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Incidence trends in house fire fatalities in eastern Scotland
J~mrtlaI~4 Clinical ForensicMedic#~e(1999)6, 233-237
© APS/HarcourtPublishersLtd 1999
ORIGINAL C O M M U N I C A T I O N
Incidence trends in house fire fatalities in eastern Scotland L. B. Jordan, T. J. Squires, A. Busuttil Forensic Medicine Unit, Department of Pathology, University Medical School, Edinbu@, UK SUMMARY. Fatal house fires occur more frequently in Scotland than elsewhere in Great Britain. 1,2Over the last few years several educational campaigns were initiated to instruct the public in the risk factors associated with such fire fatalities and to promote the installation of functional domestic smoke detectors. An epidemiological survey of house fire deaths in the Lothian and Borders region of Scotland over the first half of the present decade, was carried out to evaluate any changing incidence trends by comparison with a survey of the fatalities from the first half of the previous decade. The impact of such campaigns in reducing house fires appears to be limited. © APS/Harcourt Publishers Ltd 1999
Journal of Clinical Forensic Medicine (1999) 6, 233-237
INTRODUCTION
METHOD
Despite numerous safety awareness campaigns, fire in the home remains a serious problem. Scotland has a high fatality rate as a result of domestic conflagration, approximately twice that of England and Wales, and higher than most parts of Europe. 1,3 A survey of all fire fatalities in Scotland during the period 1980-1990 identified several factors as being important in conflagration resulting in death. The very young and the elderly exhibited the highest risk of mortality) 4 Nights, weekends and the winter months are the most common times for increased fire incidence. 3 Alcohol intoxication and social deprivation are associated with domestic fire tragedies 2,3"6,7,9,1°,H and the misuse of smoking materials is the single most important cause of fatal
DETAILS OF INVESTIGATION Fire fatalities were identified from 'certificates of the cause of death' of cases referred to the Forensic Medicine Unit of the University of Edinburgh. The geographical area covered by this unit includes the entire Lothian and Borders region of Scotland. The Lothian and Borders fire brigade serves this area. As a consequence of the 'Fatal Accidents and Sudden Death Inquiry (Scotland) Act 1976', certain categories of death must be investigated, including death by 'burning or scalding as a result of fire or explosion'. Therefore, the public prosecutor, the Procurator Fiscal (PF) in Scotland, is duty bound to investigate any death suspected to result from fire or explosion and determine any criminal involvement. Current practise indicates that the PF instructs a full autopsy and appropriate toxicology in all such deaths. This ensures all fire fatalities within the Lothian and Borders region are included in this survey.
fires.2,3,6,7,12
These factors are well described in the academic literature and have formed the cornerstone of most Government-sponsored safety campaigns. The focus of this survey was to identify whether any significant changes in fire fatality trends over a 10 year period (1981-1985 vs. 1991-1995) had occurred.
1981-1985 data collection
Data pertaining to 1981-1985 were extracted from a previous data-collection exercise performed by the Forensic Medicine Unit, and formed part of the work involved in a previous survey5 The data were obtained from information in procurator fiscal, autopsy, toxicology; police and fire brigade reports, as well as details from expert investigative reports (e.g. gas and electricity) and witness accounts.
Dr L. B. Jordan MB, ChB, Dr 37. Squires Phi), Professor A. Busuttil M D FRCPath, Forensic Medicine Unit, Department of Pathology, University Medical School, Teviot Place, Edinburgh EH8 9AG, UK. Correspondence to: Dr L. B. Jordan
233
234
Journal of Clinical Forensic Medicine
Each fire incident was considered from two aspects. First, the incident itself was considered as a discrete entity and data relative to, for example, the cause of fire were recorded. Second, information from each fatality was recorded. This approach permits a separate analysis of fire incidents and fire fatalities. It is, therefore, important to distinguish between results that present numbers of incidents and those that contain numbers of fatalities. The data were entered into a prepared proforma and subsequently onto a database application (4th Dimension by ACI) run on an Apple Macintosh.
4 3.5 3 "5 2.5 2 1.5 ¢r" 1 0.5 0 0-14
15-39
40-74
Age Groups.
75+
[_.O...1981.85 [-!~1991-95 /
Fig. 1 Fatality rates by age group, fatal house fires in Lothians and Borders, 1981-1985 and 1991-1995. Risk factor is the percentage of fatalities divided by the percentage of the population.
1991-1995 data collection Similar information-gathering techniques to those of the 1981-1985 data collection were used, although data were obtained solely from Forensic Medicine Unit files, which comprise autopsy, toxicology and preliminary police reports (all the data available to the PF except the fire brigade reports). For compatibility and comparison the same database application and proforma were used. Comparisons were made on the basis of direct analysis, and use of the two-sample t-test. Data quality It is important to note that each case file is not equal in quality to all others and this applies to the entire data set, particularly the preliminary 'police sudden death' reports which provided the widest variation in quality, mostly relating to the incident itself and not the postmortem information. Often reports were completed and submitted before all the evidence and fire investigation had been compiled, in some cases identification relied solely on medical/dental records, so details were scant. Varying detail and quality in the information available may be related to the technique and experience of the individual police officer involved, and the extent to which information was made available to that officer. Regarding autopsy data, all deaths were examined post mortem by Edinburgh forensic pathologists, and followed a standardized report involving the expected variation in judgement, style and technique. Variation in the postmortem state of the victim prior to autopsy also occurred, and occasionally toxicology reports had not been married with the appropriate file. No comment can be made of the percentage of case files retrieved of each data set. However, in the 1981-1985 data set, a change in fire recording from central crown office storage to local Forensic Medicine Unit/PF office storage occurred. 'Weeding' of files to reduce the bulk was commonplace, and loss
associated with manual filing makes objective assessment difficult. With the 1991-1995 data set, a modified filing system was, and is, used. A cover note of a file (brief description of the individual involved: date of birth, cause of death, etc.) is stored separately from the master file, reducing the risk of losing a file without having a record of its previous existence. Despite a lack of fire brigade reports for corroboration, as all 1991-1995 files are held at the Edinburgh Forensic Medicine Unit, they are more likely to be complete than the previous data set, partially compensating for the lack of fire service information.
RESULTS AND DISCUSSION The mean annual death rate (per 100 000) in domestic conflagrations during the period 1981-1985 was 1.39 (59 deaths in a population of 846 717. ~This decreased to 1.32 (57 deaths in a population of 861 95@ during 1991-1995. Lothian and Borders had 16.5% of the total Scottish population between 1981-1985, reaching 16.8% between 1991-1995, whilst the overall population of Scotland decreased by over 23 000.1 There was no significant change in the diurnal, weekly, monthly or annual distribution of fire events, the mean number of fire fatalities per incident decreased from 1.11 (59 deaths, 53 incidents 1981-1985) to 1.04 (57 deaths, 53 incidents 1991-1995). The number of incidents with multiple (i.e. greater than one) fatalities was seven incidents in 1981-1985 and three incidents in 1991-1995. The number of incidents with multiple 'personsassociated' was 14 incidents in 1981-1985 and 11 incidents in 1991-1995. This difference, indicates that more fires in 1991-1995 involved only one 'person' and those with multiple 'persons-associated' were more likely to result in only one fatality. The reason for this is unclear.
Incidence trends in house fire fatalities in eastern Scotland
Other/Unknown
Ha,way > "o,
LT_
Bathroom ! Kitchen ~ i t
m
II i
Bedrrom
i
,v,n0rrom iH
......
Unknown ~
!
Child Play ~ WFR
i
Chip Pan All Heaters All Gas ~ All Electrical
Smoking Materials
I
0 0
10
20
30
40
50
Fig. 2 Location of victims in fatal house fires, Lothian and Borders, 1981 1985 and 1991-1995. The category of 'Unknown/Other' includes the following: those fatalities whose location is not specified in the report, escape locations, e.g. pavement, common stairwell, living-bed areas and bed-sits, etc.
Other/Unknown
H
i
Ha,way LT_ ~5
Bathroom
O3
Bedrrom
IIEI I II I
Kitchen
I1:
......... !
i
Livingrrom 0
10
20
30
40
t t
', t
i ¸¸ !i ¸
]
]
10
20
30
m1991-95~ , ~ 1981-85~
Percentage of Total.
235
50
Percentage of Total.
Fig. 3 Seat of Fatal house fires, Lothian and Borders, 1981 1985 and 1991-1995 'Other/Unknown' includes unknown fire initiation sites including living-bed areas, open plan bed-sits, etc.
The elderly population remains the greatest at risk of death in a domestic fire, for reasons extensively documented elsewhere. 2 5.i3.~4There was a decrease in the number of deaths in the 0-14 age range in the 1991-1995 study (see Fig. 1). However, the low absolute numbers render it impossible to detect a statistically significant trend in the 'relative risk' in the younger age groups, over the two periods of the survey. This decrease may be an indication of a reduction in the number of children playing with matches that are involved in fire inducation. This perhaps shows the success of governmental safety campaigns such as those aimed at parental education (e.g. reducing the availability of incendiaries), and school level education aimed at child awareness of environmental dangers. However, other factors, such as altered smoking habits, reduction in the use of coal fires and free standing heaters, may have resulted in less freely accessible potential incendiaries for children. Thus, a demographic and circumstance change may have added to the impact of governmental campaigns, or even been solely responsible. The age distribution of fire fatalities can be seen in Figure 1 and the data supporting the above statements is shown graphically; the 'relative risk' is the ratio of the percentage of fatalities against the percentage of
Percentage.
Fig. 4 Causes of Fatal house Fires, Lothian and Borders, 1981 1985 and 1991-1995. These categories are not mutually exclusive. ' W F R ' means 'Wilful Fire Raising'. 'Child Play' means child associated fires or child playing with incendiaries.
the population? There were no significant sex differences identified, nor were significant changes between the data sets. Regarding the incidents: the number of victims found in a bedroom were significantly less in the 1991 1995 survey. Similarly, the bedroom was less likely to be the seat of the fire in the later study (Figs 2 & 3). The difference between the place of fire and position of victim was presumably related to attempts to escape from the fire or to fetch items such as water to extinguish the fire, or due to smoke-inhalation induced death where victims had been sleeping, e.g. the bedroom. Figure 4 shows the causes of fatal house fires and includes a graphical representation. These categories shown are not mutually exclusive, they are a result of the combination of various values into more than one category; for example, an electric heater falls into 'all electric' and 'all heaters'. It is noticeable that Figure 4 contains many 'unknown' causes within the 1991-1995 subset; 16.4% of the total compared with only 3.8% in 1981-1985. It is important to note that the 'unknown' indicates that no official cause for the fire is recorded within the police or forensic medicine reports. This can be due to several factors: first, there was no official cause found; second, the final police report was not privy to the fire investigation and; third, the cause of the fire was not recorded within the files accessible for the 1991-1995 data set, i.e. they were completed prior to the completion of a fire investigation. Although, the overall proportion of fatal fires ignited as a result of 'smoking materials' (e.g. cigarettes, pipes, hot ashes, matches) has increased, one can speculate as to whether campaigns which emphasized the dangers of smoking in bed have resulted in the appropriate decline in bedroom fatalities. Alternate suggestions include changed trends in home heating methods avoiding the use of coal fires
236
Journal of Clinical Forensic Medicine
and standalone heaters. Moreover, in the later period there were no fatal fires caused by the misuse of ‘electric blankets’, there were six such cases in 1981-1985. The reduction in the number of electrical fires of all causes is largely attributable to this, and correlates well with an informed safety campaign of the time, leaflet distribution and appropriate warnings on new apparatus. However, the reduction in ‘all heaters’ category, which includes any independent form of heating, excluding central heating, does show a reduction in the later period. This may be associated with increased use of safer centrally heated systems and a reduction in open coal fires; these caused six fatal fires in 1981-1985 but only two in 1991-1995. This may also have impacted on the need to utilize electric blankets. ‘Chip pan’ fires as a cause of fatal conflagration appear to have increased despite governmental campaigns promoting the risks of using such cooking devices, and the introduction of ‘oven ready chips’ in the previous decade. This may be a cultural aspect of southeastern Scotland, and may vary considerably within the UK. Overall, the reductions in electrical, ‘all heater’, and child-associated fires have been compensated for by the increase in gas-related, smoking-related, ‘chippan’-related and ‘unknown’ categories of fire causes. Regarding smoke detectors/alarms, in 7.3% of fires involving fatalities in the 1991-1995 survey, there was evidence that a smoke detector/alarm was activated. In the majority of fatal fires there was no functioning smoke detector/alarm (1981-1985: 98.1%; 1991-1995: 90.9%). This is highly significant, as the main aspect of past and continuing government safety campaigns is the drive for smoke-detector/alarm installation. The implication being that there is a ‘core’ of people liable to initiate and/or die in fires (e.g. the elderly, the intoxicated, the young, the smoker) and that these people are the least likely to have smoke detector/alarms. Possible reasons include cost, lack of awareness and irritation with false alarms. An important point raised by a ‘detector give-away’ in the USA, is that an active participation of the population at risk is required for smoke detector/alarms to have an effect on fatality rates, and not just information giving.15,16 This may also relate to many socio-economic factors that can influence fire fatality.2~3~6~7.9.10J’ Those socio-economic classes that are most at risk are probably the groups least likely to pay attention to safety campaigns. The number of fire victims in which the primary cause of death was certified as ‘burns’ fell by more than 50% between 1981-1985 and 1991-1995. The certification of ‘smoke inhalation’ remained approximately constant, with a greater proportion being certified as the combined effect of smoke inhalation and
Other Smoke ihalation & Smoke inhalation Burns 0
10
20 Percentage
30
40
of Total
Fig. 5 Causes of death (a) in Fatal house Fires, Lothian and Borders, 1981-1985 and 1991-1995. The category of ‘Other’ includes causes of death such as injury sustained during the escape and later hospital-related deaths, for example, gross fungal infections.
burn injury. However, the changes in cause of death were not statistically significant and it is probable that they reflect changes in death certification rather than actual mechanism of death in fire. The appropriate data are displayed in Figure 5. The percentage of incidents involving alcohol and mean alcohol levels showed no statistically significant changes between the two periods (63”/0 in 1981-1985, 65% in 1991-1995). There is essentially no overall change and no further comment is warranted, with the exception of adding that alcohol is a highly significant contributor to fire fatality. As intoxication has been shown to impair the victims judgement and ability to escape from a conflagration,17 and increased the chances of error in the handling of equipment and smoking materials.*J8 A similar situation is true of socio-economic disadvantage, as already associated in many previous investigations.* The main point to note is that there has been no overall reduction in fatality rate.
CONCLUSIONS
Prevention campaigns have had only limited success in reducing the fatality rate. Smoke-detector/alarm campaigns have had little impact on the ‘core’ group involved in fire fatalities, which is surprising as these campaigns were designed to be the most pervasive and persuasive. The success of these campaigns, i.e. the number of lives saved by smoke detectors/alarms cannot be addressed by these data. Less importantly: ‘chip pan’ warnings have had little impact. ‘Stop smoking in bed’ campaigns may have actually influenced the public, reducing the incidence of the bedroom as a seat of fire, but smoking materials as a cause of fatal fires have increased. Child safety advice may be responsible for the demographic changes seen between the two periods of this survey, and is a possible reason for optimism.
Incidence trends in house fire fatalities in eastern Scotland
Research is required into risk assessment exercises in the elderly population. It is potentially valuable to target resources to this high-risk group, and research may take the form of assessing risk of fire, lifestyle, heating/cooking facilities, etc. Further targeting of other high-risk groups, such as the socially disadvantaged, may help too. Fires caused by careless disposal or misuse of smoking materials have increased despite being targeted by safety campaigns. No significant changes in the association between alcohol and socioeconomic factors related to fatal fires. Improvement in campaign effectiveness, education and impact on high-risk group fatality rates will need more novel methods and active participation of those groups in question. REFERENCES
1. The Registrar General for Scotland: Annual Report. Edinburgh: HMSO, 1980-1995. 2. Squires TJ, Busuttil A. A survey of fire fatalities in Scotland, 1980-1990. Edinburgh: University of Edinburgh Press, 1993. 3. Chernichko L, Saunders LD, Tough S. Unintentional house fire deaths in Alberta 1985-1990: a population study. Can J Public Health 1993; 84(5): 317-320. 4. Elder A, Squires T J, Busuttil A. Fire fatalities in the elderly population. Age & Ageing 1996; 25:214-216. 5. Gulaid JA, Sacks J J, Sattin RW. Deaths from residential fires among older people, United States, 1984. J Am Geriatr Soc 1989; 37(4): 331-334.
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6. Patetta M J, Cole TB. A population-based descriptive study of housefire deaths in North Carolina. Am J Public Health 1990; 80(9): 1116-1117. 7. Runyan CW, Bangdiwala SI, Linzer MA, Sacks JJ, Butts J. Risk factors for residential fires. N Engl J Med 1992; 327(12): 859-863. 8. Squires T J, Busuttil A. Child Fatalities in Scottish Fatal Fires 1980-1990: a Case of Child Neglect? Child Abuse & Neglect 1995; 19(7): 865-873. 9. Gormsen H, Seppesen N, Lund A. The causes of death in fire victims. Forensic Sci Int 1984; 24(2): 107-111. 10. Haberman PWl Alcohol and alcoholism in traffic and other accidental deaths. Am J Alcohol Abuse 1987; 13(4): 475-484. 11, Squires TJ, Busuttil A. Alcohol and House Fire Fatalities in Scotland 1980-1990. Med Sci Law 1997; 13(4): 321-325. 12. Mierley MC, Baker SR Fatal house fires in an urban population. JAMA 1983; 249(11): 1466-1468. 13. Copeland AR. Accidental fire deaths. The 5-year Metropolitan Dade County experience from 1979 until 1983. Z Rechtsmed 1985; 94(I): 71-79. 14. Yoshida M, Adachi J, Watabiki T, Tatsuno Y, Ishida N. A study on house Fire victims: age, carboxyhemoglobin, hydrogen cyanide and hemolysis. Forensic Sci Int 1991; 52(1): 13-20. 15. Gorman RL, Charney E, Holtzman NA, Roberts KB. A successful citywide smoke detector giveaway program. Pediatrics 1985; 750): 14-18. 16. Mallonee S, Istre GR, Rosenburg M et al. Surveillance and prevention of residential-fire injuries. N Engl J Med 1996; 335(1): 27-3l. 17. Barillo DJ, Rush Jr BE Goode R, Lin RL, Freda A, Anderson Jr EJ. Is ethanol the unknown toxin in smoke inhalation injury? Am Surg 1986; 52(12): 641-645. 18. Howland .I, Hingson R. Alcohol as a risk factor for injuries or death due to fires and burns: review of the literature. Public Health Rep. 1987; 102(5): 475-483.
© APS/HarcourtPublishersLtd 1999
ORIGINAL C O M M U N I C A T I O N
Incidence trends in house fire fatalities in eastern Scotland L. B. Jordan, T. J. Squires, A. Busuttil Forensic Medicine Unit, Department of Pathology, University Medical School, Edinbu@, UK SUMMARY. Fatal house fires occur more frequently in Scotland than elsewhere in Great Britain. 1,2Over the last few years several educational campaigns were initiated to instruct the public in the risk factors associated with such fire fatalities and to promote the installation of functional domestic smoke detectors. An epidemiological survey of house fire deaths in the Lothian and Borders region of Scotland over the first half of the present decade, was carried out to evaluate any changing incidence trends by comparison with a survey of the fatalities from the first half of the previous decade. The impact of such campaigns in reducing house fires appears to be limited. © APS/Harcourt Publishers Ltd 1999
Journal of Clinical Forensic Medicine (1999) 6, 233-237
INTRODUCTION
METHOD
Despite numerous safety awareness campaigns, fire in the home remains a serious problem. Scotland has a high fatality rate as a result of domestic conflagration, approximately twice that of England and Wales, and higher than most parts of Europe. 1,3 A survey of all fire fatalities in Scotland during the period 1980-1990 identified several factors as being important in conflagration resulting in death. The very young and the elderly exhibited the highest risk of mortality) 4 Nights, weekends and the winter months are the most common times for increased fire incidence. 3 Alcohol intoxication and social deprivation are associated with domestic fire tragedies 2,3"6,7,9,1°,H and the misuse of smoking materials is the single most important cause of fatal
DETAILS OF INVESTIGATION Fire fatalities were identified from 'certificates of the cause of death' of cases referred to the Forensic Medicine Unit of the University of Edinburgh. The geographical area covered by this unit includes the entire Lothian and Borders region of Scotland. The Lothian and Borders fire brigade serves this area. As a consequence of the 'Fatal Accidents and Sudden Death Inquiry (Scotland) Act 1976', certain categories of death must be investigated, including death by 'burning or scalding as a result of fire or explosion'. Therefore, the public prosecutor, the Procurator Fiscal (PF) in Scotland, is duty bound to investigate any death suspected to result from fire or explosion and determine any criminal involvement. Current practise indicates that the PF instructs a full autopsy and appropriate toxicology in all such deaths. This ensures all fire fatalities within the Lothian and Borders region are included in this survey.
fires.2,3,6,7,12
These factors are well described in the academic literature and have formed the cornerstone of most Government-sponsored safety campaigns. The focus of this survey was to identify whether any significant changes in fire fatality trends over a 10 year period (1981-1985 vs. 1991-1995) had occurred.
1981-1985 data collection
Data pertaining to 1981-1985 were extracted from a previous data-collection exercise performed by the Forensic Medicine Unit, and formed part of the work involved in a previous survey5 The data were obtained from information in procurator fiscal, autopsy, toxicology; police and fire brigade reports, as well as details from expert investigative reports (e.g. gas and electricity) and witness accounts.
Dr L. B. Jordan MB, ChB, Dr 37. Squires Phi), Professor A. Busuttil M D FRCPath, Forensic Medicine Unit, Department of Pathology, University Medical School, Teviot Place, Edinburgh EH8 9AG, UK. Correspondence to: Dr L. B. Jordan
233
234
Journal of Clinical Forensic Medicine
Each fire incident was considered from two aspects. First, the incident itself was considered as a discrete entity and data relative to, for example, the cause of fire were recorded. Second, information from each fatality was recorded. This approach permits a separate analysis of fire incidents and fire fatalities. It is, therefore, important to distinguish between results that present numbers of incidents and those that contain numbers of fatalities. The data were entered into a prepared proforma and subsequently onto a database application (4th Dimension by ACI) run on an Apple Macintosh.
4 3.5 3 "5 2.5 2 1.5 ¢r" 1 0.5 0 0-14
15-39
40-74
Age Groups.
75+
[_.O...1981.85 [-!~1991-95 /
Fig. 1 Fatality rates by age group, fatal house fires in Lothians and Borders, 1981-1985 and 1991-1995. Risk factor is the percentage of fatalities divided by the percentage of the population.
1991-1995 data collection Similar information-gathering techniques to those of the 1981-1985 data collection were used, although data were obtained solely from Forensic Medicine Unit files, which comprise autopsy, toxicology and preliminary police reports (all the data available to the PF except the fire brigade reports). For compatibility and comparison the same database application and proforma were used. Comparisons were made on the basis of direct analysis, and use of the two-sample t-test. Data quality It is important to note that each case file is not equal in quality to all others and this applies to the entire data set, particularly the preliminary 'police sudden death' reports which provided the widest variation in quality, mostly relating to the incident itself and not the postmortem information. Often reports were completed and submitted before all the evidence and fire investigation had been compiled, in some cases identification relied solely on medical/dental records, so details were scant. Varying detail and quality in the information available may be related to the technique and experience of the individual police officer involved, and the extent to which information was made available to that officer. Regarding autopsy data, all deaths were examined post mortem by Edinburgh forensic pathologists, and followed a standardized report involving the expected variation in judgement, style and technique. Variation in the postmortem state of the victim prior to autopsy also occurred, and occasionally toxicology reports had not been married with the appropriate file. No comment can be made of the percentage of case files retrieved of each data set. However, in the 1981-1985 data set, a change in fire recording from central crown office storage to local Forensic Medicine Unit/PF office storage occurred. 'Weeding' of files to reduce the bulk was commonplace, and loss
associated with manual filing makes objective assessment difficult. With the 1991-1995 data set, a modified filing system was, and is, used. A cover note of a file (brief description of the individual involved: date of birth, cause of death, etc.) is stored separately from the master file, reducing the risk of losing a file without having a record of its previous existence. Despite a lack of fire brigade reports for corroboration, as all 1991-1995 files are held at the Edinburgh Forensic Medicine Unit, they are more likely to be complete than the previous data set, partially compensating for the lack of fire service information.
RESULTS AND DISCUSSION The mean annual death rate (per 100 000) in domestic conflagrations during the period 1981-1985 was 1.39 (59 deaths in a population of 846 717. ~This decreased to 1.32 (57 deaths in a population of 861 95@ during 1991-1995. Lothian and Borders had 16.5% of the total Scottish population between 1981-1985, reaching 16.8% between 1991-1995, whilst the overall population of Scotland decreased by over 23 000.1 There was no significant change in the diurnal, weekly, monthly or annual distribution of fire events, the mean number of fire fatalities per incident decreased from 1.11 (59 deaths, 53 incidents 1981-1985) to 1.04 (57 deaths, 53 incidents 1991-1995). The number of incidents with multiple (i.e. greater than one) fatalities was seven incidents in 1981-1985 and three incidents in 1991-1995. The number of incidents with multiple 'personsassociated' was 14 incidents in 1981-1985 and 11 incidents in 1991-1995. This difference, indicates that more fires in 1991-1995 involved only one 'person' and those with multiple 'persons-associated' were more likely to result in only one fatality. The reason for this is unclear.
Incidence trends in house fire fatalities in eastern Scotland
Other/Unknown
Ha,way > "o,
LT_
Bathroom ! Kitchen ~ i t
m
II i
Bedrrom
i
,v,n0rrom iH
......
Unknown ~
!
Child Play ~ WFR
i
Chip Pan All Heaters All Gas ~ All Electrical
Smoking Materials
I
0 0
10
20
30
40
50
Fig. 2 Location of victims in fatal house fires, Lothian and Borders, 1981 1985 and 1991-1995. The category of 'Unknown/Other' includes the following: those fatalities whose location is not specified in the report, escape locations, e.g. pavement, common stairwell, living-bed areas and bed-sits, etc.
Other/Unknown
H
i
Ha,way LT_ ~5
Bathroom
O3
Bedrrom
IIEI I II I
Kitchen
I1:
......... !
i
Livingrrom 0
10
20
30
40
t t
', t
i ¸¸ !i ¸
]
]
10
20
30
m1991-95~ , ~ 1981-85~
Percentage of Total.
235
50
Percentage of Total.
Fig. 3 Seat of Fatal house fires, Lothian and Borders, 1981 1985 and 1991-1995 'Other/Unknown' includes unknown fire initiation sites including living-bed areas, open plan bed-sits, etc.
The elderly population remains the greatest at risk of death in a domestic fire, for reasons extensively documented elsewhere. 2 5.i3.~4There was a decrease in the number of deaths in the 0-14 age range in the 1991-1995 study (see Fig. 1). However, the low absolute numbers render it impossible to detect a statistically significant trend in the 'relative risk' in the younger age groups, over the two periods of the survey. This decrease may be an indication of a reduction in the number of children playing with matches that are involved in fire inducation. This perhaps shows the success of governmental safety campaigns such as those aimed at parental education (e.g. reducing the availability of incendiaries), and school level education aimed at child awareness of environmental dangers. However, other factors, such as altered smoking habits, reduction in the use of coal fires and free standing heaters, may have resulted in less freely accessible potential incendiaries for children. Thus, a demographic and circumstance change may have added to the impact of governmental campaigns, or even been solely responsible. The age distribution of fire fatalities can be seen in Figure 1 and the data supporting the above statements is shown graphically; the 'relative risk' is the ratio of the percentage of fatalities against the percentage of
Percentage.
Fig. 4 Causes of Fatal house Fires, Lothian and Borders, 1981 1985 and 1991-1995. These categories are not mutually exclusive. ' W F R ' means 'Wilful Fire Raising'. 'Child Play' means child associated fires or child playing with incendiaries.
the population? There were no significant sex differences identified, nor were significant changes between the data sets. Regarding the incidents: the number of victims found in a bedroom were significantly less in the 1991 1995 survey. Similarly, the bedroom was less likely to be the seat of the fire in the later study (Figs 2 & 3). The difference between the place of fire and position of victim was presumably related to attempts to escape from the fire or to fetch items such as water to extinguish the fire, or due to smoke-inhalation induced death where victims had been sleeping, e.g. the bedroom. Figure 4 shows the causes of fatal house fires and includes a graphical representation. These categories shown are not mutually exclusive, they are a result of the combination of various values into more than one category; for example, an electric heater falls into 'all electric' and 'all heaters'. It is noticeable that Figure 4 contains many 'unknown' causes within the 1991-1995 subset; 16.4% of the total compared with only 3.8% in 1981-1985. It is important to note that the 'unknown' indicates that no official cause for the fire is recorded within the police or forensic medicine reports. This can be due to several factors: first, there was no official cause found; second, the final police report was not privy to the fire investigation and; third, the cause of the fire was not recorded within the files accessible for the 1991-1995 data set, i.e. they were completed prior to the completion of a fire investigation. Although, the overall proportion of fatal fires ignited as a result of 'smoking materials' (e.g. cigarettes, pipes, hot ashes, matches) has increased, one can speculate as to whether campaigns which emphasized the dangers of smoking in bed have resulted in the appropriate decline in bedroom fatalities. Alternate suggestions include changed trends in home heating methods avoiding the use of coal fires
236
Journal of Clinical Forensic Medicine
and standalone heaters. Moreover, in the later period there were no fatal fires caused by the misuse of ‘electric blankets’, there were six such cases in 1981-1985. The reduction in the number of electrical fires of all causes is largely attributable to this, and correlates well with an informed safety campaign of the time, leaflet distribution and appropriate warnings on new apparatus. However, the reduction in ‘all heaters’ category, which includes any independent form of heating, excluding central heating, does show a reduction in the later period. This may be associated with increased use of safer centrally heated systems and a reduction in open coal fires; these caused six fatal fires in 1981-1985 but only two in 1991-1995. This may also have impacted on the need to utilize electric blankets. ‘Chip pan’ fires as a cause of fatal conflagration appear to have increased despite governmental campaigns promoting the risks of using such cooking devices, and the introduction of ‘oven ready chips’ in the previous decade. This may be a cultural aspect of southeastern Scotland, and may vary considerably within the UK. Overall, the reductions in electrical, ‘all heater’, and child-associated fires have been compensated for by the increase in gas-related, smoking-related, ‘chippan’-related and ‘unknown’ categories of fire causes. Regarding smoke detectors/alarms, in 7.3% of fires involving fatalities in the 1991-1995 survey, there was evidence that a smoke detector/alarm was activated. In the majority of fatal fires there was no functioning smoke detector/alarm (1981-1985: 98.1%; 1991-1995: 90.9%). This is highly significant, as the main aspect of past and continuing government safety campaigns is the drive for smoke-detector/alarm installation. The implication being that there is a ‘core’ of people liable to initiate and/or die in fires (e.g. the elderly, the intoxicated, the young, the smoker) and that these people are the least likely to have smoke detector/alarms. Possible reasons include cost, lack of awareness and irritation with false alarms. An important point raised by a ‘detector give-away’ in the USA, is that an active participation of the population at risk is required for smoke detector/alarms to have an effect on fatality rates, and not just information giving.15,16 This may also relate to many socio-economic factors that can influence fire fatality.2~3~6~7.9.10J’ Those socio-economic classes that are most at risk are probably the groups least likely to pay attention to safety campaigns. The number of fire victims in which the primary cause of death was certified as ‘burns’ fell by more than 50% between 1981-1985 and 1991-1995. The certification of ‘smoke inhalation’ remained approximately constant, with a greater proportion being certified as the combined effect of smoke inhalation and
Other Smoke ihalation & Smoke inhalation Burns 0
10
20 Percentage
30
40
of Total
Fig. 5 Causes of death (a) in Fatal house Fires, Lothian and Borders, 1981-1985 and 1991-1995. The category of ‘Other’ includes causes of death such as injury sustained during the escape and later hospital-related deaths, for example, gross fungal infections.
burn injury. However, the changes in cause of death were not statistically significant and it is probable that they reflect changes in death certification rather than actual mechanism of death in fire. The appropriate data are displayed in Figure 5. The percentage of incidents involving alcohol and mean alcohol levels showed no statistically significant changes between the two periods (63”/0 in 1981-1985, 65% in 1991-1995). There is essentially no overall change and no further comment is warranted, with the exception of adding that alcohol is a highly significant contributor to fire fatality. As intoxication has been shown to impair the victims judgement and ability to escape from a conflagration,17 and increased the chances of error in the handling of equipment and smoking materials.*J8 A similar situation is true of socio-economic disadvantage, as already associated in many previous investigations.* The main point to note is that there has been no overall reduction in fatality rate.
CONCLUSIONS
Prevention campaigns have had only limited success in reducing the fatality rate. Smoke-detector/alarm campaigns have had little impact on the ‘core’ group involved in fire fatalities, which is surprising as these campaigns were designed to be the most pervasive and persuasive. The success of these campaigns, i.e. the number of lives saved by smoke detectors/alarms cannot be addressed by these data. Less importantly: ‘chip pan’ warnings have had little impact. ‘Stop smoking in bed’ campaigns may have actually influenced the public, reducing the incidence of the bedroom as a seat of fire, but smoking materials as a cause of fatal fires have increased. Child safety advice may be responsible for the demographic changes seen between the two periods of this survey, and is a possible reason for optimism.
Incidence trends in house fire fatalities in eastern Scotland
Research is required into risk assessment exercises in the elderly population. It is potentially valuable to target resources to this high-risk group, and research may take the form of assessing risk of fire, lifestyle, heating/cooking facilities, etc. Further targeting of other high-risk groups, such as the socially disadvantaged, may help too. Fires caused by careless disposal or misuse of smoking materials have increased despite being targeted by safety campaigns. No significant changes in the association between alcohol and socioeconomic factors related to fatal fires. Improvement in campaign effectiveness, education and impact on high-risk group fatality rates will need more novel methods and active participation of those groups in question. REFERENCES
1. The Registrar General for Scotland: Annual Report. Edinburgh: HMSO, 1980-1995. 2. Squires TJ, Busuttil A. A survey of fire fatalities in Scotland, 1980-1990. Edinburgh: University of Edinburgh Press, 1993. 3. Chernichko L, Saunders LD, Tough S. Unintentional house fire deaths in Alberta 1985-1990: a population study. Can J Public Health 1993; 84(5): 317-320. 4. Elder A, Squires T J, Busuttil A. Fire fatalities in the elderly population. Age & Ageing 1996; 25:214-216. 5. Gulaid JA, Sacks J J, Sattin RW. Deaths from residential fires among older people, United States, 1984. J Am Geriatr Soc 1989; 37(4): 331-334.
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6. Patetta M J, Cole TB. A population-based descriptive study of housefire deaths in North Carolina. Am J Public Health 1990; 80(9): 1116-1117. 7. Runyan CW, Bangdiwala SI, Linzer MA, Sacks JJ, Butts J. Risk factors for residential fires. N Engl J Med 1992; 327(12): 859-863. 8. Squires T J, Busuttil A. Child Fatalities in Scottish Fatal Fires 1980-1990: a Case of Child Neglect? Child Abuse & Neglect 1995; 19(7): 865-873. 9. Gormsen H, Seppesen N, Lund A. The causes of death in fire victims. Forensic Sci Int 1984; 24(2): 107-111. 10. Haberman PWl Alcohol and alcoholism in traffic and other accidental deaths. Am J Alcohol Abuse 1987; 13(4): 475-484. 11, Squires TJ, Busuttil A. Alcohol and House Fire Fatalities in Scotland 1980-1990. Med Sci Law 1997; 13(4): 321-325. 12. Mierley MC, Baker SR Fatal house fires in an urban population. JAMA 1983; 249(11): 1466-1468. 13. Copeland AR. Accidental fire deaths. The 5-year Metropolitan Dade County experience from 1979 until 1983. Z Rechtsmed 1985; 94(I): 71-79. 14. Yoshida M, Adachi J, Watabiki T, Tatsuno Y, Ishida N. A study on house Fire victims: age, carboxyhemoglobin, hydrogen cyanide and hemolysis. Forensic Sci Int 1991; 52(1): 13-20. 15. Gorman RL, Charney E, Holtzman NA, Roberts KB. A successful citywide smoke detector giveaway program. Pediatrics 1985; 750): 14-18. 16. Mallonee S, Istre GR, Rosenburg M et al. Surveillance and prevention of residential-fire injuries. N Engl J Med 1996; 335(1): 27-3l. 17. Barillo DJ, Rush Jr BE Goode R, Lin RL, Freda A, Anderson Jr EJ. Is ethanol the unknown toxin in smoke inhalation injury? Am Surg 1986; 52(12): 641-645. 18. Howland .I, Hingson R. Alcohol as a risk factor for injuries or death due to fires and burns: review of the literature. Public Health Rep. 1987; 102(5): 475-483.