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What’s New in the Patient Safety World

October 2022

Portable Oxygen and Ambulance Fire



A patient died and a paramedic was seriously burned when an ambulance caught fire in a hospital driveway in Honolulu (Adams 2022a). Though the investigation into the accident is still ongoing, preliminary reports suggest that a spark allowed the fire to spread in an oxygen-rich environment. Photos and videos of the event show flames coming from inside the ambulance cabin rather than near the ambulance’s engine (Jedra 2022).


An official said the fire likely started when the patient's source of oxygen was switched to a portable oxygen cylinder (Adams 2022b). It was reported that "there was a sound described as a pop followed by a bright flash of light, with the back of the ambulance was filling with smoke and fire." In the ambulance, prior to the blaze, the patient was using a CPAP device connected to oxygen supplied via the main oxygen tank on the ambulance. The patient was switched to a portable oxygen tank as the ambulance approached the hospital, which is apparently “standard practice”.


Quite frankly, we’re surprised such fires have not occurred more frequently. In the ambulance you often have an oxygen-rich environment confined to a relatively small, closed space. Most patients are not intubated and the oxygen is often administered via face mask, so that oxygen typically leaks into the air. Almost anything that can cause a spark, including defibrillator paddles, could trigger a fire in an oxygen-rich environment.


It turns out that, maybe such ambulance fires are more common than we knew. The Jedra article cites news reports of ambulance fires in recent years in many places, including North Carolina, Massachusetts, Maryland, Mississippi, New York, New Jersey, Texas, Virginia, and more than once in California. Officials have cited engine trouble, electrical issues and other mishaps in those cases. In most of these the cause of the fire was not determined but, in several, oxygen cylinders were said to explode.


In the New York incident, an ambulance that had been idling by a maintenance bay had caught fire, and then tanks of compressed oxygen inside the burning ambulance blew up, sending shrapnel hurtling through the air in a 100-foot radius.


We’ll never know what actually caused the fire in the Hawaii incident. But perhaps the “standard practice” of switching from the ambulance’s oxygen source to a portable oxygen cylinder might need to be reviewed. Maybe the oxygen cylinder would be better accessed outside the ambulance. However, the Hawaii incident should lead to all organizations operating ambulances (including air ambulances) to assess their risks and vulnerabilities with regard to oxygen and oxygen cylinders.






Adams A. Patient Dies, Paramedic Seriously Hurt After Ambulance Mysteriously Catches Fire in Hospital Driveway. At a Wednesday night press conference, an official said the ambulance "possibly" exploded. People 2022; Published on August 25, 2022



Jedra C. Oxygen Tanks May Have Caused Honolulu Ambulance Fire to Spread Faster, Experts Say. Honolulu Civil Beat 2022; September 2, 2022


Adams A. Portable Oxygen Tank Likely Caused Ambulance Fire Outside Hospital That Killed Patient. Yahoo News 2022; September 16, 2022







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