UMass medical students educate Carlisle seniors on oxygen & fire safety 

09aKC-MedicalStudents
UMass Medical School students that participated in a project in Carlisle studying the dangers of smoking near oxygen equipment include (left to right): Katherine Pereira, Aqib Chaudhry, Prashanth Rau, Timothy Boardman and MichelleEpstein. Students are pursuing degrees in medicine or nursing. (Photo by Karina Coombs)

by Karina Coombs

Smoking can be dangerous in unexpected ways, particularly when mixed with medical oxygen use. “A gentleman had lit up a cigarette while attached to oxygen and set all the tubing attached to his face on fire,” related University of Massachusetts (UMass) Medical School student Timothy Boardman who also has experience as an EMT and volunteer firefighter in Swansea. The burning tubing resulted in significant personal injury. Boardman was one of five UMass medical students who participated in a student clerkship, researching and creating materials to educate Carlisle seniors about medical oxygen and fire safety. 

Population Health Clerkship

Three medical and two graduate nursing school students spent two weeks at Town Hall under the supervision of Board of Health (BOH) Agent Linda Fantasia as part of a UMass Medical School Population Health Clerkship course. Carlisle was the students’ host community and the BOH provided them with a focus of study and a target population. The goal was to create a set of materials that could be used to make seniors aware of the potential fire danger in and around their homes when using oxygen. In Massachusetts, residents over the age of 65 are most at risk of dying in fires. 

Medical student Aqib Chaudhry explained the clerkship was part of an 18-month course at the medical school’s Worcester campus that discussed disparities and inequalities in health care and how that impacts access to health care and proper physician care. “We’re focusing on a population that may not have appropriate information to make life changes to make them safer,” said Chaudhry. “We educate them, provide resources and they can reduce high-risk behaviors.” Chaudhry explained that while the clerkship developed recommendations for Carlisle residents, the findings were generalized enough to apply to other communities.

Fantasia explained that she first became aware of the UMass Medical School clerkship program when her daughter visited a neighboring community as part of her medical school program. Fantasia contacted the school and offered Carlisle as a host community. Fantasia said there is no cost to the town. Carlisle gives the students the topic of study, a place to work and arranges for interviews. The BOH is also expected to attend the students’ poster presentation. In exchange, the students create materials beneficial to the town which advance awareness of the particular issue studied.

Oxygen-enriched environments and fire hazards

While there is approximately 20% oxygen in the atmosphere, medical oxygen provides air that can reach 100% concentration. At this level, the air becomes highly flammable if a heat source is present. “Oxygen makes everything in it burn faster and hotter,” said Boardman, explaining that the presence of enriched oxygen levels allows things to burn that normally would not, including flame-resistant materials. Boardman noted that even the flame-resistant gear worn by firefighters would burn under these conditions. 

Furthermore, while people using oxygen are supposed to use signage to alert the public to the presence of oxygen tanks, they do not always do this, adding to the danger for both first responders as well as neighbors in multi-unit dwellings. “The key is to prevent these fires in the first place so we aren’t faced with that situation,” added Boardman.

Ordinary heat sources can trigger a disaster both for the patient on oxygen, as well as anyone in the immediate vicinity. A dryer, oven, space heater, hair dryer, candle or match can ignite the oxygen if close enough to the source. “It doesn’t strike you that these things can cause a fire,” said medical student Prashanth Rau. “Just knowing this is a big step in safety.” 

Smoking and oxygen

Smoking in an oxygen rich environment also increases the chance of fire. Between 1997 and 2013 the State Fire Marshal notes there have been 34 deaths related to smoking and oxygen. As recently as March, a Westfield fire claimed the life of a 72-year-old woman and forced the evacuation of 100 residents of her elderly apartment complex. The cause of the fire was ruled to be smoking near a home oxygen system, an issue that is getting more attention as more seniors use oxygen in their homes instead of a hospital setting, noted Fantasia. 

Carlisle Village Court went smoke-free as of January 1 and Benfield Farms will also be smoke-free within the building. Fantasia is working with others to see if the entire property can be made smoke-free. She explained that there were not a lot of smoking cessation programs for seniors. Fantasia said that while Emerson Hospital did offer a hypnosis program to help seniors quit, it was held at night when they typically do not go out. “We can do better,” she said. 

The role of doctors and pharmacists

In an effort to find out what doctors were telling their patients about oxygen and fire safety, the students met with a local pulmonologist and respiratory therapist. Both instruct their patients that they cannot smoke and also be on oxygen. Going one step farther, the pulmonologist will not give a prescription for oxygen if the patient is a current smoker and if she discovers a patient is smoking she will have the system removed from the home and pull the prescription.

Both the students and Fantasia also explained that oxygen is not just for patients that have lung disease as a result of smoking. There are a number of other factors that could require the use of oxygen. “Just because you never smoked doesn’t mean you’ll never need this information,” said Boardman. 

Getting the word out

In addition to gathering information from the Massachusetts Fire Academy, the Federal Emergency Management agency and the National Fire Academy, the students met with Fire Chief David Flannery who was receptive to the idea of having a long-term program targeting and educating seniors. The students produced a pamphlet that will be distributed at Town Hall, once Fantasia identifies printing funds and may also be distributed by the Fire Department during Council on Aging (COA) presentations.

To directly reach the seniors within Carlisle, the students collaborated with the COA and filmed a CCTV program for COA Happenings that will air in November. They also held a community meeting at the Gleason Library and created online resources explaining oxygen therapy and fire safety for the BOH website. These materials can be found at: www.carlislema.gov/pages/CarlisleMA_Health/HomeOxygen.

The students completed their project on October 25 and returned to the UMASS Medical School campus in Worcester to begin writing personal reflections detailing the immersion course. A poster session will be held on campus on November 5 and the final poster will be on display at Town Hall later in the month. “Telling people how to take small steps to make a big difference is what this clerkship is focused on,” concluded Rau. ∆