The "Let's Get Alarmed!" initiative: a smoke alarm giveaway programme

Journal of Public Health, 2012

Background Deaths and injuries related to fires are largely preventable events. In the UK, a plethora of community-based fire safety initiatives have been introduced over the last 25 years, often led by fire and rescue services, to address this issue. This paper focuses on one such initiative-home safety assessments (HSAs). Cheshire Fire and Rescue Service (in England) implemented a uniquely large-scale HSA intervention. This paper assesses its effectiveness. Methods The impact of HSAs was assessed in relation to three outcomes: accidental dwelling fires (ADFs), ADFs contained and injuries arising from ADFs. A two-period comparison in fire-related rates of incidences in Cheshire between 2002 and 2011 was implemented, using Poisson regression and adjusting for the national temporal trend using a control group comprising the 37 other English non-metropolitan fire-services. Results Significant reductions were observed in rates of ADFs [incidence rate ratios (IRR): 0.79, 95% confidence interval (CI): 0.74-0.83,

The European Journal of Public Health, 2005

Background: In 2001, 486 deaths and 17 300 injuries occurred in domestic fires in the UK. Domestic fires represent a significant cost to the UK economy, with the value of property loss alone estimated at £375 million in 1999. In 2001 in the US, there were 383 500 home fires, resulting in 3110 deaths, 15 200 injuries and $5.5 billion in direct property damage. Methods: A cluster RCT was conducted to determine whether a smoke alarm give-away program, directed to an inner-city UK population, is effective and cost-effective in reducing the risk of fire-related deaths/injuries. Forty areas were randomized to the giveaway or control group. The number of injuries/deaths and the number of fires in each ward were collected prospectively. Cost-effectiveness analysis was undertaken to relate the number of deaths/injuries to resource use (damage, fire service, healthcare and giveaway costs). Analytical methods were used which reflected the characteristics of the trial data including the cluster design of the trial and a large number of zero costs and effects. Results: The mean cost for a household in a give-away ward, including the cost of the program, was £12.76, compared to £10.74 for the control ward. The total mean number of deaths and injuries was greater in the intervention wards then the control wards, 6.45 and 5.17. When an injury/death avoided is valued at £1000, a smoke alarm give-away has a probability of being cost effective of 0.15. Conclusions: A smoke alarm give-away program, as administered in the trial, is unlikely to represent a cost-effective use of resources.

Fire Safety Science, 2011

Australia has a high rate of smoke alarm ownership, with compulsory installation requirements across all states. Although this is pleasing, it is not correct to assume that a smoke alarm will be in functional order without appropriate maintenance. Procedures to optimise smoke alarm performance include yearly replacement of the battery, and monthly testing of the alarm sounder and cleaning of the unit with a vacuum cleaner. The current study interviewed 500 people randomly selected from shopping centres in Melbourne, Australia, about the maintenance of their smoke alarm. Overall it was found that 17 % of people reported never changing the battery. Most people who reported never changing their smoke alarm battery owned hardwired alarms. Only 57 % reported cleaning their alarms, and of these, 75 % did so less often than recommended. Lower numbers still reported cleaning their smoke alarm (21 %), and only 15 % of these people reported following the correct cleaning procedure. Implications are discussed in relation to targeting community information campaigns.

Public Health Reports, 2007

Objectives. This study was conducted to estimate (1) the proportion of U.S. homes with installed smoke alarms and fire escape plans, and (2) the frequency of testing home smoke alarms and of practicing the fire escape plans. Methods. The authors analyzed data on smoke alarms and fire escape plans from a national cross-sectional random-digit dialed telephone survey of 9,684 households. Results. Ninety-five percent of surveyed households reported at least one installed smoke alarm and 52% had a fire escape plan. The prevalence of alarms varied by educational level, income, and the presence of a child in the home. Only 15% tested their alarms once a month and only 16% of homes with an escape plan reported practicing it every six months. While smoke alarm prevalence in U.S. homes is high, only half of homes have a fire escape plan. Additional emphasis is needed on testing of installed smoke alarms and on preparedness for fire escape plans.

Injury Prevention, 2001

Objective-To estimate the cost eVectiveness of the Lifesavers Residential Fire and Injury Prevention Program (LRFIPP), a smoke alarm giveaway program. Setting-In 1990, the LRFIPP distributed over 10 000 smoke alarms in an area of Oklahoma City at high risk for residential fire injuries. The program also included fire prevention education and battery replacement components. Methods-A cost eVectiveness analysis was conducted from the societal and health care systems perspectives. The study compared program costs with the total costs of medical treatment and productivity losses averted over a five year period. Fatal and non-fatal residential fire related injuries prevented were estimated from surveillance data. Medical costs were obtained from chart reviews of patients with fire related injuries that occurred during the pre-intervention period. Results-During the five years postintervention, it is estimated that the LRFIPP prevented 20 fatal and 24 nonfatal injuries. From the societal perspective, the total discounted cost of the program was $531 000. Total discounted net savings exceeded $15 million. From the health care system perspective, the total discounted net savings were almost $1 million and would have a net saving even if program eVectiveness was reduced by 64%. Conclusions-The program was eVective in reducing fatal and non-fatal residential fire related injuries and was cost saving. Similar programs in other high risk areas would be good investments even if program eVectiveness was lower than that achieved by the LRFIPP.

2009

BMC Health Services Research, 2010

Background: Older adults are at increased risk both of falling and of experiencing accidental domestic fire. In addition to advanced age, these adverse events share the risk factors of balance or mobility problems, cognitive impairment and socioeconomic deprivation. For both events, the consequences include significant injury and death, and considerable socioeconomic costs for the individual and informal carers, as well as for emergency services, health and social care agencies. Secondary prevention services for older people who have fallen or who are identifiable as being at high risk of falling include NHS Falls clinics, where a multidisciplinary team offers an individualised multifactorial targeted intervention including strength and balance exercise programmes, medication changes and home hazard modification. A similar preventative approach is employed by most Fire and Rescue Services who conduct Home Fire Safety Visits to assess and, if necessary, remedy domestic fire risk, fit free smoke alarms with instruction for use and maintenance, and plan an escape route. We propose that the similarity of population at risk, location, specific risk factors and the commonality of preventative approaches employed could offer net gains in terms of feasibility, effectiveness and acceptability if activities within these two preventative approaches were to be combined. Methods/Design: This prospective proof of concept study, currently being conducted in two London boroughs, (Southwark and Lambeth) aims to reduce the incidence of both fires and falls in community-dwelling older adults. It comprises two concurrent 12-month interventions: the integration of 1) fall risk assessments into the Brigade's Home Fire Safety Visit and 2) fire risk assessments into Falls services by inviting older clinic attendees to book a Visit. Our primary objective is to examine the feasibility and effectiveness of these interventions. Furthermore, we are evaluating their acceptability and value to key stakeholders and services users. Discussion: If our approach proves feasible and the risk assessment is both effective and acceptable, we envisage advocating a partnership model of working more broadly to fire and rescue services and health services in Britain, such that effective integration of preventative services for older people becomes routine for an ageing population.

The European Journal of Public Health, 2011

Background: An evaluation of a smoke-free home initiative launched in Rotherham, northern England, in July 2009. Methods: Two approaches were used: (i) a postal survey of participants 4 months after signing up as a SFH and (ii) a telephone consultation. The survey was sent to 620 households (of 654 who signed up to the scheme); 289 (46.6%) were returned. The telephone consultation involved 20 households before and 20 after signing up to the scheme. Results: Of the households that permitted some smoking at home before the initiative, $78% became smoke free after signing up (uncertainty due to missing replies). A high number of participants (169, 60.8%) were already informally smoke free. The most common reasons for participation concerned health, environment, and fire safety. Participants were motivated by, amongst other things, information given in a booklet and by the offer of a fire-safety referral. The most immediate benefits noted by participants were improvements in house hygiene. The most important hindrance to success seemed to be a lack of power to enforce the ban at home, particularly on the part of those living in smokers' homes. Conclusion: The Rotherham initiative succeeded in creating smoke-free homes. The results should help those planning similar initiatives. Important points include that: many participants had already instituted some rules regarding smoking at home; whether and how to include households that are already smoke-free; risk of fire and concern with house hygiene are important motivations; those living in smokers' homes may lack power to initiate smoke-free rules.

BMC Public Health, 2014

The UK has one of the highest fatality rates for deaths from fire-related injuries in children aged 0-14 years; these injuries have the steepest social gradient of all injuries in the UK. Children's centres provide children under five years old and their families with a range of services and information, including home safety, but their effectiveness in promoting injury prevention has yet to be evaluated. We developed a fire prevention intervention for use in children's centres comprising an Injury Prevention Briefing (IPB) which provides evidence on what works and best practice from those running injury prevention programmes, and a facilitation package to support implementation of the IPB. This protocol describes the design and methods of a trial evaluating the effectiveness and cost-effectiveness of the IPB and facilitation package in promoting fire prevention.

BMC health services …, 2010

Background: Older adults are at increased risk both of falling and of experiencing accidental domestic fire. In addition to advanced age, these adverse events share the risk factors of balance or mobility problems, cognitive impairment and socioeconomic deprivation. For both events, the consequences include significant injury and death, and considerable socioeconomic costs for the individual and informal carers, as well as for emergency services, health and social care agencies. Secondary prevention services for older people who have fallen or who are identifiable as being at high risk of falling include NHS Falls clinics, where a multidisciplinary team offers an individualised multifactorial targeted intervention including strength and balance exercise programmes, medication changes and home hazard modification. A similar preventative approach is employed by most Fire and Rescue Services who conduct Home Fire Safety Visits to assess and, if necessary, remedy domestic fire risk, fit free smoke alarms with instruction for use and maintenance, and plan an escape route. We propose that the similarity of population at risk, location, specific risk factors and the commonality of preventative approaches employed could offer net gains in terms of feasibility, effectiveness and acceptability if activities within these two preventative approaches were to be combined. Methods/Design: This prospective proof of concept study, currently being conducted in two London boroughs, (Southwark and Lambeth) aims to reduce the incidence of both fires and falls in community-dwelling older adults. It comprises two concurrent 12-month interventions: the integration of 1) fall risk assessments into the Brigade's Home Fire Safety Visit and 2) fire risk assessments into Falls services by inviting older clinic attendees to book a Visit. Our primary objective is to examine the feasibility and effectiveness of these interventions. Furthermore, we are evaluating their acceptability and value to key stakeholders and services users. Discussion: If our approach proves feasible and the risk assessment is both effective and acceptable, we envisage advocating a partnership model of working more broadly to fire and rescue services and health services in Britain, such that effective integration of preventative services for older people becomes routine for an ageing population.

American Journal of Preventive Medicine, 1998

Injury Epidemiology, 2014

Background: Door-to-door canvassing and installation of smoke alarms have been found to be effective at increasing the number of homes protected. This analysis reports on how smoke alarm coverage changes six months after a home visiting program in a large urban sample, and how this change varies by characteristics of the residents and characteristics of the services delivered during the home visit. Methods: Fire department Standard and Enhanced home visiting programs were compared. During the home visit, fire fighters installed lithium battery smoke alarms. Residents in the Enhanced program received tailored education about fire safety. Six months after the home visit, participating residences were visited to complete a follow-up survey and to have the installed alarms checked. Results: 81% of the 672 homes that had a working smoke alarm on every level of the home at the end of the home visit remained safe at follow-up, and 87% of the residents found the home visit was very useful, and these rates did not differ between the Enhanced and Standard programs. The degree to which firefighters delivered their services varied, although households in which the resident's engagement with the fire department team was rated as excellent were 3.96 times as likely to be safe at follow-up compared to those with poor or fair resident engagement (p=0.03). Conclusions: There is a need to better understand how to maximize the time spent with residents during smoke alarm home visiting programs. This study helps with the development of methods needed for implementing and evaluating such programs in real-world settings.

American Journal of Public Health, 1988

As part of a smoke detector give-away program, 388 adults were surveyed to characterize smoke detector ownership in a low-income population and to identify those who would acquire a free smoke detector following their child's visit to the hospital. Factors associated with smoke detector ownership included higher education, home ownership (vs public housing), knowledge of the city smoke detector law, and the practice of other injury prevention measures. Regardless of ownership, the great majority of parents (82 per cent) acquired a free smoke detector, but those previously without a smoke detector were more likely to do so. These characteristics of smoke detector usage and acquisition should be considered in targeting future intervention strategies.

New England Journal of Medicine, 1996

Journal of epidemiology and community health, 2014

Although working smoke alarms halve deaths in residential fires, many households do not keep alarms operational. We tested whether theory-based education increases alarm operability. Randomised multiarm trial, with a single arm randomly selected for use each day, in low-income neighbourhoods in Maryland, USA. Intervention arms: (1) Full Education combining a health belief module with a social-cognitive theory module that provided hands-on practice installing alarm batteries and using the alarm's hush button; (2) Hands-on Practice social-cognitive module supplemented by typical fire department education; (3) Current Norm receiving typical fire department education only. Four hundred and thirty-six homes recruited through churches or by knocking on doors in 2005-2008. Follow-up visits checked alarm operability in 370 homes (85%) 1-3.5 years after installation. number of homes with working alarms defined as alarms with working batteries or hard-wired and number of working alarms pe...