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Smoke Inhalation and Fires
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Smoke Inhalation and Fires

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According to the National Fire Protection Association smoke inhalation is the number one cause of death from fires. Fifty to eighty percent of all deaths take place because of smoke inhalation, rather tha burns. That being said, in all of the websites, and all of the handouts, and all of the classes about "what to do in case of fire" smoke is rarely, if ever mentioned. I have to wonder if the people who write these advice columns are smoking funny cigarettes. Or get their information on fires from television shows.  In a given fire the degree of smoke may vary, and my experiences are anecdotal and date back many years. The key teaching point is that in heavy smoke:

(a) visability may be absolutely positively ZERO. (b)  you cannot inhale without laryngospasm, causing uncontrolable coughing, if not respiratory arrest.

Heavy smoke is the "bad news bear".

Let's take the case of a forest fire. It has been decades since I fought one. Look at the attached image of the smoke from a fire. Such smoke may entirely obscure a road to such a degree that one cannot drive without running off the shoulder. In America the driver's side can be used to closely follow the curb line. But you will be on the wrong side of the road and likely to have a head-on collision if you keep going. In the case of a building fire, the hallway may be so obscured you can't see your finger held up in front of your nose. In such an envornment one may not be able to exist without a Scott airpack or the equivelant.  In the case of a subway fire (the smoke is especially acrid, especially from electrical fires in transformers or motors), again, visibility may be zero. In many advice columns they tell you to hold your hands on a door to see it it is hot (good advice) and then to "stay low". When that door is opened visibility in the hall may not exist. So here is the advice that may save your life: If at all possible avoid entering areas where smoke is that thick, unless there is no alternative. Under many circumstances it may be best to remain in your hotel room (for example) until fireman arrive to reach you with rescue ladders. Another reason to avoid a high-rise hotel room. In many structures the windows are constructed of glass that resists breaking. And windows may not open fully. Pick up a small end-table, take a run from across the room and smash it into the window like a battering ram while closing your eyes. Have a moistened cloth or towel available to place over your mouth (and that of your children). When in clear air take deep breaths and hold them while you penetrate the smoke-filled hallway. Be prepared for complete disorientation. A flashlight will be useless. You will immediately lose track of direction. Thus, slide your hand continually against a wall to maintain your orientation. This is an excellent reason to insist that every family member familiarize themselves with emergency exists in any hotel or motel or nightclub when they enter.  It will be obvious that any object you hold in your hands or arms from a compute to papers will interfere with your safe evacuation. If encountering heavy smoke DROP THEM. The air will always be better and more friendly to life near the floor.  If with a child have them hold your hand. If two children make a daisy chain. Tell your children to hold their breath. They should expect their eyes to tear and burn. Tell them if they inhale they should expect to cough and gag, but reassure them to continue - that this is normal. Tell them DO NOT STOP. During fire drills have a practice "breath-holding" contest while the children expeditiously walk to the exit. See how far they can walk in this manner. This should convey to them that they should use the closest exit available at all times. The one that is the shortest distance away.

As far as actions after exiting a smoke filled area, oxygen is commonly prescribed. What is needed are emergency aerosolizers of albuterol sulfare, precribed for asthmatic attacks. As far as I know not a single fire unit in the United States carries these and the paramedic units only use them under their protocols for asthmatic attacks. There are few contraindications and the use of albuterol sulfate may save your life. If you are a volunteer fireman fighting a forest fire, you should carry such a prescription inhaler. Afterwards drink plenty of fluids and use an expectorant such as guinefesin tablets to bring up mucus and debri.
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Other side effects include a loss of peripheral vision, judgement, and development of confusion. Years ago I partook in the United States Federal Aviation Agency program to demonstrate the effects of hypoxia on judgement. In the demonstration (available to commercial pilots) up to eighteen people are seated in a chamber and the oxygen concentration is progressively decreased. You are videotaped in the chamber and asked to do simple math problems and answer easy questions. The effects are similar to those of a person exposed to high concentrations of carbon monoxide in a fire. Even though one is convinced at the time you "are normal" a review of the videotapes and audio shows quite conclusively that low oxygen levels (such as experienced at high altitude or in escaping a fire) turn an experienced pilot into a confused bumbling idiot. The lessons learned are that the effects of carbon monoxide (or low oxygen) on judgement, reasoning and coordination are not  always apparant when you are experiencing them. Be prepared in a fire, if exposed to high levels of smoke and carbon monoxide to experience considerable degradation of mental abilities before actually losing consciousness.
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