Toxic levels of carbon monoxide at Kelowna rink led to 12 men falling ill after rec hockey game
Credit to Author: Gordon McIntyre| Date: Tue, 03 Mar 2020 00:56:23 +0000
A heads-up physician at Kelowna General Hospital reached out to Interior Health to report a cluster of respiratory illness despite B.C. having no mandatory reporting of such clusters, a report released on Monday said.
A 56-year-old recreational hockey player had been admitted to the hospital on Feb. 9 with acute respiratory distress, the day after playing a game at an indoor arena in Kelowna, and while recovering mentioned that several other players had complained of similar symptoms, according to a case report in the B.C. Medical Journal published on Monday.
“A cluster investigation team was struck immediately to determine if the players had been exposed to a disease-causing agent,” says the report, written by seven scientists and public health officials.
“This case highlights the importance of health-care providers reporting disease clusters to public health authorities, even when the causative agent may not be reportable under the British Columbia Public Health Act.”
A team of Interior Health officials — including environmental health officers, a communicable disease specialist, and an epidemiologist — reported that 12 of 16 players who had been on the ice on Feb. 8 became ill. One of the 12 was out of the country, and of the other 11, none reported being smokers or users of recreational drugs.
It wasn’t Coronavirus causing the players’ respiratory problems — rather it was toxic levels of carbon monoxide, nitrogen dioxide and particulate matter infiltrating the players’ lungs.
The Interior Health team determined contributing factors to the high levels of the toxins included older-model ice resurfacing and edging equipment, unseasonable cold weather outside meaning doors were left closed more than usual, and the failure of heating, ventilation and air conditioning equipment.
These “created the perfect storm opportunity for toxic levels of CO, NO2 and particulate matter to accumulate indoors,” the report says.
The higher respiratory rate of the players as they skated increased their exposure to pollutants over that of staff, who did not report symptoms, according to the report.
“The incident described in this case report highlights the importance of real-time air quality monitoring in indoor ice arenas and the need to follow administrative protocols such as proper ventilation maintenance.”
The section of the B.C. Public Health Act that mandates reporting infections or exposure requires reporting cases of communicable disease to a medical health officer, including food or waterborne illnesses, and clusters of gastrointestinal illness.
In B.C., unlike Alberta, there is no requirement to report a cluster of respiratory illness.
“Therefore, a health care provider could be dealing with a significant illness cluster, such as the one we investigated, yet not be required to report to the (medical health officer),” the report reads. “In contrast, the Alberta Public Health Act … requires that any disease occurring in epidemic form or at an unusually high rate, or any illness suspected to pose a public health threat, be reported to (a medical health officer).
“Furthermore, in Alberta, reporting requirements extend beyond health care workers to teachers and persons in charge of an institution.”
The report urges front-line health care professionals to report any unusual events with possible public-health implications, even if the provincial Health Act does not make it mandatory to do so.
Efforts are underway, the report notes, to amend the province’s regulations to align with Alberta’s and require more inclusive reporting.
A health ministry spokeswoman said the province is undertaking a further analysis on the potential expansion to address this.
“It’s important to note that health officers, including medical health officers and environmental health officers, have broad powers under the Public Health Act to identify, prevent and mitigate health hazards,” she said in an email.
The monitoring of indoor rinks is a shared responsibility of employers, local governments and WorkSafeBC, which has a report on the hazards of carbon monoxide in sports arenas on its website.
WorkSafeBC also posts a table of exposure limits for chemicals and substances, which includes CO and NO2, under the Occupational Health and Safety Regulation.
It’s far from the first time there have been health emergencies in indoor arenas, but usually they’re related to ammonia poisoning.
Three people died at Fernie in 2017 because of an ammonia leak from an ice-chilling system, and dozens of non-fatal “refrigerated release incidents” have been reported to Technical Safety BC since 2007, including Olympic silver medallist and longtime figure skating coach Karen Magnussen, who was rushed to hospital in 2011 after inhaling ammonia gas at the North Shore Winter Club.