Fire fatalities in long term oxygen therapy users due to smoking: A description and analysis of 11 deaths

RATIONALE: Many patients suffering hypoxemia due to chronic lung or cardiac disease can benefit from long term oxygen therapy (LTOT) in the out-of-hospital setting. A primary indication for LTOT is chronic obstructive pulmonary disease (COPD), and COPD is most commonly due to chronic smoking. As such, many patients for whom LTOT is indicated are active smokers, despite recommendations to quit. Smoking near a purified oxygen source increases the risk of fire and possible death. OBJECTIVES: The objectives of this study were to determine the incidence of LTOT-associated fire deaths within Ontario, Canada. METHODS: Data regarding LTOT-associated fire deaths in Ontario over a 15-year period (2004-2018) was compiled using provincial Coroner and Forensic Pathology records and compared with client user data from the Home Oxygen Reimbursement Program (Ontario Ministry of Health: Assistive Devices Program). MAIN RESULTS: Herein, we present the circumstances and pathological findings of 11 deaths. We identified 7 males and 4 females with an average age of 69 that all died in their homes from fire complications resulting from smoking while using LTOT. Nearly all decedents were alone when the fire started, and most were pronounced dead within 2 hours of the fire starting. Death was most often a complication of smoke/hot gas inhalation in the setting of chronic lung and/or heart disease. Only 2 cases showed evidence of carbon monoxide poisoning (carboxyhemoglobinemia) contributing to death. CONCLUSION: We advocate increased vigilance in the selection, support and monitoring of patients using LTOT that continue to smoke due to the risk for harm, including death.