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, glue, 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 about the treatment of 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 personnel hear often are:
- That 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-products.
- 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 a 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 than waiting for trained professionals to arrive.
- Firstly, the patients need 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, and 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.
