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Coroners’ concerns to prevent harms
Emollients and smoking: a fire hazard that could be prevented to reduce future deaths
  1. Maja Karolina Bilip1,
  2. Georgia C Richards2
  1. 1 John Radcliffe Hospital, Oxford, UK
  2. 2 Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
  1. Correspondence to Dr Maja Karolina Bilip, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK; maja.bilip{at}doctors.net.uk

https://doi.org/10.1136/bmjebm-2020-111648

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    Emollients are readily available in prescription and over-the-counter products, and are commonly used in homes and healthcare facilities. These products are not harmful or flammable in isolation, but if they are combined with flames, such as the light of a cigarette, and fabric, they accelerate fires, resulting in burns and deaths. This article describes a prevent future death case report of a 74-year-old woman who succumbed to burns in the presence of paraffin based emollient creams and a lighted match. We highlight the fire risks of such products and the need for greater awareness among the public and healthcare professionals.

    This article is part of the coroners’ concerns to prevent harms series.1 It discusses a prevention of future death report on the fire accelerant properties of emollient products.2

    Products containing emollients, from E45 and Vaseline to Cetraben, are widely available over the counter or by prescription. In the past 12 months (October 2019 to September 2020), more than 15 million items containing emollients were dispensed in England, costing more than £93 million.3 They come in various formulations, including liquids, creams and ointments (box 1), and are used to hydrate the skin. Emollients can contain paraffin, an oily liquid composed of saturated hydrocarbons from petroleum,4 to help form a protective film over the skin and trap moisture. Paraffin is cheaper than alternative agents, such as lanolin or olive oil.5 If their residue on fabric is exposed to fire (eg, from the light of a cigarette or stovetop), emollients (both paraffin free and paraffin based) can act as accelerants to the fire, and have devastating consequences. It was previously thought that the risk of fire was posed only by emollients containing more than 50% paraffin, but it has been acknowledged that the fire risk cannot be excluded …

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    Footnotes

    • Twitter @Richards_G_C

    • Contributors MKB identified the prevent future death case reports, conducted a systematic literature search and wrote the first manuscript draft. GCR submitted the freedom of information request for the data on the number of deaths from emollient related fires and burns, analysed the data, and edited and contributed to the manuscript drafts.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests GCR is financially supported by the National Institute of Health Research (NIHR) School for Primary Care Research (SPCR), the Naji Foundation, and the Rotary Foundation to study for a Doctor of Philosophy (DPhil/PhD) at the University of Oxford. GCR is the editorial registrar of BMJ Evidence-Based Medicine, founded the Coroners’ Concerns to Prevent Harms series and is developing the preventabledeathstracker.net. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

    • Provenance and peer review Not commissioned; externally peer reviewed.