Health impacts and economic costs of residential fires (RESFIRES study): protocol for a population-based cohort study using linked administrative data

Factors associated with residential fire-related hospitalisations and deaths: A 10-year population-based study

This study aims to identify residential fire risk factors and their health outcomes in terms of hospital admissions from burns and smoke inhalation together with related readmissions, length of hospital stay (LOS), costs of hospitalisation and mortality within 30 days of the fire incidence. Residential fire-related hospitalisations from 2005 to 2014 in New South Wales, Australia were identified using linked data. Univariate and multivariable Poisson regression analyses were performed to determine factors associated with residential fires on hospital admission and loss of life. During the study period, 1862 individuals were hospitalised due to residential fires. In terms of prolonged LOS, high hospitalisation cost or mortality, fire incidents' that damaged both contents and structures of the property; were ignited by smokers' materials and/or due to mental or physical impairment of the residents had more adverse outcomes. Individuals aged 65 and over with comorbidities and/or acquired severe injuries from the fire incident were at a higher risk of long-term hospitalisation and death. This study provides information to response agencies in communicating fire safety messages and intervention programs to target vulnerable population. In addition, it also supplies indicators on hospital usage and LOS following residential fires to health administrators.

Community Fire Risk Reduction: Longitudinal Assessment for HomeSafe Fire Prevention Program in Canada

(1) Background: Residential fires represent the third leading cause of unintentional injuries globally. This study aims to offer an overview and a longitudinal evaluation of the HomeSafe program implemented in Surrey in 2008 and to assess its effectiveness in mitigating fire-related outcomes. (2) Methods: Data were collected over a 12-year period (2008-2019). Assessed outcomes comprised frequency of fire incidents, residential fires, casualties, functioning smoke alarms, and contained fires. The effectiveness of each initiative was determined by comparing the specific intervention group outcome and the city-wide outcome to the pre-intervention period. (3) Results: This study targeted 120,349 households. HomeSafe achieved overwhelming success in decreasing fire rates (-80%), increasing functioning smoke alarms (+60%), increasing the percentage of contained fires (+94%), and decreasing fire casualties (-40%). The study findings confirm that the three most effective HomeSafe initiatives were firefighters' visits of households, inspections and installations of smoke alarms, and verifications of fire crew alarms at fire incidents. Some initiatives were less successful, including post-door hangers (+12%) and package distribution (+15%). (4) Conclusions: The HomeSafe program effectively decreased the occurrence and magnitude of residential fires. Lessons learned should be transferred to similar contexts to implement an evidence-based, consistent, and systematic approach to sustainable fire prevention initiatives.

The Impact of Reduced Fire Risk Cigarettes Regulation on Residential Fire Incidents, Mortality and Health Service Utilisation in New South Wales, Australia

Smoking materials are a common ignition source for residential fires. In Australia, reduced fire risk (RFR) cigarettes regulation was implemented in 2010. However, the impact of this regulation on residential fires is unknown. This paper examines the impact of the RFR cigarettes regulation on the severity and health outcomes of fire incidents in New South Wales (NSW), Australia, from 2005 to 2014. Fire department data from 2005 to 2014 were linked with ambulance, emergency department, hospital, outpatient burns clinic and mortality datasets for NSW. Negative binomial regression analysis was performed to assess the changes to fire incidents' severity pre- and post-RFR cigarettes regulation. There was an 8% reduction in total fire incidents caused by smokers' materials post-RFR cigarettes regulation. Smokers' materials fire incidents that damaged both contents and structure of the building, where fire flames extended beyond the room of fire origin, with over AUD 1000 monetary damage loss, decreased by 18, 22 and 12%, respectively. RFR cigarettes regulation as a fire risk mitigation has positively impacted the residential fire incident outcomes. This provides support for regulation of fire risk protective measures and bestows some direction for other fire safety policies and regulations.

Comparison of causes, characteristics and consequences of residential fires in social and non-social housing dwellings in New South Wales, Australia

There are over 17,000 residential fire incidents in Australia annually, of which 6,500 occur in New South Wales (NSW). The number of state-provided accommodations for those on low incomes (social housing), is over 437,000 in Australia of which 34% are located in NSW. This study compared causes, characteristics and consequences of residential fires in social and non-social housing in NSW, Australia. This population-based study used linked fire brigade and health service data to identify those who experienced a residential fire incident from 2005 to 2014. Over the study period, 43,707 residential fires were reported, of which 5,073 (11.6%) occurred in social housing properties. Fires in social housing were more likely to occur in apartments (RR 1.85, 95%CI 1.75-1.96), caused by matches and lighters (RR 1.62, 95%CI 1.51-1.74) and smokers' materials (RR 1.51, 95%CI 1.34 - 1.71). The risk of health service utilisation or hospital admission was 16% (RR 1.16, 95%CI 1.04-1.28) and 25% (RR 1.25, 95%CI 1.02-1.51) higher in social housing respectively. Those aged 25-65 were at 40% (RR 1.40, 95%CI 1.14 - 1.73) higher risk of using residential fire-related health services. Almost 88% of social housing properties did not have a functioning fire detector of any type, and 1.2% were equipped with sprinklers. Overall, the risk of residential fire incidents and associated injuries was higher for residents in social housing. Risk mitigation strategies beyond the current provision of smoke alarms are required to reduce the impact of residential fires in social and non-social housing.

Interventions for Preventing Residential Fires in Vulnerable Neighbourhoods and Indigenous Communities: A Systematic Review of the Literature

Globally, residential fires constitute a substantial public health problem, causing major fire-related injury morbidity and mortality. This review examined the literature on residential fire prevention interventions relevant to Indigenous communities and assessed their effectiveness on mitigating fire incidents and their associated human and economic burden. Electronic databases including MEDLINE, EMBASE, CENTRAL, and Web of Science Core Collection were reviewed for studies on fire prevention interventions published after 1990 and based on the 4E’s of injury prevention approaches (Education, Enforcement, Engineering, and Engagement). The grey literature and sources including indigenous organizational websites were also searched for eligible studies. Two authors independently screened, selected, and extracted data, in consultation with experts in the field. Outcomes measured included enhanced safety knowledge and practices, decreased residential fires incidents, reduced fire-related injuries and deaths, and lowered costs for healthcare needs. After removing duplicates, screening titles and abstracts, and assessing full texts, 81 articles were included in this review. Of the included studies, 29.1% implemented educational interventions within a variety of settings, including schools, community centres and homes, and included healthcare professionals and firefighters to raise awareness and the acquisition of fire safety skills. Engineering and environmental modifications were adopted in 20.2% of the studies with increased smoke alarm installations being the leading effective intervention followed by sprinkler inspections. Moreover, engagement of household members in hands-on safety training proved to be effective in enhancing household knowledge, fire safety decisions and practices. More importantly, effective outcomes were obtained when multi-faceted fire safety interventions were adopted, e.g., environmental modification and educational interventions, which together markedly reduced fire incidents and associated injuries. This review reveals the dearth of fire prevention evidence gathered directly within Indigenous communities. Nonetheless, relevant fire prevention recommendations can be made, calling for the adoption of combined and context-sensitive fire prevention interventions tailored to targeted Indigenous and vulnerable communities through multiple approaches and measures. Follow-ups and longitudinal studies are critical for accurate evaluation of the long-term outcomes and impacts on preventing residential fires.

Estimating the Total Number of Residential Fire-Related Incidents and Underreported Residential Fire Incidents in New South Wales, Australia by Using Linked Administrative Data

The rate of fires, and particularly residential fires, is a serious concern in industrialized countries. However, there is considerable uncertainty regarding the reported numbers of residential fire incidents as official figures are based on fires reported to fire response agencies only. This population-based study aims to quantify the total number of residential fire incidents regardless of reporting status. The cohort comprised linked person-level data from Fire and Rescue New South Wales (FRNSW) and health system and death records. It included all persons residing at a residential address in New South Wales, Australia, that experienced a fire between 1 January 2005 and 31 December 2014. The capture-recapture method was used to estimate the underreporting number of residential fire-related incidents. Over the study period, 43,707 residential fire incidents were reported to FRNSW, and there were 2795 residential fire-related health service utilizations, of which 2380 were not reported. Using the capture-recapture method, the total number of residential fire incidents was estimated at 267,815 to 319,719, which is more than six times the official records. This study found that 15% of residential fire incidents that were identified in health administrative dataset were reported. The residential fire incidents that were not reported occurred mainly in socio-economically disadvantaged areas among males and adults.