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IAFC MEMBER ALERT: FOR IMMEDIATE REVIEW
Contact: International Association of Fire Chiefs
Nancy Weaver, Chief of Staff, nweaver@iafc.org
Jennifer Ashley, CAE, Director of Communications, jashley@iafc.org
703/273-0911 • www.iafc.org

 

Burglar Alarms Emitting Smoke

Causing Concern for Fire Chiefs

Fairfax, Va., May 11, 2007... The International Association of Fire Chiefs (IAFC) is concerned about a new burglar alarm system that deploys dense smoke to incapacitate an intruder. The systems are sold on the premise of protecting a property by having a blinding smoke screen quickly fill an area when a burglar alarm is activated. In turn, the blinding smoke may likely activate a smoke/fire alarm; this would precipitate a fire department response. 

Chief Alan Perdue, chair of the IAFC Fire and Life Safety Section, brought the new alarms to the attention of the IAFC board of directors, saying that several national franchise businesses are reportedly installing this type of system.

 

“In essence, a complement of 15 to 20 firefighters is sent to a report of smoke in a building, but when they arrive, they have a burglary in progress with a perpetrator who may be armed at worst and disoriented and confused at best. The entire fire response lends itself to multiple situations where a firefighter or citizen can lose their lives, all because a burglar alarm was activated, generating a false fire alarm response,” said IAFC President Chief Jim Harmes.

 

The International Fire Code specifically prohibits these types of systems, and the National Fire Protection Association (NFPA) 101 Safety to Life standard has provisions that prohibit anything from impeding egress from a building. Dense smoke certainly impedes anyone from safely exiting a building. Fire departments may not be notified of installations of these alarm systems in their jurisdictions, because they are part of a burglar alarm system.

 

Companies that install these devices are willingly transmitting a false alarm to a fire department. These smoke barrier systems not only will unnecessarily tie up community resources, but more importantly may also put their fire and EMS personnel’s lives at stake.

 

“To put it directly, this type of system jeopardizes the life of every firefighter who responds to an emergency when the system has been activated, and it has the potential to endanger every citizen who encounters a fire truck responding with red lights and sirens to a fire alarm where there is no fire.” said Harmes.

 

The Central Station Alarm Association is not in favor of these types of systems. “The Central Station Alarm Association (CSAA) represents the nation’s burglar and fire alarm monitoring and installing companies and completely supports the IAFC position on eliminating the use of smoke barriers. The smoke barriers present an inherent danger to firefighters and law enforcement, and the rationale for their use is fundamentally flawed,” said CSAA President John Murphy.

 

The IAFC encourages fire department officials to be aware of these types of installations. The Fire and Life Safety Section board is meeting on this issue next week and as additional information is obtained, we will communicate it to members.

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April 2007

Pediatric Iron poisoning:  A retrospective case study

Back ground:  20 month old male patient who had “gotten into”, and possibly ingested, a unknown quantity of Grandmothers iron supplement tablets while at grandparents house for day care.

Grand parents reported that pt was found with a open bottle of “Feosol”(iron sulfate 65mg/tab) tablets and multiple tablets on floor with pt sitting amongst the tablets.   Bottle when purchased contained 60 tablets and was opened 20 days earlier with 1 tablet taken per day.  Grandmother was able to find  21 tablets on the floor and surrounding area leaving 19 tablets unaccounted for.

 

Assessment and treatment:  Pt on arrival to the ED was in the care of his grandfather. Pt's mother had been contacted by grandparents and was in route to the ED.  Pt was  A&O and responding to stimuli/environment appropriately and had no signs of distress.  Physical exam found vital signs to be within expected norms for his age.  Green staining was noted on palm of hands and on tongue (with this preparation/brand the tablets were green). Pt's weight was determined to be 25 lbs.

Treatment while in the ED included establishment of IV access for fluids and so that conscious sedation medications could be given.  Conscious sedation was accomplished using weight based Ketamine.  Once sedated a size 10 fr NG tube and size 10 fr Foley catheter were placed for the purpose of gastric lavage and to monitor urine output and color (iron when excreted by the kidneys will turn the urine rust color). Labs including CBC, CMP, and Serum Iron levels were drawn.  IV NS was infused with a bolus of 20ml/kg given.  Due to the small size of the NG tube aspiration of gastric  contents to check for pill fragments was not possible. Chest and abdominal X rays were done to check for presence of pills on X ray, and for confirmation of NG tube placement.  A solution of Polyethylene glycol (GoLytely) was ordered from pharmacy to be given via the NG for the purpose of whole bowel irrigation.  Arrangements were also made for transfer to the Pediatric ICU at DHMC. (due to it being  bright sunny day the pt was transported via helicopter vs ambulance).  Due to the rapid response of DHART and pharmacy having to mix then package the proper volume of “GoLytely” whole bowel irrigation was not started prior to transfer but was to be done upon pt arrival @ DHMC. Copies of all labs and X rays were sent with the pt to DHMC.

So why all the concern and rapid transfer to a Hospital with a PICU???

Iron overdose in the pediatric population, esp in the < 6 yrs of age group, remains a under recognized and potentially life threatening problem. According to the FDA iron overdose is the leading cause of death due to poisoning in the under 6yrs age group. For the years 1988 to 1992 almost 17% of pediatric deaths reported to poison control centers were due to Iron overdose. 

The recommended dietary allowance for iron is  10 mg/day for children age 6 months to 4 years, 15 mg/day for persons 11 to 50, for people >50 10mg/day,  and for women who are pregnant (mom of the toddler we have been called for?) is 30mg/day. 

Overdoses of iron affect 4 main body systems: Gastrointestinal, Hepatic, Cardiovascular, and Central nervous system.   As few as 36 prenatal iron supplement tablets (60mg elemental iron/tab) or 120 children's multivitamin tablets (15mg to 18mg elemental iron/tab) can be lethal to a 2 year old,  and 1/3 as many tablets can result in serious injury to a child.   Yet many iron supplement preparations are sold in bottles of 60 or more (many warehouse stores like Sam's club, or BJ's sell iron tablets in bottles of 150 to 200 or more tablets).

Treatment goals are aimed at prevention of absorption. Activated charcoal is not used with iron ingestions as the charcoal will Not bind with iron.  Whole bowel irrigation is the treatment of choice to remove iron from the GI tract before it can be absorbed. 

According to Web MD serum iron levels should be drawn between 2 and 6 hours post ingestion to establish peak serum iron levels.  Labs drawn more than 6 hrs post ingestion may result in the serum iron levels being falsely low. How aggressive treatment needs to be is best based on peak serum levels.  Per Web MD ingestions of less than 20 mg/kg in general do not result in serious symptoms.   Ingestions of between 20 and 60 mg/kg body weight result in moderate symptoms.  And ingestions of  greater than 60mg/kg result in serious symptoms requiring treatment in a specialized care center.  (in the case above the potential ingestion was 1235 mg, if he ingested all 19 tablets, or  102mg/kg).

Factors which make this a high risk OD:

*Iron is a very common supplement in the home of parents, and especially grandparents, for the prevention or treatment of anemia.

*In order to hide the bad taste of Iron in it's elemental form.  Most iron preparations are prepared with colored outer coating which hides the taste and makes them easier to swallow But also makes them have a very similar appearance to many candy's such as  “skittles” or “M&M's”

*Although most Iron preparations are packaged in “child resistant” bottles many cases have been reported where children have been able to open that child resistant cap either by themselves, or with assistance of a older sibling. Because of the high dosage of elemental iron in prenatal preparations by FDA mandate prenatal iron preparations must be packaged in individual “blister” packs.

*Chewable children's vitamins may include iron in their ingredients.  Although this is a small amount of iron in comparison to adult forms this has the added allure to the child of being chewable, and good tasting, so more tablets may be ingested in a accidental ingestion.

Conclusion:  Iron OD in children remains a major problem in children, esp those less than 6 yrs old.  In general if called to a potential ingestion of iron in a pediatric patient the patient needs to be transported to the ED for evaluation and treatment. At no time should a pediatric patient with potential iron OD be “signed off” by EMS  without consultation with medical control.