Tracking the Silent Killer

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HA Magazine reports on how the Gas Safety Trust has announced funding for Public Health England's Coroners' Carbon Monoxide testing pilot study.

In June, the Gas Safety Trust (GST) confirmed funding for Public Health England’s carbon monoxide (CO) pilot study, which will develop a protocol for coroners to test for CO at post-mortem.  Every year in the UK, over 200 people go to hospital with suspected carbon monoxide poisoning, which leads to around 40 deaths; so it is not before time that this ‘silent killer’ was investigated more deeply.

Public Health England (PHE) was established on 1 April 2013 to bring together public health specialists from more than 70 organizations into a single public health body. PHE aims to protect and improve the nation's health and wellbeing, and reduces health inequalities.

But it was way back in 2011 that the All Party Parliamentary Carbon Monoxide Group (APPCOG) report identified a key role for coroners to support increased detection of CO poisoning in England and Wales. The report recommended: “the Government should ensure that all coroners’ post-mortems routinely test for carboxyhaemoglobin (COHb) levels”.

Worryingly, the report acknowledged the difficulty for coroners in recognizing CO as a possible cause of death and also suggested that there is a potential under-diagnosis of CO poisoning by clinicians. Unlike doctors, though, coroners are in a unique position to identify the circumstances leading to a CO fatality, including the source of CO, where it is located, and the behaviour of those involved; being that an inquest has an overview on the entire picture.

This study will take the important first steps towards obtaining a more complete estimate of the number of CO deaths by testing at post-mortem. The aim of the study is to establish a protocol for testing and reporting of CO poisoning at post-mortem in England and Wales.

Dr Giovanni Leonardi, Head of the Environmental Epidemiology Group at PHE’s Centre for Radiation, Chemical and Environmental Hazards, said: “This is an important pilot study which will develop a method for establishing how often CO poisoning is being missed by clinicians and the impact this has on CO being identified as a cause of death. We will need to share this information with coroners before they will consider wider testing for CO at post-mortem.

“We will also need to assess the extra burden wider testing would have on staff, including pathologists and laboratory workers. The pilot will show how feasible it is for coroners to conduct extended testing for CO at post-mortem and will help Public Health England’s understanding of accidental CO poisoning.”

Chris Bielby, Gas Safety Trust Chairman added: “This study will begin to address the longstanding barrier to understanding the number of fatalities caused by carbon monoxide poisoning in England and Wales. Many people agree that carbon monoxide poisoning is under-diagnosed by both medics and coroners due to its characteristics.

“The only way to really know is for CO levels to be tested at post-mortem. Hopefully this pilot will develop a protocol that will allow us to reach the true scale of the problem in England and Wales.”

Specialist in domestic smoke alarms, heat alarms and CO detectors, Aico Ltd, is also pleased that the study is underway.  Michael Wright, Marketing Manager at Aico, spoke exclusively to HA Magazine saying: “Aico welcomes this new initiative as an important move towards developing a more accurate picture of the impact and danger of CO in the home.  Many organizations in this field, including CoGDEM and a number of charities, work very hard to raise awareness of CO and the additional information that this pilot can lead to providing will only help with this.

“It is widely thought that the true level of CO poisoning is under-reported - the pilot lays the groundwork to begin to combat this. Ultimately gaining improved insight into the extent and causes of CO fatalities can lead to improved education, awareness and potentially save lives.”

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