Homeless Tent Fires: A Descriptive Analysis of Tent Fires in the Homeless Population

Abstract

Tent fires are a growing issue in regions with large homeless populations given the rise in homelessness within the US and existing data that suggest worse outcomes in this population. The aim of this study is to describe the characteristics and outcomes of tent fire burn injuries in the homeless population. A retrospective review was conducted involving two verified regional burn centers with patients admitted for tent fire burns between January 2015 and December 2020. Variables recorded include demographics, injury characteristics, hospital course, and patient outcomes. Sixty-nine patients met the study inclusion criteria. The most common mechanisms of injury were by portable stove accident, assault, and tobacco or methamphetamine-related. Median percent total body surface area (%TBSA) burned was 6% (IQR 9%). Maximum depth of injury was partial thickness in 65% (n=45) and full thickness in 35% (n=24) of patients. Burns to the upper and lower extremities were present in 87% and 54% of patients, respectively. Median hospital Length-of-Stay (LOS) was 10 days (IQR=10.5) and median ICU LOS was 1 day (IQR=5). Inhalation injury was present in 14% (n=10) of patients. Surgical intervention was required in 43% (n=30) of patients, which included excision, debridement, skin grafting, and escharotomy. In-hospital mortality occurred in 4% (n=3) of patients. Tent fire burns are severe enough to require inpatient and ICU level of care. A high proportion of injuries involved the extremities and pose significant barriers to functional recovery in this vulnerable population. Strategies to prevent these injuries are paramount.

A scoping review of surgical care for people experiencing homelessness: prevalence, access, and disparities

“…Psychiatric comorbidities included mood disorders, psychotic disorders (reported in pregnancy), and high rates of substance use (smoking, alcohol use, intravenous drug use, multidrug use), reported in primary studies. 58 , 64 , 65 …”

“… 117 The majority of comments presented concerns regarding living conditions. The lack of stable housing was described as a possible reason for leaving against medical advice, 57 readmission, 54 , 92 extended hospital stay, 55 , 58 , 67 , 87 , 93 , 94 and missing follow-up appointments. 36 , 64 , 79 , 95 – 97 In addition, authors commented on how the lack of a regular address leaves home nursing services inaccessible, 97 terminal care impossible, 49 and deters patients from procedures.…”

“… 22 , 38 – 40 , 43 , 45 , 51 , 57 , 58 , 63 , 70 , 79 , 86 , 95 – 97 , 100 , 103 – 106 PEH can present with more progressed disease and serious conditions affecting indications for and outcomes of surgery. 36 , 43 , 44 , 58 , 60 , 61 , 81 , 92 , 100 , 106 , 107 Treatment compliance following surgery was also documented as a challenge. 35 , 48 , 103 …”

“…Four primary studies 36,47,54,55 reported that the average age of PEH was younger than that of individuals with housing for similar disease processes, and another primary study 38 reported fewer elderly PEH. Four primary studies 47,[56][57][58] also reported that PEH were more likely to be from racialized groups, including Black, Hispanic, and Native American.…”

“…Many studies discussed barriers or challenges PEH face when it comes to surgical care, including 48 primary studies, 19,31,[34][35][36][39][40][41][43][44][45][47][48][49][50]54,55,[57][58][59][60][61][62][63][64]66,69,72,73,75,[79][80][81]86,91,96,98,100,[102][103][104][105][107][108][109]111,112,114,116 9 abstracts, 37,38,42,…”