Every year, from June through November, hurricanes threaten and often devastate areas of the eastern US seacoast, the Gulf Coast, and Caribbean islands. With successive hurricanes, acute gasoline and carbon monoxide (CO) poisonings persistently accompany the direct effects of wind and water on human health.¹

Following hurricanes, the most frequent serious concerns called in to poison control centers are CO and gasoline exposures.^{1-Reference Iqbal, Clower and Hernandez3} In a Texas study, during the evacuation and landfall periods, the mean daily call volume for gasoline exposure significantly increased from the baseline (pre-evacuation) period. During post-evacuation, the mean daily call volume significantly increased from the baseline period for both CO and gasoline.^{Reference Forrester2}

Carbon monoxide poisoning is a leading preventable cause of morbidity and mortality in disaster-affected areas. Generators have been reported as the primary exposure source for over 80% of fatal cases and more than half of non-fatal cases. Most CO cases occurred within 3 days of disaster onset.^{Reference Iqbal, Clower and Hernandez3} Less has been reported about gasoline exposure and poisoning, but loss of power often results in handling gasoline for generators or siphoning gasoline from fuel tanks.

On October 29, 2012, Hurricane Sandy made landfall near Atlantic City, New Jersey, wreaking damage from flooding, waves, and wind. There were widespread power outages, evacuations, and gasoline shortages.

Among a total of 10 806 calls to the New Jersey Poison Information and Education System (NJPIES) from October 26, when evacuation began, through December 2012, 498 calls from the public and professionals were deemed Sandy-related. Sandy-related case volumes peaked from October 30 through November 4.

The 2 most frequent Sandy-related exposures were gasoline exposure (n = 160 [32.1%]) and CO exposure (n = 100 [20.1%]), which followed the pattern seen after hurricanes such as Katrina and Wilma in 2005, Ike in 2008, and Irma in 2017.^{1,Reference Forrester2,Reference Mulay, Ramadugu and Atrubin4} Carbon monoxide and gasoline exposures accounted for most calls.

Figure 1 shows the timing of the calls for CO and gasoline. Calls with either of these exposures peaked on November 1, which was 3 days after landfall. The source of most (64%) calls about CO exposure was a health care facility, whereas only 6.3% of gasoline calls were initiated in this manner. Excluding information-seeking calls and restricting to calls reporting an actual exposure (n = 380), gasoline exposure calls were predominantly males (86.9%) and CO exposure calls, females (61%) (P < 0.0001).

FIGURE 1 Calls to NJPIES for Carbon Monoxide and Gasoline Exposures, October 15 – December 31, 2012.

It was surprising to us that, after more recent storms in 2017 and 2018, storm-related CO poisoning continued to occur, despite 3 decades of prevention efforts.^{Reference Mulay, Ramadugu and Atrubin4-6} Research has shown that, despite public health messaging and warnings from national, state, and regional entities on the dangers of CO and gasoline exposures, these exposures still occur.^{1,Reference Forrester2}

NJPIES provided essential guidance and information to health care facilities and individuals during Hurricane Sandy. A Google search of “How to siphon gas” identified 20 500 results, suggesting that the dangers of this activity are still not widely known.⁷ The need remains for enhanced prevention and intervention strategies, in addition to ongoing public education on the proper handling of fuel and use of gasoline-powered generators.