NEHA November 2022 Journal of Environmental Health

November 2022 • Journal of Environmental Health 19 to safely evaluate themselves or others and respond to their surroundings. Second, the presence of alcohol might blunt the symptoms of CO poisoning and prevent a person from rescuing themselves or others who are ice fishing with them. Third, the presence of both alcohol intoxication and CO poisoning can confound the evaluation of these individuals in an emergency medical setting (Kao & Nañagas, 2004; Kouimtsidis, 2002; Moon et al., 2020) and might result in a failure to identify CO poisoning or accurately assess its clinical severity, potentially leading to overtreatment or undertreatment of the patient. The treatment of CO poisoning includes the administration of 100% oxygen that competitively inhibits the binding of the CO molecule to hemoglobin, which enables improved oxygen delivery at the tissue level and speeds elimination of CO through the lungs (Weaver et al., 2000). Oxygen delivered under hyperbaric conditions has the potential to be an even more e‡ective treatment for CO poisoning, by more quickly eliminating CO as well as favorably modulating inflammation. These e‡ects result in a potential mitigation of tissue injury and prevention of long-term neurologic sequelae (Weaver et al., 2002). In the rural areas of the upper Midwestern U.S., however, where ice fishing is commonplace, there are limited resources for testing and confirming the diagnosis of CO poisoning (Masters et al., 2019) and only three hyperbaric chambers suited to handle an emergent CO-poisoned patient (Chin et al., 2016). Additionally, given that ice fishing most commonly takes place in rural areas, access to appropriate care can be limited or at the very least delayed by long or complicated transportation, making the prevention of CO poisoning even more crucial. Our study was limited by the availability and willingness of the participants to provide information via the survey. Additionally, these data were anonymous and self-reported, and validity was not confirmed. While originally included in the conception of this study, actual CO and alcohol levels were not measured. Future research should consider confirming and quantifying these exposures as well as their associations with particular survey responses to further characterize risks and potential targets for prevention. The results of our survey demonstrate that while there is an overall awareness of CO in the ice fishing community, more e‡orts need to be made to increase knowledge about the specific risks to ice fishers posed by prolonged periods of fishing while using propane heaters and consuming alcohol. Moreover, additional e‡orts should be made to increase the presence of, use of, and response to CO detectors. Finally, the greatest priority for public health o–cials and those who support the sport should be to encourage people who ice fish to seek medical care when symptoms of CO poisoning present or when known exposures to elevated levels of CO occur. Seeking medical care can prevent injury and even death among those looking to experience the joys of winter through recreational ice fishing. Acknowledgements: This research was not supported by any grants or other financial sponsor. Both authors were involved in the study conception and design; acquisition, analysis and interpretation of data; manuscript drafting; and manuscript submission. The authors have no financial disclosures to report. Corresponding Author: Christopher T. Bird, 701 Park Avenue, Minneapolis, MN 55415. Email: bird48f3@yahoo.com. Associated Press. (2017, January 18). One ice angler dead, four hospitalized after being overcome by carbon monoxide poisoning. Outdoor News. https://www.outdoornews.com/2017/01/18/one-ice-angler-dead- four-hospitalized-overcome-carbon-monoxide-poisoning/ Chin, W., Jacoby, L., Simon, O., Talati, N., Wegrzyn, G., Jacoby, R., Proano, J., Sprau, S.E., Markovitz, G.H., Hsu, R., & Joo, E. (2016). Hyperbaric programs in the United States: Locations and capabilities of treating decompression sickness, arterial gas embolisms, and acute carbon monoxide poisoning: Survey results. Undersea & Hyperbaric Medicine, 43(1), 29–43. Davis, D. (2017, January 27). After carbon monoxide killed Minnesota ice fisherman, his mother warns others. Twin Cities Pioneer Press. https://www.twincities.com/2017/01/27/after-carbon-mon oxide-killed-minnesota-ice-fisherman-his-mother-warns-others/ Hampson, N.B. (2016a). Cost of accidental carbon monoxide poisoning: A preventable expense. Preventive Medicine Reports, 3, 21–24. https://doi.org/10.1016/j.pmedr.2015.11.010 Hampson, N.B. (2016b). U.S. mortality due to carbon monoxide poisoning, 1999–2014: Accidental and intentional deaths. Annals of the American Thoracic Society, 13(10), 1768–1774. https://doi. org/10.1513/AnnalsATS.201604-318OC Hudson, B. (2017, January 26). Family wants son’s carbon monoxide death to be a warning to others. CBS News Minnesota. https://min nesota.cbslocal.com/2017/01/26/carbon-monoxide-ice-fishing/ Jackson, D.L., & Menges, H. (1980). Accidental carbon monoxide poisoning. JAMA, 243(8), 772–774. https://doi.org/10.1001/ jama.1980.03300340048024 Kao, L.W., & Nañagas, K.A. (2004). Carbon monoxide poisoning. Emergency Medicine Clinics of North America, 22(4), 985–1018. https://doi.org/10.1016/j.emc.2004.05.003 Kouimtsidis, C. (2002). Acute carbon monoxide poisoning and alcohol intoxication: A rare condition that is complex to manage. Crisis, 23(2), 74–76. https://doi.org/10.1027//0227-5910.23.2.74 Masters, T., Willenbring, B., Westgard, B., Cole, J., Hendriksen, S., Walter, J., Logue, C., & Olives, T. (2019). Availability of bedside and laboratory testing for carbon monoxide poisoning in the upper Midwestern United States. Western Journal of Emergency Medicine, 20(3), 506–511. https://doi.org/10.5811/westjem.2019.2.41428 Minnesota Department of Natural Resources. (2019). 2019 Legislative Report: Carbon monoxide exposure in fish houses and ice shelters. https://www.leg.state.mn.us/docs/2019/mandated/190117.pdf References continued on page 20

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