US, resulting in 3,250 non-firefighter deaths, 17,175 injuries, and nearly $4.4 billion in property loss. These figures do not include the estimated 90% of fires not reported to fire departments. More than half of all fatal residential fires started between the hours of 11 pm and 7 am. Incidence of SI increases from less than 10% in patients with a mean total body surface area (TBSA) burn size of 5% to more than 80% in patients with a mean TBSA burn size of 85% or more. SI is present in one third of patients treated at burn centers.

SI is devastating, as the presence of an inhalation injury has a greater effect on mortality than either patient age or surface area burned. Internationally: The US has one of the highest fire fatality rates in the developed world, accounting for 2.3 deaths per 100,000 population. In fact, fire death rates in the US and Canada are twice as high as in Western Europe and Japan. Background: Smoke inhalation (SI) was described as early as the first century AD, when Pliny reported the execution of prisoners by exposure to the smoke of greenwood fires.

SI and thermal injury. Inhalation injury from smoke and the noxious products of combustion in fires may account for as many as 85% of fire-related deaths in the US, many of which are preventable. Even though the excellence of care rendered at today’s burn centers has greatly reduced the mortality from surface burns, the mortality from pulmonary injury has been increasing. Diagnosis of inhalation injury is not always straightforward, sensitive screening tests are lacking, and symptoms may be delayed until 24-36 hours after injury.

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