Reducing Fires and Burns from Smoking While
Contents
1. www ncbi nlm nih gov pubmed 2 1959207 8 McDonald C Crockett A and Young I 2005 Adult domiciliary oxygen therapy Position statement of the Thoracic Society of Australia and New Zealand The Medical Journal of Australia 182 12 621 626 http www mja com au public issues 182_12_200605 mcd10865_fm html 9 Lentini J 2006 Scientific Protocols for Fire Investigation Boca Raton FL CRC Press pp 242 3 10 Palmer M 2006 January 11 Oxygen Tank Explosion Fire Kills Four Texas Children Firehouse Magazine http www firehouse com article 10502359 oxygen tank explosion fire kills four texas children 11 Massey M 2008 February 6 Wrongful death suit involving four children moved to federal court The Southeast Texas Record 2013 AirSep Corporation All rights reserved 16 12 Donnelly F 2011 December 12 Staten Island family seeks justice for ghastly death of loved one Staten Island Real Time News http www silive com news index ssf 2011 12 staten_island_family wants _jus html 13 First Coast News 2011 December 2 Fire Destroys Home Oxygen Tanks Explode Woman Injured http www firstcoastnews com news article 229439 3 Fire Destroys Home Oxygen Tanks Explode Woman Injured 14 Yosim A 2011 November 14 Detectives Fire caused oxygen tank explosions ABC News Channel 12 http www wetil2 com news 29754838 detail html 15 Firefighter Nation Web Team 2010 Octobe2. MK285 1 08712 2013 AirSep Corporation All rights reserved 15 References 1 Ahrens M 2011 National Fire Protection Association Home Structure Fires http www nfpa org assets files pdf os homes pdf 2 Lynch J 2008 Diagnosis and management of COPD InnovAiT 1 3 222 232 http regp innovait oxfordjournals org content 1 3 222 full 3 American Thoracic Society and European Respiratory Society 2004 Standards for the Diagnosis and Management of Patients with Chronic Obstructive Pulmonary Disease http www thoracic org clinical copd guidelines resources copddoc pdf 4 Ahrens M 2008 National Fire Protection Association Fires and Burns Involving Home Medical Oxygen www nfpa org assets files pdf os oxygen pdf 5 Berkowitz K Chanko B and Owen S 2008 Veterans Health Administration National Ethics Teleconference Ethical Considerations in the Use of Home Oxygen for Patients and or Third Parties Who Smoke http www ethics va gov docs net NET_Topic_20080730 Use_of home O2 for patient s_who_smoke doc 6 Lindford AJ Tehrani H Sassoon EM and O Neill TJ 2006 Home Oxygen therapy and cigarette smoking a dangerous practice Annals and Burns and Fire Disasters 19 2 http www medbc com annals review vol_19 num_2 text voll9n2p99 asp 7 Murabit A and Tredget EE 2011 Review of burn injuries secondary to home oxygen Journal of Burn Care and Research 24 6 402 6 http
3. The majority of LTOT patients are elderly and many have impaired vision lower reading levels and even different primary languages Brochures and educational materials need to include pictures that perhaps realistically depict the results of a cannula fire with facial burns as this is a very real possibility for patients who smoke while using their oxygen P Educational DVDs should be produced and widely distributed These videos should teach safety measures and include graphic representations of the tragic consequences that can result to families from smoking while using oxygen The prescribing clinician and home oxygen provider share responsibility for discussing and documenting education about the hazards of smoking during oxygen therapy at the initiation of LTOT This information needs to be reviewed at regular intervals A signed checklist and agreement to comply with smoking safety guidelines should be completed by the HME provider Any witnessed violations of safety guidelines such as smoking while oxygen is in use should be reported to the prescribing clinician within 48 hours PP Repetition is an effective way to reinforce safety messages The US Food and Drug Administration FDA requires warnings about the dangers of smoking on every package of cigarettes not on the bottom of ashtrays Similarly nasal cannulas are disposable items used with all oxygen systems and require regular replacement Their u
4. or even become unrecognizable Oxygen Concentrators Inherently Safer Yet Wrongly Blamed The most common medical oxygen supplied for use in the home is an oxygen concentrator a machine that separates room air and concentrates the oxygen A trail of burned tubing outside and downstream of the machine is evidence of oxygen flowing within the tubing and an external ignition source as fire always advances toward rather than away from the oxygen supply In fact when PVC tubing was ignited by a fire investigator it stopped burning within 20 seconds of shutting off power to the oxygen concentrator Concentrators damaged by fire may incorrectly be identified as the ignition source when this burned tubing is observed by people who are not aware of this specific burn pattern This may create an erroneous belief that oxygen concentrators are unsafe when these electromechanical devices do not store oxygen cannot explode and stop functioning when fire enters the device If the concentrator is the ignition source there will be no evidence of burnt tubing leading up to the machine The cause of the fire is frequently misrepresented by grieving family members which may lead even experienced fire investigators to erroneously blame the concentrator A malfunctioning oxygen machine was initially believed to be the cause of a tragic blaze that killed four children and an elderly grandmother on LTOT because the machine was found melted in the rubble and th
5. The disease processes that necessitate oxygen therapy contribute to mortality from burns that younger healthier patients would be expected to survive These patients differ from standard burn patients because they are older have higher rates of inhalation injury and require much longer hospitalizations despite the mean affected total body surface area TBSA of only 3 percent Mortality rates attributed to home oxygen fires may be understated for these compromised patients Many times these related deaths are listed as natural causes when the exacerbation was triggered by the fire injury Some experts particularly the Thoracic Society of Australia and New Zealand feel that the risk of fire for patients who continue to smoke cigarettes while using oxygen therapy outweighs the treatment benefits Patients who remove the cannula and place it next to them while they smoke create an oxygen enriched environment particularly closest to the cannula tips of bedding and other combustible materials that can create a flash fire with just an ember While oxygen itself does not burn it greatly lowers the ignition point of combustible materials The degree of injury is related to factors that impair the patient and or delay reaction time and impairment is much more likely with smoking material fires than with other fires The percentage of alcohol involvement among fatal victims was 23 percent for smoking material home fires in 2004 2008 compared
6. and Local Government 2010 Fire and Rescue Service Monthly Bulletin London Crown Publishing http www communities gov uk documents fire pdf 1687535 pdf 22 National Health Service Primary Care Commissioning 2012 Issue Awareness Smoking related incidents between April 10 March 2011 2013 AirSep Corporation All rights reserved 17 23 National Health Service 2005 Department of Health Home Oxygen Specification 24 Federal Institute for Drugs and Medical Devices 2012 BfArM s assessment concerning oxygen concentrators http www bfarm de EN medDev riskinfo recommend oxygen_concentrators_update ht ml jsessionid 8838A2C9F8CE20EFA280B2461C3837E4 1_ cid103 25 Medicines and Healthcare Products Regulatory Agency 2008 Therapy oxygen amp fitments BPR Medical Oxygen Firebreak FireSafe Cannula Valves updated http www mhra gov uk Safetyinformation Safetywarningsalertsandrecalls fieldsafetynot ices FieldSafetyNoticesformedicaldevices CONO017810 26 Jarvis MA 2004 ABCs of smoking cessation Why people continue to smoke BMJ 328 277 9 http www epicentro iss it temi fumo pdf BMJgennaio pdf 27 Department of Veterans Affairs Veterans Health Administration 2006 Reducing the Fire Hazard of Smoking When Oxygen Treatment is Expected http www va gov vhapublications ViewPublication asp pub_ID 1407 28 Yorkshire Fire and Rescue Service 2010 Breathe Safe DVD http www westyork
7. presents delineation between the burned and intact tubing This flame can travel both externally or internally down the tubing giving off a loud whistling sound Once ignited the fire consumes the tubing leaving a charred trail of ash and melted tubing as it advances always toward the oxygen supply A 4 foot 1 2 m Salter 1600 4 cannula ignited at the tips takes about 2 5 minutes with a flow rate of 2 liters per minute LPM 4 5 minutes with a flow of 3 LPM and 10 minutes with a flow rate of 5 LPM to burn to the connection Although burn times seem counter intuitive for each liter flow listed results were validated Higher oxygen flows create a slower moving more intense fire as it burns back to the oxygen source As the tubing burns combustible materials ignite along its path creating additional fires The fire can bypass and jump sections of crossed or coiled tubing as it continues to burn towards the oxygen supply The tubing can also whip around in a manner similar to an unattended garden hose fanning its reach to ignite combustibles If a humidifier bottle is used it also will readily burn capable of causing additional damage to the device or 2013 AirSep Corporation All rights reserved 3 allowing the fire to breach the cabinet depending on its location Gathered or coiled oxygen tubing on and around the oxygen supply particularly an oxygen concentrator can cause the cabinet of the concentrator to ignite sustain heavy damage
8. smoke you must always follow these 3 life saving steps first TURN OFF the oxygen TAKE OFF the cannula LEAVE the room fil CAIRE A Chart Industries Company AitSep SeQual Turn Off Toke Off and leave is a public service message from CAIRE wwwCAlREmedicalcom 2013 AirSep Corporation All rights reserved Il DO YOU HAVE A BURNING DESIRE FOR A SMOKE Every year thousands of individuals burn their faces because they smoke while receiving oxygen therapy some even die Cigarettes ignite oxygen cannulas in an instant Please don t let this happen to you Hi If you smoke you must always follow these 3 life saving steps first TURN OFF the oxygen we OFF 2013 AirSep Corporation All rights reserved 12 WOULD YOU KILL FORE t GARETTE LER 5 over Let s make pancakes in the X Sweet dreams jenna my little helper DAR seg oxygen Fl Tragedy or Sweet Dreams It s in your hands Don t kill for a cigarette If you smoke you must always follow these 3 important life saving steps first TURN OFF the oxygen TAKE OFF the cannula LEAVE theroom CAIRE NESA Turn Off Toke Off and leave is a public service message from CAIRE wwwCAlREmedicalcom 2013 AirSep Corporation All rights reserved 13 Appendix B Warnings for User Manual WARNING DO NOT OPERATE THIS EQUIPMENT WITHOUT FIRST READING AND UNDERSTANDING THIS MANUAL IF YOU ARE UNABLE TO UN
9. to 11 percent for all other home structure fires with a known heat source as the cause of ignition The percentage with possible other drug impairment during the same time period was 10 percent for smoking material home fires compared to 4 percent for all other home structure fires with a known heat ignition source Sadly smoke alarms were not present in 43 percent of the fatalities involving home oxygen equipment Most fire deaths in the bedroom occur as a result of smoke inhalation while sleeping whether oxygen is involved or not Smoking in bed greatly increases the probability of 2013 AirSep Corporation All rights reserved 2 falling asleep and with it the probability of the cigarette touching and igniting the bedding or oxygen tubing In addition to sleeping many victims of fires caused by smoking materials are affected by alcohol drug impairment or a health condition that limits mobility cognitive function or the ability to react prior to the fire Impairment is much more likely with smoking material fires than with other fires Cannula tubing burn pattern back to the oxygen source Oxygen cannula and tubing made of polyvinyl chloride PVC is commonly used to administer oxygen therapy A cannula refers to a patient interface which has two vinyl tips or prongs for positioning at the base of the nostrils and attaches to tubing of lengths up to 50 feet 15 2 m Most homecare companies use cannulas of four or seven feet 1 2
10. viewed footage of the way these materials ignite and burn as well as the resulting injury and damage it creates then this danger would be more thoroughly and emphatically explained to patients and caregivers The use of oxygen while smoking is product misuse with deadly consequences yet patients ignore repeated warnings even after they have had near misses or burn injuries This warrants patient behavior modification through primary prevention measures education and instruction Primary prevention is always preferable to secondary prevention when dealing with the health of patients Education is the key to reducing the impact of unsafe choices and the incidence of fires as a result of this risky behavior While patients may not be as concerned with their own health and safety stressing the need for the safety of loved ones together with invoking the support of family members to reinforce the steps needed to reduce risks may prove effective Secondary prevention measures such as smoke alarms fire extinguishers and firebreaks are intended to identify and treat fires early that have already occurred but do nothing to prevent them or reduce the number of occurrences Oxygen equipment includes warnings about the dangers of smoking in their user manuals and the devices are marked with symbols prohibiting smoking yet there is no warning on the oxygen cannula While the industry s objective is no smoking the reality is that up to 50 percent of L
11. DERSTAND THE WARNINGS AND INSTRUCTIONS CONTACT YOUR EQUIPMENT PROVIDER BEFORE ATTEMPTING TO USE THIS EQUIPMENT OTHERWISE INJURY OR DAMAGE COULD OCCUR Smoking while using oxygen is the number one cause of fire injuries and related deaths You must follow WARNING these safety warnings Do not allow smoking candles or open flames in the same room with the device or within 5 feet 1 52 meters of the oxygen carrying accessories Smoking while wearing an oxygen cannula can cause facial burns and possibly death Removing the cannula and putting it on clothing bedding sofas or other cushion material will cause a flash fire when exposed to a cigarette heat source or flame If you smoke you must always follow these 3 important steps first turn off the oxygen concentrator take off the cannula and leave the room where this device is located No Smoking Oxygen in Use signs must be prominently displayed in the home or where the oxygen concentrator is in use Patients and their caregivers must be informed about the dangers of smoking in the presence of or while using medical oxygen 2013 AirSep Corporation All rights reserved 14 Appendix C Home Oxygen Fire Safety Sample Form Home Oxygen Patient Fire Safety Agreement e Patient has been informed that oxygen makes things burn easily and rapidly and there must be no open flames matches lighters candies or heat sources within 5 feet 1 2 m of the
12. TOT patients continue to smoke Although the principle of autonomy grants patients the right to continue to smoke it is imperative that they turn the oxygen off remove their cannula and leave the room where their oxygen was in use Appendix A B C For those patients who continue to disregard warnings and engage in reckless behavior pulse only oxygen delivery systems represent a viable technical solution 2013 AirSep Corporation All rights reserved 9 Smoking is the number one cause of death in home fires for all households in the United States and 7 percent of the estimated 680 home fire deaths per year are related to the use of oxygen therapy equipment For the two million households that use home oxygen there is the added hazard of high concentration oxygen While the size of the oxygen enriched environment created by an oxygen concentrator in and around the patient is debatable what happens when patients bring their cigarette too close to the cannula is irrefutable Oxygen is not flammable but it converts cannulas and oxygen tubing into easily ignited fuses set off by cigarettes causing potentially deadly situations for patients and their families Sadly most of these injuries and deaths are preventable For inquiries contact mpd airsep com 2013 AirSep Corporation All rights reserved 10 Appendix A Public Service Message CLN OKING IS A HUGE HEALTH RISK WIH OXYGEN SADEADLY COMBINATION If you
13. WHITE PAPER Reducing Fires and Burns from Smoking While Using Medical Oxygen Abstract There is a growing awareness of the incidence of fires due to smoking while on oxygen therapy equipment Smoking is the leading cause of fire related deaths in all home fires whether or not home oxygen is in use Several studies have revealed an increased incidence of burn injuries associated with home use of medical oxygen and it is believed that the frequency of fires has been grossly underestimated Clinicians providers manufacturers and regulators of this equipment strive to reduce the number of burn injuries and deaths Responses and recommendations appear to be ineffective perhaps due to a lack of communication or a knowledge deficit concerning oxygen fires particularly the incidence of unreported thermal burns the ease with which tubing is ignited while oxygen is flowing and the characteristic burn pattern toward the oxygen supply This paper discusses the causes of home medical oxygen fires explains cannula burn patterns and firebreaks and identifies potential cost effective solutions The Dangers of Smoking While Using Oxygen Therapy Equipment Ninety five percent of chronic obstructive pulmonary disease COPD is caused by smoking with most smokers eventually developing some degree of pulmonary impairment COPD may occasionally occur in nonsmokers as a result of environmental factors such as dusts chemicals or air pollution or genetic fac
14. danger to firefighters Two fatal fires caused by LTOT patients smoking in Pitt County North Carolina became significantly more dangerous for victims and rescuers after oxygen tanks exploded Both patients died in the separate incidents nine hours apart and three firefighters were injured In yet another incident in Florida two firefighters and a neighbor were injured in a mobile home fire that ignited medical oxygen tanks throwing one of the rescuers 15 feet 4 6 m in the blast Another explosion during a fatal fire in Washington caused fragments of the pressurized tanks to hit firefighters as they attempted to reach the victim who had started the blaze by smoking while using medical oxygen Although the scope of this paper does not address fires outside of the home environment these incidences do happen in other settings with any type of oxygen source including piped oxygen in facilities Fires and burns have occurred in hospitals automobiles or any other area where patients use medical oxygen and smoke Patients smoking while using oxygen recently caused two fires in hospitals in the United Kingdom UK In December 2011 a lung cancer patient did not survive a fire ignited by a cigarette lit in a hospital bathroom after removing an oxygen mask connected to a tank Another patient in 2012 using an oxygen canister sparked an explosion with his lighter burning his hands and nose A smoker with oxygen tanks in the car endanger
15. ducing fire potential is directly related to its proximity to the ignition point In the UK home oxygen installation is rather unique A house is piped with safety tubing affixed to the wall with two or more outlets where the cannula is attached The National Health Service NHS Home Oxygen Service Specification 2005 has a requirement for firebreaks Although not detailed in the requirement it is largely accepted that firebreaks need to be placed as close to the patient as possible Other agencies and standards require oxygen concentrators to be fitted with a means of preventing fire from entering the machine Therefore there needs to be at least two firebreaks one close to the patient and another at the oxygen supply Since humidifiers are highly flammable with oxygen flow a firebreak would also be needed at this spot amounting to three firebreaks per installation The overwhelming majority of home oxygen fires are started by the patient at the cannula Currently there is no firebreak device on the market that fits into the most common point of ignition the ends of the cannula prongs Inner channels are incorporated in most cannulas and tubing as a safety feature the purpose which is to prevent the occlusion of oxygen flow when tubing is kinked These channels prevent the splicing of oxygen tubing to accommodate the firebreak consequently the closest opportunity to install a firebreak is at the connection between the cannula a
16. e family reported it to be the ignition source Later investigation revealed that the family had attempted to move a burning couch outside but could not get it out the door it is now believed that the fire started when the patient was smoking while using her oxygen on the couch Another grieving family attributed their loved one s death to an exploding oxygen concentrator even though her death certificate states that the cannula the tube which delivers oxygen into the nostrils ignited Additionally in both of these fires as well as all others the fire advanced toward the oxygen supply not away from it since oxygen flow is needed within the cannula to produce its characteristic burn pattern this provides evidence that the machine was not the source of ignition Oxygen Gas Cylinders and Liquid Oxygen Canisters Present Additional Hazards An even greater hazard is present during fire with liquid oxygen canisters or compressed oxygen gas cylinders Unlike oxygen concentrators which separate the oxygen present in room air these oxygen systems add oxygen contents to the room and can rupture or explode releasing large quantities of oxygen into the room greatly increasing the rate of combustion generating more heat and even causing fragments of the tanks to become 2013 AirSep Corporation All rights reserved 4 projectiles A recent mobile home fire in Florida caused oxygen tanks to explode accelerating the fire as well as the
17. ed rescue workers as well as his own life when his car exploded and the cylinders became missiles Firebreaks Firebreaks are secondary prevention measures as are smoke alarms and fire extinguishers because they do not prevent fires but instead attempt to reduce negative consequences Firebreaks are single use thermal fuses designed to stop the flow of oxygen along the oxygen supply tubing thus preventing the spread of fire past their location They are used as connectors in the oxygen supply line or at the oxygen source incorporating a small piece of plastic that holds open a spring loaded valve When the fire reaches the plastic it melts allowing the spring to push the valve shut stopping the flow of oxygen They can be installed between the cannula and the oxygen supply tubing and at the oxygen source They are promoted to provide additional time for evacuation to prevent the spread of fire upstream to the equipment and to reduce the probability that the fire will spread further The BOC Group holds the patent for this device which is manufactured by BPR Medical in the UK While some agency and home medical equipment HME providers view firebreaks as a way of improving patient safety others share an unfavorable view regarding them as only a secondary measure that increases cost and does not address the behavior modification needed to lessen the high incidence of thermal burns to the face Others are concerned that firebreaks may se
18. l rights reserved 7 reduce this type of fire injury or resulting death since the fire begins proximal to its placement in the tubing Effective Solutions for Reducing Fires Burns and Deaths While Using Oxygen The most important solution is a coordinated effort by prescribing clinicians and equipment providers to highlight and stress the dangers of smoking while on oxygen therapy through aggressive patient and caregiver warnings and education by prescribing clinicians and equipment providers Smoking cessation is the safest way to reduce the incidence of home oxygen fires Unfortunately an estimated 30 50 percent of these patients continue to smoke Many are unwilling to quit at this point in their lives after decades of smoking Nicotine addiction is a chronic relapsing disease less than 3 percent of attempts to quit result in sustained 12 month cessation LTOT patients who smoke must be offered smoking cessation interventions such as nicotine replacement therapy to prevent nicotine withdrawal If patients are going to continue to smoke it is imperative that they understand the importance of turning off the oxygen removing their cannula and leaving the room where their oxygen was in use These three precautions in addition to thoroughly explaining the dangers and consequences of smoking with oxygen therapy equipment need to be clearly stated and presented separately from the accompanying user manual
19. ll rights reserved I occur during the initial lighting of the cigarette bringing the cigarette too close to the cannula tips and having it flare up or through the relighting of cigarettes which might be more common since the mandated use of self extinguishing cigarettes Smoking while using oxygen therapy greatly increases the risk of facial burns Facial burns account for 89 percent of all thermal burns and although the overall burn size is generally small due to the intense heat of the flame and possible inhalation of hot toxic smoke significant injuries frequently occur to the patient s upper and lower airways This can require hospital admission or specialized treatment at burn centers and often results in death At least a thousand burn injuries a year happen when cannula tips ignite after coming in close contact with cigarettes lighters or matches In many cases patients quickly remove the cannula and extinguish the fire and fire authorities are never notified by the patient or hospital Patients are usually hesitant to report these occurrences possibly due to embarrassment or because they do not want to get blamed for the incident since they were informed of the fire danger and fear their oxygen equipment will be removed although this rarely occurs Consequences of these fires can be catastrophic for home oxygen patients since their health is often already so fragile that even small burn injuries frequently have poor outcomes
20. nd the oxygen tubing Common cannula lengths are four and seven feet 1 2 and 2 1 m with a seldom used one foot 3 m cannula available The cannula is added to one or more 25 foot 7 6 m sections of oxygen tubing While it appears that a shorter length cannula would be safer a firebreak connected to a one foot cannula would be easily bypassed by a cigarette dangling from the outstretched arm of a sleeping patient creating the deadliest of all scenarios 2013 AirSep Corporation All rights reserved 6 A firebreak located close to or at the oxygen supply has minimal benefit A fire reaching this point has traveled the length of the tubing already creating serious damage There is an elevated risk when gas and liquid oxygen cylinders and canisters are involved large quantities of oxygen can be released or the cylinder can rupture or explode with the intense heat of a fire An oxygen concentrator does not present this danger as it will stop functioning when fire enters the unit Limitations A 2008 product recall was issued in response to the possibility of inappropriate activation of firebreaks which would stop the flow of oxygen As a result of this possibility instructions for use have been amended to recommend a backup oxygen supply for patients who could be distressed or suffer injury or death if their oxygen flow is stopped unexpectedly Firebreaks do not prevent fires injuries or even deaths Firebreaks do not extingui
21. nd the wrong message to patients smoking while on oxygen therapy is somehow made safer with the installation of these devices Firebreak use may give patients a false sense of security and promote dangerous behavior Unfortunately many incidences of fires and burns while using oxygen therapy remain undocumented making it difficult to accurately report incidences and properly credit 2013 AirSep Corporation All rights reserved 5 potentially effective measures However in the UK where firebreak use has been required since 2006 there is a comprehensive reporting system in addition to an established working group of oxygen suppliers health care agencies and Fire and Rescue Services whose goal is to raise awareness of the dangers of smoking while using oxygen Unfortunately according to the Department of Health the collated smoking related oxygen fire incidents results are alarming 141 incidences of which 106 were related to smoking occurred in the period April 2010 March 2011 Based on 100 000 patients on home oxygen this correlates to an annual incident rate in the UK of one incident per 709 patients more than double the US incident rate It is possible that a false sense of security may contribute to the higher UK rate In considering the use of firebreaks it is important to consider their placement in the oxygen cannula and tubing as well as their limitations Placement A firebreak s effectiveness in re
22. or 2 1 m and supply ample lengths of additional oxygen tubing in the range of 25 to 50 feet 7 6 to 15 2 m This allows a patient to move about freely within the home and away from the oxygen supply which is often heavy and difficult to move The oxygen equipment can be located in a central position of the home such as a hallway living room bedroom or even on a different floor or level Tubing is commonly gathered and coiled up to prevent tripping and clutter while it rests on the floor as one does with a long extension cord When a patient moves around the home the position of the tubing changes and touches combustible materials such as carpeting bedding furniture curtains and clothes Although the cannula does not easily ignite in room air or with a pulsing oxygen conserving delivery system when a continuous flow of oxygen passes through it the cannula tips and tubing will easily ignite when in close proximity to any flame or ember The nasal cannula tubing a PVC product produces toxic black smoke when burning releasing highly flammable vinyl chloride gas Although referred to as a cannula fire a more accurate description is cannula torch or fuse because of its intense flame and the speed with which it ignites combustibles as the fire advances up the tubing towards the oxygen supply Any portion of the cannula and tubing can ignite from a flame or cigarette ember and the point of ignition is generally very recognizable as it
23. oxygen equipment or oxygen cannula and tubing e Patient has been informed that no smoking is permitted while oxygen is in use e Patient has been informed that no smoking is permitted while wearing an oxygen cannula as it results in fire facial burns and possibly death e Patient has been informed that removing the cannula and placing it on surfaces such as bedding sofas and other cushion material while oxygen is flowing will cause a flash fire when exposed to a cigarette heat source or flame e Patient has been informed that oxygen must be turned off when not in use e If unable to stop smoking the patient has been instructed on the 3 Life Saving Steps always turn off the oxygen take off the cannula and leave the room where the oxygen supply is located e Smoke alarms are present and patient agrees to test alarms monthly e No Smoking Oxygen in Use signs are provided and posted The 3 Life Saving Steps signs are provided and posted I agree to comply with the above safety guidelines Patient Signature Date HME Representative Signature Date HME Representative Comments Note These safety warnings must be covered during oxygen equipment installation and at each patient visit If risky behavior is observed such as smoking while using oxygen smoking in close proximity to oxygen equipment or accessories or absent smoke alarms this form will be signed and forwarded to prescribing clinician within 48 hours
24. r 20 Florida Firefighters Injured In Mobile Home Explosion Firefighter Nation http my firefighternation com forum topics florida firefighters injured q forum topics florida firefighters injured 16 Cuniff M 2011 July 18 Official Cigarettes oxygen tanks sparked fatal blaze The Spokesman Review http www spokesman com stories 201 1 jul 18 fire official cigarettes oxygen tanks sparked fata 17 McEwen A 2012 January 2 Cancer patient on oxygen dies as cigarette sparks fire Edinburgh Evening News http www scotsman com edinburgh evening news edinburgh cancer patient on oxygen dies as cigarette sparks fire 1 2033505 18 Patient at North Manchester General hospital sparks explosion by smoking while attached to oxygen tank 2012 January 7 Manchester Evening News http menmedia co uk manchestereveningnews news s 1469954_patient at north manchester general hospital sparks explosion by smoking while attached to oxygen tank 19 Akin S 2012 February 28 Officials Car explosion happened after man with oxygen tanks in back of car lit cigarette The Record http www northjersey com topstories hackensack Fire_ officials 3 injured i n Hackensack car explosion html 20 Department of Communities and Local Government 2011 Fire Kills Campaign Annual Report 2010 11 London Crown Publishing http www communities gov uk documents fire pdf 1992322 pdf 21 Department of Communities
25. ser instructions present the best opportunity for a repetitive highly visual safety message FDA involvement would be required to implement this intervention 2013 AirSep Corporation All rights reserved 8 Clinicians and providers should strive to fully inform patients and their families of the risks and benefits of oxygen therapy However should the patient choose to continue to smoke without taking the necessary precautions the risk of unsafe oxygen use may lead to a difficult decision of equipment removal as an alternative clinicians should consider exchanging continuous flow delivery with a pulse only system These systems are widely used for ambulation and conserve oxygen by allowing flow only when triggered by inhalation This prevents oxygen enrichment of seating and bedding materials when the cannula is placed on them and greatly reduces the oxygen zone about the face The cannula does not easily ignite or burn back to the source when used with these systems Conclusion Regulating agencies HME providers manufacturers and health care providers who prescribe oxygen equipment all strive to formulate and recommend effective strategies to reduce the incidence of fires involving home oxygen equipment These strategies must be effectively communicated to our patients and caregivers It is dramatic to witness how easily and violently a nasal cannula burns Perhaps if those who are setting up equipment and taking care of LTOT patients have
26. sfire gov uk breathe safe dvd rsc32 29 First Media Production 2010 Smoking while on Oxygen Therapy Informational Video http www youtube com watch v xP4vslfVbBY West 30 National Ethics Committee of the Veterans Health Administration 2010 Ethical Considerations that Arise when a Home Care Patient on Long Term Oxygen Therapy Continues to Smoke http www ethics va gov docs necrpts NEC_Report_20100301 Smoking while on LT OT pdf 31 US Food and Drug Administration US Department of Health amp Human Services 2012 http www fda gov TobaccoProducts GuidanceComplianceRegulatoryInformation ucm2 76626 htm 77 1Rev A 04 13 2013 AirSep Corporation All rights reserved 18
27. sh fires Combustible items such as clothing bedding carpeting curtains or furniture already ignited will continue to burn Firebreaks do not prevent oxygen enrichment of bedding and seating materials when a cannula is placed on them Firebreaks are ineffective when the fire is started upstream of the device Firebreaks can be bypassed by the fire when positioned on flammable surfaces or when the tubing is coiled Firebreaks do not stop the release of thick noxious smoke which can overcome patients very quickly Firebreaks are directional and may be inserted the wrong way by patients Firebreaks have a 4 year life span Firebreaks create back pressure and can result in reduced oxygen delivery when using orifice flow controllers or reduced sensitivity and performance when using oxygen conserving devices If devices deliver both continuous flow and pulse flow delivery the firebreak may need to be removed during the pulse flow delivery mode Firebreaks built into oxygen concentrators or added to their outlets do not address the humidifiers when used Firebreaks only partially limit fire potential requirement mandates would add substantial cost without evidence of effectiveness Of the 1190 thermal burns annually 1059 or 89 percent burn the face of the patient Patients who smoke and set themselves on fire at the cannula pull it off quickly and extinguish the fire It is unlikely that firebreaks will 2013 AirSep Corporation Al
28. tors such as alpha 1 antitrypsin deficiency COPD is the most common reason for long term oxygen therapy LTOT prescriptions An estimated 182 home fires in the United States US involve oxygen therapy equipment each year resulting in 60 injuries and 46 deaths An additional 1190 thermal burns involving oxygen therapy equipment require treatment each year in emergency rooms with nearly half resulting in hospital admissions yet the majority are not reported to fire officials For the two million oxygen patients in the US this means one burn for each 1 543 patients every year Smoking rates for oxygen patients in the US vary greatly some sources estimate 10 to 20 percent while other sources estimate rates as high as 30 to 50 percent Smoking while on oxygen therapy is responsible for the majority of home oxygen fires and resulting deaths These incidents are well documented due to the involvement of fire departments However patients who smoke while using home oxygen cause an alarming number of thermal burns in the US each year that are not reported to fire authorities It is feared that this number is greatly underestimated and will grow as the 50 to 75 year old population grows along with their need for oxygen therapy equipment Oxygen patients have been observed smoking while using their oxygen therapy and many have even reported engaging repeatedly in this risky behavior Cannula ignition can 2013 AirSep Corporation A
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