Massive Carbon Monoxide Exposure Event in a Primary School

On January 14, 2019, a massive carbon monoxide exposure event occurred in a Montreal-area primary school. The event appears to have been caused by a faulty heating system and there are still unanswered questions as to why no carbon monoxide alarm went off. A large number of children and staff experienced symptoms, ranging from headache to loss of consciousness. At least 35 children and 8 employees were transported to hospital and several were treated with hyperbaric oxygen.

Given the intensity of exposure and the prevalence of significant symptoms, the Environmental health team at Montreal Public Health, in collaboration with Ste-Justine Children’s Hospital, the local health administration, the school administration, and the Quebec Public Health Institute (INSPQ), spearheaded the organisation of an on-site follow-up clinic to screen for late symptoms in all staff and children. Over the course of four days, this massive and complex operation aimed to provide a neuro-cognitive screening of all of the school’s children and staff, with more in-depth evaluation by a pediatrician for those with signs or symptoms.  Out of 274 children who were present on the day of the event, 244 children were evaluated during the on-site clinics. Of these, 106 children were referred for secondary evaluation by a pediatrician. We are in the process of analysing results, which will provide a portrait of the prevalence and nature of symptoms.

An opportunity for advocacy

In Quebec, carbon monoxide detectors were made obligatory in long-term care facilities in 2014 and in daycares in 2016, in both cases, new regulations followed exposure incidents (long term care incident, daycare incident). As it became evident that this event was of an unprecedented size, we immediately began to think of opportunities for advocacy. We rapidly got in touch with our colleagues at the ministerial level and also focused our media interventions on the importance of carbon monoxide detectors in preventing health impacts. Within four days of the event, the Ministry of Education had requested that all schools throughout the province provide immediate proof of measures taken to install or verify detectors and indicated their intention to develop regulation before this summer.

Lessons learned

Although it is extremely unfortunate that so many children and employees were exposed to carbon monoxide, the rapid ministerial response demonstrates the importance of making sure that such events are used to move forward public policy. This pattern of regulatory change in response to exposure incidents is not unique to Quebec  and is likely to continue to be a reality in environmental health practice. While we will always work to prevent these types of unfortunate events, especially when the preventive measures are relatively simple to implement, we also need to be ready to use events such as these to catalyse policy change locally, and whenever possible, as broadly as possible.

This event also demonstrated the important role that media coverage can play in potentiating the advocacy work that public health units such as ours do. Although policy decisions are complex and not always easy to understand, the media coverage that we received undoubtedly helped provide visibility and generate pressure for rapid and appropriate solutions.

About the author

David Kaiser is a public health and preventive medicine specialist at Montreal Public Health, where he is the physician responsible for the environmental health team. David is also director of the residency program in public health and preventive medicine at McGill University.

PHOTO CREDIT: Allen McInnis, Montreal Gazette