E-cigarettes - beware of the rocket in your pocket
Dear Editor,
We read with interest the recent RCP report on e-cigarettes (EC) and tobacco harm reduction [1]. However, with regards to harm reduction, we felt an important point had been neglected. There is a real risk of explosion, fire and significant injury from EC and the re-chargeable lithium ion batteries that power them, a risk that was addressed to some degree in Public Health England’s 2015 report on EC [2]. Clearly it is not only the nicotine delivery that requires regulation but also the production standards of the devices, their chargers and batteries.
We recently published the first case series of burn injuries as a direct result of EC devices [3]. These unfortunate EC users described their devices bursting into flames like a "rocket in my pocket". These patients suffered significant burns to their thighs that required hospitalisation and surgical management. They used commonly available EC devices. They were not second hand, counterfeit or damaged devices, but devices ordered and purchased from shops now common place on our high-streets. These are not unique incidents. For example, two almost identical incidents were recently caught live on CCTV in both the USA and the UK [4,5]. Reports of injuries have rocketed in the last 6 months. A casual review of the internet media sources reveals an alarming epidemic of EC related fires and explosions, resulting in at least eight significant EC related burn injuries reported in the UK alone in 2016 [6].
This is a big problem with potential to cause serious harm or death [7]. We would strongly recommend urgent consumer guidance on the safe charging and storage of EC devices and lithium ion batteries in order to reduce this risk. We would welcome the regulation that would come with MHRA licencing, which would undoubtedly drive significant improvements in operating guidance, as well as product quality and safety. It is completely unconscionable that public users are currently being sold devices with the potential to spontaneously explode and seriously injure. It would be completely unconscionable to prescribe such a device to a patient without a guarantee of safety. Given these devices are now being proposed for use by some of our young [8] and potentially most vulnerable [9] patients, these concerns need to be highlighted and considered as a matter of urgency.
[1] Nicotine without smoke: Tobacco harm reduction - A report by the Tobacco Advisory Group of the Royal College of Physicians. April 2016. Available online at: https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-toba...
Accessed: 29/04/2016
[2] McNeill A, B.L., Calder R, Hitchman SC, Hajek P, McRobbie H. E-cigarettes: an evidence update, A report commissioned by Public Health England. Public Health England, 2015.
[3] Nicoll K.J, Rose A.M, Khan M.A.A, Quaba O and Lowrie A.G. Thigh burns from exploding e-cigarette lithium ion batteries: First case series. Burns, April 2016. Article in press - DOI: http://dx.doi.org/10.1016/j.burns.2016.03.027
[4] Fox 5 KRBK. E-Cig Explodes in Man’s Pocket. Video available at: https://www.youtube.com/watch?v=lBDuKArHltc
Accessed: 29/04/2016
[5] Williams A. Terrifying moment an e-cigarette explodes 'like a rocket' in a father's pocket just inches away from his seven-year-old son's face at a skating rink. MailOnline. http://www.dailymail.co.uk/news/article-3469555/Terrifying-moment-e-ciga...
Accessed: 29/04/2016
[6] Google Search: “e-cigarette explodes” https://www.google.co.uk/search?q=ecigarette+explodes&ie=utf-8&oe=utf-8&...
Accessed: 29/04/2016
[7] BBC News. Man killed as e-cigarette 'explodes', Merseyside fire service says. http://www.bbc.co.uk/news/uk-england-merseyside-28701515
Accessed: 29/04/2016
[8} Sutfin E et al. The Impact of Trying Electronic Cigarettes on Cigarette Smoking by College Students: A Prospective Analysis. American Journal of Public Health: August 2015, Vol. 105, No. 8: e83–e89.
[9] Borderud S.P, Li Y, Burkhalter J.E, Sheffer C.E, Ostroff J.S. Electronic cigarette use among patients with cancer: characteristics of electronic cigarette users and their smoking cessation outcomes. Cancer. 2014 Nov 15;120(22):3527-35. doi: 10.1002/cncr.28811. Epub 2014 Sep 22.
Competing interests:
No competing interests
29 April 2016
Aidan M Rose
Clinical Lecturer in Plastic Surgery
Kenneth J Nicoll, Omar Quaba and Alastair G Lowrie
School of Medicine, University of Dundee
Department of Plastic and Reconstructive Surgery, Ninewells Hospital and Medical School, School of Medicine, University of Dundee
Rapid Response:
E-cigarettes - beware of the rocket in your pocket
Dear Editor,
We read with interest the recent RCP report on e-cigarettes (EC) and tobacco harm reduction [1]. However, with regards to harm reduction, we felt an important point had been neglected. There is a real risk of explosion, fire and significant injury from EC and the re-chargeable lithium ion batteries that power them, a risk that was addressed to some degree in Public Health England’s 2015 report on EC [2]. Clearly it is not only the nicotine delivery that requires regulation but also the production standards of the devices, their chargers and batteries.
We recently published the first case series of burn injuries as a direct result of EC devices [3]. These unfortunate EC users described their devices bursting into flames like a "rocket in my pocket". These patients suffered significant burns to their thighs that required hospitalisation and surgical management. They used commonly available EC devices. They were not second hand, counterfeit or damaged devices, but devices ordered and purchased from shops now common place on our high-streets. These are not unique incidents. For example, two almost identical incidents were recently caught live on CCTV in both the USA and the UK [4,5]. Reports of injuries have rocketed in the last 6 months. A casual review of the internet media sources reveals an alarming epidemic of EC related fires and explosions, resulting in at least eight significant EC related burn injuries reported in the UK alone in 2016 [6].
This is a big problem with potential to cause serious harm or death [7]. We would strongly recommend urgent consumer guidance on the safe charging and storage of EC devices and lithium ion batteries in order to reduce this risk. We would welcome the regulation that would come with MHRA licencing, which would undoubtedly drive significant improvements in operating guidance, as well as product quality and safety. It is completely unconscionable that public users are currently being sold devices with the potential to spontaneously explode and seriously injure. It would be completely unconscionable to prescribe such a device to a patient without a guarantee of safety. Given these devices are now being proposed for use by some of our young [8] and potentially most vulnerable [9] patients, these concerns need to be highlighted and considered as a matter of urgency.
[1] Nicotine without smoke: Tobacco harm reduction - A report by the Tobacco Advisory Group of the Royal College of Physicians. April 2016. Available online at: https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-toba...
Accessed: 29/04/2016
[2] McNeill A, B.L., Calder R, Hitchman SC, Hajek P, McRobbie H. E-cigarettes: an evidence update, A report commissioned by Public Health England. Public Health England, 2015.
[3] Nicoll K.J, Rose A.M, Khan M.A.A, Quaba O and Lowrie A.G. Thigh burns from exploding e-cigarette lithium ion batteries: First case series. Burns, April 2016. Article in press - DOI: http://dx.doi.org/10.1016/j.burns.2016.03.027
[4] Fox 5 KRBK. E-Cig Explodes in Man’s Pocket. Video available at: https://www.youtube.com/watch?v=lBDuKArHltc
Accessed: 29/04/2016
[5] Williams A. Terrifying moment an e-cigarette explodes 'like a rocket' in a father's pocket just inches away from his seven-year-old son's face at a skating rink. MailOnline.
http://www.dailymail.co.uk/news/article-3469555/Terrifying-moment-e-ciga...
Accessed: 29/04/2016
[6] Google Search: “e-cigarette explodes” https://www.google.co.uk/search?q=ecigarette+explodes&ie=utf-8&oe=utf-8&...
Accessed: 29/04/2016
[7] BBC News. Man killed as e-cigarette 'explodes', Merseyside fire service says. http://www.bbc.co.uk/news/uk-england-merseyside-28701515
Accessed: 29/04/2016
[8} Sutfin E et al. The Impact of Trying Electronic Cigarettes on Cigarette Smoking by College Students: A Prospective Analysis. American Journal of Public Health: August 2015, Vol. 105, No. 8: e83–e89.
[9] Borderud S.P, Li Y, Burkhalter J.E, Sheffer C.E, Ostroff J.S. Electronic cigarette use among patients with cancer: characteristics of electronic cigarette users and their smoking cessation outcomes. Cancer. 2014 Nov 15;120(22):3527-35. doi: 10.1002/cncr.28811. Epub 2014 Sep 22.
Competing interests: No competing interests