PEDIATRICS Vol. 99 No. 3 March 1997,
p. e3
Copyright ©1997 by the American Academy of Pediatrics
ELECTRONIC ARTICLE:
Childhood Burn Injuries Related to Gasoline Can Home Storage
Christopher S. Kennedy* and
Jane F. Knapp
From the * Division of Emergency Medicine, Children's Hospital
Medical Center of Akron, Akron, Ohio; and the
Division of Emergency
Medicine, Department of Pediatrics, Children's Mercy Hospital and
University of Missouri-Kansas City School of Medicine, Kansas City,
Missouri.
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
CONCLUSION
RECOMMENDATIONS
ACKNOWLEDGMENTS
ABBREVIATIONS
REFERENCES
ABSTRACT
Objective. To examine the risks
associated with home storage of gasoline and to outline prevention
strategies to avoid further injury and death.
Design. Case series.
Patients and Other Participants. Twenty-five patients less
than 6 years old were selected for study (3 by presentation to a
tertiary care Children's Hospital Emergency Department, and 22 from
the National Electronic Injury Surveillance System Data during the same
calendar year).
Main Outcome Measures. Data collected included child's
age; burn injury, either percent body surface area or minor, moderate, or major burn classification; mortality; circumstances related to
ignition of gasoline, such as behaviors, and if can was opened or
closed; and flame source.
Results. Boys were involved in 95% of cases. Mean age was
2.7 years. The source of ignition was a pilot light in 100% of cases. Forty-four percent of patients died. Only vapors were ignited in 56%
of cases. The gasoline can was described as closed in 64% of cases.
Conclusion. Gasoline is dangerous. The rectangular red
metal gasoline can is not safe either. National building codes and can
specifications are needed to prevent serious injury and deaths among
young children. gasoline storage, pediatric burn injuries, fire safety.
INTRODUCTION
Gasoline is a near-perfect engine fuel. It has a high heat of
combustion and a low ignition temperature. These same properties that
make gasoline an excellent fuel also make it one of the most dangerous
household substances. Gasoline is dangerous because it is highly
volatile
the fumes are capable of ignition up to 12 feet away from a
pooled source.1 The inherit danger is further multiplied by
its explosive potential. When ignited, gasoline vapors form a fireball
with 10 times the heat released in the liquid state.2 One
gallon of gasoline contains the explosive force of 20 sticks of
dynamite.1
A lack of understanding of the explosive nature of gasoline by the
public seems to contribute to both its improper storage and misuse as a
solvent, engine primer, and fire starter.3 This lack of
awareness is perpetuated because current fire and burn prevention
programs frequently do not include information about gasoline
safety.3
Major burns sustained by five children in one summer prompted this
retrospective study. Each case involved gasoline stored in red
rectangular metal cans being tipped near a source of flame. These burn
cases led us to review current storage standards for gasoline. In
addition, the National Electronic Injury Surveillance System (NEISS)
Data was examined to see if similar cases emerged.
METHODS
Five children presented to the Children's Mercy Hospital (CMH)
Emergency Department (ED) between June and September 1990; three of
these children were under 6 years old, one was 7 years old, and one was
11 years old. Each child had burns related to ignition of gasoline
stored near a source of flame. To target the group at highest risk for
nonintentional injuries, children less than 6 years old were chosen;
thus, two CMH patients were excluded. Twenty-seven additional children
less than 6 years old were identified using NEISS data for the calendar
year 1990. Because each CMH case involved gasoline stored in a gasoline
can, we focused on injuries related to this mode of storage. Only
children with burns sustained when gasoline was stored in a gasoline
can were included. Exclusion criteria included a history of storage in any other container eg, a paper cup, or in which no container description was available. Five NEISS cases were excluded on this basis. The 22 remaining NEISS children had sustained burns in mechanisms similar to our 3 patients. In all cases gasoline ignition was the primary source of injury. When combined with the CMH cases, these 25 children formed the sample for the study.
Variables for review included age (years), sex, percent body surface
burned, depth of burn, circumstances relating to ignition, and deaths.
Circumstances related to ignition included: identification and location
of the flame source, any behaviorial factors, whether the can was
opened or closed, and whether or not vapors or liquid gasoline was
ignited. Burn severity was defined using American Burn Association
criteria.8
RESULTS
Data for all the CMH cases is presented in Table 1,
and NEISS cases are presented in a similar format in Table
2.
Boys were involved in 95% of cases, and the mean age was 2.7 years.
Ignition source was a pilot light in all 25 (100%) of the cases. Four
fires were ignited by natural gas dryers, and 21 were ignited by hot
water heaters. Eleven (44%) patients died as a result of their
injuires. Vapors were ignited in 14 (56%) of 25 cases. The gasoline
storage can was described as closed in 64% of the cases.
DISCUSSION
Gasoline-related thermal injuries account for 13 000 to 15 000
ED visits per year.3 Total gasoline-related injuries (ie, ingestions, inhalations, etc) by some estimates number 42 000 per
year.8 Between 400 to 700 children are hospitalized
annually with moderate to major gasoline-related burns (Minnesota
Technical Institute, unpublished data, 1988). Two hundred fifty to 300 of these are children less than 5 years old.
Gasoline storage in the home presents a complex problem. Not only does
it require a leakproof container, but also to use gasoline it must be
transferred out of the container to the engine tank. The ideal mode of
storage for gasoline would be intrinsically effective in preventing
injury. Currently there is no single strategy available that is
intrisically safe. For this report we focus on the container and
storage location in the home.
We chose children less than 6 years old for the study because they are
a high-risk group for nonintentional gasoline burns in the home. This
is related to widespread availability, poor storage practices, and the
young child's inherent explorative behavior. At this stage of
development they are totally unaware of the hazards gasoline introduces
into their environment. Although older children and adults may misuse
gasoline as an inhalant, solvent, or fire starter, children less than 6 years old do not do so with intention. Thus, when isolated by age,
these children identify the risks that exist even when gasoline is
stored in what is sold as a proper container.
The most frequently recommended container is the red metal gasoline can
for 1- or 2-gallon amounts (see Fig 1). Upon closer examination, this container is usually rectangular, has top and bottom
seams, and at least one side seam running the full height of the can.
The spout is usually removable and inverted into the can, replaced by a
screw-on cap. Each rectangular can also has a vent, usually with a
plastic cap.
Fig. 1.
Structural elements of the standard rectangular metal gasoline can.
[View Larger Version of this Image (25K GIF file)]
There are no Occupational Safety and Health Administration standards
for gasoline stored in small quantities in the home (less than 7 gallons) with regard either to storage location or can design. In the
midst of the late 1970s gasoline shortage, concerns over the lack of
standards for gasoline containers prompted an epidemiologic survey of
gasoline can related injuries by the United States Consumer Products
Safety Commission (USCPSC).7 The recommendations from this
study were that standards be developed regarding can design. The
standards describe a container which " ... ought to be
structurally sound, ought not to leak, either in storage or while
gasoline is poured, and ought to be reasonably child-proof." At this
point 48 states continue to have no container standards. Only
Massachusetts and California have adopted container regulations that
comply with the USCPSC recommendations for structural integrity. But
they do not require containers to be child-proof, and do not address
vapor leakage around spouts, seams, or vents.
All 25 children in this case review sustained thermal injuries related
to can failure. In this study can failure is defined as a container
that does not meet the USCPSC criteria outlined above. Although
complete descriptions and manufacturers were not available, each of
these injuries may have been prevented by using a safety can (Fig
2). This can design has many advantages over the red
rectangular can. It utilizes a broad base with rounded top to be
essentially tip-proof regardless of the amount of gasoline it contains.
It has only a single seam around the bottom, which is augmented. The
spout is fixed, thus, potential leakage points for either liquid or
vapors are greatly reduced. Sixty-four percent of the cases presented
were the result of closed cans being tipped with leakage around spouts
or seams. A safety can may have prevented these. In the remaining 36%
of the cases cans were described as open. The safety can reduces this
risk with a spring-loaded cap, also making it child-proof. To further
prevent leakage of vapors, there is no separate vent. The lid is also
self-sealing by means of a rubber gasket, so no vapors will leak out
unless the lid is held open.
Fig. 2.
Structural advantages of a safety can.
[View Larger Version of this Image (25K GIF file)]
The safety can we describe here is tested and approved according to the
Underwriters' Laboratories (UL) specifications. Only representative
containers are tested, and although it is theoretically safer there are
no data currently available regarding actual consumer use.
Although the focus here is on metal cans, plastic containers for
gasoline storage are now widely available. It deserves mentioning that
according to UL engineers plastics are inherently permeable to gasoline
vapors. This permeability increases as the containers age. Although
plastic technology has improved and permeability has been decreased,
most plastic containers are actually tested and sold as temporary
storage containers. This means that they are only intended for usage
for 30 days or less, a fact that most consumers may not know.
The 1979 USCPSC report also references a letter from Dr Richard C. Miller, a professor of pediatric surgery at the University of
Mississippi Medical Center, expressing concern about observed burn
injuries caused by the ignition of gasoline by the pilot lights of
gasoline water heaters located in the utility rooms adjacent to
carports or garages.7 He was further concerned about the
lack of building codes in his area prohibiting this practice. The
USCPSC report corroborated this finding that gasoline water heaters are
a common source of ignition for gasoline injury events.
Our data reiterates Dr Miller's concerns, as well as the USCPSC
findings. The ignition source in 100% of our cases was a pilot light;
84% (21/25) were hot water heaters, and 16% (4/25) were from gas
dryers. None were in secured storage locations, and all cans were
within 12 feet of the flame source at the time of the injury. Ignition
of only vapors started the fires in 56% of cases. In the United
States, regional variation exists in hot water heater placement. In
warmer climates, hot water heaters are more apt to be in utility rooms,
breezeways, or in the garage, increasing the likelihood of gasoline
being stored nearby. Thus, in addition to problems with the container,
storage location appears to be a consistent factor related to injury.
Children with gasoline burns have a high frequency of major
injuries.5,6 Our study supports this finding; 88% of
children sustained major burns and 44% died. This represents a higher
mortality rate than for other burn injuries.
CONCLUSION
No injury is potentially more disfiguring, disruptive to a
child's life, and more painful to endure than burn injuries. The horrific tragedy of each gasoline burn injury to a young child is
magnified when it is considered that all he/she comprehends is the
pain. Limited NEISS data were available for comparison of overall
morbidity, however, each of the CMH cases presented demonstrates the
severity of these injuries in individual pain and suffering. Burns this
extensive require multiple surgical procedures, years of
rehabilitation, and are costly economically.
Each of the cases presented appears to be an isolated event of
unlikely circumstances, but when taken together striking similarities emerge. The most important of these similarities involve gender, can
design, storage location, and burn severity. Fire safety courses and
media coverage of gasoline-related thermal injuries seldom address
issues related to storage. The general public and parents remain
unaware of the danger and high-risk behaviors continue.
Currently there is no storage method intrinsically effective in
preventing burn and explosion injury, similar to kill switches on
lawnmowers or the airbag for motor vehicles. Despite education efforts,
gasoline may still be stored near a pilot light. The most obvious
prevention strategy would be to not store gasoline in the house and not
within 50 feet of a pilot light. One alternative would be to sell
prepackaged amounts of gasoline in a closed container that is made to
be hooked up directly to the engine, as a replacement tank, similar to
current practices for propane.
In this study we identify issues regarding the currently accepted safe
practices for storage of gasoline; the most important of these are can
design and storage location. Prevention strategies aimed at public
education are not enough. The rectangular red metal can poses its own
risks with leakage of vapor or liquid at seams, around spouts, and
lids. They may tip over easily even when full. Although California and
Massachusetts have can standards that address structural integrity,
they do not go far enough. National can standards are needed. Currently
a "safety can" is manufactured that combines a reduced number and
augmented seams, a spring-loaded, self-sealing cap, and a broad, round
base making it tip-, leak-, and child-proof. The major limitation of
this can is the price, $17, which is in part due to its low demand. In
addition, simple building code modifications restricting pilot light
location away from storage areas such as garages or breezeways may
prevent further injuries, save millions of health care dollars, and
avoid years of painful procedures.
RECOMMENDATIONS
The Can
Uniform national standards are needed for gasoline can design.
They should require that each can be approved. For approval each can
should be leak-proof for vapors and liquid; unvented, with a fixed
spout and spring-loaded, self-sealing cap; larger, clearer warning
labels; and a reduced number of seams, each reinforced.
Storage Location
Gasoline should only be stored in a shed or garage in a locking
cabinet, in a well-ventilated area. No pilot lights should be within 50 feet of the storage location, mandated by building codes where
appropriate. Manufacturers of any household appliance that uses natural
gasoline should place large warning labels that state clearly: "Do
not store gasoline within 50 feet of this appliance."
Public Awareness
Media awareness and fire safety courses should increase the time
devoted to gasoline storage practices, focusing on the dangers and safe
practices. Educational material should be included with monthly utility
bills from natural gasoline providers. They should include descriptions
regarding the potential for danger and careful instructions for proper
gasoline storage.
Physician Roles
Physicians should lobby their government to adopt standards at the
local, state, and national levels. Patient and family education should
be available at every well-baby visit.
FOOTNOTES
Received for publication May 8, 1996; accepted Sep 5, 1996.
Reprint requests to (C.S.K.) Division of Emergency Medicine,
Children's Hospital Medical Center of Akron, One Perkins Square,
Akron, OH 44308-1062.
ACKNOWLEDGMENTS
Special thanks to Matthew Maley and Katrina Wolford for their
invaluable assistance.
ABBREVIATIONS
NEISS, National Electronic Injury Surveillance
System.
CMH, Children's Mercy Hospital.
ED, emergency department.
USCPSC, United States Consumer Products Safety Commission.
UL, Underwriters' Laboratories..
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