We report the incidence and mechanisms of carbon monoxide exposure during the first 5 days after Hurricane Rita, as experienced by a Disaster Medical Assistance Team staffing the only open health care facility in the Beaumont, Texas region after the storm. Improper placement of portable generators in indoor locations or proximate to home air conditioning intake systems were completely responsible for the 21 exposures including 5 fatalities, 1 brain dead, 2 transfers for hospitalization, and 13 treated and released. We discuss the clinical presentations and treatment approaches, provide a brief overview of carbon monoxide and offer novel preventive recommendations. Portable generator use after disasters represents a predictable risk to the public. Proper ventilation requirements for generators are not adequately appreciated and engineered safeties should be explored to mitigate illness.