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Igniting concern

January 1, 2007
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A fatal Missouri fire presents an opportunity to revisit fire safety issues

Administrators of residential facilities for people with mental illness and/or substance use disorders have a lot on their minds. Keeping residents safe is one of their highest priorities, and a recent tragedy in Missouri could give them pause to reexamine their facilities' fire safety measures.

In late November a fire at a group home for the mentally ill in Anderson, Missouri, killed 10 people and injured two dozen. The fire “is the type of event that creates a wake-up call,” notes Robert Solomon, assistant vice-president for building and life-safety codes at the National Fire Protection Association (NFPA).

Fires at the settings NFPA terms “residential board and care facilities,” which include residential behavioral health facilities, assisted living homes, and other environments, are not rare, but they are usually not as deadly as the fire in Missouri. According to a November 2006 NFPA report, between 2000 and 2004 U.S. fire departments responded to an average 2,080 fires annually at residential board and care facilities. These fires resulted in an average 6 civilian deaths and 62 civilian injuries per year. The report, however, does note that residential board and care facility fires accounted for just 0.4% of all structure fires and 0.2% of civilian structure fire deaths between 2000 and 2004.

Fire-related tragedies often elicit strong reactions, and calls for greater use of sprinkler systems have been made for these and other caregiving settings (especially nursing homes). NFPA's guidelines, which are adopted by many states and local governments, do not require sprinklers in all residential board and care facilities. The Missouri home did not have a sprinkler system and was not required by the state to have one.

Cost is one reason many residential board and care facilities do not have sprinkler systems. Commenting in the St. Louis Post-Dispatch, Ed Bothe, a board member of the Missouri chapter of the National Alliance on Mental Illness and the owner of a residential care facility that does have sprinklers, said, “You may be legislating thousands of people out of a home if you say they all have to have sprinklers and you don't help pay for it,” adding, “These places operate on a very thin margin.”1

Sprinkler systems aren't the only answer to making facilities safer, notes Jimmy Castro, president of Firestop Logistics, a specialist contractor. He points out that sprinkler systems can fail and that “Smoke is just as much of a problem as the actual flame. Smoke kills more people than fire.” Smoke inhalation, in fact, was the cause of death for the Missouri home victims.

Castro, who has worked with behavioral health facilities, says that too many administrators are not aware of how their facilities are maintained, and fire risk areas include those not routinely checked, such as areas above ceilings and behind walls (at press time, investigators suspected improper wiring in the attic of the Missouri home might have caused the fire). Castro says third-party fire inspectors can help identify and correct problem areas to prevent fires.

Some of the leading causes of structural fires in residential board and care facilities, however, are not so hidden. According to the NFPA report, cooking equipment caused 70% of the fires in these settings, followed by confined or contained trash fires (4%), heating equipment (4%), smoking materials (3%), or clothes dryers or washers (3%). Three percent of the fires were intentionally set. Fires caused by smoking materials, however, led to 69% of civilian deaths.

One residential treatment facility in Illinois, in fact, has banned smoking across its 43-acre campus, including in cars in parking lots. Timberline Knolls, which cares for young women with substance abuse and eating disorders, has banned residents and staff from smoking on its grounds since January 1. “We are a healthcare facility that deals with addictions and eating disorders. Smoking is an addiction and is also one of the leading causes of fires,” comments Randy Hayes, the treatment center's vice-president of quality management and chief compliance officer.

Timberline Knolls has taken other steps to mitigate fire risks. In addition to banning candles and holding at least quarterly fire drills, the treatment center has a wireless connection to the local fire department, which has a panel that notifies firefighters of which Timberline Knolls building is experiencing an alarm. Timberline Knolls also recently updated its communication policies for keeping staff in the loop during emergencies.

These sort of proactive steps to prevent fires—and maximize response time during them—are what NFPA's Solomon hopes residential board and care facilities and regulators take away from the Missouri tragedy.


  1. Holland E, Leiser K. Deadly fire shines light on sprinkler debate. St. Louis Post-Dispatch. November 30, 2006.