Contributory factors to fire burn injury
Contributory factors to fire burn injury with alcohol involvement
Download 
Contributory factors to fire burn injury with alcohol involvement (464.52 kb)
Ashby K1, Cassell E1, Singer Y2, Stockton F3, Pepperdine S3, Cleland H2
1. Monash University Accident Research Centre 2. Victorian Adult Burns Service, The Alfred Hospital 3. Metropolitan Fire Brigade. All are based in Melbourne, Australia
1) Introduction
The link between alcohol and fire fatalities is well established. Less is known about the link between alcohol and non-fatal fire injuries, the circumstances in which they occur and the contributory factors.
2) Objectives
This exploratory study aimed to:
• gather in-depth data on fire burn injury events where alcohol played a contributory role.
• investigate attitudinal, behavioural and social/ environmental factors that increase the risk of burn injury among alcohol users.
• provide information to fire authorities to use in prevention strategies and educational resources to raise awareness of the risk of fire burn injury among alcohol users.
3) Methods
The 2 components of the study were:
1) In-depth interviews with adults burns patients treated between January 2004 and March 2007 as an inpatient or outpatient by the Victorian Adult Burns Service (the States major burns referral unit).
2) A focus group interview with experienced nurses from the VABS following a theme list based on insights gained from patient interviews.
4a) Results: Patient interviews
Of 29 eligible burns patients, 18 consented to interview (62% participation rate).
83% were male and the mean age was 33.8 (range 18-52 years).
45% typically drank at a level considered risky or high risk for acute harm (4+ sessions per week and 7+ alcoholic drinks per session).
The source of the fire was diverse: 4 incidents involved fire drums; 4 patients stood or fell in a campfire; 2 homes were destroyed by unattended cooking fires; 2 patients fell into a fireplace; and one each related to fireworks, clothing ignited by a candle, an electrical fault resulting in a house fire; a chiminea, a barbecue related cooking fire and a motor vehicle fire.
Factors that contributed to the injury included:
Personal and social factors
• Peer influence (14 occurred at parties)
• Heavier than average alcohol use and binge drinking (Av 16.9 drinks prior to injury)
• Distraction and fatigue had an additive effect to alcohol (75% occurred between 10pm & 6am)
• Alcohol use increased the risk of injury around fires (impaired judgement, slowed reaction times)
• Wearing of flammable clothing/covering
• Being alone around fire when intoxicated
• Leaving cooking unattended (e.g. fell asleep)
• Use of accelerants on, or to start, fire
Environmental factors
• Use of fire drums/perforations in fire vessel
• Lack of barriers around open fire source
• Unfamiliarity with environment
• Lack of, or disarmed, smoke alarm
• Lack of fire fighting equipment/contingency plan
Factors contributing to the severity of injury
• Slowness of retrieval of person from fire
• Inappropriate or lack of first aid
• Delay in seeking medical attention
• Poor knowledge of signs/symptoms of burn severity
Outcomes of injury
• 15 required inpatient care ranging up to 79 days
• 11 required grafting, debridement, amputation reconstructive surgery, mechanical ventilation
• 7 required extensive rehabilitation, 5 wore pressure suits for up to 3 years
• 6 described ongoing pain or physical disability
• 5 suffered ongoing psychological effects
• Half indicated they had, or intended to, alter their alcohol consumption patterns post burn
4b) Results: Nurses focus group
10 experienced burns nurses participated, they identified the following patterns:
• 2 common settings for alcohol involved fire burns were other homes and campfires
• 2 types of at-risk drinkers: young male binge drinkers and older, chronic drinkers
• Patients are often embarrassed and try to cover up the role of alcohol. Combined with a lack of understanding of burns this leads to delayed presentation and more severe outcomes.
5) Discussion
The results of this small exploratory study provide a unique insight into the experiences, attitudes and behaviour of patients who have sustained an alcohol involved fire burn injury.
Alcohol appeared a significant contributor to the fire burn/smoke inhalation injuries suffered by the 18 patients interviewed, however findings are tentative because of the small size of the study.
Injuries occurred in a variety of settings with varied outcomes in terms of severity, ongoing physical and psychological suffering and changes to participant’s behaviour related to alcohol intake post-injury.
Accessing the target group of interest was challenging. Embarrassment and fear may have prevented patients from taking part. Also, a subset of the at-risk population are know to be transient and were often lost to important outpatient follow-up and were not contactable for participation in research. Difficulties accessing the identified target groups has implications for prevention efforts.
6) Recommendations
Patient and nurse participants suggested the following prevention strategies:
• Employ TV campaigns using graphic imagery
• Fire fighters and burns victims to educate others that fire and alcohol use do not mix
• Allocate a sober ‘fire warden’ at fires, like a designated driver, to monitor fire and persons close to fire
• Develop education materials about risks of and appropriate responses to alcohol related burns
• Use catchy slogans for impact e.g. “The scars won’t go away with the hangover” or “A hangover lasts a day but the scars last a lifetime”.