Carbon Monoxide Poisonings from Forklift Use During Produce Packing Operations

In August 2013, the North Carolina Division of Public Health investigated a carbon monoxide (CO) exposure on a farm. Two employees were overcome by CO and lost consciousness while using a propane-powered forklift to load produce into a refrigerated trailer backed up to a warehouse. One employee died, and the second employee was admitted to the hospital for hyperbaric oxygen treatment. Eighteen people, ranging in age from 18 to 69 years, were potentially exposed to CO, including the two employees, a family member who discovered the employees, two bystanders who stopped to offer assistance, and 13 first responders. Thirteen people who assisted in the emergency response experienced symptoms such as headache and dizziness, and all 16 who assisted were evaluated in a local hospital emergency department and released after receiving 100% oxygen. Blood tests showed five people (the two employees, family member, and two bystanders) had elevated blood carboxyhemoglobin levels, but all first responders had levels within normal range. Firefighters measured a peak CO concentration of 2214 parts per million in the warehouse. The North Carolina Division of Occupational Safety and Health investigated and determined that the forklift, operated inside the trailer with no ventilation, was the source of the CO. Public health investigation activities included interviewing responders, obtaining ambient CO concentration measurements from the fire department, advising the local health director, reviewing medical records, and developing a line listing of exposed persons. To prevent CO poisoning, employers should consider replacing gas-powered equipment with electric equipment, which does not produce CO.