Chris Bryant and Baroness Finlay: Victims of CO poisoning must be given the treatment they need
Even low levels of carbon monoxide exposure can cause permanent damage. But models to improve treatment exist, as does the appetite amongst the medical community, write Chris Bryant and Baroness Finlay
Where we hail from in South Wales, acquired brain injury is most commonly associated with the head injuries sustained on the rugby field. Very few would link the symptoms of severe brain trauma, Parkinson’s disease or even foetal alcohol spectrum disorder with a silent, colourless, odourless gas given off by a faulty boiler or barbeque.
However, as we heard at the All-Party Parliamentary Carbon Monoxide Group’s recent roundtable, the impacts of carbon monoxide (CO) on the brain can be just as devastating. As with most acquired brain injuries, victims of CO poisoning are consistently let down by poor medical understanding, misdiagnosis, and lack of investment in treatment – as well as the tragedy that their poisoning was preventable in the first place.
CO is a highly poisonous gas given off whenever a carbon-based fuel burns incompletely – common sources include stoves, fires, faulty boilers and gas appliances, or engines. Once inhaled it binds to haemoglobin and deprives vital organs and tissues of oxygen, as well as being directly toxic to cells. In high levels, CO exposure can cause coma or death within minutes.
The common misconception has been that if you survive the initial poisoning, you will recover fairly quickly. Unfortunately for many victims this is not the case. Even low levels of CO exposure can cause permanent damage to the brain and cardiovascular system. As a result, survivors report a range of neurological and related mental health problems, including memory loss, mood swings, depression, anxiety, parkinsonism, speech disorders, disruption of fine motor control and balance, incontinence, tinnitus, and even the loss of the ability to read or write.
It is easy to see how these symptoms seriously impair a patient’s ability to live a full and active life, with the accompanying social ramifications and cost to the state. However, our health and housing systems are consistently failing those poisoned by CO, starting with the missed opportunities for prevention all the way through to the lack of accurate diagnosis, and treatments they cannot access.
By mandating CO alarms in homes – on which a decision is due from the Government this spring – and workplaces, stricter enforcement against rogue landlords, and investment in better public awareness, government could dramatically reduce the number of UK residents exposed to CO, currently estimated at well over 4,000 each year. However, improving protection does not negate the need for proper diagnostic and treatment pathways.
Firstly, as the symptoms often mimic flu, mental health issues or dementia, we must ensure GPs and nurse practitioners are able to accurately diagnose chronic CO poisoning. This means working with the Royal Colleges to roll out awareness programmes. There are simple but underused screening tools available, and investment in new diagnostic equipment in surgeries is needed.
After initial diagnosis, victims of acute CO poisoning should be treated with monitored oxygen. Hyperbaric oxygen therapy is used in some countries, but it was recently decommissioned by NHS England; better clinical trials to evaluate its use are urgent.
What happens next is just as important for long term outcomes. A specialist clinical centre, similar to those that already exist for epilepsy and traumatic brain injury, is needed to assess and plan management of CO patients with brain injury.
Specialist care from a multi-disciplinary team would mean patients can develop coping mechanisms, regain a sense of normalcy, and hopefully see a real improvement in symptoms. Data from these patients will allow optimal management strategies to be tested and evaluated, so some good may then come from their experience.
But prevention is key – mandatory alarms, ideally with electronic readouts to detect low levels, could stop countless lives being lost or damaged by this silent killer.
The brain is our most complex organ, and CO is a complex poison. However, models to improve treatment exist, as does the appetite amongst the medical community. We can no longer deny the victims of this deadly gas the comprehensive treatment they deserve.
Chris Bryant is Labour MP for Rhondda and co-chair of the APPG on Acquired Brain Injury. Baroness Finlay of Llandaff is a crossbench peer and co-chair of the APPG on Carbon Monoxide