Medical oxygen fires: how better safety can save lives

There is a need for more training and education around the risk of medical oxygen fires, explains Richard Radford, Managing Director of medical gas control specialist BPR Medical.
In 2018, an elderly man died following a blaze suspected to be caused by an oxygen cylinder explosion at a Stevenage residential care home. The resident, in his 80s, was in the room where the fire started and later died in hospital. Six other people were injured, including one resident whose condition was reported to be critical.
Not only did the incident affect these individuals directly, many other residents had to be evacuated. In fact, twenty-one were displaced, fourteen were relocated to alternative care homes nearby and seven moved to a different area of the care home.
Although the origin of the fire was not disclosed, it was almost certainly caused by a naked flame and fuelled by oxygen from the cylinder. In isolation oxygen is not flammable, but its presence in increased concentrations will enable fires to start much more easily and burn more fiercely. Birthday candles, gas stoves, or – the biggest risk factor – smoking, all pose a serious risk, as can sparks from electronic devices, and even static from clothes.
Once a fire has started in the patient's nasal cannula or tubing it will rapidly track back towards the oxygen source. This can lead to serious injury or death, especially among elderly patients. If the fire is not stopped, it can easily spread to the surrounding premises. In fact, reports from the US suggest that around a quarter of incidents in residential home oxygen fires result in whole house fires.
This danger is heightened by the presence of oxygen cylinders. Even a limited fire can create the conditions that increase gas pressure and weaken cylinder strength sufficiently to trigger an explosion. This fuels the existing fire, increasing the risk to patients and third parties, including firefighters. 
The risk is particularly acute in care homes where a number of factors can exacerbate the issue. First, there is the high number of staff – permanent and agency - as well as visitors, who may inadvertently put a patient at risk through lack of awareness, and who need to be aware of the risks associated with medical oxygen.
What’s more, while some patients benefit from the NHS Home Oxygen Service, in some cases care homes use their own equipment, or offer back-up cylinders to residents. As a result, patients can miss out on essential safety advice, and accessories (cannulae and tubing) can sometimes be sourced privately. This means that firebreaks – small, inexpensive devices that are inserted into the oxygen tubing to stop the flow of oxygen in the event of a fire - may not be fitted. Firebreaks have been fitted as standard to oxygen supplies under the NHS Home Oxygen Service since 2006, and can be vital in preventing fire from spreading, limiting injuries, or avoiding death. Untrained staff have even been known to remove firebreaks from tubing, or to cut tubing to insert a firebreak, both of which pose a serious risk to the patient. 
So, what can be done? Firstly, a greater emphasis on staff training is needed. While there are excellent examples of care homes ensuring all staff are aware of the risks, oxygen safety training is by no means universal. For example, in the Stevenage event, a member of staff claimed to have received no communication "about oxygen or fire since the incident".
The episode also flagged the importance of evacuation training for staff. Two months following the fatal fire, an inspection by the Care Quality Commission (CQC) found no staff knew the fire procedure policy. In fact, in a visit by the local Fire Authority, one member of staff reported that they "never saw" the personal emergency evacuation procedures. Considering the high concentration of vulnerable and often immobile patients, the potential consequences of a fire are much more severe than in a residential home, making proper evacuation procedures absolutely essential.
Furthermore, despite the warnings of the associated fire risk, as many as half of all patients continue to smoke while on oxygen therapy. It is therefore critical that staff are trained to understand that patients should never - under any circumstances - smoke while on oxygen, even if they are outside. 
Visitor awareness is also a priority. Oxygen hazard signs should be prominently displayed, especially if the home has a dedicated smoking area.
Furthermore, care homes should ensure they use the right accessories. This includes appropriate soft tubing and cannulae fitted with firebreaks to minimise the impact of a fire. To this end, in conjunction with the residential care sector, BPR Medical has designed a single use kit that addresses the issue.
In 2017, the Care Quality Commission (CQC) called for all care homes to review their fire safety procedures. Better oxygen safety training and awareness should therefore be high on the list of priorities. 
For more information about firebreaks visit www.firebreaks.info or www.bprmedical.com or contact BPR Medical on 01623 628281. Contact your local Fire Prevention Officer at the Fire & Rescue Service for advice on fire safety in general.