Be careful! Carbon monoxide poisoning!

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Case: At 10:33 on January 29, 2013, a carbon monoxide poisoning accident occurred at the Yongsheng Coal Mine in Dongning County, Mudanjiang City, Heilongjiang Province, resulting in 12 deaths (9 of whom were rescue workers from the coal mine) and 8 injuries, with direct economic losses amounting to 11.49 million yuan. January 29, 2013, was the 18th day of the 12th lunar month, and it marked the day when coal mining enterprises in Dongning County held traditional rituals to honor the wells. At 8:58 that day, Yin Zhenfa and Gao Bo, the investors of Yongsheng Coal Mine, led the mine’s key management staff and some workers to pay their respects at the mine entrance. After the ceremony, Yin Zhenfa, Gao Bo, and some of the mine’s management staff waited in the office for meals, while Zhang Mingbao, the head of the mechanical and electrical department, assigned Li Guangyin, the person in charge of the main fan, Tian Jinzhong, the person responsible for operating the hoists, and Liu Dunhou, the nominal technical director, to go down into the mine to pump out water. At around 9:30, Li Guangyin and two others started the main fan before descending into the well (the main fan of this well had been shut down on January 27 during the holiday). At around 10:30, as the 3 workers reached Zuoer Road, 2 of them collapsed due to poisoning, while Li Guangyin (who was less affected by the poisoning at that time) called for help from inside the well. After receiving the emergency call, the coal mine failed to report the situation in a timely manner and blindly sent personnel to carry out rescue efforts. During these self-rescue attempts, a total of 20 people from Yongsheng Coal Mine and the nearby Donglong Coal Mine went down into the mine to assist with the rescue, 5 of whom ended up in the Left Third Road tunnel by mistake. At 1:30 p.m., after receiving the report, Deputy County Head Zhang Fuguang urgently dispatched 30 members of the county’s coal industry rescue team to the scene to carry out rescue operations, and at the same time organized 50 miners from nearby coal mines to assist in the rescue efforts. At 21:40, after receiving the accident report from Dongning County, ** in Mudanjiang City had Vice Mayor Zhou Jinglong lead officials from the Safety Supervision Bureau and the Coal Bureau to the scene overnight to coordinate the rescue efforts. By 1:00 on January 30, 12 people had been rescued from the mine; 5 of them were saved from death following medical treatment, while 7 died despite efforts to save them. Eight people remain trapped underground. Therefore, requests were made for support from the rescue team of Jixi Shenglong Company under Shenmei Group and the Jixi rescue unit under Longmei Group. Following the rescue efforts, 6 people were lifted out of the well at 13:15; 3 of them had stable vital signs while 3 died. At 15:30, two more victims were brought out of the mine, and the rescue operation was completed. The accident resulted in 12 deaths and 8 injuries. Analysis 1: Carbon monoxide from the fire zones in the abandoned mines seeped into the Yongsheng Coal Mine through cracks. Due to the cessation of air supply in the mine, carbon monoxide accumulated underground; when workers entered the Zuoerping roadway to drain water, it led directly to carbon monoxide poisoning incidents. 2. Coal mining enterprises violate relevant safety laws and regulations. First, during the period when the mine is shut down, the requirement of the province’s ** regarding the \"six no-stop\" principles is not followed, and the air supply is stopped arbitrarily. Second, the mines use camouflage techniques to construct sealed areas in order to avoid regulatory inspections and operate work faces illegally. Third, there are potential fire hazards around the mine, and no effective preventive measures have been put in place. 3. Coal mines failed to take adequate measures for emergency rescue in the event of accidents. After the accident, the coal mine failed to report it in a timely manner as required by the Regulations on the Reporting, Investigation, and Handling of Production Safety Accidents, thereby delaying the optimal timing for rescue efforts. 4. Relevant personnel at coal mining enterprises carried out rescue operations blindly without any protective measures, resulting in an increase in casualties from the accident. 5. The mine violated the \"Seven Provisions for Coal Mine Managers to Protect Miners’ Lives,\" as there was a mismatch between the personnel in charge of coal mine safety, their qualifications, and their assigned roles; the actual managers lacked the necessary certificates, and safety training and education for workers were inadequate. 6. The key management personnel in coal mines lack a strong safety awareness; no emergency drills for accidents and disasters are conducted, and employees lack basic knowledge of emergency rescue, preventing them from carrying out effective self-rescue and mutual rescue. Precautionary measure 1: All types of coal mining enterprises must earnestly assume their primary responsibility for safe production and strengthen the basic management of coal mine safety. 2. \"One ventilation and three protections\" should be regarded as the top priority in coal mine safety; mine ventilation management must be strengthened to ensure the reliability of the ventilation system, and operations in conditions of no wind, weak wind, or recirculating air are strictly prohibited. 3. Mines that have ceased operations must maintain airflow even when they are shut down. Miners must carry self-rescue devices with them at all times. 4. Strengthen safety training and education for employees. It is necessary to further strengthen safety education and training for employees, comprehensively raise their awareness of self-protection and safety responsibilities, improve the quality of the management team, and eliminate any instances of violations of safety rules. Symptoms of carbon monoxide poisoning Carbon monoxide is a colorless and odorless gas that is slightly soluble in water, soluble in ethanol, benzene, and most other organic solvents, and is flammable. It is mainly used in chemical synthesis, such as the production of methanol and phosgene, as well as as a reducing agent in metal refining. It can enter the human body through the respiratory tract and primarily damages the nervous system. Carbon monoxide binds to hemoglobin in the blood, causing tissue hypoxia. In production, the ventilation in the smelting workshop is poor; engine exhaust gases and **explosions both contain large amounts of carbon monoxide. In industry, processes such as steelmaking, ironmaking, and coking are involved; in the chemical industry, the production of chemical raw materials like ammonia and formaldehyde, as well as the manufacture of chemical fertilizers and dyes, all involve exposure to carbon monoxide. Additionally, activities in the carbon and graphite industry, including the calcination of carbon and the production of electrodes, also involve contact with carbon monoxide. The time-weighted average permissible concentration in workplace air shall not exceed 20 mg/m3, and the short-term exposure permissible concentration shall not exceed 3 mg/m3. In cases of acute carbon monoxide poisoning, those with mild poisoning experience headaches, dizziness, tinnitus, palpitations, nausea, vomiting, and weakness. Those with moderate poisoning, in addition to the above symptoms, also suffer from flushed skin, pink lips, a rapid pulse, irritability, unsteady gait, confusion, and may even fall into a coma. Severe cases involve loss of consciousness, constricted pupils, increased muscle tension, frequent seizures, and incontinence of urine and feces; extreme poisoning can be fatal. Prolonged and repeated inhalation of a certain amount of carbon monoxide can cause damage to the nervous and cardiovascular systems. Mechanism of carbon monoxide poisoning Carbon monoxide poisoning occurs when toxins produced by the incomplete combustion of carbon-containing substances are inhaled through the respiratory tract. The mechanism of poisoning is that carbon monoxide binds to hemoglobin 200–300 times more strongly than oxygen does; as a result, carbon monoxide easily combines with hemoglobin to form carboxyhemoglobin, thereby preventing hemoglobin from carrying oxygen and leading to tissue asphyxia. A carbon monoxide concentration in the air of more than 30 mg/m3 can cause poisoning. It is toxic to tissue cells throughout the body, with the most severe effects on the cerebral cortex. By the time people realize carbon monoxide poisoning has occurred, it is often too late. This is because the cerebral cortex, which controls human movement, is the first to be paralyzed and damaged, preventing the person from carrying out purposeful, voluntary movements. At this point, the poisoned person still has a clear consciousness and wants to open the doors and windows to escape, but their limbs no longer respond to their commands. Therefore, victims of carbon monoxide poisoning are often unable to rescue themselves effectively. First aid for carbon monoxide poisoning: 1. Call 120 immediately to summon an ambulance. 2. Since carbon monoxide is slightly less dense than air, it floats in the upper layers; therefore, rescuers should move in a crawling position when entering and leaving the scene. It is strictly prohibited to bring open flames inside, especially in cases of gas leaks. When the concentration of gas inside is high, electrical sparks generated by ringing the doorbell or turning on indoor lights can cause an explosion. 3. Once inside, all ventilation doors and windows should be opened immediately. If the source of the gas can be identified and stopped quickly, such as by turning off the gas valve, this should be done at the same time; however, no time should be lost for this purpose, as saving lives is more important. 4. Then quickly carry the poisoned person out of the room filled with carbon monoxide, to a well-ventilated and warm place where they can lie down; loosen their collar and belt to facilitate breathing. Wait for an ambulance, ready at any time to be transported to a hospital with a hyperbaric oxygen chamber for treatment. 5. While waiting for the transport vehicle, for patients who are unconscious, their head can be turned to one side to prevent vomit from entering the lungs and causing suffocation. To help them regain consciousness, acupuncture or pressing the Renzhong point with fingernails can be used. If there is still no breathing, artificial respiration must be performed immediately. For patients in a deep coma, on-site rescue should not be attempted; they should be taken to the hospital as soon as possible. However, artificial respiration must not be stopped during transportation to the hospital in order to ensure oxygen supply to the brain and prevent irreversible damage to the cranial nerves caused by lack of oxygen.