Patient Presentation
A 7-year-old male came to clinic for his health maintenance examination. His mother had no concerns and the pertinent physical examination was normal. The diagnosis of a healthy male was made. While discussing some safety anticipatory guidance, the boy became very excited to talk about how his mother had used the fire extinguisher several days before to stop a kitchen grease fire. “You should have seen all the powder all over the place, it was a real mess” he almost shouted. “It got all over my school stuff and they were ruined but they didn’t catch fire,” he added. While retelling the story the mother was quite embarrassed, but the physician noted how she was prepared and used the fire extinguisher. She asked if the smoke detectors also went off. “Oh yeah,” the boys shrieked, “but mom yelled for my brother and I to go outside and we did. Afterwards we got to see the real mess.” The pediatrician praised the boy for following his mother’s instructions. “We didn’t have a real safety plan,” said the mother, “but we do now and we are going to practice it too.”
Discussion
Home fire safety is important. Prevention safeguards life and property.
In 2014, the U.S. Fire Administration reported there were 3,428 deaths caused by fires. The most common pediatric age group is 0-4 years, with decreasing risk with advancing age. In the adult age group, the rates hold steady until the 40-50’s when there starts to be an increasing risk in the older population again. Other groups at risk are those with disabilities, and people living in rural areas. Intentional fires or arson are highest obviously in urban environments.
The leading cause of fire deaths in the US is because of smoking. Other risk factors include lack of a working smoke alarm, use of a space heater and renting (versus owning) the home. Having a working smoke alarms in the home dramatically decreases fire injuries and property loss. In the US there is a 2-3x lower risk of fire death with a working smoke alarm. Having a smoker as noted also dramatically increases the risk, but this can be mitigated by consistent safety practices including only smoking outside the home.
Home fires can occur year round, but are more common in the winter months of December, January and February because of associated heating needs. Use of fireplaces and space heaters increases the risk of home fires. Home fires associated with religious and cultural celebrations also peak at these times with home candle fires peaking on Christmas, New Years Eve and New Years Day. Seasonal fire-related injuries are seen globally with the timing based on location and specific practices. Cooking is obviously associated with various methods for heating food and therefore fires. Stoves, ovens, microwave ovens, barbeques and grills, and fryers are just some of the potential fire hazards within the home. Electrical fires from improperly connected home products are also potential fire sources. Appliances washers, fryers, portable generators, portable fireplaces and portable space heaters are all potential fire risks. Gasoline and propane are hazardous fuels that must be stored and handled properly. Use of medical oxygen has increased over time and is another potential fire hazard in homes. Clutter around potential fire sources also increases the risk of fire starting and/or spreading.
Learning Point
Basic recommendations to help prevent fires in the home include:
- Smoke alarms
- Should be on every level of the home
- Tested and cleaned monthly
- Batteries changed yearly and as needed
- Should be < 10 years old
- Fire extinguishers
- Should be easily available throughout the home including each floor and garage
- Extinguishers types are:
- A extinguishers are for combustibles such as trash, wood
- B are for liquids/grease
- C are for electrical fires
- Extinguishers should be used by PASS
- Pull the extinguisher pin
- Aim the nozzle at the base of the fire
- Squeeze the handles together
- Sweep the extinguisher contents at the base of the fire
- Carbon monoxide alarm
- Should be one on every level of the home
- Tested and cleaned monthly
- Should be < 7 years old
- Fire safety plan
- Have a fire safety plan and practice it regularly
- Have 2 ways to get out of every room
- Crawl low when escaping to avoid smoke
- Know where to meet – near front of house is usually best
- Once out of house, stay out of house
- Cooking
- All cooking areas/surfaces should be kept free of flammable materials
- Hoods are cleaned regularly and vented to the outside
- Pots are not left unattended on stove
- Fryers are plugged directly into electrical outlet on a non-flammable surface
- Food should be removed promptly when cooked.
- Microwave ovens should only have approved containers used for heating food
- Smoking in the home
- Try to help smokers to quit smoking
- Smoke outside and use fire-safe cigarettes
- Ashtrays should be large and deep. They should be emptied into fire-proof containers or the containers used directly
- Heating
- Furnaces and chimneys should be cleaned regularly and inspected at least yearly
- All combustible materials are > 3 feet from the heat source
- Fireplaces should be used under direct supervision and extinguished completely before leaving room or going to bed
- Do not use extension cords with space heaters – they should be directly plugged into the electrical outlet
- Any space heater should be laboratory approved and have a tip-over, shut-off mechanism
- Fireplace and barbeque ashes should be placed into metal containers
- Electric
- All appliances are plugged directly into the electrical outlet
- No frayed or cracked cords
- No cords under rugs/blankets etc.
- If needed, multipronged adapters are used for additional electric outlets
- Dryer lint filters and venting systems are cleaned regularly and as needed
- Candles, Seasonal, and Recreation
- Candles or any other open flames should be kept in a fire proof container under direct supervision. They should be extinguished completely before leaving room or going to bed.
- Electrical lights or decorations should be used as directed by the manufacturer. They should be inspected before use and monitored. They should be turned off before leaving the house or for bed.
- Use of electric tools, hot glue guns, soldering irons and other home maintenace or recreational products are also potential fire sources. They should be used according to manufacturers instructions, unplugged and stored between uses.
Questions for Further Discussion
1. What summer safety tips do you suggest to families? For suggestions click here
2. What winter safety tips do you suggest to families? For suggestions click here
Related Cases
- Disease: Fire Safety
- Symptom/Presentation: Health Maintenance and Disease Prevention
- Age: School Ager
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for this topic: Fire Safety
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
To view videos related to this topic check YouTube Videos.
Al-Qattan MM, Al-Zahrani K. A review of burns related to traditions, social habits, religious activities, festivals and traditional medical practices. Burns. 2009 Jun;35(4):476-81.
Lehna C, Fahey E, Janes EG, Rengers S, Williams J, Scrivener D, Myers J. Home fire safety education for parents of newborns. Burns. 2015 Sep;41(6):1199-204.
Rohrer-Mirtschink S, Forster N, Giovanoli P, Guggenheim M. Major burn injuries associated with Christmas celebrations: a 41-year experience from Switzerland. Ann Burns Fire Disasters. 2015 Mar 31;28(1):71-5.
Wood RL, Teach SJ, Rucker A, Lall A, Chamberlain JM, Ryan LM. Home Fire Safety Practices and Smoke Detector Program Awareness in an Urban Pediatric Emergency Department Population. Pediatr Emerg Care. 2016 Nov;32(11):763-767.
National Fire Protection Association. Public Education. Available from the Internet at http://www.nfpa.org/public-education (cited 12/6/16).
United State Fire Administration. Fire Statistics. Available from the Internet at https://www.usfa.fema.gov/data/statistics/ (cited 12/6/16).
Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital
Pediatric Education 