RT Journal Article SR Electronic T1 Fatal carbon monoxide poisoning: an outdoor occupational accident case JF Injury Prevention JO Inj Prev FD BMJ Publishing Group Ltd SP A179 OP A179 DO 10.1136/ip.2010.029215.640 VO 16 IS Suppl 1 A1 G Djafari A1 I Rosenthal A1 O Ingemann-Hansen YR 2010 UL http://injuryprevention.bmj.com/content/16/Suppl_1/A179.2.abstract AB Fatal carbon monoxide (CO) poisoning by suicide or accident is well known. Most cases are due to smoke from burning buildings, town gas and car exhaust gas all in closed areas. Another suicide method identified at internet sites are mixing of sulphuric acid and formic acid resulting in CO formation. The literature has described three such cases where the victims were found in sealed rooms with deadly CO concentrations. The case victim was a healthy 41-year-old male employed at a haulage company. He was ordered to remove 6 m3 80% sulphuric acid containing acetic acid from a factory. When he began to suck up the liquid from different pallet tanks standing outside temperature and pressure arose in his vacuum tanker, and he started to pour the liquid back. He was afterwards seen lying on top of the tanker next to the lid. It later emerged that the liquid collected contained formic acid as well. The autopsy revealed bright red lividity characteristic of CO poisoning, marks in his face consistent with lying on the tanker, no airway corrosions and a postmortem CO haemoglobin level at 62%. Discussion and Conclusion To our knowledge this is the first reported case of outdoor fatal CO poisoning and also the first case with CO poisoning by accidental mixture of sulphuric acid and formic acid. To avoid occupational CO poisoning in the future safety masks should be obvious along with certainty of fluid in processing as well as safeguard the density of the vacuum package.