services to buildings and dwellings: 1.03
Crop production: 0.97
Animal production: 0.80
Investigation and security services: 0.75
Chemicals and allied products: 0.75
Benchmarking Risk of Injury and Death from TSSA-Regulated Activities against Other Jurisdictions
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
Services to buildings and dwellings: 15
Crop production: 16
Animal production: 17
Investigation and security services: 8
Chemicals and allied products: 6
Iran, Tabriz
Dianat and Nazari 2011
From 21 March 2007 to 20 March 2009 (2 years)
Unintentional, non–fire-related
Non-fatal poisonings for 2 years
Total: 1095
Male: 326
Female: 679
Age (years)
0-14: 179
15-24: 239
25-44: 414
45-64: 132
>64: 41
By type of appliances (based on 328 cases):
Fatal CO poisonings for 2 years
Total: 90
Male: 41
Female: 49
Age (years)
0-14: 12
15-24: 15
25-44: 36
45-64: 13
>64: 14
Annual average rates
Non-fatal :346
Fatal: 28
Population numbers by gender and age are not available to calculate age- and gender-specific rates.
http://www.ncbi.nlm.nih.gov/pubmed/21827338
An estimated population of Tabriz: 1.58 million
“All medical records of the patients transported by the Tabriz’s Emergency Medical Service (EMS) system in which a person received a diagnosis of unintentional CO poisoning were reviewed to identify incidents of unintentional CO-related poisoning. … All unintentional CO poisoning incidents not related to a fire were included as a case in the study. Death certificate reports related to CO poisoning confirmed by the Legal Medicine Organization (classified based on the International Classification of Diseases,
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Jurisdiction, Year
(Reference)
Year Reason/Circumstances
Injuries Deaths Rate (per 1M pop/yr) Source of data/Notes
Water heaters: 59.2%
Heating devices: 25.3%
Boilers: 7.1%
Cookers: 2.1%
Other: 2.1%
Unknown: 4.2%
10th Revision (ICD-10) codes T58 and X47) were also reviewed…”
To identify risk factors associated with CO poisoning, telephone interviews were conducted by contacting one person from each non-fatal poisoning incident.
Iran, East Azerbaijan province
Nazari et al., 2010
From 21 March 2003 to 20 March 2008 (5 years)
Unintentional, non-fire related
Non-fatal poisonings for 5 years
Total: 3078
Male: 1176
Female: 1902
Age (years)
0-9: 344
10-19: 441
20-29: 785
30-39: 605
40-49: 362
50-59: 272
>60: 269
Fatal poisonings for 5 years
Total: 346
Male: 185
Female: 161
Age (years)
0-9: 43
10-19: 51
20-29: 76
30-39: 43
40-49: 52
50-59: 47
>60: 34
Annual average rates
Non-fatal: 171
Fatal: 19
http://www.ncbi.nlm.nih.gov/pubmed/20851359
An estimated population of 3.6 million
Sources of information: medical records of patients transported by the emergency medical service (EMS) system; death certificate reports of the Legal Medicine Organization