Analysis of fire deaths in Poland and influence of smoke toxicity.

Dwelling fires have changed over the years because building contents and the materials used in then have changed. They all contribute to an ever-growing diversity of chemical species found in fires, many of them highly toxic. These arise largely from the changing nature of materials in interior finishes and furniture, with an increasing content of synthetic materials containing higher levels of nitrogen, halogen and phosphorus additives. While there is still a belief that carbon monoxide is the major lethal toxic agent in fires, the hydrogen cyanide and acid gases released from these additives are now well-recognised as major contributory causes of incapacitation, morbidity and mortality in domestic fires. Data for the total number of 263 fire death cases in the Mazowieckie region (mainly Warsaw area) of Poland between 2003-2011 for dwellings fires were obtained from pathologists, forensic toxicologists, fire fighters and analysed. Factors contributing to the death such as the findings of the full post mortem examination (age, sex, health status, burns), the toxicological analysis (carbon monoxide, alcohol etc.), and a thorough investigation of the scene (fire conditions, fuel, etc.) were taken into account and are summarised.

Human survival in volcanic eruptions: Thermal injuries in pyroclastic surges, their causes, prognosis and emergency management.

This study of burns patients from two eruptions of Merapi volcano, Java, in 1994 and 2010, is the first detailed analysis to be reported of thermal injuries in a large series of hospitalised victims of pyroclastic surges, one of the most devastating phenomena in explosive eruptions. Emergency planners in volcanic crises in populated areas have to integrate the health sector into disaster management and be aware of the nature of the surge impacts and the types of burns victims to be expected in a worst scenario, potentially in numbers and in severity that would overwhelm normal treatment facilities. In our series, 106 patients from the two eruptions were treated in the same major hospital in Yogyakarta and a third of these survived. Seventy-eight per cent were admitted with over 40% TBSA (total body surface area) burns and around 80% of patients were suspected of having at least some degree of inhalation injury as well. Thirty five patients suffered over 80% TBSA burns and only one of these survived. Crucially, 45% of patients were in the 40-79% TBSA range, with most suspected of suffering from inhalation injury, for whom survival was most dependent on the hospital treatment they received. After reviewing the evidence from recent major eruptions and outlining the thermal hazards of surges, we relate the type and severity of the injuries of these patients to the temperatures and dynamics of the pyroclastic surges, as derived from the environmental impacts and associated eruption processes evaluated in our field surveys and interviews conducted by our multi-disciplinary team. Effective warnings, adequate evacuation measures, and political will are all essential in volcanic crises in populated areas to prevent future catastrophes on this scale.

Toxic Combustion Product Yields as a Function of Equivalence Ratio and Flame Retardants in Under-Ventilated Fires: Bench-Large-Scale Comparisons.

In large-scale compartment fires; combustion product yields vary with combustion conditions mainly in relation to the fuel:air equivalence ratio (Φ) and the effects of gas-phase flame retardants. Yields of products of inefficient combustion; including the major toxic products CO; HCN and organic irritants; increase considerably as combustion changes from well-ventilated (Φ < 1) to under-ventilated (Φ = 1⁻3). It is therefore essential that bench-scale toxicity tests reproduce this behaviour across the Φ range. Yield data from repeat compartment fire tests for any specific fuel show some variation on either side of a best-fit curve for CO yield as a function of Φ. In order to quantify the extent to which data from the steady state tube furnace (SSTF [1]; ISO TS19700 [2]) represents compartment fire yields; the range and average deviations of SSTF data for CO yields from the compartment fire best-fit curve were compared to those for direct compartment fire measurements for six different polymeric fuels with textile and non-textile applications and for generic post-flashover fire CO yield data. The average yields; range and standard deviations of the SSTF data around the best-fit compartment fire curves were found to be close to those for the compartment fire data. It is concluded that SSTF data are as good a predictor of compartment fire yields as are repeat compartment fire test data.

The effect of sodium fluoride on the stability of cyanide in postmortem blood samples from fire victims.

Assigning a level of significance to cyanide concentrations found in the blood of fire victims is often hampered by the fact that cyanide is inherently unstable in cadavers and in stored blood samples. A few researchers have proposed that sodium fluoride can be used to minimize the instability of cyanide in blood samples; however, controlled studies have not been performed to support validation of this hypothesis. To test the sodium fluoride hypothesis, both treated and control blood samples from 14 autopsied fire victims were tested over a 25-30 day period. A 2% concentration of sodium fluoride was added to the blood samples at the start of testing and the samples were refrigerated between testing intervals. Cyanide concentrations in the treated and control samples were measured between 9 and 11 days post treatment and between 25 and 30 days post treatment. A statistically significant difference was not present between blood cyanide concentrations in treated and control samples between 9 and 11 days. During this time period, although there were small statistically significant increases in both treated and untreated samples the fluctuations were minor. Since the treated and control samples did not exhibit instability between 9 and 11 days, it is not surprising that the sodium fluoride appeared to have no effect. However, a statistically significant difference between blood cyanide concentrations in treated and control samples was observed between 25 and 30 days. Those samples treated with sodium fluoride showed a reduction in blood cyanide variability with virtually no overall change, over a 25-30 day period when compared to control samples, while unconditioned samples showed a significant, average increase of 35%. Based on the findings of this study, it is recommended that 2% sodium fluoride be added to blood samples obtained from fire victims to reduce cyanide instability due to bacteriological activity.

Stability of cyanide in cadavers and in postmortem stored tissue specimens: a review.

The toxicological and postmortem analysis of fire victims' blood and tissue can disclose the type and quantity of toxic species, such as carbon monoxide or hydrogen cyanide, that they inhaled prior to death. For fire cases, these toxicological data can reveal objective data about the nature and circumstances of a fire, and thus assist both the Medical Examiner and the Fire Investigator in their investigations. Assigning a level of significance to cyanide concentrations found in the blood and tissue of fire victims is often hampered by the fact that cyanide is inherently unstable in cadavers and in stored tissue samples. Numerous researchers have provided insight into and characterized the stability of cyanide in the body and in collected biological specimens. Based on studies by these researchers, the rate of transformation of cyanide in blood and tissue specimens is dependent on the initial cyanide concentration in the sample at time of death, the length of time that a sample remains in the cadaver, the length of time that a sample remains in storage, and the preservation (e.g., addition of sodium fluoride to sample) and storage conditions (e.g., temperature) of the sample.