When a team of medical sleuths reported three years ago that houseboaters on giant Lake Powell in Utah and Arizona were dying of carbon monoxide poisoning disguised as drowning, no one believed them. Independent testing proved they were right, and the boats were recalled and redesigned.
Two years ago, the team determined that people at Lake Powell were dying from carbon monoxide around smaller and faster boats, too — children falling unconscious off the swim platform and drowning, teenage bodies sinking as they tried to hang on to the back of the craft.
Their findings were good news, in a way: It meant that many boating deaths around the country might be preventable.
The Coast Guard began alerting the boating public last month that up to 15 percent of boat-related drownings could involve carbon monoxide.
Those same medical investigators have now studied every boat accident on the lake over the past nine years. Their conclusion: More than 40 percent of the drowning victims were suffocating from carbon monoxide even before they went under.
"It's a frightening number of poisonings that got totally lost," said Jane McCammon, director of the National Institute for Occupational Safety and Health's Western field office.
Nationwide, about 750 people die every year in boating accidents, and most of them drown.
Could more than a third of the deaths be due to a colorless, odorless gas whose dangers have been known for centuries?
"I can't imagine that it would be that high" nationwide, said Dr. Robert Baron, medical director for Lake Powell's Glen Canyon National Recreation Area, who first raised the alarm. "On the other hand, I want to have somebody prove to me why it's not."
That is difficult to do.
Boating accidents and injuries are known to be vastly underreported. Carbon monoxide's involvement rarely makes it into official statistics, even when the facts are obvious and authorities have confirmed the link.
In the wee hours of Sept. 23, 2001, Ralph Reyes started the engine of his 29-foot Sun Runner Ultra to generate power. He and his guests fell asleep in separate cabins on the boat, still moored at Clark's Landing off the Delaware River in Delran, N.J. Reyes and another person died.
Sgt. Reyes "just loved life," said Detective Jay Hunt, who worked with him for 22 years on the Willingboro, N.J., police force. "If you were in a 7-Eleven store and he heard you talking about boating, he would invite you on his boat."
Shortly before 8 a.m., one of Reyes' guests got up feeling sick. She tried to awaken her 30-year-old sister, who was in a closed cabin nearer the engine. Then she ran out and called 911.
The police said there was no carbon-monoxide detector on board. The Burlington County Medical Examiner's Office attributed the two deaths to carbon monoxide poisoning.
Yet the case does not appear in state marine police or Coast Guard records as related to carbon monoxide. In fact, New Jersey, Pennsylvania and Delaware authorities all say they know of no such incidents, ever — although they add that no one has thought to look until now.
Known dangers
The dangers of carbon monoxide at home and in the car have been known for years; people commit suicide by running their engine in the garage.
Carbon monoxide is a byproduct of fire and internal-combustion engines. A single carbon atom binds with a single oxygen atom to form the molecule written as CO — a form that oxygen-carrying hemoglobin in the blood prefers 240 times more than the O2 the body needs. If they are breathed in together, the body will be starved of oxygen.
The early symptoms — headache, nausea, dizziness, confusion — are similar to excess alcohol or heatstroke; many boaters have had those symptoms. Continued exposure can cause unconsciousness. In the water, that can lead to drowning.
Until recently, medical examiners had no reason to test the blood of drowning victims for CO because they were outside. CO was an "inside" hazard.
Lake Powell is the second-biggest manmade lake in North America; it took 17 years to fill after the Colorado River was dammed above the Grand Canyon in 1963. The recreation area draws 2 million visitors a year. Baron, who is an emergency-room doctor in Phoenix, signs off on every death.
In the 1990s, he noticed a pattern of accidents involving CO and houseboats. The Coast Guard declined to investigate.
When two brothers, ages 8 and 11, drowned seconds apart in 2000, the park demanded help. The government sent Denver-based McCammon, who had experience with carbon monoxide poisoning.
The boys had been playing in an enclosed air space under the anchored houseboat where the propellers can be serviced. With the generator running, as it often is on these floating vacation homes, she sampled the air the boys had breathed.
The Environmental Protection Agency limit for one hour's CO exposure is 35 parts per million. A reading of 1,200 ppm is an immediate danger to life and health; 12,000 is fatal.
McCammon got a 30,000 ppm reading.
The Coast Guard issued a recall in December 2000. And as news spread about this surprising hazard, people told Baron and McCammon about other incidents, in other states, on other kinds of boats. They started a national log.
Deadly fad
In 2001, an 18-year-old celebrating high school graduation at Lake Powell lost consciousness and drowned as he and his friends clung to the back of the swim platform of a ski boat.
The fad is called "teak surfing" — you rest your upper body on the swim platform, sometimes made of teak, as the boat gains speed and the bow rises and stern falls, then let go and "surf" the moving depression behind the boat.
McCammon again duplicated the conditions on the water: dual exhausts below the surface, four teenage bodies blocking the wind, a "ditch" in the rear that moved with the boat. Placing her probe where the boy's face was, she got a CO reading of 26,700 — double the amount that causes death.
"I was shocked," she said.
She had seen a home video of some of the teens teak surfing: "I would have done it because it looks fun. And even doing what I do, I never would have thought this could kill you."
Similar cases surfaced elsewhere. The Coast Guard issued a warning about teak surfing.
National problem?
And Baron and McCammon, having shown there was a problem, decided to try to figure out how big a problem CO really was.
They again reviewed all the drownings on Lake Powell and counted how many definitely involved carbon monoxide. The answer came a few months ago: 11 out of 69, or 16 percent.
The Coast Guard began a public-service campaign about carbon monoxide around boats.
The two investigators continued to comb their records, and excluded drownings that had nothing to do with motorboats. Now they had 26 drownings off boats, 11 of them involving CO — 42 percent.
Baron said he was "astounded" at the finding. McCammon was "incredulous."
The Coast Guard says it has no reason to doubt their statistics. "They have better numbers than we do," said Capt. Scott Evans, chief of the Guard's Office of Boating Safety.
Evans does not, however, assume that the problem is anywhere near that dire elsewhere. Around the country, nearly a quarter of boat-related drownings are from canoes, kayaks and rowboats, so they would not involve carbon monoxide; another quarter are off small outboard motorboats, none of which have been implicated at Lake Powell.
In the nation as a whole, outboards are twice as common as inboards and inboard/outboards are in Utah, where most of Lake Powell lies.
In Pennsylvania, with its smaller lakes and streams, they are three times as common. Nevertheless, the state Fish and Boat Commission was one of the agencies to act. It is expected to vote Saturday on a proposed teak-surfing ban.
At least two federal offices are using different models to try to quantify the CO-and-boating hazard nationwide. Epidemiologists will be in western Pennsylvania this weekend, interviewing boaters and testing their blood as they come on and off Youghiogheny River Lake.
Capt. Evans said he is happy to see any publicity about safety. People need to be reminded to wear life jackets, which they don't when teak surfing or sitting on a swim platform, and not to drink too much, which could cause risk-taking.
Improving equipment
Boat manufacturers are working feverishly on their end of the problem, said Monita Fontaine, the National Marine Manufacturers Association's vice president for government relations. They are hoping to eventually "engineer it away" through technology such as catalytic converters that can work in a marine environment.
Technology to detect carbon monoxide in the open air is years away. Detectors inside the cabins of new boats have been mandated since 1998. Some insurance companies require them on newly purchased used boats.
Still, marine CO detectors have developed a reputation for false alarms, and some boat owners ignore or disable them. "What we're thinking," said Phil Cappel, chief of a product assurance division for the Coast Guard, "is (some) people thought they were false alarms, and they weren't."
With all the news about carbon monoxide and drownings, little attention has been paid to these "on-the-boat" hazards. The national case list that Baron and McCammon started a couple of years ago has grown to nearly 500 confirmed accidents, including 94 deaths involving CO poisoning.
Nearly a third of those took place on or in the boat.
"Last year," McCammon said, "there were three incidents on Lake Powell that had to do with (CO) detector issues, disabled or not working or whatever."
She hopes to tackle that next.