The fire-safe cigarette: a burn prevention tool.

Cigarettes are the most common ignition source for fatal house fires, which cause approximately 29% of the fire deaths in the United States. A common scenario is the delayed ignition of a sofa, chair, or mattress by a lit cigarette that is forgotten or dropped by a smoker whose alertness is impaired by alcohol or medication. Cigarettes are designed to continue burning when left unattended. If they are dropped on mattresses, upholstered furniture, or other combustible material while still burning, their propensity to start fires varies depending on the cigarette design and content. The term "fire-safe" has evolved to describe cigarettes designed to have a reduced propensity for igniting mattresses and upholstered furniture. Legislative interest in the development of fire-safe smoking materials has existed for more than 50 years. Studies that showed the technical and economic feasibility of commercial production of fire-safe cigarettes were completed more than 10 years ago. Despite this, commercial production of fire-safe smoking materials has not been undertaken. The current impasse relates to the lack of consensus on a uniform test method on which to base a standard for fire-safe cigarettes. Although the fire-safe cigarette is a potentially important burn prevention tool, commercial production of such cigarettes will not occur until a standard against which fire-starting performance can be measured has been mandated by law at the state or federal level. The burn care community can play a leadership role in such legislative efforts.

Burn incidence and medical care use in the United States: estimates, trends, and data sources.

Recent estimates related to annual burn incidence and medical care use in the United States include 5500 deaths from fire and burns (1991), 51,000 acute hospital admissions for burn injury (1991 to 1993 average), and 1.25 million total burn injuries (1992). Time trends from 1971 to 1991 reveal significant declines in each estimate. Taking into account the 25% increase in the U.S. population during this period, the rates of decline in deaths attributed to fire and burns and acute hospitalization for burn injury are both about 50%. The rates of decline are similar in sample statistics for all burns receiving medical care and for all burns above a reportable level of severity. In addition to providing current and time-series estimates, this article discusses burn injury coding issues and describes the data sources from which national and state estimates can be derived. The principal objective is to establish and describe a set of burn injury data baselines in a manner that will facilitate future tracking of burn incidence and medical care use at the national and state level by practitioners and researchers.

Progress towards a fire-safe cigarette.

About 1,000 deaths, 3,000 serious injuries, and several billion dollars in costs of property loss, health care and pain and suffering, result each year in the U.S. from fires started by dropped cigarettes. Efforts to prevent these losses have progressed from admonitory slogans to product-flammability standards to addressing the cigarette itself. Two recent federal studies have: a) concluded that it is technically feasible to produce a cigarette with a reduced likelihood of starting fires, and b) published a broadly validated method by which cigarette brands can be tested for this propensity. The long-term effort of scientists, legislators and public health activists to develop and implement a fire-safe cigarette standard also constitutes a legal liability challenge and a threat to the relative and absolute size of the cigarette market shares held by major U.S. tobacco companies.

The development of burn centers in North America.

Burn center development in North America began in the mid 1940s, surged in the 1970s, and had reached virtually every distinct medical market by 1985. The authors present chronologies of the establishment of 137 currently active burn centers in the United States and 27 burn facilities in Canada, discuss public policy and other influences on burn center development, and review burn admissions trends. Another 46 U.S. hospitals are identified as having shown interest in caring for serious burn injuries in recent decades. Since national admissions data first became available in 1970, the proportion of U.S. patients with burns treated in burn centers has increased from 10% to 40%. Data were obtained from a survey of 197 hospitals in the United States and Canada listed in recent Burn Care Resources directories of the American Burn Association and annual surveys of the American Burn Association and the National Center for Health Statistics. Further study of burn centers in both institutional and societal contexts and submittal of archival material are encouraged.

Classifying patients with burns for hospital reimbursement: diagnosis-related groups and modifications for severity.

This study was designed to evaluate the relative severity and resource consumption of hospitalized patients with burns in a national cross section of hospitals, both with and without burn centers. We investigated to determine whether clinical variables or severity of illness measures not recorded in the Uniform Hospital Discharge Data Set are significant in explaining variation in length of stay, total cost, and mortality for patients with burns. The ability of the six burn diagnosis-related groups (DRGs) to explain variation in patients' length of stay was 20% and their ability to predict total costs was 24%. For the same patient population, the explanatory power of the DRGs improved to 54% for length of stay and 44% for costs when these variables were adjusted by the Severity of Illness Index. We also investigated whether hospitals with burn centers treated a more severely ill population of patients with burns than did hospitals without such centers. Significantly higher levels of severely ill patients with burns (p less than or equal to 0.0001) were found at burn center hospitals. Other patients or treatment variables, combined with a case-mix severity measure, were evaluated for their ability to further increase the explanatory power of DRGs. We also discuss here the use of the study results for reevaluating reimbursement policy.