Traumatic brain injury is not only a devastating event in its own right, it also leaves the victim increasingly vulnerable to other accidents and injuries. Not least among these dangers is the risk of fire. Individuals who have sustained a serious brain trauma are dramatically more likely than other people to be seriously injured or killed in a fire. There are a few reasons for this. For one, brain-damaged individuals typically suffer from cognitive deficits that make it difficult for them to notice and react to uncommon stimuli. In the event of a fire, such an individual may not immediately recognize that smoke or the smell of smoke indicates danger. The problems stemming from this slower reaction time are only amplified by any motor problems. Unfortunately, many individuals with traumatic brain injury are severely inhibited in walking, and so may not be able to quickly escape a burning building. Because injured individuals are so vulnerable to fires, these individuals and those who assist them are obliged to take every possible precaution to ensure that the danger is minimized.
Of course, the best way to minimize the danger of fire injury is to prevent fires from occurring in the first place. Individuals with traumatic brain injury should work in cooperation with an occupational therapist to make their home as fire-safe as possible. The specific steps that need to be taken in order to maximize safety will depend on the individual and his or her degree of functionality: some individuals should not be allowed to cook at all, for instance, while others can be allowed to cook with the proper equipment and guidelines in place. As one would expect, the room of the house that poses the greatest threat for fire is the kitchen. An occupational therapist should make sure that the kitchen is well organized and that any safety accessories have been added. For example, many individuals with traumatic brain injury have homes that are equipped with special stoves that automatically shut off after a certain amount of time, or if there is nothing placed on the burner. Also, it is always a good idea to set up a list of steps for every task that may pose a fire hazard, as individuals with traumatic brain injury are more likely to forget steps in a process and make dangerous errors. For instance, an occupational therapist might write out a basic list of instructions for using the stove, so that the injured individual will always remember to turn the burner off when he or she is finished. It is usually best for injured individuals to stick to familiar cooking routines; asking an injured individual to improvise or work independently in the kitchen increases the risk of forgetfulness.
Although the kitchen will be the focal point of fire prevention in the home, there are other areas that can pose a threat if they are not managed. For instance, electrical cords anywhere in the house can be a fire hazard if they are allowed to become frayed or are placed in an awkward location. Cords should never be placed where they are likely to be stepped on or tripped over. Also, all the heating vents should be located, and furniture should be moved away from them. Individuals with traumatic brain injury should not be allowed to use candles or matches, as these can be dangerous if left unattended. It is much safer for injured individuals to use lighters, which will not continue to burn when the butane button is released.
Finally, and perhaps most importantly, it is essential to define evacuation routes in case of emergency. These routes should be as simple as possible, with no clutter or obstacles preventing easy passage. Individuals with traumatic brain injury may move erratically when they are under stress, so evacuation routes should be broad and easy to navigate, even in the dark. Individuals with severe motor disabilities are obliged to live on the ground floor, as attempting to negotiate stairs in an emergency situation may be too dangerous.
Besides doing everything possible to minimize the risk of fire, it is essential to implement a proper detection system in case a fire does break out. There should be at least one smoke detector in every room of the house. If possible, these smoke detectors should be connected to the house or building’s electrical supply directly, eliminating the possibility of failure due to dead batteries. Most smoke detectors that are wired in this way will contain battery backups in case of a power outage. In special cases, it may even be possible to set up a smoke detector system that automatically contacts the local emergency services any time smoke is sensed. These systems are most essential in cases where the individual is either unlikely to recognize a dangerous fire or is incapable of reacting quickly to a hazard. Of course, systems that link to the local authorities can be expensive, so those individuals who have not sustained major injuries should simply be given a battery-operated smoke detector system.
Some individuals with traumatic brain injury are capable of handling small fires. An occupational therapist should provide basic training in dealing with small fires of different types. For instance, a functional individual can be taught to smother a grease fire rather than dousing it with water. It is especially important to convey to an individual with traumatic brain injury that he or she should not attempt to fight a fire once it has reached a certain size or severity. An injured individual can become fixated on a task, which in the event of a large fire might endanger his or her safety. Fire extinguishers should be placed in most of the rooms in the house, especially the kitchen, and injured individuals should be taught how to use them. If necessary, the occupational therapist should write out a routine for using the fire extinguisher and allow the injured individual to practice until using the device becomes second-nature. If an injured individual is determined to be not competent to use a fire extinguisher, then he or she should not be encouraged to do so, as lingering in the area of a fire increases the risk of injury.
Perhaps the most important lesson that needs to be taught to an individual with traumatic brain injury is to gauge when a fire has gotten out of control, and to evacuate the building immediately when this occurs. It is not enough to draw and discuss evacuation procedures with an injured individual; he or she needs to practice evacuating the building until the routine is firmly ingrained in his or her memory. Also, in the event of a serious fire there may be obstacles in the evacuation route, and in some cases the prescribed evacuation route may be unfeasible. In order to prepare for these contingencies, the occupational therapist should help the individual to practice what to do when there are impediments to the original evacuation route. The injured individual should be equipped with a host of secondary plans in the event of a serious fire.
All of the guidelines mentioned so far can help to prevent fires and minimize injuries when they do occur. Nevertheless, these guidelines are useless unless the friends, family, and occupational therapists of the injured individual work to maintain and reinforce them. Individuals with traumatic brain injury need to be reminded constantly of the dangers associated with fire, as well as the protocol for extinguishing or evacuating in the event of a serious fire. Avoiding fire-related injury is truly a team effort.
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