Fire deaths in Cape Town, South Africa: A retrospective review of medico-legal and toxicological findings (2006 - 2018).

BACKGROUND: In South Africa, fire-related deaths are common, particularly within dense informal housing settlements. Published data on deaths from fire incidents in Cape Town is sparse. Additionally, little emphasis has been placed on the role of toxicological investigations in these deaths, despite the known risk of alcohol and drug impairment to burn injury. METHODS: A retrospective, descriptive analysis of post-mortem case reports from Salt River Mortuary was conducted to investigate all deaths in which fires were involved in the west metropole of Cape Town, between 2006 to 2018. Demographic, circumstantial, and toxicological data were analyzed using R software. RESULTS: In total 1370 fire deaths occurred over 13 years, with a mean of 106 (SD ± 18) cases per annum (≈3% of the annual caseload and a mortality rate of 5.5 per 100,000). Males (70.4%), adults (mean=30.7 years), and toddlers (1-4 years old) were notably at risk. Deaths typically occurred in the early morning (00h00 - 06h00) (45.7%), during winter (32.1%), and in lower socioeconomic areas with highly dense informal settlements (65.6%), with 29% of deaths occurring in multi-fatality incidents. Ethanol was detected (≥0.01 g/100 mL) in 55.1% of cases submitted for analysis (71.5%), with a mean of 0.18 g/100 mL, and with 93.8% of positive cases > 0.05 g/100 mL. Carboxyhaemoglobin (COHb) analysis was requested in 76.4% of cases, with 57% of cases having a %COHb of ≥ 20%. Toxicology results (for drugs other than ethanol) from the national laboratory were outstanding in 34.4% of the cases at the conclusion of the study. BAC and %COHb were significantly higher in deaths from burns and smoke inhalation (usually accidents) than deaths from combined trauma and burns (typically homicides). Fire deaths with high COHb levels were more likely to display cherry-red discoloration (OR=3.1) and soot in the airways (OR=2.7) at autopsy. CONCLUSION: This article provides an updated description of fire deaths in the west metropole of Cape Town. The importance of BAC and COHb testing in these cases was noted, and the authors call for an investigation of the role of drug impairment (specifically frequently misused drugs methamphetamine and methaqualone) as a risk factor in these deaths. Areas of high-density informal settlements, where open flames are used to heat, light, and cook, were noted as high risk.

Global population exposure to landscape fire air pollution from 2000 to 2019.

Wildfires are thought to be increasing in severity and frequency as a result of climate change1-5. Air pollution from landscape fires can negatively affect human health4-6, but human exposure to landscape fire-sourced (LFS) air pollution has not been well characterized at the global scale7-23. Here, we estimate global daily LFS outdoor fine particulate matter (PM2.5) and surface ozone concentrations at 0.25° × 0.25° resolution during the period 2000-2019 with the help of machine learning and chemical transport models. We found that overall population-weighted average LFS PM2.5 and ozone concentrations were 2.5 µg m-3 (6.1% of all-source PM2.5) and 3.2 µg m-3 (3.6% of all-source ozone), respectively, in 2010-2019, with a slight increase for PM2.5, but not for ozone, compared with 2000-2009. Central Africa, Southeast Asia, South America and Siberia experienced the highest LFS PM2.5 and ozone concentrations. The concentrations of LFS PM2.5 and ozone were about four times higher in low-income countries than in high-income countries. During the period 2010-2019, 2.18 billion people were exposed to at least 1 day of substantial LFS air pollution per year, with each person in the world having, on average, 9.9 days of exposure per year. These two metrics increased by 6.8% and 2.1%, respectively, compared with 2000-2009. Overall, we find that the global population is increasingly exposed to LFS air pollution, with socioeconomic disparities.

A study on the temperature profile of bifurcation tunnel fire under natural ventilation.

This study simulated a series of bifurcation tunnel fire scenarios using the numerical code to investigate the temperature profile of bifurcation tunnel fire under natural ventilation. The bifurcation tunnel fire scenarios considered three bifurcation angles (30°, 45°, and 60°) and six heat release rates (HRRs) (5, 10, 15, 20, 25, and 30 MW). According to the simulation results, the temperature profile with various HRRs and bifurcation angles was described. Furthermore, the effects of bifurcation angles and HRRs on the maximum temperature under the bifurcation tunnel ceiling and the temperature decay along the longitudinal direction of the branch were investigated. According to the theoretical analysis, two prediction models were proposed. These models can predict a bifurcation tunnel fire's maximum temperature and longitudinal temperature decay in the branch. The results of this study could be valuable for modelling a bifurcation tunnel fire and benefit the fire engineering design of bifurcation tunnels.

Feature extraction and machine learning techniques for identifying historic urban environmental hazards: New methods to locate lost fossil fuel infrastructure in US cities.

U.S. cities contain unknown numbers of undocumented "manufactured gas" sites, legacies of an industry that dominated energy production during the late-19th and early-20th centuries. While many of these unidentified sites likely contain significant levels of highly toxic and biologically persistent contamination, locating them remains a significant challenge. We propose a new method to identify manufactured gas production, storage, and distribution infrastructure in bulk by applying feature extraction and machine learning techniques to digitized historic Sanborn fire insurance maps. Our approach, which relies on a two-part neural network to classify candidate map regions, increases the rate of site identification 20-fold compared to unaided visual coding.

Homeless Tent Fires: A Descriptive Analysis of Tent Fires in the Homeless Population.

Tent fires are a growing issue in regions with large homeless populations given the rise in homelessness within the United States and existing data that suggest worse outcomes in this population. The aim of this study was to describe the characteristics and outcomes of tent fire burn injuries in the homeless population. A retrospective review was conducted involving two verified regional burn centers with patients admitted for tent fire burns between January 2015 and December 2020. Variables recorded include demographics, injury characteristics, hospital course, and patient outcomes. Sixty-nine patients met the study inclusion criteria. The most common mechanisms of injury were by portable stove accident, assault, and tobacco or methamphetamine related. Median percent total body surface area (%TBSA) burned was 6% (interquartile range [IQR] 9%). Maximum depth of injury was partial thickness in 65% (n = 45) and full thickness in 35% (n = 24) of patients. Burns to the upper and lower extremities were present in 87% and 54% of patients, respectively. Median hospital length of stay (LOS) was 10 days (IQR = 10.5) and median ICU LOS was 1 day (IQR = 5). Inhalation injury was present in 14% (n = 10) of patients. Surgical intervention was required in 43% (n = 30) of patients, which included excision, debridement, skin grafting, and escharotomy. In-hospital mortality occurred in 4% (n = 3) of patients. Tent fire burns are severe enough to require inpatient and ICU level of care. A high proportion of injuries involved the extremities and pose significant barriers to functional recovery in this vulnerable population. Strategies to prevent these injuries are paramount.

Crop burning and the prevalence of asthma and COPD emergency department treatments in a rural Arkansas county.

OBJECTIVE: To evaluate the impact of crop burning on the prevalence of asthma and COPD emergency department (ED) treatments in a rural Arkansas county. METHODS: Administrative datasets listing ED treatments for asthma and COPD obtained from the Arkansas Hospital Discharge Dataset System for the calendar years 2014-2016 were used in this semi-ecological study. Primary diagnosis codes (ICD-9: 490-496 and ICD-10: J40-J47) were used to identify patients who were diagnosed with asthma and COPD. Patients with a reported county of residence in Craighead County were determined as case county residents and those in Sebastian County were control county residents. Month of visit was used to determine seasonal variation. PM 2.5 air quality data were obtained from the EPA AQS Data Mart. RESULTS: Between 2014 through 2016, there were a combined total of 2,536 ED treatments due to asthma and 8,530 due to COPD in Craighead and Sebastian counties. The odds of being treated in the ED during the fall months for asthma and COPD are associated with a 20.9% increase and 16.9% increase respectively in Craighead County as compared to Sebastian Country after adjusting for potential confounders (p = 0.04, p = 0.003). PM 2.5 concentrations were higher in Craighead County than Sebastian County during the fall season (p = 0.005). CONCLUSION: Fall ED treatments for asthma and COPD were higher in Craighead County, Arkansas compared to Sebastian County, Arkansas for the years 2014-2016. PM 2.5 levels were also higher in Craighead County in the fall during these years. These differences may be attributable to crop burning.​.

Homicide and concealment of the corpse. Autopsy case series and review of the literature.

INTRODUCTION: The concealment of the body following a homicide undermines different moments of the forensic and medico-legal investigations. The aim of the present study is to provide an overview of the literature and the forensic casuistry of the Institute of Legal Medicine of Padova for analyzing and discussing diverse methodological approaches for the forensic pathologist dealing with covered-up homicides. MATERIAL AND METHODS: A literature review, updated until September 2019, was performed, and a literature pool of forensic cases was built. In-house cases were included by conducting a retrospective analysis of the forensic caseworks of Padova of the last 20 years. Data regarding epidemiology, methodology of assessment, methods of concealment, and answers to medico-legal issues were extracted for both data sets. RESULTS AND DISCUSSION: Seventy-eight papers were included in the literature review (78.2% being case reports or case series, 17% retrospective studies, and 6% experimental studies or reviews). Literature and in-house data sets consisted of 145 and 13 cases, respectively. Death scene investigation, radiology, toxicology, and additional analyses were performed in 20-54% of literature and 62-77% of in-house cases. Cover-up by multiple methods prevailed. Death was caused by head trauma in about 40% of cases (both data sets), strangulation in 21% of literature, and 7% of in-house cases, and was undetermined in 17% of literature and 7% of in-house cases. CONCLUSIONS: The methodology of ascertainment should be case-specific and based on a multidisciplinary and multimodal evaluation of all data, including those gained through novel radiological and/or analytical techniques.

A Single Center Review of the Dangers of Recreational Fires in the Pediatric Population.

The increasing trend of admissions due to recreational fires prompted a 5-year review. The retrospective chart review of pediatric burn injuries from campfires or bonfires treated at a single medical center's burn unit. The study included children within the ages of 0 to 15 admitted or transferred from January 2012 to December 2016 with first, second, and/or third degree burns by bonfires. These patients accrued burns due to active fires as well as postfire ember contact. Two hundred-eighty nine (289) were pediatric admissions out of which 66 (22.8%) were pediatric admissions associated with recreational fires. The mean annual admission for campfire or bonfire burns was 13 ± .98. The mean age was 4 ± 2.47 years. Gender distribution revealed 21 female and 45 male pediatric patients under the age of 15. From the available data, 8 (12%) of these burns occurred at home in the backyard and 16 (24%) at a public camp or park. Injury mechanisms were more commonly a result of direct contact with hot coals and embers (65%). Falls into open flame accounted for 23% (n = 15) of injuries, and flash flames accounted for 12% of injuries (n = 8). The presence of supervision was unknown in 56%; however, lack of supervision was a factor in 14% of our study population. By gaining a better understanding of the type of injury, mechanism of injury, and the demographic of recreational fire burn victims, policy, and awareness campaigns were instituted in an effort to reduce the incidence of recreational fire burns.

Impacto de la normativa autonómica para la prevención de accidentes pirotécnicos / Impact of regional laws on firework accident prevention

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2019 Writing Contest Post-graduate Winner: Fire Safety Behaviors Among Residential High-Rise Building Occupants in Hawai'i: A Qualitative Study.

The world's population is rapidly urbanizing. Today, the majority of people live in cities and many live in high-rise buildings. High-rise buildings pose many challenges with regards to occupant safety, including fire prevention and evacuation safety. The purpose of this study was to describe factors that influence fire safety behaviors among residents of high-rise buildings and the strategies that population health nurses can use to support health education for people living in high-rise environments. An exploratory, descriptive qualitative research design with purposive sampling was used. Twelve residents from 8 high-rise buildings in Honolulu, Hawai'i participated in this study. In-depth semi-structured interviews were conducted and recorded, followed by thematic analysis of the interview transcripts. Five key themes emerged from the study: (1) attitudes towards fire safety, (2) building fire safety culture, (3) perceived ability to prepare for fires, (4) intentions to prepare, and (5) occupant fire preparedness behaviors. Gaps in knowledge regarding high-rise building fire safety were identified that contributed to residents' risk and vulnerability. Fire safety is of relevance to all nurses who work with populations. Population health nursing practice addresses the health, safety, and emergency preparedness needs of clients and communities. More research should be done to improve understanding of fire safety behaviors among high-rise residents to help population health nurses and other professionals mitigate the risk of fire in residential high-rise buildings and keep individuals and families safe during actual emergencies.

Abundance and morphology of charcoal in sediments provide no evidence of massive slash-and-burn agriculture during the Neolithic Kuahuqiao culture, China.

It remains debatable whether slash-and-burn practices were adopted in rice cultivation by the Neolithic Kuahuqiao culture in the Ningshao Plain, one of the birthplaces of rice farming. Here, we established charcoal-based indices to reconstruct the history of fire and vegetation in the Ningshao Plain since the last glacial period. We collected representative modern vegetation and conducted combustion and fragmentation experiments to simulate fire and depositional processes, respectively. Charcoals from modern vegetation show clear morphological differences between herbaceous and woody plants. In particular, the length to width ratios (L/W) of herbaceous charcoals were systematically higher than those of woody charcoals, and the associated end-member values were 4.50 and 1.94, respectively. These values were then applied to sediment cores (KHQ-14/15) collected in proximity to the Kuahuqiao archaeological site. Results show that the amount of combusted herbaceous plants increased sharply after the Holocene, and the most remarkable rise occurred around 8550 yr B.P. This observation may reflect local environment (sedimentary and/or climatic) changes or small-scale early human activities. During the Kuahuqiao cultural period (8250-7450 yr B.P.), the relative abundance of woody charcoals increased, but the overall fire intensity decreased. This finding suggests that the Kuahuqiao farming was restricted to a small geographic area and large-scale slash-and-burn farming activities were not adopted.

Fire Size of Gasoline Pool Fires.

This article presents an experimental investigation of the flame characteristics of the gasoline pool fire. A series of experiments with different pool sizes and mixture contents were conducted to study the combustion behavior of pool fires in atmospheric conditions. The initial pool area of 0.25 m2, 0.66 m2, and 2.8 m2, the initial volume of fuel and time of burning process, and the initial gasoline thickness of 20 mm were determined in each experiment. The fire models are defined by the European standard EN 3 and were used to model fire of the class MB (model liquid fire for the fire area 0.25 m2), of the class 21B (model liquid fire for the fire area 0.66 m2), and 89B (model liquid fire for the fire area 2.8 m2). The fire models were used to class 21B and 89B for fuel by Standard EN 3. The flame geometrical characteristics were recorded by a CCD (charge-coupled device) digital camera. The results show turbulent flame with constant loss burning rate per area, different flame height, and different heat release rate. Regression rate increases linearly with increasing pans diameter. The results show a linear dependence of the HRR (heat release rate) depending on the fire area (average 2.6 times).

Paraffin dangers, health and socioeconomic consequences: Urgent need for policy action.

Illuminating paraffin (kerosene) is the primary cooking fuel for approximately two million South Africans. The highly flammable and toxic fuel is burnt in poorly made stoves that are prone to malfunction and are associated with accidental fires, burns and household air pollution. However, the fuel continues to be used as it is easily decanted, widely available in neighbourhood outlets, perceived as affordable, and often the only available option for low-income urban settlements. It is anticipated that increased and enforced home congestion during COVID-19 lockdowns will exacerbate exposure of homebound families to unsafe energy, especially during the cold winter months. Based on an accumulation of evidence on the health and socioeconomic impacts of paraffin, this article advocates for its expedited phase-out and substitution with safer energy.

Surgical fires: Still a burning issue in England and Wales.

A significant number of surgical fires occur each year and can have devastating effects on patients. The National Reporting and Learning System database identified 37 reports of surgical fires in England and Wales between January 2012 and December 2018 - over 52% resulting in some degree of harm. Surgical fires remain preventable adverse events that can be avoided by adherence to effective preventative strategies and improved education. This article surveys the existing literature, addressing the fire triad and how to effectively manage and prevent a surgical fire.

Identifying sociodemographic risk factors associated with residential fire fatalities: a matched case control study.

OBJECTIVES: This study aimed to investigate the association between sociodemographic factors and residential fire fatalities in Sweden. A majority of fatal fires occur in housing. An understanding of risk factors and risk groups is a must for well-founded decisions regarding targeted prevention efforts. There is a lack of consideration of the interrelation between sociodemographic factors and fire fatalities and there is a lack of high quality large-scale studies. METHODS: In this matched case-control study, residential fire fatalities (cases, n=850) (age above 19 years old) were identified in the national register on fatal fires. Four controls per case were randomly matched by gender and age. ORs were calculated to assess the association between different sociodemographic factors with residential fire fatalities using conditional logistic regression. RESULTS: Having low income, receiving social allowance and receiving health-related early retirement pension were associated with an increased risk of dying in residential fires. The results also show clearly that adults dying in residential fires to a significantly lower extent were living together with a partner, were in work, were highly educated and lived in urban areas. However, contrary to previous research, living in rented apartments appeared not to influence the risk of death. CONCLUSIONS: In this study, we show that fatalities due to residential fires in Sweden are associated with some but not all of previously published sociodemographic risk factors. The results provide valuable information that can improve the guiding and targeting of fire mortality prevention strategies in Sweden.