Carbon monoxide cases treated in state's only emergency hyperbaric chamber

Found unconscious in their St. Paul home because of a defective boiler, Tom and Nancy Nordeen were rushed this week to the state's only facility that offers emergency hyperbaric oxygen treatment.

The Nordeens remained in critical condition on Wednesday, a day after getting treatment for carbon monoxide poisoning at Hennepin County Medical Center's hyperbaric chamber.

Carbon monoxide poisonings are most common during the winter months, when people are most likely to turn on an old boiler or furnace or use fuel-based space heaters in unventilated areas. It's also a busy time at HCMC, where the most severe carbon monoxide cases are treated and where people are sometimes flown in from greater Minnesota and neighboring states.

The facility, which delivers 100 percent oxygen to a patient in a special room with increased atmospheric pressure, has provided treatment for hundreds of people poisoned by carbon monoxide since it first opened in 1964. HCMC plans to replace the 46-year-old chamber, but budget cuts to the hospital have so far put the plans on hold.

"We've gone all the way to the point of getting a contractor, deciding on the space, getting the approvals, and that was right before the recession hit," said Dr. Cheryl Adkinson, medical director for hyperbaric medicine at HCMC and a physician in the emergency department.

Although a spending plan passed recently by Congress includes $400,000 for a new hyperbaric chamber, HCMC estimates the total replacement cost will be $10 million.

Carbon monoxide poisoning, which deprives the body of oxygen and can kill people, is just one condition treated using hyperbaric chambers. The facilities are also used for things like healing wounds, responding to radiation tissue damage and treating decompression sickness for scuba divers.

"It's a resource to all Minnesotans, not just those who live in Hennepin County and not just those who are poor."

Although there are 1,500 hyperbaric chambers across the country (Minnesota has at least three), a much smaller number of them are available for emergency carbon monoxide treatment, said Dr. Peter Bennett, director of the Undersea and Hyperbaric Medical Society based in Durham, N.C.

Rising medical costs and budget cuts have limited the number of hospitals that can have emergency hyperbaric chambers available 24 hours a day, seven days a week, he said.

"Many hospitals can't afford to have people sitting around with no patients just in case they come in," Bennett said.

HCMC plans to keep operating its hyperbaric chamber, but the aging facility is more prone to needing adjustments and repairs. A recent round of budget cuts, which came after the state cut the General Assistance Medical Care program for low-income adults, forced HCMC to eliminate more than 150 positions and close two clinics.

"The Hennepin County hospital is in serious financial straights. This facility is part of Hennepin County Medical Center and so it shares that threat," Adkinson said. "It's a resource to all Minnesotans, not just those who live in Hennepin County and not just those who are poor."

Adkinson said if HCMC were to close the hyperbaric chamber, people would have to go to Milwaukee or Iowa City, Iowa, for emergency carbon monoxide treatment.

"It's very expensive to have a subspecialty unit available 24-7," she said. "It's not profitable for that, so it's a service."

Although many states, including Minnesota, have laws requiring homes to have carbon monoxide detectors, Bennett predicted there would still be plenty of cases, especially in the northern half of the country where winter is a bigger concern.

"The fact is that people will do what they do," Bennett said, adding that it's hard to enforce laws requiring installation of detectors in older homes. "(Carbon monoxide poisoning) is going to happen. It happens every year.

The Centers for Disease Control and Prevention is conducting a study on carbon monoxide poisoning and treatment, which Bennett said will provide comprehensive information about how prevalent the issue is and how well health care providers are able to respond to it.

As part of the study, the Minnesota Department of Health found that 61 Minnesotans died from accidental carbon monoxide poisoning from 2003 to 2007, with the number of fatalities peaking in the fall and winter months.

Carbon monoxide poisoning also caused 175 hospitalizations and 1,261 emergency department visits during the same period.

Symptoms of carbon monoxide poisoning include severe headache, dizziness, nausea, and drowsiness.

(MPR's Brandt Williams and Madeleine Baran contributed to this report.)

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