An oxygen firebreak, also known as a fire stop valve or fire safety valve, is a thermal fuse designed to extinguish a fire in the delivery tube being used by a patient on oxygen therapy and stop the flow of oxygen if the tube is accidentally ignited. Oxygen firebreaks are fitted into the oxygen delivery tubing close to the patient, typically around the patient's sternum where the two nasal cannula tubes join and connect to the delivery tubing.
Home oxygen fires
Oxygen is not flammable, but when it is present in increased concentrations it will enable fires to start much more easily. Once a fire has started, if supplemental oxygen is present it will burn more fiercely, based on the principle of the fire triangle. Materials that do not burn in ambient air may burn when there is a greater concentration of oxygen present than there is in air. Most home oxygen fires are caused by patients smoking whilst using medical oxygen. Other sources of naked flames, such as gas flames and birthday candles, can also pose a risk. Despite the inherent dangers, researchers estimate that between 10 and 50 per cent of home oxygen patients continue to smoke. Once a fire has started in the patient's nasal cannula it will track back towards the oxygen source and if not stopped may lead to a 'whole house' fire. Whole house fires are directly correlated with single or even multiple deaths. According to the US National Fire Protection Association (NFPA), 25% of oxygen fires get beyond the immediate surrounding area to become 'whole house' fires. While an oxygen firebreak / thermal fuse cannot stop the initial ignition, it can limit the potential for whole house fires, more serious injury and death. Firebreaks / thermal fuses can also buy more time for a patient and other individuals in the building to escape, and limit the material cost of fire damage.
Oxygen fire statistics
United States A study, The prevalence and impact of home oxygen fires in the USA Archived 2019-09-25 at the Wayback Machine, published in September 2019, analysed media reports of home oxygen fire incidents between December 2017 and August 2019. The report found 311 incidents, resulting in 164 deaths, equivalent to one patient death every four days. It also found that a third of reported incidents referenced exploding cylinders, posing a significant risk to third parties, including emergency services. The study estimates that there are between 100 and 150 deaths every year from home oxygen fires in the US, describing it as a 'material health issue'. Further research published in November 2021 confirmed that home oxygen fires remain a material public health challenge. The study, Firebreaks: a risk-based approach to safer home oxygen delivery examined media reports of home oxygen fire incidents between August 2019 and July 2021. 256 incidents and 152 deaths were recorded in this 23-month period, equating to a death every four days, consistent with the previous research. Over the total study period of 3.5 years, there were 567 fires involving home oxygen and 316 deaths, including two firefighters who lost their lives. The new report also examines the significant impact of burns resulting from home oxygen fires, drawing on a study by Wake Forest Baptist Medical Center in 2020 which found home oxygen fires cause at least 1,000 burn injuries per year. In 2008 the NFPA published a report Archived 2017-10-06 at the Wayback Machine suggesting that there are 46 deaths each year in the US from 182 fires. The report also stated that US hospital emergency rooms deal with an average 1,190 cases of burns each year as a result of home oxygen fires. However, the NFPA describes these statistics as "likely underestimates". Further analysis by Marty Ahrens on behalf of the NFPA in 2017 recorded a likely average annual death rate for home fires involving oxygen administration equipment of 70 people (or 3% or all home fire deaths), based upon figures between 2011 and 2015. The report also suggested that these fires or burns are becoming more common. In 2019 the NFPA also reported that "medicinal oxygen was involved in 13% of the home smoking material fire deaths". The United States Fire Administration (USFA) said in a 2015 report that "While no one factor is solely responsible for the increased fire risk to older adults receiving home health care, smoking in the presence of oxygen is recognized as one important problem." A study of home oxygen therapy patients in the Veterans Health Administration between 2009 and 2015 examined 123 cases of reported adverse events related to flash burns. It found that 100 cases (81%) resulted in injury, and 23 (19%) resulted in death. Although 89% of veterans claimed to have quit smoking, 92% of burns occurred as a result of smoking. In July 2022, the International Association of Fire Chiefs (IAFC) adopted a position statement on home oxygen fire safety that recommended the use of firebreaks.
Europe Not all European countries monitor data on the number of fires that occur as a result of home oxygen. Despite a European Union Medical Device Directive requiring incidents to be reported to national vigilance authorities, there is often inadequate coordination to publish the information centrally. According to the German Federal Institute for Drugs and Medical Devices (Bundesinstitut fur Arzneimittel und Medizinprodukte, BfArM) it is likely that such incidents are grossly under-reported. Data from the European Industrial Gases Association (EIGA), reports home oxygen fires caused 15 fatalities between 2013 and 2017 across 16 countries, suggesting significant under-reporting of the issue. By contrast, a white paper report, published by BPR Medical in April 2022, found that 23 deaths from home oxygen fire incidents in France and Italy, had been reported by the media between 2017 and 2021. In England and Wales, central reporting of adverse incidents is a requirement of the NHS Service Specification for Home Oxygen. After firebreaks became mandatory in 2006, the average number of deaths by fire was 0.36 per thousand patients per year. In the US, where firebreaks were not required, almost twice as many patients (0.62 patients per thousand) died. A Freedom of Information request in 2018 revealed that only one fatality relating to home oxygen fires was recorded in the five-year period between 2013 and 2017.
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