United States

Firebreaks: a risk-based approach to safer home oxygen delivery

A new study examined media reports of fires involving home oxygen between August 2019 and July 2021, building on the research that was published in September 2019 (which examined reports between December 2017 and August 2019). Findings include:

  • 256 incidents and 152 deaths recorded in the 23-month period, equating to a death every four days. This is consistent with the previous research.
  • Over the total study period of 3.5 years, there were 567 fires involving home oxygen and 316 deaths.
  • The 300+ fatalities include the deaths of two firefighters. A further seventeen firefighters sustained serious injuries.
  • Home oxygen fires cause at least 1,000 burn injuries per year.

This study reinforces the evidence that fires involving home oxygen are a material public health issue.

Download the full 2021 report

Download the infographic

Prevalence and impact of home oxygen fires

Between December 2017 and August 2019, media reports of home oxygen fires in the U.S. were recorded. The report revealed that:

  • Someone dies every four days in fires involving home oxygen in the US
  • The true death toll of home oxygen fires in the US is likely to be higher than previous estimates by the National Fire Protection Association (NFPA)
  • The death toll is at least 100 and possibly as many as 150 people each year
  • A third of home oxygen fire incidents involve a cylinder explosion, putting public and emergency services at risk

The full report – The prevalence and impact of home oxygen fires in the U.S. – reveals a material public health problem in the United States.

Download the full report

Richard Radford, Managing Director of BPR Medical, discusses the report in a podcast with David Kopf of HME Business. In the podcast, Richard details the causes and risk factors relating to home oxygen fires in the US, as well as the implications for patients and third parties.

Listen to the podcast

Download the infographic


What you need to know about thermal fuses

While as yet there is no law that specifically says that thermal fuses (firebreaks) have to be fitted in the United States, to legally market an oxygen concentrator it must have gone through the 510(k) process to demonstrate that the device is substantially equivalent to one legally in commercial distribution in the United States.

If the ISO standard (ISO 80601-2-69:2014) was used to demonstrate the safety of the device, an oxygen firebreak is a requirement.



November 2023 – Iowa Medicaid reimbursement

From November 1, 2023 Iowa Medicaid began coverage of the Firesafe Cannula Valve. In doing so, Iowa has become the first US State to fund bidirectional thermal fuses through its State Medicaid system. The announcement was made in an Informational Letter (No 2524-MC-FFS) from Iowa Department of Health and Human Services (HHS) and Iowa Medicaid on November 30, 2023. It recommends that two Firesafe Cannula Valves are fitted, the first positioned close to the oxygen supply, and the second close to the patient.

July 2022 – International Association of Fire Chiefs (IAFC) statement

In July 2022, the International Association of Fire Chiefs (IAFC) adopted a position statement on home oxygen fire safety that recommended the use of firebreaks.

As well as support for clinical risk assessment and patient education, the IAFC included the following in their ‘New Policy priorities’ section:

“Enhanced equipment safety by medical suppliers, including home safety checks, written safety instructions, and bidirectional thermal fuses in the oxygen tubing.”

March 2022 – American Burns Association (ABA) statement on use of firebreaks 

In March 2022 the American Burns Association (ABA) agreed a Position Statement on Home Oxygen Burn Prevention supporting the use of bidirectional thermal fuses in oxygen tubing.

The statement reads:

“Due to concern about the prevalence of preventable injuries and their associated high morbidity and mortality rates, the ABA seeks to educate communities and stakeholders about home oxygen therapy related burns.”

It states that:

“The ABA supports efforts to promote, enact, and sustain legislation and policies that support a multi-faceted approach to burn injury and fire prevention for users of home oxygen, with emphasis on encouraging:


  • Enhanced equipment safety by medical suppliers, including home safety checks, written safety instructions, and bidirectional thermal fuses in the oxygen tubing

March 2018 Veterans Health Administration (VA)

On March 12, 2018, the VA issued a Patient Safety Alert requiring that thermal fuses (firebreaks) are fitted to all veterans’ home oxygen installations.

The Patient Safety Alert states that two thermal fuses must be fitted per patient installation – in the case of portable devices, the requirement only applies to those with a continuous flow.

Download an illustration of how to fit thermal fuses

In addition, the Patient Safety Alert states that all unidirectional thermal fuses must be replaced with bidirectional versions at the next scheduled visit or sooner unless the unidirectional device is designed so it cannot be fitted in the wrong orientation.

Frequently Asked Questions on the VA announcement

Q.  When did the VA’s Patient Safety Alert come into effect?

Steps to implement the Patient Safety Alert started seven days after publication, however, VISNs (Veterans Integrated Service Network) were required to ensure that their home oxygen installation contracts were amended within 180 days of the Alert (in other words by October 2018).

Q.  Does the Patient Safety Alert affect all patients?

Yes, unless there are clinical reasons why a patient cannot use a firebreak. The Patient Safety Alert does not distinguish between patients that are deemed ‘high risk’ and those who are not. Besides, the risk of fire does not just come from smoking, it can come from many other sources, such as household appliances, birthday candles or stoves, so all patients are potentially at risk.

Q.  Do fires involving home oxygen now have to be reported?

Following the Patient Safety Alert, DMEs are responsible to report all fires involving home oxygen to the local VA medical center and must provide specific information about the fire. For more information speak to your local VA medical center or VISN office.

Q.  I’m a supplier – how do I find out more?

For more information about regional contracts, contact your local VISN. Details can be found here.

Download our quick guide