Injury caused by fire is the second leading cause of death in the home. No single cause has a greater impact on that statistic than inhalation injury. The presence of an inhalation injury in a fire victim is a larger factor in patient deaths than the amount or severity of the external burns that victim sustains.

There are over 100 toxic substances in fire smoke. Inhaling these toxins cause internal injury that is often hidden or overlooked due to the distraction of more visible burn trauma. It has been estimated that 50-80% of all fire related deaths are caused by smoke inhalation not burns

Symptoms of smoke inhalation can appear immediately or gradually over the first few days following the fire. Aside from obvious burns to facial openings, other symptoms can include vomiting, nausea, confusion, sleeplessness and saliva mixed with soot. An individual with these warning signs must be evaluated by a trained medical professional immediately.

Smoke inhalation injuries create three major categories of complication. An immediate complication is a decrease in oxygen levels in the victim’s tissues. Carbon monoxide instantly binds to hemoglobin in the blood cells. Hemoglobin that carries carbon monoxide can not carry oxygen. By decreasing the amount of oxygen carried in the blood, carbon monoxide poisoning causes tissue damage by hypoxia.

Another immediate complication of smoke inhalation comes from combustibles containing paper, wool, plastics and nylon components among other synthetics. When burned these materials produce cyanide. Cyanide acts in a similar manner to carbon monoxide. Cyanide bonds to ferric ions on the cellular level. This chemical bond blocks metabolism for the individual cells. The result is cellular asphyxiation and death without immediate treatment.

Thermal or heat damage to the upper airway is another common mechanism of injury. Hot gasses within the smoke will char mucous membranes that line air passages in the upper respiratory system. Thermal damage can swell these passages making breathing or clearing obstructions more difficult. Severe damage can cause respiratory failure and then death.

Another major complication is chemical injury to the lungs. Toxic substances in smoke and combustible materials can easily damage lungs. Wheezing and bronchospasms can narrow airways and increase the heart rate. Within a few days, smaller airways will slough off leading to obstruction and pneumonia.

Pulmonary irritation is the final major mechanism of injury to victims of smoke inhalation. Combustion also releases solid chunks of debris or minuscule particles into the air during a fire. These solid bits are then inhaled causing damage to the respiratory system. Inhaled material can physically damage the lungs. The body will also activate its immune system to combat the invasion. The natural inflammatory reaction that occurs can itself cause tissue damage. Increased lymph fluid production in the lungs can lead to respiratory congestion.

Many of the signs and symptoms of smoke inhalation injury are difficult to detect. Treatment by a medical professional after all suspected exposure to smoke inhalation is a prudent course of action. Smoke inhalation injuries are potentially life-long in nature.