Carbon monoxide (CO) poisoning is a pervasive yet preventable threat in the United States, causing significant harm each year. According to the U.S. Centers for Disease Control and Prevention, at least 430 Americans die annually from unintentional CO poisoning, and an estimated 50,000 people seek emergency care due to accidental exposure.
Recognizing the urgency of this “silent killer,” UL Standards & Engagement has developed the CO Risk Assessment to evaluate each U.S. state’s code and regulatory efforts, health outcomes, and public awareness. The assessment draws on multiple data sources across the last two decades to ensure a comprehensive assessment across public health outcomes, state-level mandates for indoor CO detector presence, and public awareness measures. These three pillars — weighted at 40%, 35%, and 25%, respectively — produce an overall weighted score out of 100 for each state. The weighting approach balances the diverse factors affecting CO safety, ensuring that the assessment reflects each component’s relative impact on public health.
Each state’s final weighted score is translated into a tier — from CO Safety Champion (the highest tier) to CO Safety Leader, CO Safety Advocate, or CO Safety Starter (the lowest tier) — highlighting how effectively it has addressed CO safety across the three pillars.
Overview Map of U.S. State Readiness
In ULSE’s inaugural CO Risk Assessment, six states stand out as CO Safety Champions, reflecting their strong public health outcomes, code and regulatory coverage, and public awareness: New Jersey, Virginia, Vermont, California, Arkansas, and Alabama. These CO Safety Champion states share several key attributes that contribute to their success. They have implemented uniform, statewide CO detector requirements across multiple building types, established regular inspection protocols, maintained consistent public awareness campaigns, and forged effective partnerships among public health departments, fire safety officials, and community organizations. Many have also implemented proactive measures during emergency situations, such as power outages, when CO poisoning risks typically increase due to improper generator use.
The assessment also reveals significant disparities in CO safety across states. While some, like New Jersey, Vermont, and New York, demonstrate robust regulatory frameworks and higher public awareness, others, such as Missouri and Nebraska, lag in key areas, including CO detector mandates. Public awareness also varies widely: while New Hampshire shows strong engagement in CO safety education, other states, such as Louisiana, report alarmingly low awareness scores, leaving millions of citizens vulnerable to preventable CO-related injuries and deaths.
Explore Results by Category
CO Safety Champions
CO Safety Champions are the highest scoring states in the country and lead the way in protecting their residents. These six states rank at the top in every category and are exemplary of the gold standard for CO safety. They generally mandate CO detectors in both new and existing buildings, run year-round public awareness efforts, and demonstrate strong interagency coordination to ensure compliance. Many have also instituted targeted emergency protocols to address higher CO risks during storms or power outages.
CO Safety Leaders
These 12 states are strong performers with well-rounded efforts. There is still room for further improvement to reach the top tier. CO Safety Leaders perform well across most metrics but have a few gaps preventing them from reaching the CO Safety Champion tier. While they typically have broad CO alarm requirements and effective seasonal awareness drives, some states could benefit from more consistent enforcement or better coverage for older structures. With an added focus on uniform inspection protocols and year-round outreach, they could advance to the top tier.
CO Safety Advocates
CO Safety Advocate states, the largest group in the assessment, have basic code and regulatory frameworks in place and are improving in health outcomes, yet they often lack robust public awareness campaigns. Many states in this category require CO alarms only in newer buildings, leaving existing homes less protected. Strengthening CO detector mandates, along with educational efforts, would help them make the leap to CO Safety Leader status.
CO Safety Starters
These 13 are at an early stage of implementing CO safety measures. Statewide regulations are limited or absent, relying heavily on local rules or voluntary adoption. Public education is minimal, with few resources dedicated to CO awareness. Adopting comprehensive codes, expanding inspection requirements, and allocating funds for consistent public engagement would significantly enhance safety in these areas.
Overall, the CO Risk Assessment serves as both a benchmark and a call to action. These findings emphasize that effective CO safety requires a mix of well-enforced policies, targeted public outreach, and consistent adoption of safe practices. Even the highest scoring states have opportunities to strengthen detection requirements, expand public education, and ensure equitable enforcement. By identifying best practices and areas for improvement, ULSE seeks to foster greater collaboration among regulatory agencies, industry leaders, and public health advocates. States that prioritize stronger CO safety policies and widespread education will be better positioned to prevent future tragedies, saving lives and ensuring safer environments for all residents.
Explore the full report to see the complete results for each state, along with additional findings, methodology, and recommendations for each category of readiness.