Smoke Inhalation and Safety

Smoke Inhalation and SafetyIntroduction

First responders often find themselves in the line of fire. These fires can be veld and forest fires, fires at home and at our businesses or even something as small as a vehicle fire.

The victims of these fires must be treated not only for burn wounds sustained from the fire itself but also for smoke inhalation. 

Many of us underestimate the dangers of smoke inhalation. We decided to approach our colleagues from the emergency medical services to gain some insights to the dangers of smoke inhalation and what needs to be done to treat the victims of this threat to health and safety!

What are the symptoms of someone suffering from smoke inhalation?

Smoke inhalation damages the body by simple asphyxiation (lack of oxygen), chemical irritation, chemical asphyxiation, or a combination of these.

Simple asphyxiates

Combustion can simply use up the oxygen near the fire and lead to death when there is no oxygen for a person to breathe.

The smoke itself can contain products that do not cause direct harm to a person, but they take up the space that is needed for oxygen. Carbon dioxide acts in this way.

Irritant compounds

Combustion can result in the formation of chemicals that cause direct injury when they contact the skin and mucous membranes.

These substances disrupt the normal lining of the respiratory tract. This disruption can potentially cause swelling, airway collapse, and respiratory distress.

Examples of chemical irritants found in smoke include sulphur dioxide, ammonia, hydrogen chloride, and chlorine.

Chemical asphyxiates

A fire can produce compounds that do damage by interfering with the body's oxygen use at a cellular level.

Carbon monoxide, hydrogen cyanide, and hydrogen sulphide are all examples of chemicals produced in fires that interfere with the use of oxygen by the cell during the production of energy.

If either the delivery of oxygen or the use of oxygen is inhibited, cells will die.

Carbon monoxide poisoning has been found to be the leading cause of death in smoke inhalation.

A cough

When the mucous membranes of the respiratory tract get irritated, they secrete more mucus.

Bronchospasm and increased mucus production lead to reflex coughing.

The mucus may be either clear or black depending on the degree of burned particles deposited in the lungs and trachea.

Shortness of breath

This may be caused by direct injury to the respiratory tract, leading to decreased oxygen delivery to the blood, the decreased ability of blood to carry oxygen because of chemicals in smoke, or the inability of the body's cells to use oxygen.

The patient may have rapid breathing as they attempt to compensate for these injuries.

Hoarseness or noisy breathing

This may be a sign that fluids are collecting in the upper airway and may cause a blockage.

Irritant chemicals may cause vocal cord spasm, swelling, and constriction of the upper airways.

Eyes

Eyes may be red and irritated by the smoke, and there may be burnt on the corneas in the eyes.

Skin colour

Skin colour may range from pale to bluish to cherry red.

Soot

Soot in the nostrils or throat may give a clue as to the degree of smoke inhalation.

The nostrils and nasal passages may be swollen.

A headache

In all fires, people are exposed to various quantities of carbon monoxide.

The patient may have no respiratory problems, but may still have inhaled carbon monoxide.

A headache, nausea, confusion, and vomiting are symptoms of carbon monoxide poisoning.

Changes in mental status

Chemical asphyxiates and low levels of oxygen can lead to mental status changes.

Confusion, fainting, seizures, and coma are all potential complications following smoke inhalation.

What are the major differences between smoke from fire and the inhalation of gas?

What are the major differences between smoke from a fire and the inhalation of gas?

There are very few differences between smoke inhalation and gas inhalation. Both can cause serious injury to the lungs as well as death, as both smoke and gas will replace the oxygen in your lungs.

Combustion of certain materials can form chemical smoke, which can damage your respiratory tract causing severe swelling in the airway.

Gases are substances that are completely in a gaseous state at normal temperatures and pressures. Some liquids or solids have an associated gaseous phase which is called a vapour. Smoke is a fine solid formed by incomplete burning. Fumes are fine airborne particles produced when a solid vaporises and condenses, e.g. during welding.

Smoke is a collection of tiny solid, liquid and gas particles. Although smoke can contain hundreds of different chemicals and fumes, visible smoke is mostly carbon (soot), tar, oils and ash. Smoke occurs when there is incomplete combustion (not enough oxygen to burn the fuel completely)

Are there differences to consider for first responders where victims inhale smoke from i.e. forest fires as compared to house, building or vehicle fires?

Are there differences to consider for first responders where victims inhale smoke from i.e. forest fires as compared to house, building or vehicle fires?

The type of fire is always taken into consideration. There is a saying that the smoke is more dangerous than the fire.

The treatment will be the same but the effects may change slightly based on the chemicals in the smoke.

Smoke inhalation occurs when you breathe in the products of combustion during a fire. Combustion results from the rapid breakdown of a substance by heat (more commonly called burning).

Smoke is a mixture of heated particles and gases. It is impossible to predict the exact composition of smoke produced by a fire. The products being burned, the temperature of the fire, and the amount of oxygen available to the fire all make a difference in the type of smoke produced.

A house or building would contain chemicals or compounds such as paint, glues, electronics, plastics, cupboards and laminates, carpets and curtains, all these elements are combustible and burn with ease and all release different chemicals into the air.

A vehicle has material seats, brake fluid, power steering fluid, engine and gearbox oil, petrol or diesel, as well as lots of different types of plastics all of which will release their own combination of chemicals into the air.

Natural toxic resins may be contained within a burning tree.

What are the most important misconceptions on the treatment from smoke inhalation?

What are the most important misconceptions on the treatment from smoke inhalation?

The biggest misconception around smoke inhalation is that it is not a serious injury. Most patients say that they are ok and often try to decline medical assistance as they think they are “fine”, where its best to be assessed and treated by medics.

Generally, smoke can reach very high temperatures, and if inhaled, can lead to serious injuries to the respiratory tract and lungs. This needs to be treated immediately, and further medical support should be sought.

Some misconceptions emergency personal hear often are:

  • That the fire is what generally kills or injures a person.
    It is important to highlight that a person can asphyxiate in just 3-5 minutes in thick smoke filled with toxic by-product.
  • That glass of milk or cough syrup will help you breathe better.
    Your lungs are filled with toxic chemicals and thick soot, this has taken up all the space in your lungs, so little oxygen exchange to takes place so giving person milk or thick sticky cough medicines could aggravate the injury or even make things worse.

Smoke is a collection of tiny solid, liquid and gas particles. Although smoke can contain hundreds of different chemicals and fumes, visible smoke is mostly carbon (soot), tar, oils and ash. Smoke occurs when there is incomplete combustion (not enough oxygen to burn the fuel completely).

What are the most important steps to take on the scene and with the treatment of the victim of smoke inhalation?

Personal safety to yourself is paramount, if there is a chance that you would be taking a serious risk, rather wait for trained professionals to arrive.

  • Firstly, the patients' needs to be removed from the source of the smoke to an area upwind from the fire. You and the patient need to be moved from the “hot zone” to a well-ventilated area.
  • Once this is done, a full assessment should be completed to assess what level of care the patient requires.
  • Speak to them to establish their level of consciousness and ask them if they are in pain, where is the pain.
  • How they answer the questions should give you an indication of smoke inhalation.
  • Look into their nostrils and mouth for classic signs of soot.
  • If the person experiences any of the following symptoms associated with smoke inhalation seek medical attention immediately:
  • Difficulty in breathing.
  • Mental confusion.
  • Prolonged coughing.
  • Hoarse voice.

As soon as the assessments are complete, nebulised oxygen should be administered. As stated above, further medical attention should be sought, as to ensure no further damage had been sustained to the respiratory tract.

What are the best ways to mitigate smoke inhalation where emergency services cannot avoid the smoke [i.e. firemen]?

What are the best ways to mitigate smoke inhalation where emergency services cannot avoid the smoke [i.e. firemen]?

Mitigating smoke inhalation.

  • Some of the more modern buildings have fire resistant passages, doors and escape routes included in their construction.
  • Know your escape routes.
  • Get down, the heat of the fire forces smoke and noxious gases to rise, which clears a low area of relatively clean air to breathe near the floor.
  • Various emergency services, specifically firefighters, make use of SCBA's, or self-contained breathing apparatus. These allow emergency personnel to enter buildings that would otherwise be impossible.

If a patient is in a room that is filled with smoke, it is best to crawl on their hands and knees to exit the room.

Any advice on prolonged symptoms and time of recovery - Longer term strategy for healing?

Any patient that has suffered smoke inhalation should seek emergency medical assistance. Depending on the damage sustained, these injuries can be lengthy in terms of healing. It is unfortunately very difficult to discuss strategies for healing until the damage is fully assessed. Treatment can be as small as basic oxygen medication or as far as in-depth surgery.

At-home treatment

In addition to taking medications and following instructions prescribed by your doctor, there are some at-home things you can do following smoke inhalation treatment:

  • Get plenty of rest.
  • Sleep in a reclined position or prop your head up with pillows to help you breathe easier.
  • Avoid smoking or second-hand smoke.
  • Avoid things that may irritate your lungs, such as extremely cold, hot, humid, or dry air.
  • Carry out any breathing exercises as instructed by your doctor, also known as bronchial hygiene therapy.

Smoke inhalation recovery and long-term effects and outlook

Smoke inhalation recovery and long-term effects and outlook

Recovery from smoke inhalation depends on many factors like the severity of the injuries, your overall lung health prior to an injury.

  • It'll take time for your lungs to fully heal and you'll likely continue to experience shortness of breath and tire more easily for a while.
  • People with scarring may have shortness of breath for the rest of their lives. Hoarseness for some time is also common in people with smoke inhalation.
  • You may be given medication to take while you recover.
  • You may need long-term inhalers and other medications to help you breathe better, depending on the damage to your lungs.
  • Follow-up care is an important part of your recovery.
  • Ensure you have follow-up appointments with your specialist.

A word of appreciation to the following for their assistance:

Shawn Herbst, Netcare911

Russel Meiring and Ineke van Huyssteen, ER24

Robert Mckenzie, KZN EMS

Also view:

Safety and Escape from Vehicle Fire

Safety from Fire at our Homes

Safe Driving near Veld and Forest Fires

Safety with Gas

Prevention from and Treatment of Burns

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