Home Oxygen Deaths Higher in U.S.

[J.Adderton, BSN, MSN]

A new study, produced by BPR Medical Gas Control, shows more Americans die in fires associated with home oxygen equipment than previously reported, with a person dying every four days. Results from The Prevalence and Impact of Home Oxygen Fires in the U.S also found the fire impact extended beyond the oxygen users themselves to other people, with 11 third party deaths reported. Third party death included firefighters, family members, and other residents... Police, neighbors and other persons trying to assist or evacuate others are at significant risk for being injured or killed in residential fires.

Problem Scope

Data information for the study was collected from media reports of U.S. home oxygen fires between December 2017 and August 2019. During the 20 month period, 311 incidents claimed 164 lives, with the majority of victims being home oxygen users. The numbers are in contrast with the National Fire Protection Association (NFPA) reporting in 2017 that up to 70 people are killed each year from home oxygen fires. The BPR study also found:

• Media coverage included 71 serious injuries with 63 victims being the oxygen user.
• Emergency departments recorded approximately 1,200 injuries from home oxygen fires yearly.
• 72% of oxygen fires in the study were most likely caused by patients smoking while on oxygen
• 40% of oxygen fires in the study destroyed the home or dwelling

Comparison to Other Countries

The U.S appears to have a higher death rate, 6.7 per 100,000 oxygen patients, when compared to other countries. The U.K. has the best record for safety after the implementation of national measures and mandatory laws in 2006 to reduce the risk of home oxygen fires.. Between 2013 and 2017, only one death caused by home oxygen use was recorded. When compared to the U.K., the risk of dying in a fire caused by home oxygen is 20 times higher in the U.S. Best practices in the U.K. include strong regulation, mandatory reporting and fitting of thermal fuses to oxygen tubing that cut the flow of oxygen in the event of a fire.

How Fires Start

Most oxygen fires in the study, 51 percent, were judged to be caused by smoking while using oxygen. Some cases specifically identify cigarette ashes that dropped on oxygen tubing as the source of ignition. In other cases, users may have been reluctant to admit smoking while using oxygen because they did not want their oxygen removed.

Cylinder Explosion

One third (102 out of 311) of the reported cases had at least one oxygen cylinder in the fire. A volunteer firefighter died after being hit by shrapnel from a cylinder explosion. The majority of home oxygen users have concentrators, but cylinders are used for portable oxygen and in-home back-up. The study authors report anecdotal evidence that some oxygen users have stores of up to 20 cylinders in and around the home. Rising temperatures increase gas pressure within the cylinder and weakens the cylinder’s metal in home fires, even with fitted safety valves.

Working Smoke Detectors Save Lives

Most of the media reports in the study didn’t specify if there was a working smoke detector in use. However, there were quotes from firefighters stressing the importance of smoke alarms. A recent NFPA study found 57% of U.S. home fire deaths did not have a working smoke detector. And, with a working smoke detector, you are 54% more likely to survive.

Study Limitations and Recommendations

The study method only captured fires linked to home oxygen use that were reported in the media. The results most likely still underestimate the numbers and the problem severity. As other countries have demonstrated, much of fires caused by home oxygen can be prevented with policy change and affordable risk control measures. Since the study is on-going, it is hoped that valuable data will be collected to support the needed change.

Have you had a patient injured in a home oxygen fire? Tell us about your experience?

New York State Home Oxygen Fire Safety

The COPD Foundation: Playing With Fire

[marienm, RN, CCRN]

Burn ICU nurse here: I've taken care of a couple of patients whose oxygen was ignited by e-cigarettes as well. I don't have the specifics about what type of e-cig, but basically anything that heats up doesn't belong near oxygen tubing! All of the e-cigs with a battery have a heating element inside.

Notably, one of these patients was *in* a local hospital, on their chronic oxygen, with an NG tube placed for bowel decompression. When they secretly used the e-cig it ignited their oxygen tubing and it also burned off the external part of the NGT. So the facility intubated the patient and then had to retrieve the NGT via endoscopy before transferring the patient to us!

[J.Adderton, BSN, MSN]

Wow, that is an outcome I had never thought about.