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PAPERS: Carolyn DiGuiseppi, Ian Roberts, Angie Wade, Mark Sculpher, Phil Edwards, Catherine Godward, Huiqi Pan, and Suzanne Slater Incidence of fires and related injuries after giving out free smoke alarms: cluster randomised controlled trial BMJ 2002; 325: 995 [Abstract] [Full text]

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Response from a fire officer

Roger Greet   (7 November 2002)

Fire prevention and elderly people

Tischa JM van der Cammen, Eva Mann   (5 December 2002)

Response from a fire officer 7 November 2002
Roger Greet, Deputy Chief Fire Officer Dorset Send response to journal: Re: Response from a fire officer	As a professional fire officer I have read with interest the article and ongoing debate relating the issue of free of smoke detectors and the suggested outcomes from the research. I would suspect that one element hich is perhaps overlooked in the debate is that of "ownership". This, I feel , has two elements. The first is the gift of the smoke detector itself. Being given something doesn't bring with it the same sense of ownership as one which has been worked for and then purchased. It would not be appropriate to discuss the relative merits or otherwise of the purchasing power given the social economic elements of the study on which some would I have no doubt wish to dwell, however I suspect the relative cost of these units through subsidised purchase could go someway to addressing concerns. Turning to the second string of my observation is the ownership of risk and this is much more difficult to grapple with. In Dorset we have developed a multi agency community safety centre "Streetwise" in which visitors, mostly children, confront a number of safety related issues - fire being one. These messages are intended to provide an holistic safety message for each of the visitors. These messages also reinforce elements of citizenship and personal responsibility e.g. fire on a heathland highlights the loss of flora and habitat etc. Another scenario relates to a damaged telephone kiosk and during the visit one of the group is expected to call to the emergency services only to find that they are unable to complete the task because of vandalism. Being a coastal area there is another scene which depicts the seaside and is used to discuss the risk not only in the water but also sunbathing and walking near the edges of cliffs etc. The overall intention is to provide every visitor with some of the underlying tools for life which it is hoped will ensure they recognise their personal responsibility to contribute to a safer environment for us all. Finally your readers will be heartened to know that there is ongoing research as to the provision of sprinklers for the domestic environment. I like many of my colleagues are hopeful that this will bring about an increase in active systems which will not only inform those in the property of a fire but will at the same time tackle it as well. The long term aim is to ensure that sprinklers become as widely accepted as a must have in a new home as fitted carpet. Incidentally the costs are about the same. Undoubtedly the focus of installations will be mandated to those premises presenting the highest risk. From my experience a high number of fire deaths and serious injuries indicate that a significant proportion of those at risk are effected by drugs or alcohol with the associated debilitating effects. Perhaps this is another area worthy of research. Like many professionals, members of the Fire Service are working actively in many areas of Community Fire Safety to promote Fire Prevention to reduce fire deaths and injuries, the costs of which are not insignificant to the health budgets. (see UK Governments' "Safe as Houses Report"). However I would like to add support for the humble smoke detector which if properly installed and maintained have an important part to play in helping to create a safer society for us all. Roger Greet Deputy Chief Fire Officer Competing interests:   None declared
Fire prevention and elderly people 5 December 2002
Tischa JM van der Cammen, consultant physician and senior lecturer in Geriatric Medicine Erasmus Medical Center PO Box 2040 Rotterdam-3000CA The Netherlands, Eva Mann Send response to journal: Re: Fire prevention and elderly people	Sir, We were impressed by the study of DiGiuseppi et al.(1) which made it painfully clear how difficult it can be to implement preventive measures in the community. The study raises the issue of how to protect vulnerable and high risk persons from fire and fire related injuries. In general practice as well as in the care of the elderly, we are frequently confronted with patients who are at increased risk of fire in their homes, due to a variety of physical and mental diseases or handicaps, which are associated with inattention to danger. This is illustrated by the following two cases. Case 1. A 90-year old widow lived alone in her own home. In 1987 cognitive impairment was diagnosed. In the summer of 1991 she had a stroke in the right temporo-parieto-occipital area. She recovered almost fully from hemiparesis and returned home. Between November 1991 and November 1992 there was a further decline in cognitive function. On 2 November 1992, while alone in her room, her clothes caught fire from a candle light. By the time her son and daughter-in-law realized the fire, she was already severely burned. She died two days later in the intensive care. Case 2. An 85-year old woman lived with her husband in a wooden farmhouse. In 2000 she had an ischemic stroke in the area of the right medial cerebral artery, resulting in a left sided hemiparesis. She recovered well. In 2001 a depression was treated with paroxetine. At that time, the first symptoms of cognitive impairment occurred, Mini-Mental State Examination(2)score was 22/30 points. In February 2002, her husband died in his sleep. Her depression worsened. Two weeks after her husband's death, she could not sleep, put on a candle light in her living room, forgot it, and went to sleep in her bedroom. The candle ignited a fire, the house burned down completely. She died in the fire. While residential and nursing homes have fire prevention regulations, older persons in their own home remain at high risk of fire related injuries, especially if multimorbidity is present. Despite the fact that we are aware of the dangers for this category, the limitations of our preventive possibilities are obvious. However, every possible effort should be made to implement joint prevention programs, especially in view of the options which the latest developments in housing technology might offer for this kind of problem. Tischa JM van der Cammen, consultant physician and senior lecturer in geriatric medicine Section of Geriatric Medicine, Department of Internal Medicine, Erasmus Medical Center, Room D442, Po Box 2040, 3000 CA Rotterdam, The Netherlands vandercammen@inw1.azr.nl Eva Mann, general practitioner, diploma in geriatrics Osterreichischen Artzekammer References 1. DiGiuseppi C, Roberts I, Wade A, Sculpher M, Edwards P, Godward C, Pan H, Slater S. Incidence of fires and related injuries after giving out free smoke alarms: cluster randomised controlled trial. BMJ 2002; 7371: 995- 997. 2. Folstein MF, Folstein SE, McHugh PR. Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12:189-198. Competing interests:   None declared Editorial note The relatives of the patients whose cases are described in this rapid response have given their signed informed consent to publication.