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BACKGROUND

This chapter covers damage to a body resulting from acute exposure to thermal energy—that is burns and scalds, but also smoke inhalation. Further, this review focuses on unintentional fire and burn injuries. Intentional burn injuries (self-inflicted or homicidal) happen worldwide,1,2 but are especially concerning in certain regions in the world, particularly among young women.1,3 The prevention of intentional burn injuries are more appropriately covered by interventions related to violence and self-directed harm.

Exposure to fires, flames, and hot items can lead to serious health outcomes, including painful long-lasting scars, impaired lung function, and loss of life. Generally, the most serious injuries among these result from fires (e.g., home fires, cooking fires), but they can result from numerous sources, including hot liquids or surfaces, fireworks, or blast explosions.1,7 Thermal burns to the skin can occur from contact with a hot object, liquid, or surface such as irons, heaters, microwaved liquids, metal playground slides exposed to the sun, electrical outlets, or open flames. Contact with hot liquids such as grease, heated food, leaking hot water bottles, or steam, through spills or immersion, causes scald burns. Inhalation burns caused by breathing in the products of combustion during a fire, are a key concern in structure fires.8 This harmful smoke may contain chemicals or poisons such as carbon monoxide. Inhaling harmful smoke can cause the lungs and airways to become irritated, swollen, and blocked.9 A damaged airway and lungs prevent oxygen from getting into the blood stream (asphyxiation) and respiratory failure may develop.

Preventing unintentional fire and burn injuries covers a broad landscape from preventing the precipitating event (e.g., preventing a fire from starting or preventing skin contact with a hot liquid) to preventing an injury even if the event has occurred (e.g., creating lifesaving egress from a fire). Advances in both of these areas have significantly reduced fire and burn injury rates,10 and yet the United States fire death rate is at least double that of some other industrialized countries such as Australia, Spain, and Germany.11 Major concerns for fire morbidity and mortality worldwide include structure fires, but regional concerns exist as well (e.g., wildfires in the United States; cook stove-related injuries in some developing countries). The authors of this chapter reviewed the nature and burden of residential fire and burns in the United States, risk and protective factors, and interventions to prevent fires and injuries. They also examined the burden and prevention of wildfires in the United States. Finally, as examples of fire concerns outside the United States, the authors considered the fire burden and prevention measures in three other countries (China, India, and Australia).

NATURE AND BURDEN OF THE PROBLEM

Home fires are a major public health concern that result in substantial morbidity and mortality. In 2017, 499,000 structure fires were reported to local fire departments in the United States, 72% ...

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