Fire

Definition
Fire is defined as a rapid oxidation process with the evolution of heat and light.
Fatalities
In 2005, there were 3,197 accidental exposures to smoke, fire, and flames
(ICD-10 code: X00–X09) in the United States. Table 7.26 shows a breakdown
of these deaths by sex and race that year.
Fundamentals of Deaths by Fire
Four components are required for a fire: fuel, oxygen, heat, and an uninhibited
chemical reaction.
Fuel can be any substance that will burn or support • combustion and
can take the shape of a solid, such as wood; a liquid, such as gasoline;
or a gaseous vapor, such as natural gas. Note that the fuel can only
be volatilized in the vapor state; therefore, when wood burns, the
burning takes place at the surface of the wood where the vapors are
created by heat and ignited.
• Oxygen acts as the oxidizing agent required to support combustion.
• Heat is required to increase the temperature of the fuel in the presence
of oxygen to cause ignition. Heat is the energy possessed by
Table 7.26 Fire Deaths by Total Number, Sex, and Race, United States, 2005
Total Male Female White Black
3,197 1,886 1,311 2,351 746
Accidental Deaths 147
a material due to its molecular activity. The five types of heat production
are chemical, mechanical, electrical, compressed gas, and
nuclear.
The last condition for a fire is a chemical reaction • that must be continuously
and precisely reproduced to maintain combustion. This
reaction must contain the oxidation reaction producing sufficient
heat to maintain continuous oxidation, the fuel mass must be broken
down and liberated (vaporized) from the mass itself, and the vapors
must combine with the oxygen.
The causes of deaths associated with a fire are smoke inhalation and
burns. The manner of death can be accidental, suicide (self-immolation), or
homicide (arson). The most common causes of accidental fire death are associated
with smoking, cooking, candles, and electrical malfunctions. The role
of the death investigator in fire-related deaths is to work closely with the fire
marshal and police arson teams to ascertain whether the origin of the fire
was accidental or deliberate (suicide or homicide). The forensic autopsy is
conducted in the same manner regardless of preliminary opinions as to the
cause of the fire, and all fires are treated as suspicious. The external examination
of the body would note the types of burns (first, second, and third
degree), the location of the burns, and the percentage of the body burned
based on the rules of nines (explained later). Body fluid would also be collected
in the standard manner.
A critical medicolegal question involved in fire deaths is whether the
victim was alive or dead when the fire started. To make this determination,
the airway of the victim is carefully examined. If the victim was alive when
the fire started and failed to exit the structure because he or she was overcome
by smoke or suffered a cardiac event, the victim would have inhaled
the smoke and other gases in the atmosphere. An examination of the airway
would reveal soot deposited in the nostrils, mouth, larynx, trachea, and
bronchi. Caution should be taken because an absence of this feature is not
a proof-positive indication that the victim was dead at the start of the fire;
a toxicological analysis of the blood should be conducted. Analysis of the
blood would be positive for carbon monoxide and possibly other airborne
compounds such as cyanide, commonly given off by burning furniture and
some flooring materials. If, on the other hand, the victim was already dead
when the fire started and the fire was used to conceal a homicide, an examination
of the airway would show no soot and analysis of the blood would be
negative for carbon monoxide.
148 Forensic Epidemiology
Mechanisms
The two main mechanisms of death associated with a fire are burns and
smoke inhalation. A less common mechanism is blunt force trauma (BFT)
caused by falling debris.
Burns are caused by the body coming into contact with a hot surface over
70°C and may be classified into first, second, and third degree. The determination
is based on the depth of the burns in the skin. First-degree burns
are superficial burns similar to sunburn. Second-degree burns are deeper
(partial thickness) and are characterized by the formation of blisters. Thirddegree
burns are deep (full thickness) with destruction of the epidermis and
dermis. The extent of burns to the body is determined by using the “rules of
nines.” This rule states that the head is 9%, the upper extremities are 9% each,
the front of the torso is 18%, the back is 18%, each lower extremity is 18%,
and the perineum is 1%. The calculation of the total body burned is by adding
up all the surfaces with burn injuries.
Individuals that die in a fire may not display visible external injuries;
in these cases the cause of death is by smoke inhalation. During a fire, the
atmosphere contains carbon monoxide (CO), cyanide, and other toxic gases.
The classic signs of CO poisoning are a cherry-red coloration of the muscles,
internal organs, and blood. Carbon monoxide is a colorless, odorless, tasteless
toxic gas produced as a by-product of combustion. The sources of this
gas include fires, fireplaces, gas stoves, and automobile exhaust. The medical
effects of CO inhibit the hemoglobin of the red blood cell from binding with
oxygen. The symptoms of concentrations of CO are shown in Table 7.27.
Death from fire can be immediate or delayed. Immediate deaths are
caused by direct thermal injury caused by burns to the body or from smoke
inhalation. Deaths that occur days after the fire (delayed deaths) are the result
of shock, fluid loss, or acute respiratory failure caused by inhalation of gases
that injured the respiratory system. Deaths occurring several weeks after the
event are caused by sepsis or chronic respiratory insufficiency.
Table 7.27 Carbon Monoxide Concentration and Its Effects on
the Body
Concentration Symptoms and medical effects
10% None (heavy smokers can have a CO concentration ~ 9%
15% Mild headache
25% Nausea, severe headache
30% Symptoms intensify
45% Unconsciousness
50%+ Death
Accidental Deaths 149
Forensic Epidemiological Investigation of Fires
Forensic epidemiologists investigating fire deaths should begin by collecting
the data listed in Table 7.28. The investigation of fire deaths can be conducted
on four levels: basic epidemiological characteristics, cause of the fire, cause
of death, and the roles of drugs or pre-existing medical conditions in the
deaths. In addition, data collected on fire fatalities can also highlight risk
factors that could prevent future deaths.
The annual number of fire-related fatalities and a profile of these victims
by age, sex, and race are essential to illustrate the population most likely to
die in an accidental fire. Table 7.29 shows the total number of fire fatalities
Table 7.28 Basic Forensic Epidemiological Data
Used in Investigation of Death Involving Fire
Characteristic Variables
Basic epidemiological features Age
Sex
Race
Location of incident Residence:
Occupied
Vacant
Business
Vehicle
Time/date of incident
Place of death Scene
Residence
Hospital
Smoke detectors Installed and operating
Installed but not
operating
None
Origin Location of start of fire
Cause Electrical
Cooking
Smoking
Matches
Total amount of body burned %
Survival time
Table 7.29 Accidental Deaths from Fire, Allegheny County,
1998–2005
1998 1999 2000 2001 2002 2003 2004 2005
Number of cases 21 17 10 17 14 12 17 15
150 Forensic Epidemiology
covering an 8-year period. To place this number into perspective, the number
of fire deaths in other locations of similar demographics would be required.
The profile of the fire victims in 2005 is shown in Table 7.30. The victims
ranged in age from 15 to 89 and the majority was white males. Because of
the small number of cases, several years of data should be used to gain a
better representation of the fatalities. Once this larger population has been
obtained, the cause of the fire can be described within each age grouping.
Questions to ask include whether the causes of fires are a function of age.
The forensic epidemiologist can also examine the time and month of
the fires. The time that the fire started is an important piece of information
because it can be used to explain, for example, why individuals may have
failed to escape. A 5-year analysis of the time a fire started (Table 7.31) clearly
shows that the majority of fires occurred between midnight and 6:00 am.
Typically, during these times, individuals are sleeping and may be disorientated
upon waking due to the smoke, pass out from the carbon monoxide levels,
or suffer a cardiac event in an attempt to flee the house. The month that
Table 7.30 Accidental Deaths from Fire by Age, Sex, and Race,
Allegheny County, 2005
Age White male White female Black male Black female Total
15–19 1 — — — 1
35–39 1 — — — 1
40–44 2 — — — 2
45–49 3 1 — — 4
55–59 1 — — — 1
60–65 — — 2 — 2
75–79 1 1 — — 2
80–84 — — 1 — 1
85–89 — — — 1 1
Total 9 2 3 1 15
Table 7.31 Number of Deaths from Fire
during Different Time Periods, Allegheny
County, 2001–2005
Time 2001 2002 2003 2004 2005
0000–0600 5 5 2 5 7
0601–0900 — 1 — 3 3
0901–1200 5 4 — 1 2
1201–1600 6 1 4 1 1
1601–2000 — 2 1 4 2
2001–2400 1 1 5 3 —
Total 17 14 12 17 15
Accidental Deaths 151
the fire occurred can be an indication of the cause of the fire. Fires in the cold
winter months can be related to the use of a fireplace, candles, or electrical
overload. This is supported by data shown in Table 7.32, which indicate that
the majority of fires occurred in the colder months. Important comparisons
could include the time, cause versus month, and cause of the fire.
The role of the ME/C office is to determine the cause and manner of
death; the office often relies on the skills of outside agencies to assist them in
this duty. In most fires, the fire marshal’s office will conduct an independent
investigation of the fire to determine its cause and its point of origination, and
will rule as to the type of fire. The reports also note the number, location, and
level of operation of smoke detectors within the residence. The fire marshal’s
Table 7.32 Number of Deaths Occurring Each
Month, Allegheny County, 2001–2005
Month 2001 2002 2003 2004 2005
January — 1 1 6 3
February — 5 1 1 3
March 3 1 — 4 1
April 1 1 1 2 —
May 4 — 2 — 4
June — — 4 — —
July 2 — — 2 2
August 2 1 1 — —
September 2 2 1 — —
October — — — — —
November — 1 — 1 —
December 3 2 1 1 2
Total 17 14 12 17 15
Table 7.33 Source of Fire, Allegheny County,
2001–2005
Activity 2001 2002 2003 2004 2005
Cooking 5 2 2 2 3
Smoking 4 4 2 2 5
Electrical malfunction 2 1 3 3 1
Driving 1 — 1 1 —
Oxygen tank — — — — 2
Heater — — — — 1
Fire for warmth — 1 — — 2
Candle — — 2 1 —
Unknown 5 6 2 8 1
Total 17 14 12 17 15
152 Forensic Epidemiology
office can rule the fire as accident, arson, or cause unknown. Table 7.33 shows
the causes of fires in Allegheny County between 2001 and 2005. The two
most common causes were associated with smoking and cooking.
Forensic epidemiological research can classify house fires into preventable
and nonpreventable. Preventable fires are those associated with
behaviors or activities that increase the risk for a fire, such as smoking, unsupervised
cooking, using candles, and unsafe use of heaters and fireplaces.
Nonpreventable fires are typically associated with unseen risks such as poor
wiring and malfunctioning electrical equipment. Based on the information
from the fire marshal’s report, residential fires can be separated by the operating
level of the smoke detectors into (1) none, (2) present but nonoperational,
or (3) present and operational.
Advantages and Limitations of Forensic
Epidemiological Investigation of Fires
The main advantage of forensic epidemiological investigation of deaths
involving fire is that these types of deaths undergo several types of independent
investigation, including the ME/C office, the fire marshal’s office, and
the police. The forensic investigation of the body provides information on the
effects of fire and smoke inhalation upon the body and the toxicological analysis
provides the chemicals released into the atmosphere and inhaled by the
victims. The limitation of investigating fires is minimal; the main limitation
is that, in a number of fires, the cause of the fire remains undetermined.