More information

"Fires and Burns Involving Home Medical Oxygen" report (PDF, 224 KB)
Errata incorporated November 6, 2008. Download the errata. (PDF, 75 KB)

Selected Published Incidents Involving Medical Oxygen (PDF, 572 KB)

Fact sheet
"Fires and Burns Involving Home Medical Oxygen" fact sheet (PDF, 44 KB)

Safety tips
Read NFPA's safety tips on medical oxygen. (PDF, 383 KB)


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Report: NFPA's "Fires and Burns Involving Home Medical Oxygen"
Marty Ahrens
Issued: August 2008

This report includes estimates of emergency room visits for thermal burns and fire department responses to home fires involving medical oxygen. A review of literature on the topic from the fire service and health care sources is included. Policy and regulatory issues are also discussed. 

Executive Summary

The exact number of people receiving home oxygen therapy is unknown. In a 2006 study done for the American Association for Homecare, Morrison Informatics, Inc. noted that more than 1 million Medicare recipients use this therapy.1 Bowles reported that in the 30 Oklahoma cases of burns due to smoking while on medical oxygen with known insurance information, only 53% were on Medicare.Combining the two studies gives a very rough estimate of 2 million households using oxygen. When medical oxygen is not used according to directions, the patient and others are at risk of fire and burns as well as property damage. 

Technically, fire is defined as “a rapid oxidation process, which is a chemical reaction resulting in the evolution of light and heat in varying intensities.”3 Oxygen is one of three parts of the fire triangle.4 A heat source and fuel (something that can burn) are also required. Oxygen itself is not flammable. The heat triggers a chemical reaction between the oxygen and fuel molecules. Normally, air is 21% oxygen. Increased oxygen makes more oxygen available for the chemical reaction, meaning that any fire that occurs will burn faster and hotter. Increased oxygen also lowers the temperature at which things will ignite, including hair, clothing, plastic, skin oils, furniture, etc. Because oxygen is colorless and odorless, elevated levels are not detectable by human senses. In many ignitions associated with home medical oxygen, only the area around the patient’s face was enriched. However, melted tubing, leaks, and other equipment breaches can result in a much larger enriched area.

Most of the medical literature on incidents involving home medical oxygen has focused on patients treated at burn centers or included in burn registries. In most cases, only the patient was hurt, although some involved death to other household members or building occupants. The fire service and fire protection literature also includes reports about the dangers of smoking on oxygen, but it also addresses issues of oxygen storage, fire protection, and the dangers of firefighting in an oxygen-enriched atmosphere. A related topic, injuries incurred by emergency responders due to problems with regulators in portable oxygen systems, is also relevant. The literature from both disciplines is summarized here.  

1 Morrison Informatics, Inc. A Comprehensive Cost Analysis if Medicare Home Oxygen Therapy: A Study for the American Association for Homecare, June 27, 2006. p.2.
2 Angie Bowles. “Burn Injuries Due to Smoking while Using Oxygen Therapy, Oklahoma, 2001-2005, Injury Update, A Report to Oklahoma Injury Surveillance Participants, September 28, 2007.
3 National Fire Protection Association. Illustrated Dictionary of Fire Service Terms, Sudbury, MA:  Jones and Bartlett Publishers, 2006, p. 52.
4 Safety Advisory Group, European Industrial Gases Association. Fire Hazards of Oxygen and Oxygen Enriched Atmospheres, Brussels: 2000.