Lethal carbon monoxide generated from small internal combustion engines.

This article examines seven fatal carbon monoxide (CO) poisoning cases investigated by the North Carolina Office of the Chief Medical Examiner (NC OCME) from 2013 to 2020, highlighting the risks posed by small internal combustion engines operated in poorly ventilated environments. Sources of CO included pressure washers, propane-powered forklifts, inboard engine boats, motorcycles, heaters, and generators. The study emphasizes the limitations of electrochemical (EC) gas monitors used by first responders, particularly their cross-sensitivity to interfering gases like acetylene, which can lead to false readings. It underscores the importance of educating first responders, forensic professionals, and public health officials about less common CO sources, proper equipment use, and scene safety to prevent accidental deaths. The article also discusses the influence of environmental factors and advocates for enhanced public awareness and training to reduce CO-related fatalities from small engine use.