Is ethanol the unknown toxin in smoke inhalation injury?

Of the 12,000 fire-related deaths occurring annually in the United States, it is estimated that 60 to 80 per cent are due to smoke inhalation. Plastic and synthetic materials which have been introduced in home construction and furnishings produce a more toxic smoke when burned. Efforts to identify a "supertoxin" in this smoke have been unsuccessful to date. An alternative approach is to examine why victims are unable to escape, and become exposed to smoke for lethal periods of time. The authors examined the circumstances of death in 39 fire victims (27 adults, 12 children) over a 25-month period. Detailed examination of the fire scene, autopsy studies, and toxicologic analysis were carried out. Position of the victim, and escape efforts were noted. Carbon monoxide was elevated in all victims, with "lethal" levels (= greater than 50%) in 21/39 victims. Cyanide was detected in 24/29 victims, but none had lethal (3 mg/L) levels present. Ethanol was detected in 21/26 adults (80%) and 0/12 children (0%). 18/26 adult victims had ethanol levels above the statutory level of intoxication (10 mg%). Victims found in bed (no escape attempt) had a mean blood ethanol level of 268 mg%, compared with a mean level of 88 mg% in those victims found near an exit (P = .006). Ethanol intoxication significantly impairs the ability to escape from fire and smoke and is a contributory factor in smoke-related mortality.