Learning from the past: Following April fire, Nevada embraces new preventative measures
The Nevada Fire Department is hopeful that enhanced safety regulations for private oxygen use can save lives.
A fatal house fire caused by an oxygen tank and cigarettes inspired the Nevada Public Safety Department to pursue thermal fuses, a safety device meant to reduce a fire's intensity for patients on oxygen.
Nevada fire chief Ray Reynolds believes thermal fuses are the solution the entire country has been waiting for. In a previous Ames Tribune interview, Reynolds said that many fires in Nevada are caused by residents who smoke during oxygen treatments. He said it threatens the community and those fighting the fires.
Mandated thermal fuses could drastically lower the chance of fatality.
“This is monumental news for Iowans and the rest of the nation," Reynolds said. "Our fire department is leading efforts in Iowa and in the U.S. to get Medicare and the private insurance industry to follow suit. People are being injured and dying in oxygen-rich fires as a result of home oxygen use.”Reynolds said oxygen tanks have been key in Nevada's two most recent fire fatalities. A fatal fire in April 2022 was also caused by complications with an oxygen tank.
Iowa's Department of Health and Human Services is the first federal organization in the country to distribute an informational letter on the cost of thermal fuses for Medicaid patients.
Iowa Medicaid has sent guidance to home medical equipment suppliers as well and they also offer reimbursement for installation.
The Department of Veterans Affairs implemented a thermal fuse mandate for all veterans who are prescribed home oxygen.
What is a thermal fuse?
Thermal fusers are bidirectional valves placed at the oxygen concentrator and in the oxygen tubing near the patient. The flow of oxygen is stopped when the fire reaches the device, reducing the intensity of the fire.
In their research, Reynolds and the Nevada Fire Department discovered thermal fuses were common in many European nations and were mandated in the United Kingdom.
Between 2019 and 2021 across 40 states, Reynolds said, 256 fires were caused by smokers who also had access to private oxygen tanks. Of those fires, 152 led to death and 77 homes were destroyed.
Compare that, Reynolds said, to a five-year span in the United Kingdom where Firesafe Thermal Shut-off Valves are legally required on oxygen tanks. Only a single fire-related fatality caused by an in-home oxygen tank was reported from 2013-2018.
"Since they have mandated it, in a five-year period they've had one fatality," Reynolds said. "That is significant."
The Nevada Fire Department was captivated by the low overhead of a thermal fuse as well, which costs $4.45.
"Medicare could've paid $4.45 times two, because you put one at the concentrator − which is the source of oxygen production − and then you put one on the cannula, closest to the patient," Reynolds said. "I thought, 'For under $9 we probably could have reduced the significance of this fire.' We still would've had a fire, but it wouldn't have been fueled by an oxygen concentrator pumping oxygen in the room."
The individuals injured in April's fire were Medicare recipients. Medicare ended up paying $1.2 million for the fire, Reynolds said.
In 2018, the Department of Veteran Affairs adopted mandatory use of thermal fuses for patients receiving home oxygen therapy. The local fire department was motivated to approach other state agencies as well, including the Department of Health and Human Services, Medicaid and Medicare.
"My position was, if one federal agency says it's good enough, how come the other federal agencies doesn't adopt the same thing?" Reynolds said." We've been seeing the need for this; it just takes initiative to do it."
Nevada learns from two home oxygen fires
Nevada's most recent fatality was at 710 South 11th Street, in three 10-plex apartment buildings. An investigation revealed the fire was caused by smoking while a home oxygen concentrator was in use.
Two other individuals suffered severe burns from the waist up. With the help of security and officer body cameras, Reynolds said firefighters could see the fire unfold.
"When that fire took off, it really opened my eyes to the danger," Reynolds said.
The 2022 fire was at a mobile home with a resident who had been living dependent on oxygen for several years. Reynolds remembers the department visiting her house many times for medical and respiratory reasons. His crew warned her about smoking while on oxygen and how it could ignite a fire.
The woman passed away 24 hours after the fire.
More: Oxygen tanks can cause house fires. One Iowa fire chief is working to reduce that threat.
Fire department offers knowledge at the state level
The Nevada fire chief initially didn't know much about home oxygen fires. Reynolds often heard of other horrific fires while serving on the board of the International Association of Fire Chiefs.
Determined to find a solution, Reynolds and his team pursued the possibility of thermal fuses. Given their low cost and federal agency approval, the Nevada Fire Department was eager to bring their solution to the state level.
"When we approached (the state of Iowa) with the project they were all over it," Reynolds said. "Within a matter of 30 days they were pushing out guidance and said we'll pay for safety equipment, because it means saving lives in Iowa."
Iowa Medicaid has become the first in the nation to adopt a program to reimburse for thermal fuses. But the Nevada Fire Department is far from done. Their next goal is to get Medicare to follow the VA and adopt mandatory use.
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What is Medicare's role with oxygen tanks?
Medicare is a federal system of health insurance for people over 65 years of age and for certain younger citizens with disabilities.
Initially, if someone with Medicare were on oxygen, they would receive $185 worth of products, including cannula and oxygen supplies. In 2013, Medicare renegotiated to reduce the amount to $85.
The Nevada Fire Department has approached Medicare about thermal fuse reimbursement. Reynolds said it was important to get Medicare on board, insisting the agency would make good on the investment.
"If Medicare were to make this $9 decision out of all the things they pay money for, it would return on its investment quite easily," Reynolds said. "Our one fire was $1.2 million; Medicare would spend under $9 to put these safety features and reduce fires by 12% in the country."
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Improving mental health
The regularity of local fires has had a negative impact on Nevada's department.
One of Nevada's firefighters left the staff after a home oxygen fire in November of 2022. The first responder felt the job was too much. Another firefighter suffered from post-traumatic stress and was suicidal after pulling a burning person out of a building.
The most dangerous thing a firefighter has to deal with is knowing someone is trapped inside a burning building, Reynolds said.
"The mental health aspects of what we ask volunteer firefighters 18 years of age to do is something I feel responsible for doing my part to stop," Reynolds said. "We take extreme risks and put our people in extreme risks for the potential chance of saving someone's life. For me, I feel like it's a firefighter safety initiative if we can get a reduction in these home fires and prevent people from being burnt."
Rather than focusing on smoking habits, the Nevada Fire Department is attempting to make a positive change and reduce the deadly impact of home oxygen fires, thereby protecting its community and its firefighters.
Ultimately, Reynolds said an innovative fire department is always better than a reactive one.
"At the end of the day, you should want people to not have fires and have their lives destroyed," Reynolds said. "I tell everybody, 'Fire is not important until it happens to you. Then it's the most important thing in your life."
Celia Brocker is a government, crime, political and education reporter for the Ames Tribune. She can be reached at CBrocker@gannett.com.
This article originally appeared on Ames Tribune: Nevada Fire Department adopts safety measures after fatal oxygen fire
