An analysis of the factors implicated in fire deaths in children

The aim of this study was to determine: 1) the factors implicated in fire deaths in children, 2) the relevance of blood carbon monoxide (CO) and hydrogen cyanide (CN) concentrations in child fire victims. 34 child fire victims (17 males: 17 females) were studied. Mean age was 4.5 years. In 12 cases medico-legal autopsies were performed, but no toxicological analyses were done (group A). In 14 cases autopsies were not performed, but blood CO and CN concentrations were measured in the victims (group B). In the remaining 8 cases both toxicological analyses and medicolegal autopsies were done (group C). In 29 cases out of 34, children had been left alone by their parents. In 20 cases out of 34, children had 80% burns of their body surface. In groups A and C autopsies enabled violence or other criminal cause of deaths to be excluded. All victims had smoke inhalation. The mean blood CN concentration in the 22 fire victims (groups B and C) was 70.67 +/- 14.11 micromol/l (0-207). The mean blood CO concentration was 1.89 +/- 0.51 mmol/l (0.11-5.89). There was no significant correlation between CN and the CO blood concentrations. There was no significant correlation between the burn surface area and the blood concentration of either CN or CO. In 11 cases, one or both gases concentrations were in the potential toxic range (CN: 40-<100 micromol/l; CO: 1-<5.8 micromol/l) but below the lethal range. Therefore these deaths were considered to be due to the combined effect of gas toxicity. It is concluded that: 1) In case of fire death, a medico-legal autopsy should be performed to confirm that victims suffered smoke inhalation and to exclude violence or other criminal cause of deaths; 2) Blood CN and CO measurements identify the exact contribution of each to the death; 3) Immediate blood sampling at the scene of death should be done because CN may disappear rapidly from body tissue after death.