In emergencies call 999

Emollient skin products

  • Emollient skin products are widely prescribed and dispensed for various skin conditions such as psoriasis and eczema.
  • They are safe to use but can soak into clothing, dressings and bedding leaving a flammable residue.
  • If exposed to a naked flame or a heat source, such as a cigarette, lighter, gas cooker, heater or fire, these saturated fabrics can catch fire; the paraffin residue will help the fire develop and spread rapidly which could result in serious injury or death.

Following five deaths in West Yorkshire since 2015, we are trying to raise public awareness about the potential fire risks so that emollient skin products are used safely and everyone stays safe and well within their home.

Useful links

WYFRS links

Leaflet – Caring for people who use paraffin-based creams, airflow or oxygen equipment

Letter to GPs from Deputy Chief Fire Officer(Opens in a new window)

Video – Health and Care Professional Informative(Opens in a new window)

Video – Paraffin-based skin product – fire tests(Opens in a new window)

External links

Medical and Healthcare products Regulatory Agency warning  2016(Opens in a new window)

Coroner’s report  for Pauline Taylor(Opens in a new window)

NICE/ BNF summary information(Opens in a new window)

NHS Improvement Patient Safety Alert (page 17)(Opens in a new window)

Coroner’s report for Brian Bicat

Drug Safety Update-December 2018

Public FAQs

What are emollient skin products?

They are moisturisers which may contain paraffin, shea or cocoa butter, beeswax, lanolin, nut oil or mineral oils and they work by covering the skin with a protective film or barrier which keeps the moisture in.

Are they only prescribed by doctors?

Emollients are commonly prescribed by GPs, nurses and other clinicians over long periods of time to treat skin conditions such as psoriasis, eczema and sores. Many of these products can also be purchased over the counter in chemists and supermarkets.

Are they safe to use?

Yes they are. We encourage their use as recommended by medical professionals and the manufacturer’s instructions.

Are they flammable?

No. If you put a match to a sample of emollient skin product it would not ignite.

So, why should I be concerned?

Regular use of these products, over a number of days, can lead to them soaking into your clothing, bedding and bandages/dressings. This residue then dries within the fabric. If you then introduce an ignition or heat source such as accidentally

  • Dropping a cigarette, lighted match or lighter
  • Sitting too near to a gas, halogen or open fire
  • Catching your clothing on a hob when cooking

you can cause a fire to develop, burn intensely and spread rapidly. This could lead to a serious injury or death. Nationally, there have been at least 56 deaths associated with emollient skin products within the last 10 years.

What can I do to make sure I’m safe?

  • Never smoke in bed
  • Do not smoke if there is any chance your clothing or dressings could be contaminated with these products
  • Do not cook if there is any chance your clothing or dressings could be contaminated with these products
  • Do not sit too close to any open fires, gas fires or halogen heaters
  • Wash your clothing and bedding daily at the highest temperature recommended by the fabric care instructions. This should reduce some of the contamination but may not remove it completely.

What can I do to make sure my friends and family are safe?

Share this information with them so that they are also aware of the potential risks.

‘Health care professionals may not be aware of the potential fire hazard posed by emollient creams which contain a lower level of paraffin’

HM Assistant Coroner Mary Burke July 2017

‘Review patients with repeat prescriptions for emollients and cross-reference with those that smoke. Give safety advice retrospectively and review prescriptions’

HM Senior Coroner Martin Fleming July 2018

 

We know that emollient skin products are safe to use but they can soak into clothing, dressings and bedding leaving a flammable residue. If exposed to a naked flame or a heat source, such as a cigarette, lighter, gas cooker, heater or fire, these dried fabrics can catch fire. The emollient residue will help the fire develop and spread rapidly which could result in serious injury or death.

 

Case study – Pauline Taylor’s story

 

Pauline Taylor was a 74 year old grandmother who lived alone in a flat in Huddersfield. She had been a regular smoker throughout her life. In early 2015, her health deteriorated and she had become bed bound. Despite requests from her daughters to stop smoking, she continued to do so in bed. She had several daily visits from her supportive family, care staff and the district nursing team and received daily applications of Zerobase for her psoriasis. This product is a paraffin-based moisturiser with 11% paraffin content. On 29 May 2015, Pauline received a visit from one of her carers late in the evening and was presenting as expected. However, just under five hours later the care line was activated and West Yorkshire Fire and Rescue Service and members of her family were alerted. The fire crew entered the property using breathing apparatus but unfortunately Pauline had died. The subsequent Coroner’s hearing found that matches and emollient creams had accelerated the fire and contributed to its intensity. Pauline’s daughters have since been campaigning alongside us to raise public and health professional awareness around this issue.

 

Case study 2  – Brian Bicat’s story

Brian Bicat was 82 years old and well known on the Bradford jazz scene. He lived with his wife in a first floor flat.  He used Diprobase cream and Hydromol ointment for a long term skin condition and more recently ulcerated legs. Each morning, while his wife went to the local park for a short walk, Brian sat outside on the
balcony having a cigarette and completing a Suduko puzzle. On 22 September 2017 Brian was on the balcony in his dressing gown which he had double-knotted and often used to pat himself dry after a shower and an application of emollient. Whilst lighting a cigarette he dropped the cigarette, a match or lighter on his dressing gown accidentally setting it alight. By the time he had run to the bathroom, the dressing gown was fully alight. He managed to douse himself in the shower and by the time his wife returned he was sitting on the side of the bed. She immediately called 999 and Brian was airlifted to Pinderfields where he sadly died that evening. Brian and his wife had not been informed by any of the health professionals working with him that these emollients could leave a flammable residue on dressings, bedding and clothing.

 

 

What can you do to help?

In a hospital setting

  • Patients should be given information that includes advice about the potential fire risks of smoking (or being near to people who are smoking), or exposure to any open flame or other potential cause of ignition during treatment. In hospital units initiating therapy, this should be given in both verbal and written form.
  • Fire safety information should be displayed prominently in every ward area where patients may be treated with significant quantities of emollient products.
  • If, against advice, a patient intends to go off the ward to smoke they should be informed of the risk and advised to wear a thick outer covering that has not been contaminated with emollients.
  • Relatives or carers should be informed if a patient does not comply with safety advice and instructions during treatment involving significant quantities of emollients.

In a community setting

  • Consider the smoking status of your patients before commencing treatment.
  • Patients and clients should be given information that includes advice about the potential fire risks of smoking (or being near to people who are smoking), or exposure to any open flame or other potential cause of ignition during treatment.
  • This information should be given on the first occasion that such treatment is prescribed or applied by a healthcare professional and a record kept confirming that the advice has been given. Regular checks should be made to ensure the advice has been given and understood.
  • Patients and their families should be provided with safety advice about regularly changing clothing or bedding saturated with emollient products (preferably on a daily basis), as the emollient soaks into the fabrics and can potentially be a fire hazard. Chairs or seating may also have the potential to become contaminated. Please note that regularly washing fabrics will reduce the contamination but may not totally remove it.
  • Encourage your patients and clients to share the advice they have been given with their family.
  • Review/inform the GP if your patient has a previous history of smoking and is displaying memory issues and/or confusion.
  • Share this information with your colleagues and teams.

Record the advice you have given in your patient/clients Care Plan

General practitioners

  • Consider the smoking status of your patients before commencing treatment.
  • Patients should be given information that includes advice about the potential fire risks of smoking (or being near to people who are smoking) and their exposure to any open flame or other potential cause of ignition such as cooking if there is any possibility of their clothing, bandages or bedding being contaminated with these products.
  • This information should be given on the first occasion that these products are prescribed and a record kept confirming that such advice has been given. A check should be made on subsequent occasions that the advice has been received previously and understood.
  • Review your patient’s use of emollient skin products if they have a previous history of smoking and are displaying memory issues and/or confusion.
  • Consider alternative treatments where people smoke and/or have a condition which places them at high risk of fire such as memory loss, poor concentration or drowsiness.
  • Share this information with your colleagues and teams.
  • Display and disseminate appropriate information to your patients.
  • Encourage your patients to share this advice with their family.

19 December 2018: Press release from the Medical and Healthcare products Regulatory Agency

In response to recent scientific and statistical evidence on the potential fire risks of emollients, the MHRA convened an ad hoc Expert Group to advise the Commission on Human Medicines (CHM) on the benefits and risks of these emollient products and the appropriate regulatory action to minimise risk and protect public health.

The CHM advised, in order to protect public health, that

  • outer packaging and product containers should include a warning about the fire hazard, with the advice not to smoke or go near naked flames
  • where available, the Patient Information Leaflet or Instructions for Use and the Summary of Product Characteristics should be updated to include warnings about the risk and how best to minimise it

Additionally, MHRA is setting up a specific stakeholder group to make proposals for measures to promote education and awareness of this risk.

Useful links

WYFRS links

Research from Anglia Ruskin University shows hidden fire risk of emollients – 2019

Leaflet – Caring for people who use paraffin-based creams, airflow or oxygen equipment

Letter to GPs from Deputy Chief Fire Officer

Video – Health and Care Professional Informative

Video – Paraffin-based skin product – fire tests

External links

Medical and Healthcare products Regulatory Agency warning  2016

Coroner’s report  for Pauline Taylor

NICE/ BNF summary information

NHS Improvement Patient Safety Alert (page 17)

Coroner’s report for Brian Bicat

Drug Safety Update-December 2018

‘Health care professionals may not be aware of the potential fire hazard posed by emollient creams which contain a lower level of paraffin’ 

HM Assistant Coroner Mary Burke July 2017

 

‘Health care professionals including pharmacists to verbalise product warnings at the point of prescription, dispensing or point of sale’

 

HM Senior Coroner, Michael Fleming, July 2018

 

 

We know that emollient skin products are safe to use but they can soak into clothing, dressings and bedding leaving a flammable residue. If exposed to a naked flame or a heat source, such as a cigarette, lighter, gas cooker, heater or fire, these dried fabrics can catch fire; the emollient residue will help the fire develop and spread rapidly which could result in serious injury or death.

What can you do to help?

  • Ask your customers what their smoking status is when dispensing or selling emollient skin products.
  • Talk to them about the potential fire risks of using these products, especially if they are smoking, cooking or near to an open flame.
  • Record any advice you have given on their Patient Medication Record, remembering to communicate this to them at regular intervals.
  • Take care not to cover up the flammability warning on products which have them.
  • Refer people back to the GP where they smoke and/or have a condition which places them at high risk of fire such as memory loss, poor concentration or drowsiness; and add their details to their Patient Medical Record.
  • Share this information with your colleagues and teams.

Case study – Pauline Taylor’s story

Pauline Taylor was a 74 year old grandmother who lived alone in a flat in Huddersfield. She had been a regular smoker throughout her life. In early 2015, her health deteriorated and she had become bed bound. Despite requests from her daughters to stop smoking, she continued to do so in bed. She had several daily visits from her supportive family, care staff and the district nursing team and received daily applications of Zerobase for her psoriasis. This product is a paraffin-based moisturiser with 11% paraffin content. On 29 May 2015, Pauline received a visit from one of her carers late in the evening and was presenting as expected. However, just under five hours later the care line was activated and West Yorkshire Fire and Rescue Service and members of her family were alerted. The fire crew entered the property using breathing apparatus but unfortunately Pauline had died. The subsequent Coroner’s hearing found that matches and emollient creams had accelerated the fire and contributed to its intensity. Pauline’s daughters have since been campaigning alongside us to raise public and health professional awareness around this issue.

 

Case study – Brian Bicat’s story

Brian Bicat was 82 years old and well known on the Bradford jazz scene. He lived with his wife in a first floor flat.  He used Diprobase cream and Hydromol ointment for a long term skin condition and more recently ulcerated legs. Each morning, while his wife went to the local park for a short walk, Brian sat outside on the balcony having a cigarette and completing a puzzle. On 22 September 2017 Brian was on the balcony in his dressing gown which he had double-knotted and often used to pat himself dry after a shower and application of emollient. Whilst lighting a cigarette he dropped the cigarette, a match or lighter on his dressing gown accidentally setting it alight. By the time he had run to the bathroom, the dressing gown was fully alight. He managed to douse himself in the shower and by the time his wife returned he was sitting on the side of the bed. She immediately called 999 and Brian was airlifted to Pinderfields where he sadly died that evening. Brian and his wife had not been informed by any of the health professionals working with him that these emollients could leave a flammable residue on dressings, bedding and clothing.

 

 

 

 

 

Useful links

WYFRS links

Research from Anglia Ruskin University shows hidden fire risk of emollients – 2019

Video – Health and Care Professional Informative

Video – Paraffin-based skin product – fire tests

Leaflet – Caring for people who use paraffin-based creams, airflow or oxygen equipment

Pharmacy Toolkit

Letter to pharmacists from Deputy Chief Fire Officer

Pharmacy bag sticker

Pharmacy fire hazard postcard

Pharmacist Information – tips and prompts

External links

Medical and Healthcare products Regulatory Agency warning  2016

Coroner’s report for Pauline Taylor

NICE/ BNF summary information

NHS Improvement Patient Safety Alert (page 17)

Project description

This project aims to

  1. Raise awareness amongst the public, health and care professionals, pharmacists and other fire and rescue services about the potential fire risks associated with the use of emollient skin products when they become soaked into fabrics and an ignition source is introduced.
  2. Reduce the likelihood of further fire fatalities across West Yorkshire which are connected to unsafe behaviours around the use of emollient skin products.
  3. Lobby for national changes to medicine and medical device labelling.
  4. Support scientific testing into the flammability of differing % level paraffin-base and non-paraffin based products.
  5. Work with manufacturers to develop effective washing care instructions for saturated fabrics.
  6. Work with other fire and rescue services to create a toolkit of resources which can be utilised to raise awareness with the public and locally based stakeholders.

 

For further information, or if you wish to share or discuss an idea about the project please contact us at paraffinproject@westyorksfire.gov.uk

Useful links

WYFRS links

Pharmacy Toolkit

Letter to pharmacists from Deputy Chief Fire Officer

Pharmacy bag sticker

Pharmacy fire hazard postcard

Pharmacist Information – tips and prompts

External links

Coroner’s report for Pauline Taylor

Coroner’s report for Brian Bicat

Drug Safety Update-December 2018

 

If you have any concerns or would like to talk to us about any issues please get in touch.

01274 682311 and ask for your local district prevention team in Bradford, Calderdale, Kirklees, Leeds or Wakefield.