ESTABLISHING A RELATIONSHIP BETWEEN ALCOHOL AND CASUALTIES OF FIRE 

Federal Emergency Management Agency 
United States Fire Administration 
National Fire Data Center 

This publication was produced under contract by TriData Corporation for the 
United States Fire Administration, Federal Emergency Management Agency. Any 
information, findings, conclusions, or recommendations expressed in this 
publication do not necessarily reflect the views of the Federal Emergency 
Management Agency or the United States Fire Administration. 

Federal Emergency Management Agency 
United States Fire Administration 
National Fire Data Center 

ESTABLISHING A RELATIONSHIP BETWEEN ALCOHOL AND CASUALTIES OF FIRE 

Prepared by: 
TriData Corporation 
1000 Wilson Boulevard 
Arlington, Virginia 22209 
October 1999 

TABLE OF CONTENTS 

I. EXECUTIVE SUMMARY........ 1 
II.INTRODUCTION.......... 3 
III. ALCOHOL'S PHYSIOLOGIC EFFECTS.......... 7 
IV. ALCOHOL'S INVOLVEMENT IN UNINTENTIONAL INJURIES AND FIRE CASUALTIES. 9 
ALCOHOL AND UNINTENTIONAL INJURIES ...... 9 
ALCOHOL AND FIRE CASUALTIES............. 10 
ALCOHOL AND BURNS .......... 11 
ALCOHOL AND SMOKE INHALATION ..... 13 
V. ALCOHOL, UNINTENTIONAL INJURIES, AND FIRE CASUALTIES.... 14 
ALCOHOL AND ALCOHOL'S ROLE IN INJURY..... 14 
Drinking Patterns ....... 14 
Alcohol's Role in Unintentional Injury........ 15 
Caretakers Under the Influence............ 16 
Gender Effects........ 17 
LEADING CAUSES OF FIRE CASUALTIES .......... 19 
Smoking ......... 19 
Arson............... 21 
INTERNATIONAL STUDIES ....... 22 
VII. SMOKE ALARMS AND THE ALCOHOL-IMPAIRED FIRE CASUALTY..... 24 
VIII. CASE STUDY: RESULTS FROM THE ONTARIO FIRE REPORTING SYSTEM... 25 
BACKGROUND....... 25 
FIRE CASUALTIES.......... 25 
DEMOGRAPHICS OF FIRE CASUALTIES ...... 26 
Age........ 26 
Gender ....... 29 
CAUSES OF FIRE CASUALTIES ......... 30 
ALCOHOL CONSUMPTION AND DRINKING PATTERNS ... 32 
UNINTENTIONAL INJURY DEATHS..... 32 
IX. CASE STUDY: FIRE FATALITIES IN MINNESOTA ..... 34 
BACKGROUND ....... 34 
FIRE FATALITIES ...... 34 
DEMOGRAPHICS OF FIRE FATALITIES ..... 35 
Age....... 35 
Gender ..... 37 
FIRE FATALITY CAUSES ...... 38 
ALCOHOL CONSUMPTION AND DRINKING PATTERNS .. 39 
UNINTENTIONAL INJURY DEATHS......... 39 
X. CONCLUSION.................. 40 

Establishing a Relationship Between Alcohol and Casualties of Fire 1 

I. EXECUTIVE SUMMARY 

Though the rate has significantly decreased, the United States continued into 
the late 90's with one of the highest fire death rates in the industrialized 
world. Given the advancements in fire prevention, including public education, 
building design, consumer product safety, and sophisticated levels of the fire 
protection in this country, it is puzzling 
to many as to why this is so. In an effort to identify the underlying problem( 
s), researchers have been delving deeper into the extent to which human behavior 
affects our fire losses. 

The connection between alcohol and the ignition, detection, and escape from the 
fire has been broadly examined by numerous medical and fire protection 
organization studies. A series of landmark studies undertaken by the Johns 
Hopkins University and the National Bureau of Standards in the 1970's were among 
the first to discover a definitive link between alcohol consumption and fire 
deaths. Many studies have now confirmed their general findings. 

Alcohol intoxication may increase the risk of initiating a fire by impairing 
one's judgment and coordination. An intoxicated individual who is smoking may 
also succumb to the depressant effects of alcohol, fall asleep and drop a lit 
cigarette on upholstery or clothing. Intoxication also acutely diminishes one's 
ability to detect a fire. Under the sedative effects of alcohol, an alcohol-
impaired person may fail to notice the smell of smoke, or fail to hear a smoke 
alarm. Escape from a fire can be hampered by the loss of motor coordination and 
mental clarity caused by alcohol, even when warning signs are heeded. 
Furthermore, burns are more physiologically damaging in the presence of alcohol. 

Several researchers have found that about half of all adult fire fatalities were 
under the influence of alcohol at the time of the fire. Men have been found to 
consistently outnumber women among fire casualties and do so with even greater 
disparity for fire victims under the influence of alcohol. In addition, the 
younger adult population (ages 15 to 34) seems to incur the greatest number of 
alcohol-impaired fire casualties. Drinking behaviors that are characteristic of 
various age groups and sexes may explain these findings. 

Establishing a Relationship Between Alcohol and Casualties of Fire 2 

Studies have also provided conclusive evidence supporting the deleterious 
effects of chronic and acute alcohol abuse on the occurrence and recovery from 
burn injuries. Burn injury victims have been found to be disproportionately 
likely to have been intoxicated at the time of injury or known to be heavy 
drinkers. From a physiological standpoint, burn victims with histories of 
alcoholism tend to have longer hospital stays, more complications, and higher 
mortality rates as a result of their burns. 

Questions still remain as to the extent that alcohol affects fire losses. How do 
we explain the fact that some industrialized countries with some of the highest 
alcohol consumption rates per capita, e. g. Germany and the Netherlands, have 
relatively low fire death rates? Researchers have suggested that alcohol-related 
unintentional injuries have more to do with alcohol drinking patterns than the 
total amount of alcohol consumed per capita. Who drinks, where they drink, what 
they drink, and under what social, cultural, and religious circumstances they 
drink are perhaps more significant factors than the amount of alcohol consumed. 
A lone drinker at home is probably at greater risk of a fire emergency than a 
group of people drinking at a bar or restaurant. Moreover, the number of drinks 
consumed in a single sitting seems to matter a great deal. 

Alcoholics have a disproportionately high rate of fire fatalities relative to 
their percentage of the total population. Non-intoxicated fire victims also may 
be affected by alcohol: they may have been entrusted to the care of an alcohol-
impaired individual. These fire fatalities would not be reported as related to 
alcohol when blood alcohol levels (BALs) are taken of victims only. As a result, 
the estimated number of alcohol-related fire casualties as well as the magnitude 
of the problem may be underestimated. 

Smoking fires are the leading cause of fire fatalities. The incidence of such 
fatal fires is higher among those who are under the influence of alcohol and 
most smoking-related fire fatalities have some connection to alcohol 
consumption. 

In summary, there is a clear connection of alcohol and fire fatalities. Unlike 
the connection between alcohol consumption and vehicle fatalities, the 
connection is not often referred to in prevention programs, nor has much been 
done to address the problem. 

Establishing a Relationship Between Alcohol and Casualties of Fire 3 

II. INTRODUCTION 

Alcohol consumption plays a key role in American society. It is heavily embedded 
in our social framework and tied to many of our traditions. Every socio-economic 
class and race consumes alcohol. It is heavily advertised, readily available and 
is produced in a multitude of forms at a variety of costs. Yet, the negative 
impact of alcohol on the nation may be more devastating than any other 
substance. It is centrally related to a number of persistent threats to public 
health. These include unintentional injuries such as burns, falls, drownings, 
and motor vehicle crashes; violent crimes such as rape, homicide, and arson; 
chronic diseases such as cancer, enteric disease, and cardiovascular disease; 
and social problems such as unintended pregnancies, the promulgation of sexually 
transmitted diseases, child neglect, "failed" marriages, and homelessness. 

Numerous studies have shown the deleterious effects of alcohol on cognitive and 
physical functions. 1,2 Alcohol affects judgment, balance and motor 
coordination, all of which lead to an increased rate of unintentional injury. 3 
Many of the studies produced on the relationship between injury and alcohol 
impairment focus on injuries that result from motor vehicle crashes. Motor 
vehicle crashes are the leading cause of fatal injuries in the United States. 4 
Even now, alcohol has been found to be involved in 40 percent of all motor 
vehicle fatalities. 5 This reality drives nationwide research and prevention 
efforts focusing on the role alcohol plays in these events. 

1 P. F. Waller, J. R. Stewart, A. R. Hansen, J. C. Stutts, C. L. Popkin and E. 
A. Rodgman. "The Potentiating Effects of Alcohol on Driver Injury." Journal of 
the American Medical Association. 1986. Sep 19; 256( 11): 1461-6 2 C. J. 
Cherpitel. "The Epidemiology of Alcohol Related Trauma." Alcohol, Health and 
Research World. 1992. 16( 3): 191-196.
3 P. F. Waller, J. R. Stewart, A. R. Hansen, J. C. Stutts, C. L. Popkin and E. 
A. Rodgman. "The Potentiating Effects of Alcohol on Driver Injury." Journal of 
the American Medical Association. 1986. Sep 19; 256( 11): 1461-6 4 Centers for 
Disease Control and Prevention. "Report of Final Mortality Statistics - 1995." 
Monthly Vital Statistics Report. 1997. Jun 12: 45( 11) S2: 1-33. 
5 "Traffic Safety Facts 1995: Alcohol," National Highway Traffic Safety 
Administration, National Center for Statistics & Analysis, 1996. 

Establishing a Relationship Between Alcohol and Casualties of Fire 4 

Fire, the fifth leading cause of unintentional deaths in the United States, 
causes between 4,000 and 5,000 lives and billions in property damage each year. 
6 It is estimated that, like motor vehicle crashes, alcohol is involved in over 
40 percent of all residential fire deaths. 7 Yet there is not a national 
initiative to address this problem. 

It, too, is estimated that alcohol is involved in 40 percent of all residential 
fire deaths. 8 There is, however, no equivalent and comprehensive body of 
research for the relationship between alcohol and fire. A myriad of research 
exists when relating alcohol use and vehicular accidents, homicide, and suicide, 
but not for fires. For this reason, it may appear that alcohol is less related 
to the incidence of fire when compared to other unintentional injuries than it 
really is. 

This lack of a national prevention and education campaign may be related to 
several significant obstacles hindering researchers' attempts to quantify the 
relationship between fire and alcohol use on a large scale. There is no 
nationwide attempt to collect baseline epidemiological data concerning pre-
existing medical conditions or impairments present in the fatal fire casualty. 
Such an endeavor would demand closer collaboration between fire departments, 
fire investigators, pathologists, toxicologists and statisticians than current 
convention allows. Spot studies with a wide variety of time frames, sample 
sizes, and lack of controls have been the hallmark of studies examining alcohol 
and fires, not a sustained national data collection as exists for vehicle 
accidents. 

Alcohol impairment has been one of the data items requested by the National Fire 
Incident Reporting System (NFIRS) in reporting the condition of a fire victim, 
but this information is not routinely reported by participating fire 
departments. Fire departments and investigators tend to be reluctant to record 
alcohol abuse by those who cause or are injured by fires. The reasoning behind 
their reluctance has ranged from a humanitarian concern for the victims of fire 
and their loved ones already suffering from the effects of a fire to a lack of 
training and authorization to test people for alcohol or drugs. In addition, 
there is the potential for legal ramifications concerning wrongful accusations 
about intoxication. 

6 U. S. Fire Administration, Fire in the United States: 1987-1996, Eleventh 
Edition, FA-173/ August 1999, (Emmitsburg, MD: U. S. Fire Administration). 7 S. 
W. Marshall, C. W. Runyan, et al. "Fatal Residential Fire: Who Dies and Who 
Survives?" The Journal of the American Medical Association. 279( 20): 1633-1637, 
May 1998. 

Establishing a Relationship Between Alcohol and Casualties of Fire 5 

Data from independent studies have proven difficult to compare due to the 
variation in the definition of alcohol-impairment and in measurements made of 
BALs. 9 In other cases, the sample size is simply too small to derive any 
statistical significance in itself, but is still suggestive of a pattern. 
Without full cooperation and standardized techniques for data collection, it is 
difficult to perform an in-depth and integrated study into the involvement of 
alcohol and fires. 

Much of what we now know about alcohol's involvement in fires has stemmed from 
medical literature and research rather than fire research, with two large 
exceptions: The Johns Hopkins and Minnesota studies, which will be discussed in 
the body of the report. The results of such studies are limited and precarious 
for a number of reasons. Medical studies have traditionally been sporadic and 
usually confined to a city's or state's medical records. In addition, not all 
burn centers routinely screen their burn or fire-related injury patients for 
alcohol use, so the number of missed patients varies greatly. 

Medical scientists have addressed the issue of alcohol's relation to injuries 
caused by fires in many small-scale studies. By examining data from both burn 
centers and emergency departments a clear pattern has emerged. Alcohol use is 
associated with injury by fire. Unfortunately, without the integration of on-
scene data, specifically the origins of particular fires, the activities of the 
injured at the time of the fire and their proximity to the point of ignition, 
the medical studies paint only half of a picture. There is no solid data on the 
mechanism by which alcohol is associated with fire injury. 

The number of studies that examine the relationship between alcohol use and 
fires is increasing. Evidence exists that portrays alcohol's detrimental effects 
on fire losses and both human and property terms. People who use and abuse 
alcohol are being identified as a growing high-risk fire group that must be 
targeted by prevention efforts. 

This report examines fire and alcohol studies performed by medical scientists, 
fire investigators, and social theorists. The physiological effects of long and 
short-term alcohol use are described. Alcohol's effect on behavior and its role 
in unintentional injuries is examined. The demographics of alcohol use and abuse 
as well as societal 

8 Ibid. 

Establishing a Relationship Between Alcohol and Casualties of Fire 6 

factors influencing alcohol use are noted. Caretakers who are under the 
influence of alcohol are also studied in regards to how their impairment may 
affect a dependent individual. 

The demographics of fire and fire fatalities are described. The leading causes 
of fire fatalities are also discussed, specifically how and to what extent they 
are affected by alcohol. The influence of alcohol in these fatal fire events is 
examined. 

It is the intent of this report to: 

  Identify patterns and trends in alcohol use and fire casualties. 
  Summarize the existing quantitative data on the involvement of alcohol in fire 
deaths. 
  Summarize the impact of socio-economic and demographic variables on alcohol 
use and fire casualties. 
  Identify those who are most affected by alcohol's involvement in fires. 
  Analyze two case studies from Ontario and Minnesota to provide further input 
concerning the question of alcohol use and fire. 
  Demonstrate the need for public awareness and education on the role of alcohol 
use in fatal fires. 

9 Blood alcohol level, also known as blood alcohol concentration, is the amount 
of alcohol in the blood. It is usually expressed in g/ dl. The National Highway 
Transportation Safety Administration considers fatal vehicle crashes as alcohol-
related if the individuals involved have BALs greater than .01g/ dl. 

Establishing a Relationship Between Alcohol and Casualties of Fire 7 

III. ALCOHOL'S PHYSIOLOGIC EFFECTS 

Alcohol affects the incidence and severity of unintentional injuries in a 
variety of ways. Alcohol depresses the central nervous system, potentially to 
the point of stupor, coma, and death. Individuals who consume large quantities 
of alcohol experience disordered thought patterns, impaired judgment, impaired 
perception, and a decrease in generalized motor control. As blood alcohol 
concentration increases in the body, alcohol's depressive effects are more 
prominent. The effects of alcohol are proportionately related to the 
concentration of alcohol in the blood, which vary from person to person 
depending on numerous individual characteristics. 

Ethanol (ethyl alcohol) or "grain alcohol" is found in distilled spirits, wine, 
and beer. It is the agent responsible for the physiologic effects of alcoholic 
beverages. Ethanol is the most commonly used mood-altering drug in the United 
States. 

When ingested, ethanol is absorbed into the blood stream unaltered in the 
stomach and upper digestive system. Fatty foods and/ or milk can slow this 
absorption. As it is absorbed, ethanol is distributed to all bodily tissues and 
fluids in the same concentration as it is in blood. For this reason blood 
ethanol level tests (reported in mg/ dl) are used to medically define the degree 
of intoxication. The drinker's size, sex, body build, and metabolism all 
influence blood alcohol concentration and subsequently the degree of 
intoxication. In time, ninety percent of the ingested ethanol reaches the liver 
where it is metabolized. The remaining ten percent is excreted unchanged in 
breath, perspiration, and urine. 10 

In the central nervous system, alcohol acts directly as a depressant. At low 
levels it results in motor coordination dysfunction and intellectual confusion. 
As judgment becomes impaired, the user may appear giddy, act excited, or become 
aggressive. This is a result of depression of inhibitions and impaired reasoning 
ability. The motor and intellectual effects become more pronounced as the level 
of alcohol in the blood stream is increased. 11 

10 K. L. McCance and S. E. Huether. Pathophysiology: The Biologic Basis for 
Disease in Adults and Children. 1994. St. Louis, MO: Mosby. Pp 62-3. 
11 K. L. McCance and S. E. Huether. Pathophysiology: The Biologic Basis for 
Disease in Adults and Children. 1994. St. Louis, MO: Mosby. Pp 62-3. 

Establishing a Relationship Between Alcohol and Casualties of Fire 8 

At higher blood concentration levels, respiration becomes affected. If these 
effects become pronounced due to increasing blood ethanol concentrations (at 
about 400 mg/ dl or 0.40 percent BAL) or persist for a long period, the user can 
become comatose or die. 12 

Chronic alcohol use is responsible for pathophysiologic changes in almost every 
tissue in the body. Chronic alcohol use is related to an increased tendency 
toward hypertension, higher incidence of acute and chronic pancreatitis, 
regressive changes in skeletal muscle, and cirrhosis. 13 Research shows that 
chronic alcohol users have significantly shortened lifespans. 14 

12 K. L. McCance and S. E. Huether. Pathophysiology: The Biologic Basis for 
Disease in Adults and Children. 1994. St. Louis, MO: Mosby. Pp 62-3. 
13 K. L. McCance and S. E. Huether. Pathophysiology: The Biologic Basis for 
Disease in Adults and Children. 1994. St. Louis, MO: Mosby. Pp 62-3. 
14 R. M. Costello, P. Parsons-Manders and S. L. Schneider. "Alcoholic Mortality: 
A Twelve Year Follow-up." American Journal of Drug and Alcohol Abuse. 1978. 5( 
2): 199-210. 

Establishing a Relationship Between Alcohol and Casualties of Fire 9 

IV. ALCOHOL'S INVOLVEMENT IN UNINTENTIONAL INJURIES AND FIRE CASUALTIES 

Alcohol and Unintentional Injuries 

Unintentional injuries account for over 90,000 deaths and millions of non-fatal 
injuries each year. 15 They are also the leading cause of death for all people 
under the age of 44. Motor vehicle crashes, fires, burns, falls, drowning, and 
poisonings are the top ranking causes of death from unintentional injuries. 
Numerous studies have identified a significant relationship between alcohol and 
unintentional injuries and deaths. In fact, in emergency room and trauma center 
studies of alcohol and injury, alcohol was found to be associated with trauma 
cases rather than medical problems among a representative sample of patients 
admitted to the same facility. 16 That is, when a patient was admitted with an 
injury, the injury was likely to be alcohol-related. When a patient was admitted 
with a 
non-injury (e. g. illness), alcohol had little or no relationship to the 
illness. It has been estimated that nearly 50 percent of adult trauma patients 
in the United States are injured under the influence of alcohol. 17 

Short-term physiological effects of alcohol have been shown to diminish motor 
coordination and balance, as well as impair perception and judgment. The 
propensity for injuring oneself under these conditions is great. In a study 
performed by researchers from the Alcohol Research Center at the California 
Pacific Center Research Institute, the association between alcohol and injuries 
was examined among an emergency room patient sample. Of those identified with a 
positive BAL, 23 percent reported feeling drunk at the time of the incident, and 
of these, 45 percent felt the event could have been avoided had they not been 
drinking. 18 

Not only does alcohol impair physical capabilities; it has been theorized that 
alcohol perpetuates accident-prone behavior. A classic example of this is the 
drunk 

15 U. S. Department of Commerce, Bureau of the Census. The Statistical Abstract 
of the United States - 1993 113 th ed. 1993. Washington, DC: GPO. 16 C. J. 
Cherpitel, "Alcohol and Injuries: A Review of International Emergency Room 
Studies," Addiction. 88: 923-937, 1993. 
17 C. W. Dunn, D. M. Donovan , L. M. Gentilello, "Practical Guidelines for 
Performing Alcohol Interventions in Trauma Centers," Journal of Trauma. 42(2): 
299-304, February 1997. 

Establishing a Relationship Between Alcohol and Casualties of Fire 10 

driver who fails to fasten his seat belt and as a result of his alcohol-impaired 
driving ability, sustains life-threatening or fatal injuries. Researchers from 
the Boston University School of Public Health found that an average daily intake 
of 5 or more alcoholic beverages elevated the relative risk for injuries among a 
sample population. These drinkers were 1.7 times more likely to sustain an 
unintentional injury and twice as likely to require hospitalization as a result 
of their injuries when compared to non-drinkers. 19 

Alcohol and Fire Casualties 

In the United States, fire-related injuries rank fifth among unintentional 
injuries, after motor vehicle crashes, poisoning, falls, and drowning. 20 The 
linking of alcohol abuse to fire casualties is a subset of the broader 
correlation between alcohol and traumatic accidents. 

Some of the most persuasive data come from studies of traumatic injuries 
suffered by chronic alcohol abusers. Researchers in Toronto tracked the 
mortality experience of alcoholics and found their fire death risk to be 9.7 
times greater than that of the rest of the population. 21 

Definitions: Acute Alcohol Abuse - A single or specific situation of alcohol 
intoxication. 

Chronic Alcohol Abuse - The use of alcohol, for the purpose of intoxication, 
more often than once per week for a period exceeding six months. 

Alcoholism - An incurable disease defined in the Diagnostic Service Manual of 
the American Psychological Association. An alcoholic does not necessarily 
currently abuse alcohol. 

In 1987, two researchers from the Boston University Medical School's Public 
Health Department conducted a pioneer study evaluating alcohol and fire victims. 
Jonathan Howland and Ralph Hingson performed a literature survey on alcohol 
involvement in fire fatalities and serious burns in the United States and abroad 
for the time period of 1958 to 1981, and looked for a pattern across various 
studies. The two researchers concluded that of the fatalities screened for BALs, 
a significant portion of the 

18 C. J. Cherpitel, "Injury and the Role of Alcohol: Countywide Emergency Room 
Data." Alcoholism, Clinical & Experimental Research. 18( 3): 679-84, June 1994. 
19 R. W. Hingson, R. I. Lederman and D. C. Walsh. "Employee Drinking Patterns 
and Accidental Injury: A Study of Four New England States." Journal of Studies 
on Alcohol. 46( 4): 298-303, July 1985. 
20 Centers for Disease Control and Prevention. Injury Mortality 1986-1992. 
Hyattsville, MD: Centers for Disease Control and Prevention, 1995. 
21 Schmidt and De Lint, "Causes of Death of Alcoholics," Quarterly Journal of 
Studies on Alcohol 33( 1): pp. 171-85, 1972. 

Establishing a Relationship Between Alcohol and Casualties of Fire 11 

fire fatalities were legally drunk at 0.08 percent BAL or 0.1 percent BAL, 
depending on jurisdictional standards, or had elevated BALs. Half of all people 
over the age of 15 who died in fires had elevated BALs. 22 An earlier study that 
examined fire deaths in Memphis, Tennessee found that 83 percent of people 
between the age of 16 and 60 had been drinking at the time of their death. 23 
While these data are relatively dated, all indications are that it remains 
accurate. A recently published study, which analyzed all fatal residential fires 
in North Carolina, revealed that for fire fatalities age 18 and older, 53 
percent had BALs equivalent to over 0.1 percent and that 28 percent had 
histories of alcoholism. 24 

Alcohol and Burns 

Alcohol use by the burn patient is a very specific concern. Chronic alcohol use 
has been shown to disrupt the immune system response to a significant burn. 25 
This appears to be the result of alcohol-related damage to the spleen and lymph 
nodes hindering synthesis of a key immune system component. 26 Acute alcohol 
intoxication also poses a problem for the burn patient. Both burn injuries and 
alcohol (ethanol) intoxication suppress the immune system. When they occur 
together, a synergistic effect has been documented, resulting in a very 
suppressed immune response. 27, 28 In either case, chronic or acute, the 
presence of ethanol use in the burn patient results in a higher rate of 
infectious complications and increased mortality. Researchers from the 
University of Washington Burn Center in Seattle found alcoholic patients with 
burn injuries had an overall mortality rate three times that of non-alcoholics 
and also died of smaller burn 

22 J. Howland and R. Hingson, "Alcohol as a Risk factor for Injuries or Death 
Due to Fires and Burns: Review of the Literature." Public Health Reports. 102( 
5): 475-83, Sept-Oct. 1987. 
23 W. S. Hollis, "Drinking: Its Part in Fire Deaths," Fire Journal, pp. 10-12, 
May 1973. 
24 S. W. Marshall, C. W. Runyan, et al. "Fatal Residential Fire: Who Dies and 
Who Survives?" The Journal of the American Medical Association. 279( 20): 1633-
1637, May 1998. 
25 M. Kawakami, A. A. Meyer, M. C. Johnson, S. DeSerres and H. D. Peterson. 
"Chronic Ethanol Exposure Before Injury Produces Greater Immune Dysfunction 
After Thermal Injury in Rats." Journal of Trauma. 1990. Jan; 30( 1): 27-31. 26 
T. Tabata and A. A. Meyer. "Immunoglobulin M Synthesis After Burn Injury: The 
Effects of Chronic Ethanol on Postinjury Synthesis." Journal of Burn Care and 
Rehabilitation. 1995. Jul-Aug; 16( 4): 400-6. 
27 M. Kawakami, B. R. Switzer, S. R. Herzog and A. A. Meyer. "Immune Suppression 
After Acute Ethanol Ingestion and Thermal Injury." Journal of Surgical Research. 
1991. Sep; 51( 3): 210-5 
28 Chronic Ethanol Intake and Burn Injury: Evidence for Synergistic Alteration 
in Gut and Immune Integrity," Journal of Trauma. 38( 2): 198-207, February 1995. 

Establishing a Relationship Between Alcohol and Casualties of Fire 12 

wounds. Surviving alcoholic burn patients required significantly more 
intravenous antibiotics and fluids and longer hospitalization. 29 

Research examining the effect of alcohol on burns has shown that alcohol acts at 
the cellular level by preventing post-injury homeostasis. It also acts 
systemically by interfering with the body's vasoconstriction response to shock, 
a common complication of serious burn injuries. Two studies performed by the 
Department of Plastic and Reconstructive Surgery and Burn Unit in Cologne, 
Germany recently examined the relationship between alcohol use and burn 
injuries. Patients with positive BALs were found to have a significantly higher 
fatality rate (31 percent) in comparison to patients with a negative BAL (18 
percent), even though both groups had equal total burn surface area and were of 
similar ages. 30 In a study of burn patients from the University of Florida's 
College of Medicine, researchers reported that the average length of stay for 
the alcohol group was 9 days longer than the average stay in the burn center, 
resulting in additional medical costs of $337,500. 31 

Some studies have found that alcoholics also comprise a large portion of the 
burn-injured population. A study performed in New York City found that 19 
percent of burn victims treated at the New York Hospital Burn Center had an 
alcohol abuse problem, as detected from patient interviews using the 
standardized CAGE questionnaire on alcohol use. 32 While attempting to determine 
predictors for post-traumatic stress after burn injuries, researchers from 
Cornell University and Columbia University College of Physicians and Surgeons in 
New York City discovered that 24 percent of the patients screened had histories 
of alcoholism, and 18 percent had drug abuse histories. It is significant to 
note that only 7 percent of the adult population in general are alcoholics. The 
high percentage of alcoholics and other alcohol abusers among the burn 
population surveyed in these studies is suggestive of drinking patterns 
witnessed in alcoholics that elevates their risk for fire injury. 

29 J. D. Jones, B. Barber and L. Engrav, "Alcohol Use and Burn Injury." Journal 
of Burn Care and Rehabilitation. 12( 2): 148-152, March-April 1991. 30 A. Haum, 
W. Perbix and H. J. Hack, "Alcohol and Drug Abuse in Burn Injuries" Burns. 21 
(3): 194-1999. May 1995. 
31 P. S. Powers, B. Stevens, et al., "Alcohol Disorders Among Patients with 
Burns: Crisis and Opportunity." Journal of Burn Care and Rehabilitation. 15( 4): 
386-91, July-August 1994. 
32 L. Bernstein et al., "Detection of Alcoholism Among Burn Patients," Hospital 
Community Psychiatry. 40: 255-6, 1992. 

Establishing a Relationship Between Alcohol and Casualties of Fire 13 

Alcohol and Smoke Inhalation 

The overwhelming majority of fire fatalities perish as a result of smoke and 
toxic fume inhalation as opposed to burn injuries. 33, 34 Sensitivity to smoke 
is a key means by which the human body detects a fire. Mitchell et al. found 
evidence to suggest that alcohol not only impedes the detection of smoke, but 
also helps to facilitate its passage into the body. 35 In a study performed by 
researchers from the Queens Medical Center in England, the effect of ethyl 
alcohol ingestion on upper airway reflexes, e. g. coughing and sneezing, was 
examined for a sample of healthy, young men. This research found that ethyl 
alcohol caused depression of the upper airway reflexes, particularly when BALs 
were in excess of 0.1 percent BAL. 36 This finding supports the earlier research 
presented by Mitchell et al., which revealed that in addition to enhancing the 
toxic effects of gases such as carbon monoxide, BALs depressed the cough reflex 
as well. 

33 H. Gormsen, N. Jeppesen and A. Lund, "The Causes of Death in Fire Victims," 
Forensic Science International. 24( 2): 107-11, February 1984. 
34 J. R. Hall and B. Harwood, "Smoke or Burns- Which is Deadlier?" Fire Journal. 
89( 1): 38-43, January-February 1995. 
35 Mitchell et al., "Effects of Ethanol and Carbon Monoxide upon Two Measures of 
Behavioral Incapacitation's on Rats," Proceedings of the Western Pharmacology 
Society, Sec. 21, pp427-431( 1978) 
36 R. Erskine, P. Murphy and J. A. Langton, "The Effect of Ethyl Alcohol on the 
Sensitivity of Upper Airway Reflexes." Alcohol & Alcoholism. 29( 4): 425-31, 
July 1994. 

Establishing a Relationship Between Alcohol and Casualties of Fire 14 

V. ALCOHOL, UNINTENTIONAL INJURIES, AND FIRE CASUALTIES 

Alcohol and Alcohol's Role in Injury 

Drinking Patterns 

In 1995, a national survey of adults over the age of 18 in the United States was 
conducted to identify the drinking behaviors of Americans. In this survey 
performed by the Centers for Disease Control and Prevention (CDC), Americans 
over the age of 18 were asked if they drank at least 1 alcoholic beverage during 
the past month. The majority of adults (53 percent) said yes. Those individuals 
aged 18 to 24 and 25 to 34 accounted for the highest percentage of drinkers at 
57 percent and 63 percent respectively. Of those aged 18 to 24, 71.8 percent 
reported drinking anywhere from 1 to 5 days per month. For those aged 25 to 34, 
68 percent claimed the same frequency. In addition, respondents were asked how 
many drinks were consumed on the average for the days they drank. Respondents 
aged 18 to 24 comprised the largest percentage of the 5 drinks or more category, 
followed closely by the age bracket 25 to 34. In fact, the 5 drinks or more 
category constituted one-quarter of respondents age 18 to 24. 37 

The same survey recorded different, yet intriguing, results for respondents aged 
65 and older. Approximately 35 percent reported drinking during the previous 
month. Of this group, the majority reported drinking only between 1 and 5 days 
per month. However, another one-quarter of respondents aged 65 and older claimed 
that they consumed alcohol anywhere from 21 to 31 days per month. The 
overwhelming majority of this same age group (63 percent) claimed that they 
consumed 1 to 2 alcoholic drinks on those days when they drank. 

What does this mean? The youngest portion of the adult population surveyed, 
ages 18 to 24, is drinking with less frequency than the older groups, but with 
more intensity when they do drink. This phenomenon, dubbed binge drinking by 
researchers, is seen in high-school adolescents and young college adults. For 
the elderly community, the 

37 Behavioral Risk Factor Surveillance System, "Nationwide Alcohol Consumption," 
Online Prevalence Data, Centers for Disease Control and Prevention, 1995. 

Establishing a Relationship Between Alcohol and Casualties of Fire 15 

results are just the opposite; the elderly average more alcohol consuming days 
per month, but with less volume per session. 

Alcohol's Role in Unintentional Injury 

Drinking has been associated with increased risk for unintentional injuries of 
all types. Sensation seeking and risk-taking are prevalent among the younger 
populations that use or abuse alcohol. It is this type of behavior that is 
predictive of incurring unintentional injuries and accident statistics are a 
prime indicator of this. In a review of adolescent injuries and the involvement 
of alcohol, researchers from the Harborview Injury Prevention and Research 
Center in Seattle Washington reported that of 319 young adults aged 18 to 20 
admitted to the trauma center, 41 percent tested positive for alcohol. 38 
Approximately 22 percent were legally intoxicated at the time of their injury, 
indicated by BALs of 0.1 percent or more. 

In 1996, researchers from the Edwin Albano Institute of Forensic Science 
performed a study aimed at quantifying the role of substance abuse in fatal 
fires occurring in New Jersey over a 7-year period. Records of fire fatalities 
of all ages were retrospectively examined for the nearly 30 percent of fire 
victims who tested positive for BALs of any concentration. Of these victims, 58 
percent were between the ages of 21 and 50. That very same year, the National 
Center for Health Statistics reported that only 37 percent of all fire 
fatalities were age 21 to 50. 

The very young and the very old have a much higher fire death rate than the 
average population. The risk of fire death drops considerably after the age of 5 
and experiences minimal change until the age of 55, at which point the risk 
begins to rise substantially. 39 Young children and older adults are typically 
high-risk groups because they are physically unable to escape a fire. People 
between the ages of 5 and 55 years generally do not suffer from physical 
inability and are capable of removing themselves from danger, which is one 
explanation for their lower fire death rates. Alcohol-impaired 
fire fatalities exhibit an age pattern that is quite the opposite of overall 
fire death profile. The majority of alcohol-impaired deaths are between the ages 
of 18 and 40, the 

38 F. P. Rivara, J. G. Gurney, R. K. Ries and D. A. Seguin, "A Descriptive Study 
of Trauma, Alcohol, and Alcoholism in young adults." Journal of Adolescent 
Health. 13( 8): 663-667, December 1992. 
39 U. S. Fire Administration, Fire in the United States: 1987-1996, Eleventh 
Edition, FA-173/ August 1999, (Emmitsburg, MD: U. S. Fire Administration). 

Establishing a Relationship Between Alcohol and Casualties of Fire 16 

population most expected to escape injury. This pattern suggests that a 
relationship exists between intoxication and the risk of injury from a fire. 

Caretakers Under the Influence 

When examining the prevalence of alcohol involvement in all types of 
unintentional injuries, children are not typically pictured. Alcohol impairment 
is viewed as an adult activity that precludes children by virtue of their age 
and innocence. Unfortunately, children are not exempt from the harmful effects 
of alcohol, primarily through no fault of their own. As an example, a recent 
study performed by the CDC found that for 60 percent of child passenger 
fatalities, the driver of the child was impaired. 40 

Numerous studies have examined the impact of parental drinking patterns on the 
health and well-being of children. Researchers from the Department of Pediatrics 
at the Albert Einstein College of Medicine found that the children of mothers 
characterized as problem drinkers had over twice the risk of serious injury as 
children of mothers who were non-drinkers. 41 They also concluded that children 
with two parents who are problem drinkers are at an even greater risk. 

As previously noted, children are one of the highest risk groups for residential 
fire deaths. While not traditionally considered in studies examining alcohol and 
fire deaths, alcohol-related fires often affect them too. A study performed by 
Marshall et al. found that of the juvenile fatalities examined, approximately 15 
percent died in fires where the surviving adult was impaired by alcohol or other 
drugs. 42 In another study performed by Hollis et al., the authors stated that 
in a review of case files of fire fatalities under age 16 or over age 60, "case 
after case revealed that fire deaths of children were attributed to the 

40 U. S. Department of Health and Human Services, Centers for Disease Control 
and Prevention. "Alcohol Related Traffic Fatalities involving Children- United 
States, 1996", Morbidity and Mortality Weekly Report 
1997; 46( 48): 1130-1131. 
41 P. E. Bijur, M. Kurzon, et al., "Parental Alcohol Use, Problem Drinking, and 
Children's Injuries", Journal of the American Medical Association. 267( 23): 
3166-71 June 1992. Serious injuries were those resulting in hospitalization, 
surgical treatment, missed school, and/ or one half day or more spent in bed. 
42 S. W. Marshall, C. W. Runyan, et al., "Fatal Residential Fires: Who Dies and 
Who Survives?" Journal of the American Medical Association. 279( 20): 1633-1637, 
May 1998. 

Establishing a Relationship Between Alcohol and Casualties of Fire 17 

parents failure to perceive and respond to a fire emergency because of 
impairment of their sensory, judgment, or physical functions by alcohol 
consumption." 43 

A small child often will hide behind a bed or in a corner during a fire while 
awaiting help from parents or caretakers. In the case of an alcohol-impaired 
caretaker, the help is unlikely to arrive and the child is left behind. 
Furthermore, a rapidly evolving fire leaves little chance for a firefighter to 
find and rescue the child in time. 

Elderly and disabled individuals who need help are also at high risk for death 
from fires, much like young children. An Assistant Fire Marshal of the Memphis 
Fire Department stated that many elderly individuals had died in fires because 
their caretakers, often their own children, were too impaired by alcohol to 
recognize the fire and render assistance in time. 44 

Gender Effects 

There are wide gaps between male and female fire death rates, unintentional 
injury rates, and drinking rates in the United States. There is a wealth of data 
documenting this. Males comprise the majority of fatal and non-fatal injuries of 
all types year after year. They also have higher drinking rates and greater 
total alcohol consumption. 

Fire injuries and deaths are not exempt from this pattern. Men continue to have 
almost twice as many fire deaths as women among nearly all age groups. 45 Over 
the past two decades, data from the NFIRS has consistently found the ratio of 
male to female fire deaths to be between 1.6 and 2.0 to 1. Additional evidence 
from the medical profession supporting this finding comes from the landmark 
study performed by Berl et al., from the Johns Hopkins University. In it, male 
fire fatalities in the State of Maryland were shown to 50 percent higher than 
female fire fatalities. 46 

43 W. S. Hollis, et al., "Drinking: Its Part in Fire Deaths," Fire Journal, May 
1973. 
44 W. S. Hollis, et al., "Drinking: Its Part in Fire Deaths," Fire Journal, May 
1973 45 U. S. Fire Administration, Fire in the United States: 1987-1996, 
Eleventh Edition, FA-173/ August 1999, (Emmitsburg, MD: U. S. Fire 
Administration). 
46 W. G. Berl and B. M. Halpin, "Human Fatalities From Unwanted Fires," Applied 
Physics Laboratory, The Johns Hopkins University. FPP TR 37, December 1978. 

Establishing a Relationship Between Alcohol and Casualties of Fire 18 

Data from the NFIRS found that men outnumber women by between 1.5 to 1.8 to 
1 for fire injuries as well. 47 Medical data again concur with this finding. 
While conducting an injury survey among patients in four emergency room/ trauma 
centers, researchers found that men outnumbered women in all six of the most 
commonly seen injuries. The cause of injury with the broadest contrast between 
genders was fire. Male fire injuries outnumbered female fire injuries in this 
study by about 3 times. 48 

This pattern of gender differences in injury rate is not unique to burn 
injuries. Males are injured more often than females in almost all mechanisms of 
injury. The male dominant pattern is especially pronounced in the adolescent and 
young adult. This may indicate that males engage in more high risk behaviors 
(including alcohol abuse) than females. 49 

Alcohol and drinking patterns vary between genders and may help explain the 
differing casualty rates. National estimates show that males tend to consume 
larger quantities of alcohol with greater frequency than females. Men also 
vastly outnumber women when identifying problematic drinking behaviors, such as 
binge drinking. In the CDC survey on alcohol consumption, 62 percent of the male 
respondents stated that they drank an alcoholic beverage at least once a month. 
Only 44 percent of the female respondents consumed alcohol at least once a 
month. As the number of days of alcohol consumption increased, a greater 
percentage of men than women responded affirmatively. In the higher frequency 
brackets males outnumbered females in number of days spent drinking per month by 
about 2 to 1. Females outnumbered men (1.3 to 1) only in the 1 to 5 days per 
month category. When asked how many alcoholic beverages were consumed per 
drinking session, the number of men claiming 5 drinks or more per occasion was 
nearly 3 times that of women. This response suggests that men in the United 
States drink more intensely and more frequently than their female counterparts. 
50 

47 U. S. Fire Administration, Fire in the United States: 1987-1996, Eleventh 
Edition, FA-173/ August 1999, (Emmitsburg, MD: U. S. Fire Administration). 
48 C. J. Cherpitel, "Injury and the Role of Alcohol: Countywide Emergency Room 
Data." Alcoholism, Clinical & Experimental Research. 18( 3): 679-84, June 1994. 
49 N. S. Redeker, S. C. Smeltzer, J. Kirkpatrick and S. Parchment. "Risk Factors 
of Adolescent and Young Adult Trauma Victims." American Journal of Critical 
Care. 1995. Sep; 4( 5): 370-8. 
50 Behavioral Risk Factor Surveillance System, "Nationwide Alcohol Consumption," 
Online Prevalence Data, Centers for Disease Control and Prevention, 1995 

Establishing a Relationship Between Alcohol and Casualties of Fire 19 

It has been theorized that the drinking behavior commonly seen in the male 
population is directly related to their high risk for injuries and fatalities. 
There is reason to believe that a greater number of fire fatalities that were 
under the influence of alcohol are male as well. Berl et al. reported that of 
fire fatalities examined in Maryland, males comprised 72 percent of those with 
BALs over 0.1 percent. 51 The state of Minnesota, one of the only states 
requiring BALs for all fire deaths, found similar results. For the years 1993 to 
1996, approximately 80 percent of fatalities with positive BALs were men. The 
results of a Minnesota study will be discussed in a separate section. 

Leading Causes of Fire Casualties 

Smoking 

Nationally, fire-reporting agencies have identified smoking as the fifth most 
frequent cause of residential fires, the leading cause of fire fatalities, and 
the second most common cause of fire-related injuries. 52 Smoking combined with 
alcohol use creates an even greater risk for fire injuries and fatalities, as 
evidence suggests that the two exert a synergistic effect on each other. 

Studies have also shown that smokers are more inclined to engage in risk-taking 
behavior and are more commonly involved in accidents. Researchers have concluded 
that binge drinking (as well as other specific risk-related behaviors) was 
correlated to smoking among the youth in the United States. 53 Many of the 
various risk factors for injuries in general, including fire injuries, are 
inter-related and magnify the effects of the other. 

A relatively new phenomenon of "social drinking" has been identified by 
researchers that may, in turn, lead to alcohol-related fire fatalities. Social 
smoking is a trend identified in the college age population where the individual 
smokes only when in specific social situations. These situations include parties 
and bars. 54 Additional research 

51 W. G. Berl and B. M. Halpin, "Human Fatalities From Unwanted Fires," Applied 
Physics Laboratory, The Johns Hopkins University. FPP TR 37, December 1978. 
52 . S. Fire Administration, Fire in the United States: 1987-1996, Eleventh 
Edition, FA-173/ August 1999, (Emmitsburg, MD: U. S. Fire Administration). 53 L. 
G. Escobedo, "Relationship Between Cigarette Smoking and Health Risk and Problem 
Behaviors Among U. S. Adolescents," Archives of Pediatric & Adolescent Medicine. 
151( 1): 66-71, January 1997. 
54 D. Hines, A. C. Fretz and N. L. Nollen, "Regular and Occasional Smoking by 
College Students: Personality Attributions of Smokers and Non-Smokers." 
Psychological Reports. 1998. Dec; 83( 3 pt 2): 1299-306. 

Establishing a Relationship Between Alcohol and Casualties of Fire 20 

has linked social smoking to binge drinking and severe alcohol intoxication. 55 
The link between smoking and fire has been well established through fire data 
analyses. The effects of alcohol consumption would likely lead to an 
inattentiveness to lit cigarettes and, potentially, to fire. Social smoking may 
become a significant link between alcohol abuse and fire. 

Researchers from the University of Chicago Department of Psychiatry concluded 
that smokers consume more alcohol than do non-smokers, heavy drinking tends to 
be associated with heavy smoking, and a large majority of alcoholics, 
characterized by heavy drinking, are smokers. 56 Another study reviewing people 
aged 40 to 49 years who received check-ups from 1979 to 1985, found alcohol use 
to be strongly associated with the number of cigarettes smoked per day. 57 
Alcohol and smoking represent independent fire safety risk factors. Alcohol 
intoxication leaves the drinker bereft of control and mental acuity. Smoking has 
been associated with the ignition of many fires in which the smoker is 
intimately involved, a factor that significantly contributes to the severity of 
smoking fire-related injuries and deaths. 58 When used together, alcohol and 
smoking increase one's chance of starting a fire while at the same time decrease 
the chances of detecting, mitigating, and escaping the fire. 

Interviews from households in King County, Washington that had sustained a fire-
related injury or fatality were conducted in an effort to identify the risk of 
fire injury in relation to the incidence of smoking and alcohol use. Using a 
control group of households that had not experienced a fire emergency, 
researchers concluded that households with alcohol drinkers who consumed 6 or 
more drinks per occasion increased their risk for burn injury by 8 times. 59 
Further analysis revealed that households with higher drinking levels were 
associated with higher smoking levels as well. Heavy or 

55 J. B. Schorling, M. Gutgesell, P. Klas, D. Smith and A. Keller. "Tobacco, 
Alcohol and Other Drug Use Among College Students." Journal of Substance Abuse. 
1994. 6( 1): 105-15. 
56 J. P. Zacny, "Behavioral Aspects of Alcohol-Tobacco Interactions," Recent 
Developments in Alcoholism. 8: 205-219, 1990. 
57 G. D. Friedman, I. Tekawa and A. L. Klatsky, "Alcohol Drinking and Cigarette 
Smoking: An Exploration of the Association in Middle-Aged Men and Women," Drug 
and Alcohol Dependence. 27( 3): 283-290, May 1991. 
58 U. S. Fire Administration, National Fire Incident Reporting System 
59 J. E. Ballard, T. D. Koepsell and F. Rivara, "Association of Smoking and 
Drinking with Residential Fire Injuries," American Journal of Epidemiology. 135 
(1): 26-34, January 1992. 

Establishing a Relationship Between Alcohol and Casualties of Fire 21 

binge drinking was identified as a predictor for fires and burn injuries, and 
when coupled with smoking, appeared to be even more of a significant factor. 60 

Arson 

Arson is the second leading cause of fire deaths in the United States. Alcohol 
may be a factor contributing to the act of arson and hence, to fire casualties. 
Alcohol has long been associated with violent crimes in this country and around 
the world. Arson, especially when associated with residential fires, is a 
violent crime meant to hurt, kill, and destroy. A variety of motives can be 
attributed to arson acts, but alcohol is most prevalent in incidents of arson 
that are meant to inflict physical harm. 61 

Social scientists have theorized as to why alcohol seems to promulgate criminal 
activity. Some theories suggest that alcohol could be directly linked to crime 
through its pharmacological properties or indirectly through social learning 
about typical behavior under the influence. MacAndrew and Edgerton (1969) showed 
that "at least some part of drunken comportment is learned." 62 They also showed 
that an important factor in drunken behavior is that in some cultures, including 
our own, alcohol can serve to initiate a normative "time out" where people are 
allowed to deviate from social norms. 63 While this research is 30 years old, 
there is little information readily available to indicate that it is invalid 
today. 

Researchers have also discovered a strong association between heavy drinking and 
criminal behavior, both in terms of the need to engage in criminal behavior and 
in terms of perceptions of the risk and moral condemnation associated with it. 
MacAndrew and Edgerton found that heavy drinking led to unstable moral 
evaluations and irrational perceptions regarding the consequences of their 
behaviors. 64 Such instability in moral 

60 J. E. Ballard, T. D. Koepsell and F. Rivara, "Association of Smoking and 
Drinking with Residential Fire Injuries," American Journal of Epidemiology. 135 
(1): 26-34, January 1992. 
61 Ibid. 
62 MacAndrew and Edgerton (1969), as cited in L. Lanza-Kaduce, D. M. Bishop, L. 
Winner, "Risk Benefit Calculations, Moral Evaluations, and Alcohol Use: 
Exploring the Alcohol-Crime Connection," Crime and Delinquency. Vol. 43, no. 2, 
1997. 
63 Ibid. 
64 L. Lanza-Kaduce, D. M. Bishop, L. Winner, "Risk/ Benefit Calculations, Moral 
Evaluations, and Alcohol Use: Exploring the Alcohol-Crime Connection." Crime and 
Delinquency. Vol. 43, no. 2, 1997. 

Establishing a Relationship Between Alcohol and Casualties of Fire 22 

evaluations was not identified among moderate or light drinkers or abstainers, 
even in the same social situations. 65 

A recent study in Minnesota that examined the relation of drugs and alcohol to 
arson found a prominent correlation between alcohol and arson fires. Since 1994, 
the state of Minnesota has required autopsies to be performed on all fire-
related deaths, one of the only states to do so. The data show that nearly 48 
percent of all Minnesota fire deaths involve drug and/ or alcohol use. The state 
then became interested in learning the extent to which drugs and alcohol played 
a part in incendiary fires so that they could develop strategies to minimize the 
number of any future arson fires with those contributing factors. 66 

The study found evidence of an arson trend in which socio-economic deprivation, 
coupled with alcohol use resulted in the commission of arson. Similarly, there 
was evidence of alcohol use among suspects who set fires to fraudulently collect 
on insurance policies. In these cases, alcohol may have been used to give 
suspects the "courage" to commit the act, to dull their sense of wrongdoing, or 
to help them rationalize their own acts since they were drunk at the time. 67 

International Studies 

Similar patterns of alcohol usage that correlate to fire are found in other 
cultures. The use of alcohol appears to be a significant factor in explaining 
international differences in fire death rates. Approximately 80 percent of 
Finnish male fire fatalities were found to have been drinking at the time of 
their death. 68 The association between house fire fatalities and high blood 
alcohol concentrations has also been recognized as a particular problem in 
Scotland. 69 The death rate for fatal fire accidents in Denmark has 

65 Ibid. 
66 United States Fire Administration, Minnesota Department of Public Safety, 
Office of the State Fire Marshal, and TriData Corporation, The Connection Among 
Drugs, Alcohol, and Arson in Minnesota, April 1998. 
67 Ibid. 
68 R. Hohanen, et al., "Males as a High-Risk Group for Trauma," The Journal of 
Trauma. 30: 155-162, 1990. 
69 T. Squires, A. Busuttil, "Alcohol and House Fire Fatalities in Scotland, 
1980-1990," Medicine, Science & the Law. 37( 4): 321-5, 1997. 

Establishing a Relationship Between Alcohol and Casualties of Fire 23 

doubled since 1951, attributed mostly to fire accidents associated with smoking, 
which often included alcohol intoxication. 70 

70 P. Leth, M. Gregersen, S. Sabroe, "Fatal Residential Fire Accidents in the 
Municipality of Copenhagen, 1991-1996." Preventive Medicine. 27( 3): 444-51, 
May-June 1998. 

Establishing a Relationship Between Alcohol and Casualties of Fire 24 

VII. SMOKE ALARMS AND THE ALCOHOL-IMPAIRED FIRE CASUALTY 

Attempting to quantify the extent to which alcohol impairs one's ability to 
detect and escape from a fire is difficult. In an effort to establish a clear 
relationship between the ability to perceive a fire and subsequently escape from 
it, researchers have examined the relationship between alcohol impairment and 
the function of smoke alarms. The presence of a working smoke alarm 
significantly reduces the risk of becoming a fire fatality. 71, 72 Many fire 
prevention programs revolve around installing and maintaining smoke alarms. 
However, existing evidence seems to point to alcohol impairment as being a 
strong independent risk factor for deaths caused by fires. In a study performed 
by Runyan et al., the fire fatality risk ratio for an alcohol-impaired person 
was more than double the risk ratio of a person living without a smoke alarm. 73 

Smoke alarms have been found to be most protective against death from a fire for 
small children, but only when alcohol and/ or drugs do not impair the caretaker. 
74 Children who are unable to help themselves depend upon their parents for 
escaping a fire. Failure to respond to a smoke alarm in adequate time allows a 
fire to rapidly evolve and significantly reduce ones chances of escaping. Even 
if an impaired parent survives, it is often too late to retrieve the child, or 
escape together. 

71 L. E. Smith, Fire Incident Study: National Smoke Detector Project. EPHA, 
Directorate for Epidemiology, US Consumer Product Safety Commission. Bethesda, 
MD. January 1995; page 3. 
72 As cited in "Perspectives in Disease Prevention and Health Promotion Progress 
Toward Achieving the National 1990 Objective for Injury Prevention and Control," 
Morbidity and Mortality Weekly Report. 37( 9): 138-149, March 1988; E. 
McLoughlin et al. "Smoke Detector Legislation: Its Effect on Owner-occupied 
Homes," American Journal of Public Health. 75: 858-862, 1985. 
73 C. W. Runyan, et al, "Risk Factors For Fatal Residential Fires," New England 
Journal of Medicine. 327( 12): 859-863, 1992. 
74 Ibid. 

Establishing a Relationship Between Alcohol and Casualties of Fire 25 

VIII. CASE STUDY: RESULTS FROM THE ONTARIO FIRE REPORTING SYSTEM 

Background 

Ontario, one of Canada's largest provinces, comprises over one third of Canada's 
population. In 1997, Ontario experienced a total of 139 fatal fires, which 
killed 154 persons. 75 The Ontario Fire Reporting System requires all fire 
departments to report and record every fire incident and casualty. This 
information is then registered with the local provincial governments. A unique 
and helpful attribute of OFRS is that separate categories which distinguish 
alcohol impairment from impairments caused by other drugs are used to describe 
the condition of the fire victim prior to injury or death. 

Fire Casualties 

From 1990 to 1995, Ontario experienced a total of 5,934 casualties from fire. 
[Note: 1993 has been omitted from this study due to reporting errors. As a 
consequence, the time frame reflects five years rather than six.] Of these 
casualties, 410 were impaired by alcohol at the time of their injuries and 7 
were impaired by drugs. Alcohol-impaired casualties resulted in 178 fatalities 
and 232 injuries (Table 1). While alcohol-impaired casualties only accounted for 
7 percent of all Ontario's fire casualties, alcohol-impaired victims accounted 
for 22 percent of all fire deaths (Table 2). 

Table 1. Distribution of Ontario Fire Casualties 
Type of Casualty Total Deaths Percent of Total Injuries Percent of Total 

All Fire Casualties 5,934 797 13% 5,137 87% 
Non-Alcohol-Impaired Casualties 5,524 619 11% 4,905 89% 
Alcohol-Impaired Casualties 410 178 43% 232 57% 

75 Data for this section comes from the Office of the Fire Marshall of Ontario 

Establishing a Relationship Between Alcohol and Casualties of Fire 26 

Table 2: Alcohol-Impaired Casualties' Prominence in Ontario Fire Deaths 
All Fire Casualties Alcohol-Impaired Casualties Percent of All Fire Casualties 

Total Casualties 5,934 410 7% 
Deaths 797 178 22% 
Injuries 5137 232 5% 

The proportion of fire fatalities was markedly different between the alcohol-
impaired and non-alcohol-impaired casualties. Alcohol-impaired victims accounted 
for a larger proportion of fire fatalities than injuries. Fire victims who were 
not under the influence of alcohol were far less likely to killed (11 percent) 
than to be injured. In the alcohol-impaired group, fatalities represented 43 
percent of the casualty total. The sharp rise in the percentage fatalities when 
alcohol was involved suggests that alcohol affects the severity of a fire 
casualty. Alcohol-impaired fatalities occurred nearly four times as often as 
non-alcohol-impaired fatalities and over three times as often as fire fatalities 
in general. Alcohol impairment appears to lead to more serious, fatal, injuries 
from fires. 

Demographics of Fire Casualties 

Age 

One-quarter of the alcohol-impaired fire fatalities were aged 25 to 34, despite 
the fact that the same age group accounted for only 16 percent of fire deaths 
overall and 14 percent of the non-alcohol-impaired casualties (Figure 1). 
Victims aged 35 to 44 and 45 to 54 followed at 19 percent and 16 percent 
respectively. 

Establishing a Relationship Between Alcohol and Casualties of Fire 27 

Figure 1: Alcohol-Impaired vs. Non-Alcohol-Impaired Fire Deaths by Age (Ontario 
1990-1995, excluding 1993) 

Approximately 35 percent of all fire deaths aged 25 to 34 and aged 45 to 54 (45 
of 129 fatalities and 28 of 79 fatalities, respectively) were impaired by 
alcohol; 15 to 24 year-olds and 35 to 44 year-olds exhibited similar percentages 
at 34 percent and 31 percent, respectively. These four consecutive age groups 
(ages 15 to 54) accounted for not only 75 percent of alcohol-impaired deaths, 
but also a large proportion (one-third) of fire deaths in their age groups. By 
comparison, the 15 to 54 age groups accounted for only 42 percent of non-
alcohol-impaired deaths (Figure 2). 

Establishing a Relationship Between Alcohol and Casualties of Fire 28 

Figure 2: Distribution of Alcohol-Impaired vs. Non-Alcohol-Impaired Fire Deaths 
(Ontario 1990-1995, excluding 1993) 

For those sustaining injuries (Figure 3), 35 to 44 year-olds comprised the 
largest portion of alcohol-impaired fire injuries (29 percent), followed by 25 
to 34 year olds (27 percent). Together, these two age groups accounted for over 
half (56 percent) of all fire-related injuries in which the individual was 
impaired by alcohol. 

Establishing a Relationship Between Alcohol and Casualties of Fire 29 

Figure 3: Alcohol-Impaired vs. Non-Alcohol-Impaired Fire Injuries by Age 
(Ontario 1990-1995, excluding 1993) 

Gender 

From 1990 to 1995, men had twice as many fire deaths as women; male fire 
fatalities accounted for two-thirds (66 percent) of all fire fatalities. This 
ratio rose, as did the disparity, between male and female fatalities when 
alcohol was involved. Among the alcohol-impaired fatalities, men outnumbered 
women by nearly 3 to 1, accounting for 75 percent of alcohol-impaired fatalities 
(Table 3). 

Table 3: Male to Female Fire Casualty Ratios in Ontario 
Deaths Injuries 
All Casualties 2.0 1.8 
Alcohol-Impaired 2.8 4.8 

A similar trend was found for all fire and alcohol-impaired fire injuries (Table 
3). Men accounted for 64 percent of all fire-related injuries in general and 83 
percent of those involving alcohol. Although men already outnumbered women 
nearly 2 to 1 in all fire-related injuries, this ratio rose to nearly 5 to 1 
when the injured parties were impaired by alcohol. 

Establishing a Relationship Between Alcohol and Casualties of Fire 30 

When examining male and female drinking patterns in Ontario, these discrepancies 
in fire casualties might appear puzzling. According to the Toronto Addiction 
Research Foundation, approximately equal proportions of the male and female 
population over the age of 18 were current drinkers - 85 and 80 percent 
respectively. However, when the same group was asked if they consumed more than 
5 drinks in a single sitting, 13 percent of males and 4 percent of females 
responded yes. In addition, 7 percent of males and 3 percent of females claimed 
to be daily drinkers. In effect, heavy drinkers were more than three times as 
likely to be men. Daily drinkers were more than twice as likely to be women. 

Causes of Fire Casualties 

Smoking (53 percent) followed by cooking (23 percent) and open flame fires (14 
percent) were the three leading causes for alcohol-impaired fatalities (Figure 
4). For non-alcohol-impaired fire deaths, the leading cause was smoking (35 
percent), followed by open flame (28 percent), and cooking (16 percent). More 
alcohol-impaired fires occurred as a result of smoking fires than non-alcohol-
impaired victims deaths (53 percent vs. 30 percent). 

Establishing a Relationship Between Alcohol and Casualties of Fire 31 

Figure 4: Alcohol-Impaired vs. Non-Alcohol-Impaired Fire Fatalities by Cause 
(Ontario 1990-1995, excluding 1993) 

Figure 5: Alcohol-Impaired vs. Non-Alcohol-Impaired Fire Injuries by Cause 
(Ontario 1990-1995, excluding 1993) 

Establishing a Relationship Between Alcohol and Casualties of Fire 32 

The three leading causes for alcohol-related fire injuries were cooking (43 
percent), smoking (42 percent), and open flame (9 percent) (Figure 5). Among 
non-alcohol-impaired injuries, cooking fires (42 percent) were also credited 
with causing the most injuries, followed again by smoking fires (18 percent). As 
for fire deaths, more alcohol-impaired fire injuries were injured in a smoking 
fire than non-alcohol-impaired victims (42 percent vs. 18 percent). Although 
cooking fires were the leading cause of injuries for both alcohol-impaired and 
non-alcohol-impaired persons, the percentage of cooking-related injuries 
differed by only 1 point between the two groups. 

Alcohol Consumption and Drinking Patterns 

The legal drinking age in Ontario during this period was 19. Alcohol consumption 
in Ontario comes with a relatively high degree of social acceptance. It is not 
illegal for parents to give alcohol to a child under the legal drinking age at 
home. In a 1990 nation-wide Gallup poll for Canada, 79 percent of adults over 
the age of 15 reported that they had at some point consumed alcohol. Over half 
the adult population (55 percent) said that they have 6 drinks or more in a 
sitting and 10 percent reported using alcohol daily. Among young people aged 12 
to 19 years, 73 percent stated that they had consumed alcohol at least once in 
the previous year. More than 1 in 5 of this age group admitted to drinking more 
than once a week. The United States and Canada have very similar alcohol 
consumption rates per capita; in both the United States 76 and Canada 77 , 
approximately 2.6 gallons of alcohol are consumed per year by people aged 15 and 
over. 

Unintentional Injury Deaths 

Accidents and adverse effects are the fifth leading cause of death in Canada 78 
, as in the United States. 79 Unintentional injury death rates are approximately 
30 deaths per 100,000 people in both the United States 80 and Canada. 81 In both 
countries, the age 15 to 

76 Centers for Disease Control and Prevention. "Apparent Per Capita Ethanol 
Consumption  U. S., 1977-1986," Morbidity and Mortality Weekly Report 1989. Nov 
38 (46); 800-803. 
77 Statistics Canada. "Health Indicators," National Population Health Survey. 
1996. Electronic media. Catalog no. 82-221-XDE 
78 Statistics Canada. "Causes of Death," 1996 electronic media. Catalog no. 84-
208-XP8 
79 U. S. Department of Commerce, Bureau of the Census. The Statistical Abstract 
of the United States - 1993 113 th ed. 1993. Washington, DC: GPO. 80 U. S. 
Department of Commerce, Bureau of the Census. The Statistical Abstract of the 
United States - 1993 113 th ed. 1993. Washington, DC: GPO. 

Establishing a Relationship Between Alcohol and Casualties of Fire 33 

34 population is the most active age bracket for drinking and experiences the 
highest unintentional injury death rate. Motor vehicle crashes are the leading 
cause of unintentional injury deaths involving alcohol in both countries as 
well. While less studied, the results from the Ontario Fire Reporting System 
supports the possibility that fire casualties are prominently affected by 
alcohol as well. 

81 Statistics Canada. "Causes of Death," 1996 electronic media. Catalog no. 84-
208-XP8 

Establishing a Relationship Between Alcohol and Casualties of Fire 34 

IX. CASE STUDY: FIRE FATALITIES IN MINNESOTA 

Background 

In 1991, the Minnesota Center for Health found that unintentional injury 
fatalities accounted for 31 percent of all alcohol-related deaths in the state. 
82 This was by far the majority of all fatalities involving alcohol. Of these 
deaths, 6 percent stemmed from fires. 83 In an effort to learn more about the 
nature and extent of the alcohol problem as it is related to injuries, the 
Minnesota Department of Public Safety began recording BALs for all unintentional 
injury deaths, including fire deaths. It is this practice that makes examining 
fire deaths in the state of Minnesota a useful tool by which to study the impact 
of alcohol on fire fatalities. 

Fire Fatalities 

There were a total of 255 fire fatalities in the state of Minnesota from 1993 to 
1996. 84 Of these, 74 were found to have positive blood alcohol concentrations, 
representing 30 percent of all fire fatalities and 40 percent of all fire deaths 
over the age of 15. It is important to note that autopsy reports were the source 
of the data and positive blood alcohol results of any measurement were recorded, 
not necessarily the legal intoxication standard. 

Ninety percent of alcohol-impaired fatalities met or exceeded the legal 
intoxication standard 0.1 percent BAL (Figure 6). The BALs for over half of the 
fatalities positive for alcohol were between 2 and 4 times over this limit. Most 
of the alcohol-impaired fire fatalities were severely intoxicated, often to the 
point of stupor. 

82 D. Kloehn, K. Miner, K. Daly, Alcohol Use in Minnesota: Extent and Cost, 
Minnesota Department of Health, October 1995. 
83 Ibid. 
84 Minnesota Office of the State Fire Marshal. 

Establishing a Relationship Between Alcohol and Casualties of Fire 35 

Figure 6: Minnesota Fire Fatalities with Positive Blood Alcohol Levels by Blood 
Alcohol Level (1993-1996) 

Demographics of Fire Fatalities 

Age 

Minnesota fire victims aged 25 to 34 accounted for the largest percentage (27 
percent) of fire deaths that were under the influence of alcohol at the time of 
their death. The age groups 35 to 44 and 15 to 24 followed closely behind and 
comprised 23 percent and 21 percent of all alcohol-impaired fire fatalities, 
respectively. Combined, these three age brackets represented approximately 70 
percent of all Minnesota fire fatalities with measurable BALs (Figure 7). 

Establishing a Relationship Between Alcohol and Casualties of Fire 36 

Figure 7: Minnesota Fatalities by Age Group (1993-1996) 

Approximately 40 percent of fire fatalities over the age of 15 tested positive 
for alcohol use at the time of their death. Fire death victims aged 25 to 34 
comprised the largest number of alcohol-impaired fire deaths, and at the same 
time represented the largest percentage of fire fatalities with respect to their 
age group; approximately 63 percent (19 of 40 fatalities) of all Minnesota 
deaths aged 25 to 34 were under the influence of alcohol. The age groups 35 to 
44 and 45 to 54 followed closely behind; alcohol-impaired fatalities accounted 
for 53 percent of all fire deaths in each age group. Alcohol-impaired fatalities 
aged 15 to 24 also accounted for 43 percent of fire deaths in their age bracket. 
The 15 to 54 age group accounted for 82 percent of alcohol-impaired casualties 
but only 31 percent of non-alcohol-impaired deaths (Figure 8). 

Establishing a Relationship Between Alcohol and Casualties of Fire 37 

Figure 8: Distribution of Minnesota Fire Fatalities by Age, 1993-1996 

Gender 

Men represented 65 percent of total fire fatalities and 80 percent of fire 
fatalities with positive BALs in Minnesota. The male to female ratio for fire 
deaths in general was nearly 2 to 1, but when alcohol was involved, the ratio 
rose to 4 to 1 (Table 4). For those fatalities with BALs meeting or exceeding 
the legal intoxication standard of 0.1 percent BAL, 87 percent were men. In 
addition, alcohol-impaired fire fatalities with BALs equal to or greater than 
0.4 percent were comprised entirely of men. Conversely, women outnumbered men 
for fatalities that had BALs below the intoxication standard, accounting for 74 
percent of deaths with BALs less than 0.1 percent. 

Table 4: Male to Female Fire Death Ratios in Minnesota 
Type of Casualty Ratios 
All Casualties 1.9 
Positive BALs 2.8 

Establishing a Relationship Between Alcohol and Casualties of Fire 38 

This pattern is reflected throughout all alcohol-related deaths in Minnesota, 
regardless of the cause. According to the Minnesota Department of Health, 
significant gender differences among alcohol-related deaths can be explained by 
the exaggerated drinking patterns of males. According to the Minnesota 
Department of Health, 28 percent of male adults report binge drinking as opposed 
to only 10 percent of adult females. 85 

Fire Fatality Causes 

Smoking-and heating-related fires were the leading causes of fire deaths among 
victims with positive BALs as well as those for which no BAL was recorded 
(Figure 9). Although the percentages of deaths between alcohol-impaired and non-
alcohol-impaired deaths were similar for heating fires, a stark difference 
exists for smoking fires. Nearly two-thirds (64 percent) of the alcohol-impaired 
fire deaths were killed in a smoking fire, as opposed to 37 percent of the non-
alcohol-impaired fatalities. Approximately 46 percent of deaths caused by 
smoking fires had positive BALs. In addition, over one-third of cooking fire 
fatalities and one-fourth of heating fire fatalities were under the influence of 
alcohol at the time of their death. 

Figure 9: Minnesota Fire Fatalities by Cause, 1993-1996

85 Ibid. 

Establishing a Relationship Between Alcohol and Casualties of Fire 39 

Alcohol Consumption and Drinking Patterns 

Per capita, alcohol use in Minnesota exceeds that of use nationwide. In 1991, 
the average drinker in Minnesota consumed an average of more than 2 drinks per 
day. Approximately one-third of high-school seniors in Minnesota drink to the 
point of intoxication at least once a month, or have 5 or more drinks per 
sitting. 86 

Binge drinking is more common among young persons aged 18 to 34. Males make up 
the majority of these drinkers as well. Among Minnesotan's aged 18 and older, 
men are three times more likely than women to report binge drinking. Heavy 
drinking, (those who consume 60 or more alcoholic beverages in a month) is also 
much more prevalent in males. In Minnesota, the prevalence of binge drinking 
remains higher, and the rate of abstinence from alcohol lower, than in many 
other states. 

Unintentional Injury Deaths 

In 1991, there were 35,241 deaths in Minnesota. Nearly 1,500 deaths were caused 
by unintentional and accidental injuries. Of these deaths, 31 percent were under 
the influence of alcohol. The top four causes of unintentional injury deaths in 
general were motor vehicle accidents, falls, fires and burns, and drownings. 
Motor vehicle crashes were responsible for the majority of alcohol-related 
deaths (54 percent), followed by falls (27 percent), fire-related injuries (6 
percent), drownings (5 percent), and alcohol poisoning (3 percent). 87 According 
to the Minnesota Department of Health, for the population aged 35 and younger, 
almost every alcohol-related death (97 percent) was due to an alcohol-related 
injury or act of violence. 88 

86 Ibid. 
87 Ibid. 
88 Ibid. 

Establishing a Relationship Between Alcohol and Casualties of Fire 40 

X. CONCLUSION 

Human behavior exerts a powerful impact on the risk of fire. The comportment 
with which an individual acts not only affects the ignition of a fire, but how 
one manages and escapes from it. As alcohol can significantly affect human 
behavior, it is not surprising to find that it is a major factor in fire-related 
deaths and injuries. Alcohol intoxication has been identified as the strongest 
independent risk factor affecting residential fire deaths. By altering ones 
cognitive, physiological, and motor functions, alcohol increases the chance of 
starting a serious fire while at the same time reduces the chance of survival 
from a fire or burn injury. 

The end result of acute alcohol intoxication is carelessness. It is this 
carelessness that generates the possibility of starting a fire. It reduces one's 
ability to properly detect fire and renders mechanical detection devices 
virtually useless. You cannot escape from a fire if you cannot sense it or heed 
a warning alarm. Chronic alcohol ingestion exhibits equally deleterious effects 
by weakening the body's defenses and healing mechanisms. Chronic alcoholic users 
have been shown to die from smaller burns and at a higher rate than non-drinking 
burn casualties. 

Alcohol impacts a silent population as well. Children who are cared for by an 
alcohol-impaired adult sustain serious illness and injury at a much greater 
frequency than do children of non-alcohol-impaired adults. Through no fault of 
their own, children, senior citizens, and disabled individuals lose their lives 
in fires started by another's carelessness. Unable to help themselves, these 
people die while waiting to be rescued by someone who cannot even rescue himself 
or herself. 

Smoking fires are the leading cause of fires that kill people. They leave the 
victim in a particularly vulnerable position because these individuals are 
typically intimately involved in the ignition of the fire. Often, the victim's 
clothes or nearby upholstery is the material ignited. Such intimacy 
significantly reduces one's ability to effectively mitigate or extinguish a 
rapidly evolving fire. Numerous studies have shown the correlation between 
alcohol consumption and smoking frequency. The facts strongly link increased 
drinking to increased smoking. Acting synergistically, both factors contribute 
to abnormally high risk for fire death and injury. Not only does alcohol 
impairment increase the propensity for starting a smoking fire; it increases the 
incidence and severity of potential casualties. 

Establishing a Relationship Between Alcohol and Casualties of Fire 41 

Drinking patterns seem to exert more of an effect on fire casualties than does 
total alcohol consumption. This impact has been demonstrated among all 
unintentional injuries, not only those from fire. Studies have examined the 
relationship between acute and chronic alcohol consumption and found that 
chronic users were more likely to sustain unintentional injuries than 
individuals who drank on an infrequent basis. In addition, alcohol abusers 
appear to suffer a disproportionately high number of fire fatalities and 
injuries relative to their percent of the total population. It seems likely that 
alcohol abuse may also be a major factor in explaining high fire death rates 
among nations with high alcoholism rates. 

An ounce of prevention is worth a pound of cure. So the old saying goes and 
still holds true for fire prevention. Individuals who use and abuse alcohol are 
segments of the population with extremely high fire risks. While less studied 
than other accidental and unintentional injuries, fire casualties are emerging 
as an injury subset highly influenced by problematic drinking behaviors. Fire 
fatalities and injuries can be prevented if a concerted effort is made to 
identify and modify high-risk drinking patterns. It also may be possible to 
minimize fire risk by increasing the awareness of those who drink and those who 
are surrounded by regular drinkers. Successful educational campaigns have been 
launched warning people of the dangers of drunk driving and the same can be done 
to shed light upon the subtle dangers of alcohol and fire.