BURNS, TOXIC GASES, AND OTHER FIRE-LIKE HAZARDS IN NON-FIRE SITUATIONS

BURNS, TOXIC GASES, AND OTHER FIRE-LIKE HAZARDS IN NON-FIRE SITUATIONS John R. Hall, Jr. Fire Analysis & Research Division National Fire Protection Association 1 Batterymarch Park Quincy, MA 02169-7471 www.nfpa.org February 2004 Copyright, 2004, National Fire Protection Association, Quincy MA 02169-7471

TABLE OF CONTENTS Page Table of Contents i Introduction 1 Asphyxiation and Poisoning by Gases 2 Burn Injuries 14 Explosions 24 Burns, Toxic Gases, and Other Hazards, 2/04 i NFPA Fire Analysis & Research, Quincy, MA

INTRODUCTION The mission of NFPA "is to reduce the worldwide burden of fire and other hazards on the quality of life." This includes an interest in the effects of other hazards that injure or kill people via thermal energy or poisonous gases. This report is an attempt to collect in one place what is known about the magnitude and characteristics of those kindred hazards. The first section is devoted to deaths due to gases in non-fire situations. Toxic gases, such as carbon monoxide, are the principal mechanisms of death and injury in fire but also cause asphyxiation or poisoning in non-fire situations. The second section of the report addresses burn injuries, principally in non-fire situations. Hot solid objects cause contact thermal burns. Hot liquids and steam scald. Corrosive liquids or gases cause chemical burns. Electrical current causes electrical burns. The third section briefly discusses deaths due to explosions. This report is revised annually, or less often based on the frequency of revision of the source material. However, it is likely that the sections of the report will often be distributed separately and that each edition will be the first edition for some readers. Since this report uses data and methods not used in most of NFPA's other statistical reports, each future edition will repeat the notes on methods, the analysis conclusions, and the safety recommendations, each in its own section. Burns, Toxic Gases, and Other Hazards, 2/04 1 NFPA Fire Analysis & Research, Quincy, MA

ASPHYXIATION AND POISONING BY GASES In 2000, 631 people died of unintentional exposure to gases. Table 1 indicates the death toll has been around 600 per year for several years. Prior to 1999, it was clear that more than half the total involved carbon monoxide, more often from a motor vehicle, sometimes from inadequately ventilated fueled equipment, especially gas-fueled heating equipment. (See Tables 2-3.) Carbon monoxide is a product of incomplete combustion, so it is produced by fueled equipment, especially inefficient equipment, and fires. Beginning in 1999, the 5-10% contribution of organic solvents and halogenated hydrocarbons and their vapors has been separately identified. Before being discontinued, National Safety Council estimates were issued in advance of the death certificate data they estimated and usually tracked closely. They still provide a good indication of the home share of deaths due to gas exposure. More people are killed by deadly gases in fires than in all other unintentional exposure. Best estimates are that two-thirds of all fatal injuries in fires are due to smoke inhalation, possibly in combination with other fire effects, with more than half of such deaths attributed to smoke inhalation alone. The lowest estimate is therefore more than 1,500 fatal injuries due to toxic gases from fire, which is more than double the typical recent death toll from all other unintentional exposures to such gases. Older adults are a high-risk age group for fatal injury from unintentional non-fire exposure to gases and vapors, but children are not. Figures 1 and 2 show that children, even young children, are a low-risk age group for these types of injuries, in total deaths and home deaths, respectively. Suicides involving poisoning by gases or vapors are comparable in numbers to fatal fire injuries due to smoke inhalation and much more numerous than death due to unintentional non-fire exposure to gases or vapors. Table 4 includes homicides with suicides as deaths due to intentional injury. Homicides involving poisoning by gases or vapors are a small fraction of suicides from corresponding causes, based on data prior to 1999, when homicides and suicides were shown separately. Safety Tips The best strategy to prevent poisoning by carbon monoxide is prevention, which includes appropriate inspection, installation, use, and maintenance of motor vehicles and of heating and cooking equipment. Burns, Toxic Gases, and Other Hazards, 2/04 2 NFPA Fire Analysis & Research, Quincy, MA

Learn the symptoms and possible effects of carbon monoxide poisoning (see Tables 5-6). Carbon monoxide is by far the principal toxic gas of concern for fatal injuries, whether fire or non-fire, whether unintentional or intentional. A carbon monoxide alarm cannot be used as a smoke alarm. (See NFPA 720, Recommended Practice for the Installation of Household Carbon Monoxide (CO) Warning Equipment.) Fires create other effects, notably buoyancy due to heat, that affect the best placement of detection sensors in ways not necessarily applicable to cases of carbon monoxide buildup outside fires. For example, carbon monoxide released into a home by an unvented heating device may not be hot enough to rise to the ceiling where smoke alarms are normally placed. This means installation instructions for carbon monoxide alarms may permit them to be placed lower on a wall, and they may be too slow to detect the deadly effects of a fire, filling the room from the ceiling down. If you need to warm up a vehicle, remove it from the garage immediately after starting the ignition. Do not run a vehicle or other fueled engine or motor indoors, even if garage doors are open. In the winter, be sure tail pipe outlets are clear of snow before starting the engine. Carbon monoxide emitted from an operating vehicle inside a garage can get inside an attached home, even with the garage door open. Normal circulation, particularly in a modern building tightly sealed to reduce energy costs, does not provide enough fresh air to reliably prevent dangerous accumulations in any space exposed to carbon monoxide from a nearby operating vehicle. Have your vehicle inspected for exhaust leaks, if you have any symptoms of carbon monoxide poisoning. The National Highway Traffic Safety Administration (NFTSA) advises annual inspection of mufflers and exhaust pipes for holes. Have fuel-burning household heating equipment (fireplaces, furnaces, water heaters, wood stoves, and space or portable heaters) checked every year before cold weather sets in. All chimneys and chimney connectors should be evaluated for proper installation, cracks, blockages or leaks. Make needed repairs before using the equipment. Before enclosing central heating equipment in a smaller room, check with your fuel supplier to ensure that air for proper combustion is provided. When using a fireplace, open the flue for adequate ventilation. Always check with local authorities before buying or using kerosene heaters, because they are illegal in many states. Whenever using a kerosene heater, open a window slightly. Refuel outside, after the device has cooled. Burns, Toxic Gases, and Other Hazards, 2/04 3 NFPA Fire Analysis & Research, Quincy, MA

When using barbecue grills, always use them outside. Never use them in the home or garage, where the carbon monoxide grills produce can reach lethal concentrations in a confined space. When purchasing new fueled heating or cooking equipment, select a factory-built product approved by an independent testing laboratory. Do not accept damaged equipment. Hire a qualified technician (usually employed by the local oil or gas company) to install the equipment. Ask about and insist that the technician follow applicable fire safety and local building codes. If you purchase an existing home, have a qualified technician evaluate the integrity of the heating and cooking systems, as well as the sealed spaces between the garage and house. Never use a portable generator indoors or in attached garages. They should only be used outdoors in a well-ventilated area, away from building air intakes and protected from rain, snow, or other moisture. When camping, remember to use battery-powered heaters and flashlights in tents, trailers and motor homes. Using fossil fuels inside these structures and vehicles is extremely dangerous. NFPA 501, Standard on Recreational Vehicles, requires the installation of carbon monoxide alarms in recreational vehicles. Pollution and atmospheric conditions in some areas cause low levels of carbon monoxide to be present for long periods of time. In fact, these background conditions may cause carbon monoxide alarms to sound even though conditions inside the home are not truly hazardous. But treat all carbon monoxide alarm activations as real, until it has been verified that there is no threat from equipment inside the dwelling. When you choose a carbon monoxide alarm:! Select alarm(s) listed by a qualified, independent testing laboratory.! Follow manufacturer s recommendations for placement in your home.! Call your local fire department non-emergency telephone number. Tell the operator that you have purchased a carbon monoxide alarm and ask what number to call if the carbon monoxide alarm sounds. Be sure you understand whom to call if your alarm sounds, and clearly post that number by your telephone(s). Make sure everyone in the household knows the difference between the fire emergency and carbon monoxide emergency numbers (if there is a difference).! Know the difference between the sound of the smoke alarms and the sound of the carbon monoxide alarm. Burns, Toxic Gases, and Other Hazards, 2/04 4 NFPA Fire Analysis & Research, Quincy, MA

! Have a home evacuation plan for any home emergency and practice the plan with all members of the household.! Test carbon monoxide alarms at least once a month, following the manufacturer s instructions.! Replace carbon monoxide alarms according to the manufacturer s instructions, usually about every two years.! Battery-powered carbon monoxide alarms may have unique battery packs designed to last approximately two years, compared to batteries used in most smoke alarms, which require yearly replacement. If your carbon monoxide alarm sounds:! If anyone shows signs of carbon monoxide poisoning: Have everyone leave the building right away. Leave doors open as you go. Use a neighbor s telephone to report the carbon monoxide alarm activation, following the instructions you received from the fire department when you bought the alarm. Get immediate medical attention.! If no one has symptoms of carbon monoxide poisoning: Shut down heating and cooking equipment, and call a qualified technician to inspect all equipment. Be on the lookout for any symptoms of carbon monoxide poisoning. Follow the steps above if symptoms appear. Burns, Toxic Gases, and Other Hazards, 2/04 5 NFPA Fire Analysis & Research, Quincy, MA

Table 1. Non-Fire Unintentional-Injury Deaths Due to Poisoning by Gases and Vapors 1980-2000 National Safety Coded Directly on Death Certificates Council Estimates* Year Total* Gas From Pipeline Motor Vehicle Exhaust Gas Other Utility Gas or Carbon Monoxide Other Total Home 1980 1,242 - - - - 1,200 700 1981 1,280 - - - - 1,300 800 1982 1,259 72 596 426 165 1,300 800 1983 1,251 82 580 414 175 1,300 800 1984 1,103 48 511 354 190 1,100 700 1985 1,079 49 488 392 150 1,100 700 1986 1,009 29 475 341 164 1,000 600 1987 900 53 402 288 157 900 600 1988 873 36 372 314 151 900 500 1989 921 48 355 353 165 900 600 1990 748 33 293 289 133 700 500 1991 736 20 278 316 122 700 500 1992 633 21 223 281 108 600 400 1993 660 14 245 290 111 700 500 1994 685 24 246 307 108 700 500 1995 611 27 234 272 78 600 400 1996 638 23 219 283 113 600 400 1997 576 13 208 251 104 700 400 1998 546 15 190 254 87 600 500 1999 597 (63)** - - - - 500 300 2000 631 (38)** - - - - 400 300 * Detailed breakdowns not provided prior to 1982 or after 1998. NSC estimates are not available after 2000. ** Only deaths due to organic solvents and halogenated hydrocarbons and their vapors are separately reported after 1998. Their totals are shown in parenthesis. Source: National Safety Council, Accident Facts and Injury Facts, 1981-2003 editions, 1121 Spring Lake Drive, Itasca, IL 60143; NCHS website. Burns, Toxic Gases, and Other Hazards, 2/04 6 NFPA Fire Analysis & Research, Quincy, MA

Table 2. Unintentional-Injury Non-Fire Deaths Due to Carbon Monoxide, by Type of Heating Device, 1980-2000 (Statistics Before 1990 May Not Be Fully Comparable to Statistics After 1989) Central Heating Unit (Furnace) Water Heater Space Heater or Furnace Any Device Any Device Year Natural-Gas-fueled Gas-fueled LP-Gas-fueled Liquid-fueled* Solid-fueled** 1980 78 5 150 7 10 1981 68 20 122 8 15 1982 71 12 178 37 9 1983 55 21 135 21 14 1984 47 13 104 9 24 1985 57 20 115 6 3 1986 57 7 103 19 2 1987 54 3 89 17 11 1988 83 13 84 14 5 1989 56 6 130 29 2 ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 1990 28 17 86 19 43 1991 76 13 76 22 10 1992 40 6 79 8 12 1993 43 11 83 15 10 1994 64 7 93 12 8 1995 55 5 90 7 8 1996 35 8 99 21 10 1997 61 8 55 12 6 1998 63 8 54 5 5 1999 21 1 25 2 0 2000 41 3 32 6 2 1996-2000 average 44 6 53 9 5 * Principally oil-fueled furnaces and portable kerosene heaters. ** Includes coal-fueled furnaces, wood stoves, and fireplaces. Notes: Statistics shown here include proportional allocation of deaths and injuries involving gas-fueled heating equipment with unknown type of gas fuel for 1994-2000 and unknownfueled heating equipment for 1990-2000. These allocations do not appear in the source reports. Statistics prior to 1990 do not reflect similar data categories and allocations and so may not be comparable. Source: Susan A. Vagts, "Non-Fire Carbon Monoxide Deaths and Injuries Associated with the Use of Consumer Products, U.S. Consumer Product Safety Commission, Table 1, CPSC, July 31, 2003. Additional information from previous reports in this series. Statistics no longer reported separately for individual liquid-fueled or solid-fueled heating devices. Burns, Toxic Gases, and Other Hazards, 2/04 7 NFPA Fire Analysis & Research, Quincy, MA

Table 3. Unintentional-Injury Non-Fire Deaths Due to Carbon Monoxide by Type of Cooking Device, 1980-2000 Range, Stove, or Oven Grill Year Gas-fueled Charcoal* 1980 11 18 1981 25 18 1982 4 14 1983 24 39 1984 28 38 1985 31 49 1986 23 21 1987 23 20 1988 5 29 1989 22 30 1990 10 21 1991 14 25 1992 13 27 1993 6 27 1994 9 15 1995 5 14 1996 15 19 1997 5 23 1998 3 16 1999 6 17 2000 11 8 1996-2000 average 8 17 * No gas-fueled grill incidents were reported. Source: Susan A. Vagts, "Non-Fire Carbon Monoxide Deaths and Injuries Associated with the Use of Consumer Products," U.S. Consumer Product Safety Commission, Table 1, CPSC, July 31, 2003, and previous reports in this series. Burns, Toxic Gases, and Other Hazards, 2/04 8 NFPA Fire Analysis & Research, Quincy, MA

Figure 1. Non-Fire Deaths Due to Unintentional Poisoning by Gases and Vapors (Principally Carbon Monoxide) NSC Estimated 1996-2000 Deaths per Million Population, by Age 6 5 4.8 4 Death Rate 3 2 1.8 2.2 2.1 3.6 All-Ages Average 2.1 1 1.1 0.8 0 0-4 5-14 15-24 25-44 45-64 65-74 75 & up Age Source: National Safety Council Injury Facts. Note: Rates based on 1998 resident population. Burns, Toxic Gases, and Other Hazards, 2/04 9 NFPA Fire Analysis & Research, Quincy, MA

Figure 2. Non-Fire HOME Deaths Due to Unintentional Poisoning by Gases and Vapors (Principally Carbon Monoxide) Estimated 1996-2000 Deaths, per Million Population, by Age 6 5 4.8 4 Death Rate 3 2.4 2 1.4 All-Ages Average 1.4 1 0 1.2 1.2 0.7 0.5 0-4 5-14 15-24 25-44 45-64 65-74 75 & up Age Source: National Safety Council Injury Facts Note: Rates based on 1998 resident population. Burns, Toxic Gases, and Other Hazards, 2/04 10 NFPA Fire Analysis & Research, Quincy, MA

Table 4. Deaths Due to Poisoning by Gases and Vapors 1983-2000 Intentional Undetermined Injury Whether Unintentional (Homicide or Unintentional or Year Injury Suicide) Deliberate 1983 1,251 2,548 213 1984 1,103 2,628 184 1985 1,079 2,767 152 1986 1,009 2,966 190 1987 900 3,215 169 1988 873 2,692 148 1989 921 2,228 127 1990 748 2,281 112 1991 736 2,230 102 1992 633 2,057 120 1993 660 2,092 107 1994 685 2,044 84 1995 611 2,095 107 1996 638 2,007 118 1997 576 1,918 77 1998 546 1,726 82 1999 597 (63) 1,599 (64) 89 2000 631 (38) 1,503 (65) 87 Notes: Prior to 1999, suicides were distinguished by motor vehicle exhaust vs. other gas. In the early 1980 s, motor vehicle exhaust suicides outnumbered suicides by other gas by nearly 5-to-1. In the late 1990 s, the ratio had declined to only 3-to-1. * Beginning in 1999, only organic solvents and halogenated hydrocarbons and their vapors are distinguishable, and their totals are shown in parentheses. Source: National Safety Council, Accident Facts and Injury Facts, 1988-2003 editions, 1121 Spring Lake Drive, Itasca, IL 60143; and NCHS website. Burns, Toxic Gases, and Other Hazards, 2/04 11 NFPA Fire Analysis & Research, Quincy, MA

Table 5. Physical Effects of Carbon Monoxide Concentration (Parts per Million) Symptoms 100 Threshold limit value for no adverse effects even with 6-8 hours exposure 200 Possible mild headache after 2-3 hours of exposure 400 Headache and nausea after 1-2 hours 800 Headache, nausea and dizziness after 45 minutes; collapse and possible unconsciousness after 2 hours 1,000 Loss of consciousness after 1 hour 1,600 Headache, nausea and dizziness after 20 minutes 3,200 Headache and dizziness after 5-10 minutes; uncon-sciousness after 30 minutes 6,400 Headache and dizziness after 1-2 minutes exposure; unconsciousness and danger of death after 10-15 minutes 12,800 Immediate physiological effects; unconsciousness and danger of death after 1-3 minutes Source: James H. Meidl, Explosive and Toxic Hazardous Materials, Encino, CA: Glencoe Press, 1970, Table 28, p. 293. Burns, Toxic Gases, and Other Hazards, 2/04 12 NFPA Fire Analysis & Research, Quincy, MA

Table 6. Effects of Carboxyhemoglobin (COHb) Saturation Carboxyhemoglobin Saturation (%) Symptoms 0-10 None 10-20 Tension in forehead and dilation of skin vessels 20-30 Headache and pulsating temples 30-40 Severe headache, weariness, dizziness, weakened sight, nausea, vomiting, and prostration 40-50 Same as above, plus increased breathing and pulse rates, and asphyxiation 50-60 Same as above, plus coma, convulsions, and Cheyne- Stokes respiration 60-70 Coma, convulsions, and weak respiration and pulse. Death is possible 70-80 Slowing and stopping of breathing. Death occurs within hours 80-90 Death in less than 1 hour 90-100 Death within a few minutes Source: Gordon E. Hartzell, ed., Advances in Combustion Toxicology, Vol. 1, New York: Technomic Publishing, Inc., 1989, p. 23. Burns, Toxic Gases, and Other Hazards, 2/04 13 NFPA Fire Analysis & Research, Quincy, MA

BURN INJURIES During 1991-1993, the U.S. averaged an estimated 1,129,000 burn injuries per year that were medically attended or led to at least half a day of restricted activity. That is four burn injuries for every 1,000 people in the country per year (Table 7). These burns arose from contact with hot gases, liquids, or solid objects, or electrical, chemical, or radiation effects. Burn injuries need not involve fire, and fire injuries need not involve burns. The burn injury total represented a substantial 35% drop from the 1985-1987 average and nearly half from the mid-1960s. This estimate, like most of the other figures in this section, is taken from the National Health Interview Survey (NHIS), conducted by the National Center for Health Statistics. NHIS is a survey of people in their homes, so it is not subject to the problems of underreporting that affect statistics based on injuries reported to fire departments, hospital emergency rooms, or some other organization. Males suffer more burn injuries than females, overall and relative to their shares of the population. The gap between the two sexes was wider in the latest survey analysis than ever before (Table 8). Older adults tend to have lower burn injury rates than the all-ages average. This is true even if people age 65 and older are isolated, which cannot be done with available data for three of the five survey analyses. Children show no consistent pattern of burn injury risk relative to the overall population. Unfortunately, the preschool age group, which is known to have high higher risk of fire injury than other children, cannot be isolated in the survey analyses that have been released. Burn injury rates per 100 persons are higher for the poor but show only minor differences by race and no consistent patterns by region. Burn injury rates also appear to have increased for the poor, but this conclusion is blurred, by the shifting categories used to define the poorest group. Differences by educational level are not available for all analyses and are not so consistent as differences by income. In 1991-1993, 95% of the estimated burn injuries were medically attended. The large change between 1980-1981 and 1985-1987 in percentage of burn injuries that were medically attended (See Table 9) probably reflects changes in definitions and reporting conventions, which required medical treatment or a half-day of restricted activity to qualify an injury as reportable. Some of the increase may reflect greater geographic and financial access to health care and resulting greater use of it. There is no information in the NHIS regarding the first, second, and third degree scale of burn depth nor the extent of body surface burned. More than one-third of all 1991-93 burn injuries (39%) resulted in some period of restricted activity. This was down substantially from earlier percentages. However, the average period of restricted activity with such an injury has been steadily rising. (This was calculated by Burns, Toxic Gases, and Other Hazards, 2/04 14 NFPA Fire Analysis & Research, Quincy, MA

the author by dividing the number of restricted-activity days by the number of injuries, from the source reports.) In those analyses that provide additional detail, the average length of the restricted-activity periods for females has been shorter. For all of the detailed analyses cited in this paragraph and the next one, however, the large sampling errors in the estimates raise substantial questions about the statistical significance of trends or compliance at this level of detail. Only one burn injury in nine in 1991-1993 resulted in some confinement to bed. The average period of confinement has been rising steadily and dramatically. (This was calculated by the author by dividing the number of days of bed disability by the number of bed-disabling injuries, from the source reports.) In analyses that provide additional detail, adults over age 44 have had longer average periods of bed-disabling injuries than other age groups, and males with burn injuries have been much more likely to be confined to bed than females. The rising average length of restricted activity and length of bed confinement both may reflect in part the change in definition of a reportable injury that removed the less serious injuries. Also, the decline in burn deaths means that some formerly fatal injuries are now limited to severe injuries, but this involves hundreds of cases and cannot be a large part of the explanation for averages involving hundreds of thousands of cases. Just over 100 people a year receive unintentional fatal injuries from contact with a hot object or substance. Table 10 shows this number is down by nearly half from 1980 and that hot tap water accounts for roughly half of these fatal injuries. Burn injuries result in hundreds of thousands of emergency room visits a year, including tens of thousands of hospital admissions. Table 11 shows that scalds account for one-third of those injuries and nearly half of the more serious injuries involving hospital admission. This is consistent with their more than half share of fatal injuries due to contact with hot objects or substances. The injuries shown in Table 11 were only those involving a consumer product. At about the same time, total acute burn injury admissions to hospitals averaged 51,000 per year,* or roughly two-and-a-half times the number shown in Table 11. Also, there were an estimated 23,000 admissions specifically to burn center hospitals in 1992. This suggests that nearly half of all burn injury admissions to hospitals are made specifically to burn centers. The 1995-1997 data from the Massachusetts Burn Injury Reporting System provided an indication of patterns in 1,435 burn injuries. The largest category was scalds (43%), with the leading types of scalds being hot beverages (13%), cooking liquids (8%), hot tap water (8%), cooking grease (6%), and car radiators (4%). * Peter A. Brigham and Elizabeth McLoughlin, "Burn incidence and medical care use in the United States," Journal of Burn Care and Rehabilitation, March/April 1996, pp. 95-107. Burns, Toxic Gases, and Other Hazards, 2/04 15 NFPA Fire Analysis & Research, Quincy, MA

The 1999-2000 data reported 921 burn injuries, a very similar annual rate (461 per year vs. 478 per year in 1995-97). Again, the largest category was scalds (41%), with the leading types being hot beverages (12%), cooking liquids (10%), hot tap water (9%), grease (4%), radiator (e.g., car) (2%), and steam (2%). In 2001, children under 5 accounted for 6% of the Massachusetts population but 21% of reported burns. Scalds caused 85% of the burns incurred by this age group, with the largest share from hot beverages. Electrical current led to 395 unintentional-injury deaths in 2000, the lowest number in the 21 years studied. Lightning deaths, which are counted separately, also have generally declined over the past two decades. (See Table 12.) Safety Tips Know the first aid steps to take if burns occur. Cool a burn within the first 2 minutes. Use cool water for 3-5 minutes. Do not apply ice. Cover the burn area with a clear, dry bandage or cloth. Do not apply grease, butter or ointment, or break the blister, as this may make the injury worse. Turn pot handles inward so pots cannot be knocked off the stove or pulled down by small children. Enforce a kid-free zone of three feet around stoves and other heat sources even when the unit is not in use. Place hot liquids away from the edge of the table and avoid using tablecloths that hang far over the edge, where small children could reach them and pull on them. Be especially careful with food cooked in a microwave oven, which can be dangerously hot. Remove lids or wraps carefully to prevent steam burns. Check the temperature setting on the water heater, and be sure that undiluted hot tap water is not so hot that it could scald. Set it at or below 120 F (equivalent to 49 C). Always turn on the cold water faucet first, and then add hot water. Install anti-scald devices in tubs and faucets. Learn how to stop, drop, and roll if clothes catch fire, and then cool the burned area of the body with water and call for help. Be sure all family members, including children, know the technique also. Cover unused wall outlets with safety caps to protect children, and be sure unattended children do not have access to matches, lighters, hot liquids, hot objects (like space heaters), or plugged-in electrical cords or devices. Be careful when using flammable or combustible liquids. Use them only in wellventilated areas and away from heat sources, including non-obvious heat sources Burns, Toxic Gases, and Other Hazards, 2/04 16 NFPA Fire Analysis & Research, Quincy, MA

like the pilot lights of water heaters and stoves. Avoid use of these liquids to start, enhance, or revive a planned fire, such as an outdoor grill fire, fireplace fire, or campfire. Be careful when using or working near chemicals, including car battery acid. Take steps to avoid splashes. If a burn occurs, flush the area with cool water immediately and seek medical attention. Use caution when burning trash, brush, or leaves. Discourage very old or very young family members from conducting such operations, as they may be unable to react quickly if a hazard develops. Wear tight-fitting sleeves when cooking, and be particularly careful when reaching over stove burners. Follow all requirements of the National Electrical Code. Seek medical attention in cases of electrical burn or if struck by lightning. The nature of damage and appropriate treatment can vary significantly from case to case. Burns, Toxic Gases, and Other Hazards, 2/04 17 NFPA Fire Analysis & Research, Quincy, MA

Table 7. U.S. Burn Injuries Estimated Annual Averages 1957-1961 1965-1967 1980-1981 1985-1987 1991-1993 Total 1,973,000 2,333,000 2,130,000 1,735,000 1,129,000 Rate per 100 people 1.1 1.2 1.0 0.7 0.4 Males 1,082,000 1,297,000 1,026,000 981,000 726,000 Rate per 100 males 1.3 1.4 1.0 0.9 0.6 Females 892,000 936,000 1,104,000 772,000 403,000 Rate per 100 females 1.0 0.9 1.0 0.6 0.3 Children* NA NA 571,000 385,000 376,000 Rate per 100 people 1.1 1.1 1.0 0.6 0.6 Age 45 and up NA NA 291,000** 300,000** 155,000** Rate per 100 people NA 0.8 0.4** 0.4** 0.2** * Children are defined as under 15 in 1957-1961; under 17 in 1965-1967 and 1980-1981; and under 18 in 1985-1987 and 1991-1993. ** Relative standard error of estimate exceeds 30%. NA - Not available Sources: Types of Injuries, Incidence and Associated Disability, United States: July 1957-June 1961, Series 10, No. 8, 1964; and July 1965-June 1967, Series 10, No. 57, 1970; Types of Injuries and Impairments Due to Injuries - United States, Series 10, No. 159, 1986; Types of Injuries by Selected Characteristics, 1985-87, Series 10, No. 175, 1990; and advance data from John Gary Collins, U.S. Department of Health and Human Services, National Center for Health Statistics, author of 1991-93 data analysis and previous two studies. Burns, Toxic Gases, and Other Hazards, 2/04 18 NFPA Fire Analysis & Research, Quincy, MA

Table 8. Comparative Burn Injury Rates per 100 People Annual Averages 1957-1961 1965-1967 1980-1981 1985-1987 1991-1993 Overall 1.1 1.2 1.0 0.7 0.4 Males 1.3 1.4 1.0 0.9 0.6 Females 1.0 0.9 1.0 0.6 0.3 Children* 1.1 1.1 1.0 0.6 0.6 Age 45 and up NA 0.8 0.4** 0.4** 0.2** White NA 1.2 1.0 0.7 0.4 Black NA 1.2 1.1** 0.6** 0.6** Northeast 1.0 1.0 0.7 0.8 0.3** North Central 1.0 1.3 0.9 0.6** 0.6 South 1.3 1.3 1.0 0.7 0.5 West 1.2 0.9 1.2 1.0 0.4** Poorest*** 1.2 1.5 1.9 1.8 NA Most Affluent*** 0.9 1.0 1.1 0.8** NA * Children are defined as under 15 in 1957-1961; under 17 in 1965-1967 and 1980-1981; and under 18 in 1985-1987 and 1991-1993. ** Relative standard error of estimate exceeds 30%. *** Poorest group is defined as family income less than $4,000 in 1957-61, less than $5,000 in 1965-67 and 1980-81, and less than $10,000 in 1985-87. Most affluent group is defined as family income more than $7,000 in 1957-61, more than $10,000 in 1965-67, more than $25,000 in 1980-81, and more than $35,000 in 1985-87. NA - Not available or not yet available Sources: Types of Injuries, Incidence and Associated Disability, United States: July 1957-June 1961, Series 10, No. 8, 1964; and July 1965-June 1967, Series 10, No. 57, 1970; Types of Injuries and Impairments Due to Injuries - United States, Series 10, No. 159, 1986; Types of Injuries by Selected Characteristics, 1985-87, Series 10, No. 175, 1990; and advance data from John Gary Collins, U.S. Department of Health and Human Services, National Center for Health Statistics, author of 1991-93 data analysis (forthcoming) and previous two studies. Burns, Toxic Gases, and Other Hazards, 2/04 19 NFPA Fire Analysis & Research, Quincy, MA

Table 9. Indicators of Burn Injury Severity Annual Averages 1957-1961 1965-1967 1980-1981 1985-1987 1991-1993 Number of medically attended injuries Percent of burn injuries that are medically attended Number of restricted - activity injuries Percent of burn injuries involving restricted activity Average number of restricted activity days per injury Number of bed-disability injuries Percent of burn injuries involving bed disability Average number of beddisability days per injury 1,719,000 1,932,000 1,615,000 1,614,000 1,073,000 87 87 76 92 95 NA NA 1,213,000 810,000 445,000 NA NA 57 46 39 3.7 4.0 6.1 8.8 NA NA NA 244,000* 399,000 124,000 NA NA 11* 23 11 1.1 1.5 5.7 8.1 NA * Relative standard error of estimate exceeds 30%. NA - Not available or not yet available Sources: Types of Injuries, Incidence and Associated Disability, United States: July 1957-June 1961, Series 10, No. 8, 1964; and July 1965-June 1967, Series 10, No. 57, 1970; Types of Injuries and Impairments Due to Injuries - United States, Series 10, No. 159, 1986; Types of Injuries by Selected Characteristics, 1985-87, Series 10, No. 175, 1990; and advance data from John Gary Collins, U.S. Department of Health and Human Services, author of 1991-93 data analysis (forthcoming) and previous two studies. Burns, Toxic Gases, and Other Hazards, 2/04 20 NFPA Fire Analysis & Research, Quincy, MA

Table 10. Unintentional-Injury Deaths Involving Contact with Hot Objects or Substances A. 1980-1998 Year Total 1980 194 1981 192 1982 154 1983 139 1984 142 1985 176 1986 134 1987 137 1988 122 1989 142 1990 131 1991 125 1992 131 1993 130 1994 107 1995 97 1996 104 1997 111 1998 108 B. 1999-2000 Hot object or substance 1999 2000 Hot tap water 51 55 Hot drink, food, fat, or cooking oil 14 6 Steam or hot vapors 5 3 Other hot fluid 15 17 Hot air or gas 2 2 Hot heating equipment, including pipes 17 10 Hot engines, machinery, or tools 2 4 Other hot household appliances 11 5 Other or unspecified heat or hot substance 6 8 Total 123 110 Note: Includes corrosive substances and steam Source: National Safety Council, Injury Facts, 1981-2003 editions, 1121 Spring Lake Drive, Itasca, IL 60143; and NCHS website. Burns, Toxic Gases, and Other Hazards, 2/04 21 NFPA Fire Analysis & Research, Quincy, MA

Table 11. Burn Injuries That Involved a Consumer Product and Were Reported to Hospital Emergency Rooms, 1993 Type of Burn Injury Number of Emergency Room Injuries Number of Emergency Room Injuries Admitted to Hospitals Thermal (fire or hot 151,000 (64%) 11,100 (51%) object) Scald 77,700 (33%) 9,700 (45%) Electrical 6,100 (3%) 600 (3%) Unknown-type 2,900 (1%) 200 (1%) Total 237,700 (100%) 21,600 (100%) Note: Chemical or radiation burns are not captured in this table. Some scalds may be omitted for lack of a consumer product connection. Sums may not equal totals because of rounding error. Source: Beatrice Harwood, "Common products that cause uncommonly severe burn injuries," NFPA Journal, January/February 1996, pp. 79-83. Burns, Toxic Gases, and Other Hazards, 2/04 22 NFPA Fire Analysis & Research, Quincy, MA

Table 12. Unintentional-Injury Deaths by Electrical Current 1980-2000 Year Total Home Equipment Industrial Equipment Generating Plants or Distribution Other or Unknown Lightning* 1980 1,095 177 106 122 690 94 1981 1,008 150 120 156 582 87 1982 979 151 89 150 589 100 1983 872 160 70 158 484 93 1984 888 148 68 215 457 91 1985 802 146 69 196 391 85 1986 854 150 89 182 433 78 1987 760 121 64 177 398 99 1988 714 122 75 165 352 82 1989 702 143 61 143 355 75 1990 670 100 54 160 356 89 1991 626 82 74 132 338 75 1992 525 66 37 139 283 53 1993 548 82 46 142 278 57 1994 561 84 42 144 291 84 1995 559 88 26 158 287 76 1996 482 66 15 135 266 63 1997 488 53 27 139 269 58 1998 548 59 27 144 318 63 Electric Transmission Other Year Total Lines Specified Lightning* 1999 437 127 310 64 2000 395 99 296 50 * Not included in total. Source: National Safety Council, Accident Facts and Injury Facts, 1981-2003 editions, 1121 Spring Lake Drive, Itasca, IL 60143, and NCHS website. Burns, Toxic Gases, and Other Hazards, 2/04 23 NFPA Fire Analysis & Research, Quincy, MA

EXPLOSIONS Since 1980, unintentional-injury deaths due to explosions have declined by about half. Prior to 1999, gas explosions could be distinguished from other explosions, and they consistently accounted for just under half of all such explosion deaths. (See Table 13.) Fireworks-related incidents and harm can be tracked in several ways, and Table 14 shows no sustained, substantial declines. Unintentional-injury deaths due to over-pressure ruptures of pressure vessels also declined. The decline was from a 1980-1983 range of 55-75 annual deaths to a 1999-2000 range of 30-35, which is also a roughly one-half decrease. The National Board of Boiler and Pressure Vessel Inspectors conducts an industry survey of explosions, which reported single-digit death totals for 1991 and 1992, for example. The difference between the two sets of figures probably reflects narrower focus for the Board survey, as the 1999-2000 deaths for boiler explosions alone were 3 to 6. The 30-35 range includes gas cylinders and pressurized tires, pipes and hoses. Safety Tips Follow all NFPA codes and standards related to gas and gas-fueled equipment. Discourage any consumer use of fireworks. Leave fireworks strictly in the hands of professionals who follow NFPA 1123, Outdoor Display of Fireworks. If you smell gas, leave the building immediately and call the gas utility from a neighboring building. Know the emergency number to call in the event of such a situation. Burns, Toxic Gases, and Other Hazards, 2/04 24 NFPA Fire Analysis & Research, Quincy, MA

Table 13. Unintentional-Injury Deaths Involving Explosions 1980-2000 Year Fireworks Gas Explosion Other or Unknown- Type Explosion* Total Explosions* 1980 10 142 187 339 1981 4 163 184 351 1982 5 123 150 278 1983 13 112 139 264 1984 7 114 126 247 1985 11 138 147 296 1986 8 116 118 242 1987 5 108 103 216 1988 4 67 122 193 1989 5 101 132 238 1990 5 98 99 202 1991 4 64 114 182 1992 2 79 108 189 1993 10 59 109 178 1994 4 50 104 158 1995 2 62 106 170 1996 9 49 72 130 1997 8 57 84 149 1998 13 60 82 155 Total Fireworks Other Explosion* Explosions* 1999 7 166 173 2000 5 167 172 * Does not include explosion of pressure vessel. Source: National Safety Council, Accident Facts and Injury Facts, 1981-2003 editions, 1121 Spring Lake Drive, Itasca, IL 60143; and NCHS website. Burns, Toxic Gases, and Other Hazards, 2/04 25 NFPA Fire Analysis & Research, Quincy, MA

Table 14. Fireworks-Related Injuries, Fires, and Fire Damages Year Injuries Reported to Hospital Emergency Rooms Fires Direct Property Damage in Fires (in Millions) 1980 9,400 26,400 $15.5 1981 11,400 31,800 $18.6 1982 8,500 27,800 $11.4 1983 8,300 28,000 $12.6 1984 9,900 39,400 $26.9 1985 10,300 (13,000) 51,600 $36.5 1986 12,600 (15,900) 35,100 $55.7 1987 9,000 (11,300) 37,100 $25.3 1988 10,200 (12,900) 52,100 $38.9 1989 9,700 (12,200) 33,400 $62.1 1990 12,200 33,300 $28.1 1991 11,200 (11,000) 28,000 $19.1 1992 12,900 (12,600) 25,500 $33.4 1993 12,600 (12,300) 30,200 $21.3 1994 12,600 (12,500) 38,000 $21.9 1995 11,400 (10,900) 27,400 $32.5 1996 7,600 (7,300) 24,800 $26.8 1997 8,300 20,100 $22.7 1998 8,500 21,700 $15.6 1999 8,500 24,200 $17.2 2000 11,000 2001 9,500 2002 8,800 Notes: Injuries and fires are estimated to the nearest hundred. One sampling plan for injuries was used prior to 1990 and its estimates are shown in the figures not in parentheses for 1985-1989. A new sampling plan for injuries was introduced in 1990, and its implications for earlier estimates are shown in parentheses for 1985-1989. A second change in sampling plan was made in 1997, and its implications for earlier estimates are shown in parentheses for 1991-1996. Direct property damage is estimated to the nearest hundred thousand dollars and has not been adjusted for inflation. Source: CPSC's National Electronic Injury Surveillance System (NEISS); NFIRS and NFPA survey. Burns, Toxic Gases, and Other Hazards, 2/04 26 NFPA Fire Analysis & Research, Quincy, MA