Too often, we look back on disasters and wish that steps had been taken beforehand to avoid them – or at least prevent the loss of life. We can acknowledge National Preparedness Month by learning to be proactive against hazards, especially fires.

Protecting Your Patients from Fires

The devastating wildfires in Maui – and across large swaths of North America in recent years – drive home the need for preparedness. As the US commemorates September as National Preparedness Month, nurses can recognize their unique role in protecting their vulnerable patients, family members, and community to avoid the risk of fires. It also helps to promote general measures for preparedness against all hazards.

Fires are particularly damaging because they can happen almost anywhere and spread at an astonishing pace. Fires can become life-threatening in just two minutes, engulfing a residence in five minutes. Room temperatures can rise to 600 degrees at eye level, scorching lungs and melting clothes to the skin. This video of a controlled burn shows that a Christmas tree fire can torch an entire room in less than a minute. 

Immediate Steps for Burn Patients

For nurses who are confronted with patients who are subject to such hazards, the Mayo Clinic identifies the severity of burn injuries in three basic categories:

• 1st Degree: Minor, affecting only the outer layer of the skin (epidermis), resulting in redness and pain. 

• 2nd Degree: Affecting the skin’s epidermis and dermis (second layer). 

• 3rd Degree: Reaching the fat layer beneath the skin, possibly destroying nerves and causing numbness.

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Minor burns on the skin can be treated according to basic first aid: running cool water over the area to stop further burning, minimizing pain, redness, and blisters, covering with a light sterile dressing, and seeking additional care as needed. 

Deep or widespread burns can be complex and life-threatening, leading to complications such as sepsis, fluid loss, and hypothermia (dangerously low body temperature). Smoke inhalation may be deceptive because the airway can swell over time, increasing breathing difficulty. 

The best action is always prevention: assessing fire risks for individuals, households, the workplace, and the community.

How To Mitigate the Increasing Impact of Wildfires

According to sources including the NFPA (National Fire Protection Association), the Maui wildfire is among the deadliest in US history. Previous US wildfires have included the 2018 Camp fire that killed 85 in California and the deadly 2020 Oregon wildfires that burned more than a million acres of land. Causes include record-high temperatures, drought conditions, and high winds from severe weather events such as thunder and lightning. More wildfires are expected due to continued dry heat, increased storm activity, and climate change. 

NFPA recommends six steps to protect a home from wildfire by reducing the risks:

1. Choose fire-resistant building materials and limit the amount of flammable vegetation in the three home ignition zones: immediate (0-5 feet around the house), intermediate (5-30 feet), and extended (30-100 feet).
   
   
2. Trim branches that overhang the home, and prune branches of large trees up to 10 feet from the ground. Remove plants containing resins, oils and waxes. Use crushed stone or gravel instead of flammable mulches in the immediate zone, and keep landscaping in good condition.
   
   
3. Class A fire-rated roofing projects (composite shingles; metal, concrete and clay tiles) offer the best protection. Repair loose shingles or tiles to keep embers from penetrating. Screen roof and attic vents to prevent ember entry.
   
   
4. Never store flammable materials under decks or porches. Remove dead vegetation and debris from under decks and porches, and between deck board joints.
   
   
5. Note that embers can collect in small nooks and ignite combustible materials, and that radiant heat from flames can crack windows. Use fire-resistant siding (brick, fiber-cement, plaster, or stucco) and dual-pane tempered glass windows.

6. Ensure that your home and neighborhood have clearly marked street names and numbers. Driveways should be at least 12 feet wide, with a vertical clearance of 15 feet, for access by emergency vehicles. 

Emergency management organizations are also studying situations such as the Maui disaster to assess what kinds of preventative measures and response protocols could spare whole populations from such a tremendous impact in the future. 

Know and Prevent the Top Five Causes of House Fires

Nurses and case managers who conduct home assessments can involve local fire departments to educate homeowners in mitigating the top five hazards of home fires:

1. Cooking: The leading cause of home fires and injuries, and the second leading cause of home fire deaths, is from cooking. Thanksgiving, Christmas Eve, and Christmas Day are the peak occasions for home cooking fires.

2. Heating: From 2016 to 2020, heating equipment accounted for 13% of all reported home fires. Annual losses were 480 deaths, 1370 injuries, and over $1 billion in property damage.

3. Electrical: Electrical distribution or lighting equipment – such as wiring, lighting, cords, and plugs – ranks first in property damage. 

4. Smoking: Cigarettes, pipes, cigars, and other smoking materials started 16,500 home structure fires in 2016, causing 660 deaths, 1060 injuries, and $372 million in property damage. 

5. Candles: From 2015-2019, fires started by candles each year caused an estimated 7,400 home structure fires, resulting in an average of 90 deaths, 670 injuries, and $291 million in property damage annually.

People with disabilities and older adults are at greatest risk from home fires. Two easy steps towards prevention include testing smoke and CO2 alarms in the home and creating a fire escape plan.

September Alert for Seniors

September is not only the annual observance of National Preparedness Month. This year’s theme also places special emphasis on preparing for older adults across all kinds of hazards. 

According to Ready.gov:

• Additional concern exists for older adults from communities disproportionately impacted by all-hazard events.

• Seniors face greater risks if they live alone, are low-income, have a disability, or live in rural areas.

• Because nursing has been ranked as the most trusted profession for 21 years, nurses top the list as effective change agents that can protect communities. The 36-page ‘Are You Ready?’ guide describes a range of disasters that can happen across the US and how to help your patients prepare and recover: know your risks, make a plan, and take action.

• To promote diversity and inclusion, ensure your patients have information about preparedness in their own language.

The nature of emergencies is that they are unexpected. By encouraging your most vulnerable patients to take basic precautions, you help them become more resilient in disasters.

The old adage is true: “An ounce of prevention is worth a pound of cure.” Everyone from individuals to our nation’s population can benefit from lessons learned through fire disasters. Knowing how devastating wildfires can be, and the severity of injuries that can result, nurses have every incentive to educate the public on stopping fires before they start. Homeowners can increase their safety through measures to limit household risks from wildfires, and by avoiding the top five causes of house fires. Acknowledging September as Preparedness Month is an ideal way to protect your patients from fires and other hazards.

Nancy Burns (EMT, CHEP, AFAA, AHA-I) is the Upper Merrimack Valley Medical Reserve Corps Coordinator at the Westford, MA Health Department. Learn more about the national MRC program and how to support their efforts here.

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