The dangers of home oxygen and smoking

QUINCY — Home oxygen equipment is a lifesaver. A medical device, it allows patients with breathing problems to stay in their homes and lead a normal life. But like any medical device, it can be deadly.

In Massachusetts several fatal fires have moved investigators to look more deeply into the dangers of home oxygen, especially when people smoke with this equipment in the house.

The Massachusetts Department of Fire Services has launched an educational campaign around this issue. Stephen D. Coan, the state fire marshal and top fire official, says he considers the issue a top priority.

"Smoking in homes where people use oxygen starts many fires each year that cause deaths and injuries," Coan said. "These fires force whole families and other building tenants out of their homes, destroy a lifetime’s possessions, and cause hundreds of thousands of dollars in property damage."

Home oxygen is pure O2 — the fuel required for fire to burn. In the presence of an open flame or spark, pure oxygen can ignite. And if a fire is already burning, bottles of home oxygen can suddenly and violently explode or release their contents into the fire, giving it more fuel, and quickly turning a small fire into a massive blaze. These fires can be more deadly for residents and more dangerous for responding firefighters.

Fire needs oxygen to burn, and the more oxygen there is in the air, the easier and faster things — furniture, clothing, bedding — will burn. Normal air is about 21 percent oxygen, while home medical oxygen is 100 percent. It’s the difference between a beer and pure rubbing alcohol.

In Quincy a woman died on the morning of Dec. 26 after fire officials said she was smoking a cigarette while using home oxygen. Donna Marani, 62, brutally burned to death in a two-alarm fire in her high-rise apartment complex. In her tiny apartment, the first thing that was visible was her front door, down a long hallway, where a sign warned passersby that home oxygen was in use and that people shouldn’t smoke. But inside the apartment, the remains of a pack of cigarettes and a lighter were visible on a table. On the floor, Marani’s oxygen unit was a charred mess. Quincy Fire Chief Joseph Barron said she was found in a hallway, between a couch where the fire started and her bathroom. The couch was burned down to the springs, with only the tatters of a Boston Red Sox blanket remaining.

"The investigation revealed the cause to be consistent with a smoking-related fire,” Coan said. "And there was home oxygen in the apartment.”

Marani was declared dead at the scene. Across the living room, a bookshelf full of Christmas cards and old photographs gave a sad reminder of the humanity surrounding the preventable danger.

"She was a smoker,” said Jenn Fell, 31, who lives in the Marani’s building with her two sons. "Several people in the building have warned her about smoking while on oxygen. … Everybody lost a really good friend out of this tragedy.”

Fell was allowed to return to her home, but the entire building, some 10 stories tall, housing low-income, elderly, and disabled city residents, smelled of smoke. Water damage seeped downstairs. Smoke and fire damage hit adjoining apartments. Two other residents were hospitalized.

On May 16, a house fire burned so intensely that firefighters in full gear and air masks were unable to reach a 73-year-old grandmother in the town of Whitman, Massachusetts. Helena Drass died in a fire that was violently accelerated by her therapeutic home oxygen containers. Fire investigators believe she was smoking a cigarette while her oxygen equipment was in use.

Drass was living with her daughter, who was out of town that night. A babysitter was hailed as a hero for getting Drass’ four grandchildren out of the house safely, but there was nothing that could be done for the grandmother.

“The fire was so intense — it did more damage in 10 minutes than most fires do in 30 minutes,” said Whitman Fire Chief Tim Grenno. Fire crews from four neighboring cities and towns helped put out the 2-alarm fire.

Elsewhere in Massachusetts, on March 27, 2004, a 39-year-old Salem woman died after she was overcome by heat and smoke when her apartment caught fire. Her roommate was using home oxygen and lit a cigarette. Six other people were hurt in the fire. On January 13, 2004, the town of Holbook battled a massive fire in a single-family home. A resident on oxygen dropped a cigarette that ignited the living room cough on fire. The fire caused several oxygen tanks in the room to rupture and explode. A firefighter was hurt. In 2003, a Boston man on home oxygen died in a flash fire. Even though his oxygen was off, there was enough remaining in the air to ignite his clothes when he lit a cigarette. He died and his wife and daughter were burned trying to save him.

On October 28, 2002, an 8-year-old girl died when her father, a smoker with lung disease, dropped a cigarette while he was using home oxygen. The tank exploded, and the little girl couldn’t escape the house.

Smoking is the leading cause of fire deaths in Massachusetts. Statewide since 1997, about two-dozen people have died and nearly 50 people have been injured in fires caused by smoking around home oxygen. According to the Quincy-based National Fire Protection Association, 46 people die each year around the country from fires sparked by improper use of home oxygen equipment — namely, smoking around such apparatus.

According to a National Fire Prevention Association research study, from 2003 to 2006, 1,190 people were burned per year in the United States from fires associated with home medical oxygen. Seventy-three percent of those fires were caused by smoking and 89 percent of victims suffered facial burns.

Coan’s office is circulating educational pamphlets to local fire departments, including a step-by-step guide for firefighters to educate residents on the dangers of smoking around oxygen. Essentially, oxygen users are told they should not smoke and should stay away from candles, gas grills, stoves, and any open flames.

"It’s a very dangerous thing. This is an issue that is extremely dangerous in homes," says Lorraine Carli, a spokeswoman for the National Fire Protection Association. "But like most fires and burns, they can be prevented by people taking some very simple steps."

Coan says that his campaign will target more than just residents and patients. He said that health care providers also have to take responsibility.

"Before sending a patient home on oxygen, health care providers must make sure the patient understands the dangers of smoking in an oxygen enriched environment," Coan writes in a statement. "Smokers should be asked about their intentions. If they are unwilling to quit, the risk of fire can outweigh the benefit of oxygen therapy."

There are simple ways to reduce risks that firefighters and officials are trying to teach. Patient on oxygen should avoid matches, lighters, cigarettes, candles, gas stoves, major appliances, electric razors, hair dyers and space heaters. Oil-based products like certain lotions or lip balms can also be dangerous for oxygen users. "You should not smoke. Your family and friends should not smoke around you," Coan said. "No one should smoke in your home. The fire danger is too great."