INVESTIGATION GUIDELINE

Attachment A DATA RECORDING SHEET FOR UPHOLSTERED FURNITURE FIRES (To be attached to CPSC Form 182, Epidemiologic Investigation Report along with a copy of the Fire Incident Report)
‘i+ \mb Hwd;=. -4 Incid’ent Qate -.- 12. a-+\ / Other .

.

.

Task Number

A. PRODUCT DESCRIPTION: tgf Sofa/Couch

I C h a i r ri S o f a b e d

1. Was upholstered furniture slipcovered? I Yes 2. Had it been reupholstered?

0 No H Unknown

C7

Yes

II ‘ N o & U n k n o w n

3. Manufacturer/Distributor/Brand t / New 4. Purchased:

0

Used

b

Unknown

If used, specify how obtained (e.g., garage sale, etc.) 5. Date Furniture Purchased: Furniture Age

6. Standard Certification Labeling; e.g., UFAC or California standard: (Copy)

B. POINT OF FIRE IGNITION ON FURNITURE: Describe’tihere fire started on upholstered furniture. . a I Inside arm I Inside back 0 Seat cushion 0 Skirt / Back 0 Welt Cord 0 Side /7 T u f t / Underside,. /I C r e v i c e

(3. AGE (IN YEARS) OF PERSON INVOLVED IN IGNITION (if appropriate): do? m

.

0

LT 5 yr;. old .

0

5 - 1 4

i7 15’- 6 4

:

065+
_

D. PRODUCT INVOLVED AS HEAT SOURCE AND TYPE (Check): Lighter -l Match Candle Heater F i r e p l a c e

Other (speciiy) Unknown

...

.

Page 10 of 11

:

INVESTIGATION GUIDELINE

I I

\

l

. -’

If lighter, specify type:
.

D Child-resistant 0 Biook

! Not child-resistant 0 Box

0 Unknown. k Unknown

If match, specify type:

If heater, specify fuel source and distance from furniture: Fuel source . E. DETECTION OF FIRE 7. * Distance from furniture

Detector (smoke, heat, c.o., sprinkler) present? 0 Yes 0 No P Unknown

If yes, specify type:

a.

Detecter went off (alarmed)? t. 0 Yes

0

No

Unknotin

.

9.

If no, do you know any reason why not; e.g., unpowered, fire too small, etc.?

10. About how soon was the fire discovered after it started? \:d F . VICTIM61 Number of Deaths G. Socio-Economic Data: 11. Education level of head of household: 0 Less than high school 12. Total household income: 0 LT $15,000
-

, 1 Jn’ ‘%&ber o f I n j u r i e s

& 0 High school
l

.
0 Some College

F-L 0 s15,ooo - $34,99,9

.

*

0 $35,000 +
-

73. Approximate home market value: (d

A Rent
General

0

Own

_

Description: Provide general description, including all other relevant factors and information on the investiga!tion form. .

.

-Page 11 of 11

iI7
1. CASE NO.

L EFR mat dl

941215HWE5022
“‘;!j$$i: ~~~~~~N ‘;zz;;;;f ’

B. SYNOPSIS OF INCIDENT OR COMPLAINT

A seven year old male died of anoxial in a residential fire.’ The victim sucessfully escaped from the burning home but went back inside to attempt to rescue his pet dog. The victim and two younger siblings were under the care of a 13 year old baby sitter in a home not equipped with a working smoke detector. The cause of the fire was either the victim playing with a cigarette lighter, or a candle accidentally tipped over into the couch. .
7. LOCATION

home, interior zouch

(tiOH8,8chw7,

[l J[O ] Longview unknown _ unknown

etrz)

0. CITY

Washington [WA] .

9. STATE

IDA. FIRST PRODUCT

CO 116 117 ID 1 [l ][6 ][O ][4 ]

11A. TRADE/BRAND NAME, MODEL NUMBER, MANUFACTURER I ADDRESS

IOB. SECOND PRODUCT

cigarette lighter
12. AGE OF VICTIM

118. TRADE/BRAND NAME, MODEL NUMBER, MANUFACTURER 6 ADDRESS

10 ID
111 parts

lC7

I

13. SEX (USE NUMERICAL CODE) MALE - 1 FEMALE - 2 UNKNOWN- 3

[l I

died

14. DISPOSITION

18

I

anoxia

15.INJURY DIAGNOSIS

16

lb I
I[6 IJO I

16. BODY PART

fire marshal! fire investigator ON snE - 1
f3

17. RESPONDENT(S) (Muthar, Friend)

18.TYPE INVESTIGATION

lS.TIME SPENT

B lb 3

I

TELEPHONE - 2 OTHER -3

EI

I1
YR

20. ATTACHMENTS

reports. photos

19 I

21. CASE SOURCE

newspaper F4C5020

w ID I

22. REVIEWED BY

lgiEwlP1

mm4[~~~1~

MO

DAY

23.PERMISSIONTODISCLOSE NAMES (NUN-NEZSS CASES ONLY) CPSC MAY DISCLOSE MY NAME [ 24. NARRATIVE (See Ins&ructkms on Page 2)
b

] CPSC MAY NO? DISCLOSE MY NAME [ X ] 25.REGIONALOFFICEDIRECTOR REVIEW

DATl

I’he respondents were the victim’s mothers companion, the officer in charge of the fire department investigation, the fire marshal. Information was a&o obtained from the official reports.

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(USE ADDmONAL SHEETS IF NECESSARY)

\
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941215HWE5022

Pre-Event
The fire occurred in a single family home located in a suburban residential neighborhood. The home was a single story, two bedroom wood framed dwelling. The home a rental occupancy which was valued at approximately $30,000. The home was not protected by a working smoke detector. The home was occupied by a 27 year old mother, her adult male companion, and her children, a four year old son, a five year o&d daughter,.and a seven year old son. Theseven year old son was the victim. The investigating officials did not document the victim's health or developmental history. No pre-existing medical conditions or impairments were identified as contributing factors. No drugs or medications were identified as contributing factors. The victim has had problems involving setting fires in the pastaccording to the police report. The mother's companion said that the living room couch was a convertible sofa bed type couch. He said that the couch was purchased new approximately five years .before the fire. He said that the couch was upholstered with a knit fabric with a fuzzy surface. He said that the fabric appeared to be some type of rayon or nylon blend synthetic fabric. He said that couch was constructed with foam cushio\ns and cotton batting stuffing. He said that the couch was not covered with a slip cover. The mother and her companion went out for the evening on the day of the - fire according 'to the official reports. They left at approximately 6:00 p.m. according to the reports. The children remained home under the care of a 13 year old male baby sitter according to the official reports. The baby sitter was &neighbor who frequently cares for the children according to the police \ report. The children watched television .and played hide and seek in the home during the evening before the fire occurred according to the fire report. The victim,apparently played with a cigarette lighter according to the official reports. The baby sitter took the lighter away from the ,victim, but left the lighter on the coffee table according to the reports. The mother's companion said that the children said that they used a candle in the living room while watching television. He- said that the candle was a votive type candle in a holder which was shaped like a wine glass with a stem. He said that the children said that they accidentally tipped the candle holder over at approximately lo:30 p.m. and the candle fell into the space between the arm of the chair and the seat cushion of the couch.

._

..

941215HWE5022 The mother's companion said that the children said that they removed the candle from the couch. .He said that they said that they thought that they had put out the fire from the candle. He said that candle may have started a smoldering fire in the couch unknown to the children. The four year old son went to bed before 9:OQ p.m. according to the fire department report. The other children fell asleep watching television in the living room according to the report. The baby sitter fell asleep in a recliner chair, the daughter fell asleep in a swivel chair, and the victim was on the couch according to the police report.
Event .

.

The baby sitter awoke and found the victim and daughter awake watching television according to the official reports. The .baby sitter noticed flames burning at the end of the couch adcording to the report. The baby sitter attempted to smother the fire with his The baby coat but was unsuccessful according to the reports. sitter then attempted to extinguish the fire with a soft drink ,according to the reports. The fire continued to burn so the baby sitter evacuated the children'and alerted a neighbor about the fire according to the repo:rts. The baby sitter instructed the victim to open the back door of the home to allow the family dog to escape according to the official reports. The baby'sitter then left the children and vent to his The victim parents house for help according to the reports. apparently found the back door of the home locked and went back into the home through the front door to attempt to rescue the dog according to the official reports. The victim was overcome by the heat and smoke while attempting to rescue the dog and was unable to escape from the house. The' baby sitter apparently returned and attempted to enter the front door but forced back by smoke and heat according to the official reports. The call for emergency assistance was received at 11:47 p.m. Police were the first according to the dispatch records. according to the records. The responders to arrive at 11:50 p.m. fire department arrived on the scene atJl:52 according to the records. . . A police officer attempted to .enter the front door and fight the fire with a portable fire extinguisher but was unsuccessful accordingto the official reports. The fire department arrived, attacked the fire and initiated search and rescue. The v$ctim was found unconscious on the living room. floor according to the official reports. The dog escaped unharmed. 2 ._

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941215HWE5022

Post Event
The emergency personnel initiated cardiopulmonary resuscitation immediately -according to the official reports. The victim was transported to a local hospital emergency room. A helicopter ambulance transported the victim approximately 45 miles to an urban burn center. ,a& remained comatose at the burn center and expired six hours after admission according to the Medical Examiner's report. The cause of death was listed as anoxic encephalopathy due to the inhalation of carbon monoxide and smoke according to the report. The victim's' blood carbon monoxide level was 66 percent saturation according to the report. A copy of the report is attached to this report as a exhibit. The fire caused an estimated $15,000 structural damage and $5,000 damage to the contents according to the fire department report. The cause of the fire was investigated by the Fire Department and the local police. The investigating officials examined the scene and interviewed the Lhildren and baby sitter. The investigating officials concluded that the victim igniting the couch while playing with the cigarette lighter was the most probable cause.of the fire. The officer in charge of the fire investigation said that the children did not mention the incident involving the candle (described by the mother's companion) during the investigation interviews. The officer said that the fire investigators did not look for evidence of a candle in the area of origin during the investigation of. the :fire. Copies of the official investigation reports are attached to this report as exhibits.
-

First

Product

Identification

.

-

An upholstered couch was identified as the first product ignited during the origin of the fire. The respondents did not know the brand name or manufacturer of the couch. The ‘mother's companion described the couch as a convertible sofa bed type which contained a fold out mattress. The mattress was folded inside the couch at the time of the fire. The companion said that the couch was upholstered with a knit fabric with a fuzzy surface. He said that the fabric appeared to be some type of rayon or nylon blend synthetic fabric. ,& said that couch was constructed with foam cushions and cotton batting He said that the couch was not covered with a slip stuffing. cover. He said that thle couch was purchased new approximately five years before the fire.

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941215HWE5022

I

Second Product Identification
The police and fire officials identified a disposable cigarette lighter as the probable source of ignition. The lighter was found in the area of origin and was identified as a non-child resistant type with a striker wheel type ignition mechanism. The investigating officials did not document the brand or manufacturer of the lighter. Photographs of the lighter are attached to this report as. an exhibit.

Third Product Identification

\

The mother's companio:n said that the children had discussed the event with family members after the official investigation was completed. The companion said that the children said that they were using a votive type candle in a wine glass shaped holder during the evening before the fire. He said that the children indicated‘ that they accidentally tipped the candle over into the space between the cushion and arm of the couch. The companion said that the family _ believes that the candle was the cause of the fire.

Standards Information
The convertible couch/sofa bed is subject to voluntary standards and the fold out mattress is subject to mandatory standards. Information concerning compliance with the applicable standards was not available. The cigarette lighter is subject to voluntary industry standards and mandatory labelinlg requirements under the Federal Hazardous Substances Act. The lighter would also be subject to mandatory standards under the Consumer Product Safety Act if.manufactured or imported after July 12, 1994. The lighter appears to bear the Federal Hazardous Substances labeling. Information concerning compliance withvoluntary standards was not available. The lighter is not child resistant but sufficient information was not available to determine if the lighter is subject to the mandatory standard. The candle ana candle holder are not subject to mandatory or . voluntary standards. .

Attachments
Exhibit Exhibit Exhibit Exhibit Exhibit # # # # # 1: 2: 3: 4: 5: Data Sheet/DMGRfW Medical Examiner's Report Fire Department Report Police Report Photographs+

-

j Qf))lbLs7]et&> fQV417&l‘e /WY- @fl*-ed*

‘1

added. Tha look at it w
CraZp.”

ami his band play at the Jubitz Westem Lmmge in Portland. They retuned at about 1 a.m. SUndap and saw fir&&m packing their gear. The pdi~e had lust arr+dagaia,thistimetoteUValpiani about her oldest SW E&ardwastirsttreatedatSt John’s Medical Center, then flown to .~manuel Hospital in Portland, every&W where he died %mdaY. The house sustained mode”& Donation damage, according to the h-mew the school, Fire Department n93toarra Waft think they haven’t heen Kathi Al kicking themselves for going OUG” Comer Sal said Adele O’Brien, Mathers’ moth- lished a ftu er. ‘But I’m a firm believer that Your her family days are numberedFinancial “1 don’t think them being home made to ac would have prevented it,‘* she

Meanwhil at St Helen! dealing wit hl?StWaY~ lecti43 food will help tb his family. “He was I said Cindi ’ COmmtiQ watching o\ &r.Thisis

-

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.INVESTIGATION GUIDELINE

Attachment A DATA RECORDlNG SHEET FOR UPHOLSTERED FURNITURE FIRES (To be attached to CPSC Form 182, Epidemiologic Investigation Report along with a copy of the Fire Incident Report}
9q\ml?m ?To$tJ

Task Number

incident Date

\I-03-9q

A. PRODUCT DESCRIPTION: I Sofa/Couch

m Chair &7 S o f a b e d 17 O t h e r a0 N o I Unknown

1. Was upholstered furniture stipcovered? f Yes 2. Had it been reupholstered? E7 Yes 3 . Manufacturer/Distributor/Bran,d 4. Purchased: m N e w Igl No

I Unknown I U Unknown

lANb3Aa~ / Used

if used, specify how obtained (e.g., garage sale, etc.) 5. Date Furniture Purchased: crk \??o ’ Furniture Age 5 YEhRS
(Copy)

6. Standard Certification Labeling; e.g., UFAC or California standard:

B. POINT OF FIRE IGNITION ON FURNITURE: Describe where fire started on upholstered furniture. I Skirt /I B&k I Seat cushion I Side / Tuft ‘I I lnside back Underside lI O t h e r 7 Y c3S . L 65 + P Inside arm 17 Crevice

IWeft Cord

C. AGE (IN YEARS) OF PERSON INVOLVED IN IGNITION (if appropriate): 1 LT 5 yrs. old fm 5 - 1 4 17 1 5 - 6 4

D, PRODUCT INVOLVED AS HEAT SOURCE AND TYPE (Check): y.. a,A Lighter veater x - x Candle’ Other (specify) U n k n o w n

Fireplace

.

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Page 10 of 11

If lighter, specify type: If match, specify type:

II Child-resistant D Ebook

&’ Not child-resistant / Box

/7 Unknown / Unknoyn

If heater, specify fuel source and distance from furniture: ., -Fuel ‘source E. DETECTlON OF FIRE 7. Detector (smoke, heat, GO., sprinkler) present? I Distance from furniture

1 Yes

w

l

No

U

Unknown

.

I

If yes, specify type: 8. Detecter went.off (alarmed)? . WC / Unknown

I yes
9.

0 No

If no, do you know any reason why not; e.g., unpowered, fire too small, etc.7

10. About how soon was the fire discovered after ,it started? F . VlCTlM(S[ 1 Number of Deaths . 8 Number of Injuries . .

G. Socio-Economic Data: 11. Education level of head of household: II High school ./

/ Less than high school . 12. Total household income: / LT S 15,000 13.

& Some College _.

,

187 $15,ooo - $ 3 4 , 9 9 9

n $35,000 +
. -

I

Approximate home market value: &T Rent

930.0~0

L3 o w n

.

General Description: Provide general description, including all other relevant factors and information on the investigation form.

Page 11 of 11

c

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5512wE50~~ ~kPt~rr ;d?r,
l

MWTNOM~H

COUNTY MEDICAL-EXAMINER’S OFFICE REPORT FORM
301

N.E. Knott St., Portland, Oregon 97212

Phone 503-246-3746 .

. Case W:

-.

. Deputy Medical Examiner: Case Reported: Date: Cause of Delay, if any: .

Chamberlain
_ ‘Time:

.

Date-. 12/m/ 94 .Arrived at Scene:

944433

12/04/94

‘09:30

15:30

.

Eye Bank NO Notified: r NO-

A. DECEDENT DA TA :

Name:

i

Ap: . 7 mos.Days. DOB:

04/06/a7

.

Sex: M ,xX F .-- ss #

- mler#s

White
Occupation: Employed by: Job Tiile 63 (DOA) (Found) at:

RaCe:e--

.

Marital S i n g l e . . . h+flm- WlcpQFwc -. status: cuw . Unemployed Retired .- .

Child Emanuel Hospital PORTLAND OR 97227 iour.
08:42

Date:

12/04/94

-E.w. Hospital Death.

strkk~t:

me.. 12/03/94
,
Admitted to Hospital: Date:

mr.

23:49

cuJntyofIncMent . (Othsrthur Mutt.) Hour.

Cowfitz

12/04/94

02:lO

Oecedentb Home Address:

last Known Alive By: Alckhess: . .

Hospital Death.

Date:

TilTl8:
Phone:

8. AGENCY DATA:

.

police:
Fire:.

Longview Longview FD

a#

*

Det-: Medix
Other:

Ambuimce:

Life Fligt --

C. TRANSPORT AND MORTUARY DATA:

Body Transported to ME Offii: Yes - No.- If Yes, vii: . Reason for Transport to ME office: .. .
Fun& Home:

,

Holman's

.

Named by:

Family . Date:-12/04/94 .

NARRATIVE REPORT: Introduction:

This 7 year old white male died 6 hours post-admission to the Oregon Bum Center after being broughit there via Life Flight from St John's Hospital in Longview Washington where he had been brought via local ground ambulance last evening after being found down in a structure fire. Cause of death appears to have been the result of smoke inhalation.

ciraJmrtancss:@etliw Exact cause and location -.of the house fire is pending details confirmation’ with the local Fire Marshall’s Office in Longview, WA. What it known at this time is that the subject and two siblings reportedly had escaped ‘the fke when the subject ran back inside to save a/family dog. Local Firefighters found the subject inside the home ’ .‘with an approximate down time of twenty minutes. The subject was found asystolic and CPR was initiated and continued. during transport to the local hospital (St John’s Hospital). The subject tived at the first Ihospital with condition unchanged. The subject was found with soot in the airway and a mbon mdnoxide level of 66% saturation. It was decided that the subject would be taken to Portland for further’ care and Life Flight was activated. The . . subjkct wz& flown to Portland where he wasadmitted to the Oregon Burn Center and diagnosed with irihalation injury as well as 5% first degree bums to the face, hands, arms, and legs. The subject remained comatose with pupils &xed and dilated. The subject remained on a ventilator with al very poor prognosis for long term survival. The subject cqtinued to-deteriorate until his eventual and not unexpected death. The hospital Admitting Department was advised to hold the subject in their’ morgue until our office could confirm details with the Lzongview FMO. ,

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FOLLOW-UP

Multnomah County Medical Examiner’s Office

INFORMATION . CmE#

94-3433

.

REQUEST DEPUTY:
I). Confirm details of fire with Longview FMO. (need exact address and time). 2). Advise Emanuel Admitting when body can be released.

ACTION TAKEN:
12/01/94 - 17:16hrs:
Contacted Longview Fire Department. The fire was at the subject's residence and reported to them at 23:49 last evening. The subject and two siblings, ages 4 and five, were being watched by a teen-aged male baby-sitter. This baby-sitter reported to investigators that he arrived at the residence about 17:30-18:oO and the children’s parent(s) left. Shortly after arriving, the baby-sitter caught the sub*t playing with a cigarette lighter and took it away from the boy but placed it on the living room coffee table. Later one of the younger children went to his room to bed. Then later yet, the three remaining persons, the subject, his younger sibling and the baby-sitter were watching television and all drifted off to sleep in the living room. The baby-sitter awoke later to find both children awake and flames coming from. an area near the end of the couch (in the living room). The baby-sitter attempted to put out the fire to no avail using a pitcher of lemonade. He then evacuated all three children and ran to a neighboring address to call the fire ’ department. The baby-sitter then instructed the subject to open the back door so their dog could escape. The baby-sitter then ran to his parent’s house to get help. Upon the arrival of the fire fighters, it was realized that the subject was not around and it was suspected that he had returned to inside the residence. Fire fighters first went to the rear door to find it locked and then entered the residence through the front -door, into the living room which was ablaze and the lifeless subject was found. Fire fighters started CPR and the child was rushed to the local hospital. It is believed that the subject had gone to the rear door to find it locked so then entered by the front door either in order to unlock and open the rear door or to rescue the dog. . The ‘fire investigation indicates that this was an accidental fire, started in the living room, suspected as being either by the subject or his younger sibling. Two lighters were found in the living room near the origin of the blaze. Emanuel Admitting was called and the child was released to the named funeral home. . . . . . .db

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Insurance Report -““’ ’ 3

SECTION
‘Response

I

A
DISPATCHED 23:49 I ARRIVED ENDTIME

Data

IR. NO. jE*p;lJo., L Incident Location

Automatic or M/A . 0 NONAPPLICABLE

Method of Alarm

Situation Found

1 ll-STRUCTURE FIRE

Action Taken 111 RESCUE,VENTILATION,EXTINGUISHMENT,SALVAGE

I & v 1

Occupant IEM EMPLOYEE Data I

I

1 DOB

r-=--l
1*
Owner Address

11/4/81

I

O w n e r [oooccu~~~~/ow~~~ 1
Data (Area Code) Phone
-!lli@ar

IGxie

Owner Naqe

I

I I Responding Personnel Personnel 114 Paid & A p p a r a t u s 0 Volga
[Tiy Total
t

4

No. of Respondiqg Apparatus
I] Engine. I-1 Tnxlc r1 Aerial IJGmnd 0 LI Tanker EMS . TIReme II Hazmats i[ others

Construction
Info

-1,

General Property use 41 ONE OR TWO FAMILY RESIDENTIAL USE

I
P-I I I

3pecific PrQperl+ use [411-ONE FAMILY DWELLING ALL YEAR Building Code Occupancy Type I~R~-DWELLJNGS & LODGING HOUSES Structure Status 12 INUSEWITHFURNI!!!3HINGSINPLACEANDBEINGUSED

I -p

ancy Status at Tiime’of Incident 11 OCCUPIED AT-TIME OF INCrDENT

Mobile Property (lf involved)
Year State .a I I 1 minor I Drivers Tikense Number State Vehicle Identification No. LCC /D.O.T. Permit NO. Model II :I(0 Type Mobile Property Vehicle License

In iuries / Fa tn Zities
SECTION B Civilian Casualties +.ries 1 Fatalities ro

Fire Casualties
Injuries Fatalities pi-l -loI

SE{ TION C C 0 N T R I B U T t N G Contributing Factors Contributing Person(s) 1 I1 I -IL\ *. Level Area of Origin A01 ABOVE GROW lST STORY ll4LMNG ROOMS, RECK ROOMS, FAMILY ROOMS Ignition Factor Horizontal Distance from Ignition Factor I Form of Heat of Ignition 45-MATCH, LIGHTER Acres Burned I I DOB >01/01/8

.

.

I 1

Mnterint First Ignited

Type Mobile Property 72 COTTON, RAYON, POLYESTER BLENDS

1

123 UPHOLSTERED FuRNlTuRE

I

E Q U I P M E N T

,Y Model , Fuel I ,

lf Equipment Inozdedz
Type EquipmentMake

MobileProperty

,

I

Model

I

Serial Number

MethodofExtiq@hent 5 WATERCARRIED ON APPARATUS I3JITIALLY ASSIGNEDTOTHEINCTDENT

ESTIMATED Property Loss I

ESTIMATED Contents Loss

15,anoq 1

5,000.q -.-

SECTION D . 2 COMPOSITIONSHINGLS

Roofcowring:

.- . . ___.- “___ I __-I ~__”

I-_ - ^

b

...... _: .--. ::. . . . __:. __ -. -:.I.:.-. . . . _ _. .

..: :’ -. _.

__.

___.

:. . 1:: _.

:.... . .. . .__ :. ____ . :. i:.

-.

.

-. ._._.

::-

3

R epo rt)

I \ Flaine

Snake

5 STORY OF ORIGIN Material Gencrating Most Smoke Type Mobile Property (72 COTTON, RAYON, POLYESTER BLENDS Avenue of Smoke Travel 1 12 CORRIDOR Type Mobile Property 8 NO DETECTOR PRESENT \ DetectorP&formance 8 NO DETECTORS PRESENT EWguishType 98 NO EXTINGUISHING SYSTEM Reason for Ext. Failure* 8 NOEXTINGUISHIN GSYSTEMFA.TLURE Sprinkler Heads ,, TypeMobileProp;: ,Activated NLlIIlk

5 CONFINED TOSTORY OF ORIGIN

.I?orr,n’

.

‘I 121 UPHowrERED I;uRNITLTRE -------I I Power Supply 1 BATTERY ONLY t Reason for Failure .

Extinhuisher Performance t3~3Qo~~ PKESENT IN ROOM OR SPACE

,

MemberMakingReport 1 Officer in charge ILT. MCKAY

. I I I

Emp. LD. 1 I I

P a g e 4 (Insurance Report) HAZARDOUS MATERIALS INFORMATION

SECTION F Esbmated No. of Chemicals Released

Area of Release

Level of Release

Chermical(sj or Trade Name

Release Factors

Haz -blat ID Sources Used

Special Haz Mat Team Actions

i
Type of Equipment I.nvol\-ed
cat Number

Disposition of Incident

DOT I.D. Number
1

DOT Hazard Ciass

I

II I

Physical State Stored Physical State Reieased

Container Description Use -1 I L Container Construcxon

Rd%ec!

L-

mr-7
Extent of Release

M% re

Suspected Environmental Contamination Ccc: 2.xter Type \ /_

,

CaFacie

,

,,~:,~,

Cont2minated Material

Fire Service Haz Mat Casualties

Injuries

Fi::z!ities

II

Member Making Report I Officio: ;I: charge [LT. MCK41’ I 1 i I I

Emp. LD. 1 I

RESPONDED TO REPORT OF HOUSE ON FIRE,FLAMES VISIBLE,PEOPLE EVACUATING. FOUND SMOKE BANKED DOWN TO ABOUT KNEE LEVEL WHEN WE ARRIVED,FLAME VISIBLE IN MIDDLE OF ROOM AND TO RIGHT. JUST INSIDE FRONT DOOR, ADVANCED PRECONNECTIN FRONT DOOR. PEOPLE OUTSIDE SAID THERE WAS ONE CHILD INSIDE WHO ENTEREDTHROUGH REAR DOOR. SECONDTEAM WENTTO REAR DOORTO ATTEMPTSEARCH,BUT FO-UND DOOR LOCKED,SO RETURNED TO FRONT DOOR TO BEGIN SEARCH. TOOK SECOND LINE IN AND ADVANCED FOR SEARCH. FIRE WAS KNOCKED DOWN & CONTROLLED BY THIS TIME AND VISIBILITY WAS IMPROVING BECAUSE VENT FAN WAS OPERATING. ONE CHILD WAS REMOVED AND GIVEN CPR IMMEDIATELY AS HE WAS REMOVED OUTSIDE. HE WAS TRANSPORTED TO ST.JOHN'S,ACCOMPANlED BY FIREFIGHTER HOLBORN WHO ASSISTED WITH CPR DURING TRANSPORT. HOUSE WAS OVERHAULED TO ChECK FOR FIRE EXTENSION. PICTURES TAKEN BYTITUS OF POINTOF ORIGIN BEFORE EXTENSIVE OVERHAUL WAS BEGUN (LAST PICTURES ON ROLL). ALL CONTENTS OF FIRE ROOM WERE REMOVED,INCLUDING THE CARPET, CEILING TILES WERE REMOVED TO CHECK FOR FIRE ES OF VALUE INCLUDING 3 RINGS,PlCTURES AND PICTURE ALBUMS WERE GIVEN TO THE FOR SAFE'KEEPING. *AGE 13, H RED AS BABY SITTER ACCORDING N 12103194 @ 530PM CHILDREN: 4 YOAm'v 7 YOAm'ABOUT 15 TO 6PM TO CARE MINUTES AFTER THE PARENTS LEFT,KEN CAUGHT EDD!: PLAYING WIT; A LIGHTER. HE TOOK THE LGHTER AND PLACED IT ON A COFFEE TABLE THAT SAT BETWEEN TWO EASY CHAIRS (ONE RECLINED AND ONE DID NOT)lN THE FROh'T ROOM. AFTER KEN TOOK THE LIGHTER,ALLTHE CHILDREN PLAYED HIDE AND GO SEEK UNTIL THE YOUNGER CHILDREN (BETH AND DONA1D)GOT SCARED BECAUSE OF THE DARK IN THE HOUSE, SO, THEY ALL DECIDED TO WATCH TV. THEY DID NOT USE THE LIGHTER TO SEE WITH WHEN THEY PLAYED HIDE AND SEEK. DONALD WENTTO BE:-BEFORE "BEN AND STIMPY" WAS OVER AT 9PM. .KEN,EDDlE AND BETHANY FELLsASLEEP WATCHING TV. KEN WOKE UP &THE OTHER TWO CHILDREN WERE AWAKE AND WATCHING TV. KEN SAW FLAMES ATTHE END OF THE COUCH,GRABBED HIS COAT AND TRIED TO EXTINGUISH THE FIRE, BUT WAS NOT SUCCESSFUL. THEN HE TRIED TO EXTINGUISH THE FIRE WITH A “WATER JUG" WHICH HAD LEMONADE IN IT,OR AT LEAST SMELLED OF LEMONADE. THE FIRE KEPT BURNING,SO KEN EVACUATED THE CHILDREN,lNCLUDING DONALD WHO HAD GONE TO HIS ROOM.THEN KEN TOLD THE LADY IN THE PINK HOUSE ABOUTTHE FIRE, AS KEN WAS RETURNING,HE TOLD EDDIETO GOTOTHE BA?K DOOR AND OPEN ITS0 THE DOG COULD GET OUT. WHILE EDDIE WAS DOING THAT,KEN WENTTO WAYE ?:5 PARENTS. EDDIE MUST HA'& ENTERED THE HOUSE THROUGH THE FR3NT DOOR AFTER FINDING THE REAR DOOR WAS LOCKED KEN ThEk TRIEDTO OPEN THE FRONT DOOR,BUT iT WAS TOO HARDTO OPEN AND HE BURNED HIS HAIR ANDITWAS HARDTO BREATHE BECAUSE OFTHE SMOKE. OFFICER M.JEWELL,LPD WAS ALSO ON SCENE AND ARRIVED BEFORE LFZ. HE SAW SMOKETOO THICK TO ENTER. FLAMES WERE IN THE CENTER OF THE ROOM,AND TO THE RIGHT OF AND INSIDETHE FRONT DOOR. HE USED HIS PORTABLE EXTINGUISHER ON THE FIRE,BUT WITHOUT MUCH RESULT BECAUSE OF THE DISTANCE FROM THE FIRE THAT HE PAD TO MAINTAIN BECAI'T: OFTHE SMOKE. HE INTERVIEWED-KEN COOLEY AFTER LFD (MCKAY,i DID. FIRE DAMAGETOTHE FRONT ROOM WAS EXTENSIVE.SOOT '; SAT AND SMOKE DAMAGEDTHE OTHER ROOMS AS WELL. DURING CLEAN- U P, A LIG HT RED LIGHTE R WAS FOL':;D ~JNDER TH E COFFEE T.ABLE ATTHEREG:-ESTOF OFFICER JEWEL FOR THE LIGHTER. A SECOND,GREEN LIGHTER AS MENTIONED BY KENTO O%CERJEWELLW&S NOT FOUND,MOSTOFTHE CONTENTS OFTHE FRONT ROOM HAVING BEEN PILED ON THE FRONT LAWN BY THIS TIME. MCKAY.

LONGVIEW FIRE DEPARTMENT

EXU&iT X 3

OfEiceofFXreMBrshal

.

DATE OF FIRE LOCATION OWNER

TIMEINVESTIGATOR 23: 49

INSURANCE COMPANY

POLICY NO.

EFFECTIW DATES BUILDING COVERAGE

CONTENTS . COVERAGE

PREVIOUS FIRE RECORD LOSS PAYABLE TO RECENTINCREASES ADJUSTER

PROPERTY INVOLVED WHERE FIRE STARTED PROBABLE CAUSE EXTENT OF DAMAGE INJURIES DEATH FINAL DISPOSITION

.,L_e_b_JJcl’ - - - - - - - - - - - - - - - - - - - -

C - I I - - - - - -- - - - - - - - - - I - - - - - - - - - - ” ----Y--------~----------II--I----------”

---”

I NC/DENT

I

70 11 12 13 14 15
TOTAL FIRE SERVlCE P E R S O N N E L RESPON‘DED GENERAL pad 10
1 0

vdnteer

NUMBER OF APPARATUS RESPONDED

Engine

Twck

Aend

Cunnd

EMS Tandre

Fi0SCU9

I Hazmats

PROPERTY USE 4 1 Type M&la P-8 MOBILE UCENSE PROPERTY (lF IT

BUILDING CODE OCCUSPECIFIC PROPERTY USE 41 1’ PACYTYPE STATE

STRUCTURE O R 3 1

STATUS MAKE

2

AT TIME OF INCtDENT

1

YEAR

LC.C.ID.0.7: PERMIT NUMBER

wAs INVOLVED)

vetlclelclenml~alNunbec

mwrs-~

f4m-&er Activated

1 S I T U A T I O N FOUNb
1

PROVIDED ON SCENE . Pvt. Amb 0 1 Pub /a&

NUMBEROF

1
REWED

AREA OF RELEASE TYPE OF EQUIPMENT IN’mLVED IN RELEASE

LEVELOF RELEASE SPECIAL HA2 MAT TEAM INJURIES HA2 MAT CASUALTY

RELEASE FACTOR 1 DISPOSITION OF INCIDENT FATALITIES

3

HA2 MAT I.0 SOURCES USED

1 PRINT MEMBER MAKING REPORT 2 I Err@oymIDr&rnter

3Qnature d m-maldrprepoR mkerirlcwgt3
L T . MCKAY

mla!e

~-

3-

---.
INCIDENT NUMBER

19

LF

2259

EXP

NO.

INVESTIGATION .STATUS

CLOSED

RESPONDED TO’ REPORT OF HOUSE ON FIRE, FiAMES VISIBLE, PEOPLE EVACUATING. ’ FOUND SMOKE BANKED DOWN TO ABOUT KNEE LEVEL WHEN WE ARRIVED, FLAME VISIBLE IN MIDDLE OF ROOM AND TO RIGHT, JUST INSIDE FRO’NT DOOR. ADVANCED PRECONNECT IN FRONT DOOR. PEOPLE OUTSIDE SAID THERE’WAS ONE CHILD INSIDE WHO ENTERED THROUGH REAR DOOR. SECOND TEAM ‘WENT TO REAR DOOR TO ATTEMPT SEARCH, BUT FOUND DOOR LOCKED, SO RETURNED TO FRONT DOOR TO BEGIN SEARCH. TOOK SECOND LINE IN AND ADVANCEd FOR SEARCH. FIRE WAS KNOCKED DOWN 81 CONTROLLED BY THIS TIME AND VISIBILITY WAS IMPROVlljG BECAUSE VENT FAN WAS OPERATING. ONE CHILD WAS REMOVED AND GIVEN CPR IMMEDIATELY AS HE WAS REMOVED OUTSIDE. HE WAS TRANSPORTED TO ST. JOHN’S, ACCOMPANIED BY FIREFIGHTER HOLBORN WHO ASSISTED WITH CPR DURING . TRANSPORT. HOUSE WAS OVERHAULED TO CHECK FOR FIRE EXTENSION. PI;CTURES TAKEN BY TITUS OF . POINT OF ORIGIN BEFORE EXTENSIVE OVERHAUL WAS BEGUN (LAST PICTURES ON ROLL). ALL CONTENTS OF FIRE ROOM WERE REMOVED, INCLUDING.THE CARPET. CEILING TILES WERE REMOVED TO CHECK FOR FIRE EXTENSIbN. UDING 3 RINGS, PICTURES AND PICTURE ALBUMS WERE GIVEN TO T OR SAFE KEEPING. ACCORDING TO KEN B. AGE IRED AS BABY SITTER AND BEGAN 12dI3/94 8 530PM T O 6 P M FOR CHILDREN: DONALD, 4 YOA; BETHANY, 5 YOA; EDDIE, 7 YOA. ABOUT 15 MINUTES E PARENTS LEFT, KEN CAUGHT EDDIE PLAYING WITH A LIGHTER. HE TOOK THE LGHTER AND PLACED IT ON A COFFEE TABLE THAT SAT BETWEEN TWO EASY CHAIRS (ONE RECLINED AND ONE DID NOT) IN THE FRONT ROOM. AFTER KEN TOOK THE LIGHTER, ALL THE CHILDREN PLAYED HIDE AND GO SEEK UNTIL THE YOUNGER CHILDREN (BETH AND DONALD) GOT SCARED BECAUSE OF THE DARK IN THE HOUSE. SO, THEY ALL DECIDED TO WATCH TV. THEY DID NOT USE THE LIGHTER TO SEE WITH WHEN THEY PLAYED HIDE AND SEEK. DONALD WENT TO BED BEFORE “BEN AND STIMPY” WAS OVER AT 9PM. KEN, EDDIE AND BETHANY FELL ASLEEP WATCHING TV. KEN WOKE UP & THE OTHER TWO CHILDREN WERE AWAKE AND WATCHING TV. KEN SAW FLAMES AT THE END OF THE COUCH, GRABBED HIS COAT AND TRIED TO EXTINGUISH THE FIRE, BUT WAS NOT SUCCESSFUL. THEN HE TRIED TO EXTINGUISH THE FIRE WITH A “WATER JUG” WHICH HAD LEMONADE IN IT, OR AT LEAST SMELLED OF LEMONADE. THE FIRE KEPT BURNING, SO KEN EVACUATED THE CHILDREN, INCLUDING DONALD WHO HAD GONE TO HIS ROOM. THEN KEN TOLD THE LADY IN THE PINK HOUSE ABOUT THE FIRE. AS KEN WAS RETURNING, HE TOLD EDDIE TO GO TO THE BACK DOOR AND OPEN IT SO THE DOG COULD GET OUT. WHILE EDDIE WAS DOING THAT, KEN WENT TO WAKE HIS PARENTS. EDDIE MUST HAVE ENTERED THE HOUSE THROUGH THE FRONT DOOR AFTER FINDING THE REAR DOOR WAS LOCKED KEN THEN TRIED TO OPEN THE FRONT DOOR , BUT IT WAS TOO HARD TO OPEN AND HE BURNED HIS HAIR AND ‘IT WAS HARD TO BREATHE BECAUSE OF TtlE SMOKE. OFFICER M. JEWELL, LPD WAS ALSO ON SCENE AND ARRIVED BEFORE LFD. HE SAW SMOKE TOO THICK TO ENTER. FLAMES WERE IN THE CENTER OF THE ROOM, AND TO THE RIGHT OF AND INSIDETHE FRONT DOOR‘. HE USED HIS PORTABLE EXTINGUISHER ON THE FIRE, BUT WITHOUT MUCH RESULT BECAUSE OF THE DISTANCE FR RE THAT HE HAD TO AFTER LFD-(MCKAY) DID. MAINTAIN BECAUSE OF THE SMOKE. HE INTERVIEWED KEN FIRE DAMAGE TO THE FRONT ROOM WAS EXTENSIVE. SOOT, HEAT AND SMOKE DAMAGED THE OTHER ROOMS AS WELL. DURING CLEAN-UP, A LIGHT RED LIGHTER WAS FOUND UNDER THE COFFEE TABLE AT THE REQUEST OF OFFICER JEWEL FOR THE LIGHTER. A SECOND, GREEN LIGHTER AS MENTIONED BY KEN “pylk! TO OFFICER JEWELL WAS NOT FOUND, MOST OF,THE CONTENTS OF THE FRONT ROOM HAVING BEEN PILED ON THE FRONT LAWN BY THIS TIME. MCKAY.

-- ,;

P FULLEF: T E N ,‘I2347 ‘2347 !I2347 12347 E N T R Y H O U S E O N F I R E , FLAMES V&SIBLE , F’EOF’LE Ef1ACUATIpjG , DISP 8 1 1 ASST 821 . ASST 816

“811

?8i6

?821

‘2347 ?34? /L334? “2347 e

ENTRtY H O U S E O N FIF:E, F L A M E S ‘JISI&LE KlISP 8 1 1 ASST 821 &ST 8 1 6

9 F’EOF’L E EVACUAT I NG‘

Xncident Number -?port Wter m Vehjcle responded withFinal approach route .- a. . . . .

m

RESPONDING

.

.

--

-

.

osi tion apparatui

Were you first to arrive ht+ene? do If not, who was?
. Obstruction to response 3r building access? . Visible flame? .Visible smoke? \/p,i . .

$/I 7&b tvb (first, second, third) .

74LdN

/vu (Parked or stalled vehicles,traffic,road repair) . t . . . * ColaiColor * - .

. \ Locations from which smoke was emitting ' 0 (Hindows, do'o';Fs, chimney; roof,. etc.) Persons or vehicles leaving scene
. .

(Color, type, mode!, license, or physical description of persons) . .. ARRIVAL AT SCENE 7 Approximate number of spectators80 Recognize anyone or anyone acting unusually? * /W , . .
. . .

.

:

.

.

.

.

(Name, address, sex, race, age, height, weight, build, complexion, hair color, etc.) . ho - 'Who?
: .

Did anyone offer their hel? .
. -

(Description of individual) T&iJe tC
. f&j

Police Officers on scene? ')/"5 Iho?. . liydrant Siamese or

35-0 f/A&cc . 3 /A * problems? &6 I&& (Broken stem, tight cap, stripped threads, Parke&cars)

P . .I .

problems? F" (Plugged, tight cap, stripped streads., etc.)

-

.

- . -

SECURITY OF BUILDING . here did.you initially gain entry?-. .. . 6as forcible entry necessary? +as door (window) damaged? -.- .Location of window and doors you entered or opened for access or ventilation (were they locked, standing open? broken? etc.) - - - ..-f cl
-. .I--_.._ .^ “._l_

.

-

--~

IJ;~xu~l ofcninprs in vail, ‘ f l o o r o r c e i l i n g s ?-. ’ .. ..a... ..

-.

-

1 OTKR F,‘Ct”:

.

‘LzcribC; -area firs < extinguiShed t o a r e a I&t . -

.

c::ttnguir.\:ed ’ . (rxte of t r a v e l )

.3 thcrr. a?:l;t’ning ur.wusl,*!mut ttils

-

f i r e ? Explain;” : Z!PW4T~V?Z

-’ -

\ .

.

. . . \:ci- briefly d e s c r i b e - Uh5i ibid you-do during the fire? ‘Use tIi;is space also to note any .-.8-r c ..L.‘e c>Ecn*atIons y c u f e e l irrportant bThich a r e n o t n o t e d above. T h i s materlaf ~911 ke kept for your infomtion in t h e f u t u r e rnd es ‘an @id in the investigation of this fire. .* * .

.

-- -

,i Incident locatjon Incident --.

-

.m- ---

.
with* .'- . PosItIon appatatu; ,mivate, /@ngine>r ttuckf . . who was J-p#&&j st, second, third) e
.

Vehicle responded Final approach route

]eJ Uere you first to arrivk bt..kene? If not, .. Obstruction to response or building access? . . . From

- APPROACHING THE SCENE whete? ' ' . . I .Colok -

Visible flame’? ;fl/c>

Locations from which smoke was I) Persons or vehicles leaving scene
. t . .

.

.

-(Color, type, mode!, license, 0; physical description of persons) . .. ARRIVAL. AT SCEHE

. Recognke anyone . or anyone acting Approximate number of spectators&J

unusually. ?2a .

l

.

-(Name, address, sex, race, age, height, weight, build, complexion., hair color, etc.) . ~~ Did anyone offer their'hel? 763 - Who?. ~~77~~~/2 . Description of indivi . Police Officers' on scene?,.Z.&W;L$hof . . . Hydrdnt problems?
l

. .
,

l

_-

:

, (Broken stem, tight cap, stripped threads, parked cars) . * . /7IV’ /5> Siamese or P.I.. problems? (Plugged, tlgSt cap, stripped streads.. etc.) *

.

. . *. . .

. -- f .-

.

.SECURIfY

:/khere did you initfally gain entry?--[&$* &m 1 . -

L

OF BUILDING . m n

.

-Was forcible entry necessary?/L31_--'-Was door (window) damaged? . Location of window aid doors 'you entered or locked, standing open? broken? etc.)-&

(rocte o f t r a v e l )

IVPMTTPE . p - s +xy bri ci’ly d e s c r i b e i Nhtii d i d you’do during t h e f i r e ? U s e t h i s s p a c e a l s o t o n o t e a n y . .* . ..:. QT?L’ o5scrvstfons ycu feel inportant w h i c h a r e n o t n o t e d a b o v e . T h i s m a t e r i a l will IX -..l.

-e-m

/, . c .

*

...

--...

.

Incident
.-.

l

Number
I

-

-

-

-

Date of Fire /A&

3-29

.
*

r
*

RESPONDING

:

l

-

.

Vehjcle responded with-

Pinal approach route f Uete you first to arrivi! ht+cene? f not, who was? (first, second, third) --Ye . ~/t/oNE Obstruction to response or building access? . -(Parked or stalled vehlcles,traffrc,road .
.

. repair)

.
Y'$sible flame'? Visible smoke?

.

APPROACHING THE SCENE . where? * *. .c * .* .

.

- .
Coloi

.
&mL -

From \Lo&

Color

Locations from which smoke was I 'Persons or vehicles leaving scene

,

.

r
l .

.

'IColor, type, mode], license, or physical description of persons)
. ..

-ARRIVAL AT SCENE .

Approximate number of spectators_ [a RecognIre anyone or anyone acting unusually? ’ (&&-, &J +tA, f%-v c.,,; pr i ,., . j,;r;: L TI).&wf. . . ‘0 . 14 \A 41 . . -(Name, address,;e& ra asi. heightb weights bUlldB cyP'exlon* hair color, etc.) . . - Who? Did anyone offer their hel? Description of individua . . . . ') . 1 -‘&o?.' '. !j&!r+/ . Police Ofjicets on scene? ' . ‘. . -. . . . Hydrant ,probl ems? (Broken stem, tight cap, stripped threads, parked cars)
. ” . . . :’

.

.

Siamese or P.I. . problems? . (Plugged, tight cap, stripped streads.. etc.) SECURITY OF BUILDING
.

*

.

-,-

.uhere did you initially gain entry?:. . . 'Was forcible entry necessary? -

.-

.-

- ----‘-IJar door (window) damaged? .

location of window at& doors you entered or opened for access Or ventilatjon (were they ' locked, standing open? broken? etc.) ' -a - .-w-s . -t-7

Fire
1 PJcrLi1.B of r,i~ss from b r o k e n window3 ,,n

l

/3 -3-3 4/ I!cport W r i t e r
-

- e-.A:

(t:hich w i n d o w a n d txs it &side o r o u t s i d e ) ?

:zcribc; arec? Eirsf cxtingui&ed t o are& Zest c::tinguicl:ed . . (rxte o f t r a v e l ) .. ..
-. - . . .. s ;

k ,3

-\ .a

this f i x u n u s u a l l y casy'or d i f f i c u l t t o extinguish? E x p l a i n . .. -. . . . . . t .h. cr 2 z!x~thing w.ususl .aljuut t h i s f i r e ? fiplain;-' ' .

V:cq- bsici'ly d e s c r i b e i Vh'3i d i d y o u do during t h e f i r e ? U s e ' t h i s s p a c e a l s o t o n o t e a n y s::!.:-lr o5servstions ycu feel ilcportant which are not. n o t e d a b o v e . T h i s m a t e r i a l vi11 Ez for y o u r i n f o r m a t i o n I n t h e futur$ end as 'an irid i n t h e i n v e s t i g a t i o n o f t h i s f i r e . .'

i-ept

-w--v

,. .
. I *‘. : .

.
--;-

..

.

..

.

--

. , .

~.-

.

* ;. -.

.

_

-.

. ~~tii3~ s5T.27,

jncident

iocation

S6-

23p
l .

. *

~tj'h~ * 3

Incident Number . .-port Writer
,--: -. t --

22
.

.

57

*‘.

Date of Fire 12 Date -.
l

yy/Q’wv/

a-

q/L/4 4 . % 5 c, I

RESPONDING . m Vehicle responded with- . 6.. i! PositIon ,)rivate, engine or truck) Final approach route

apparatus

If not, who was? . ,(first, second, third) . Obstruction to response or building access? tiOfl& (Parked or stalled vehicles,traffic,road repair) . - APPROACHING THE SCENE . . co1 oE ,,A ;+ Visible flame'? d 9 From where? . &MC Visible smoke? &k/- pvl&kL f&e) .: . - Color / f/ FLnP lo& J, r@8c,. &&J locations from which smokeawas emitting I (%ndows, doo s, chimney, roof, etc.) * Persons or vehicles leaving L+f -

Were you first to arrive bt. .$cene?

iColor, type, mode!, license, or physical description of persons) . ARRIVAL AT SCENE Approximate number of spectators, 3 Recognize anyone or anyone acting unusually? , ?j& .a.- ,-y;+ ,' 5 &.p & A +& ; &te& jL-3 . h!&J, -LPb (~,&a;!) . I I . . . . (Name, address, sex, race, age, height, weight, build, complexion, hair color, etc.) . offer

-. *’:

.

scene

d Pd./ ..

Did anyone

their'hel? 'PS - Who?' LP.b - Jekcl( f TDescription of individual) . . . . --Who') &.&l/ Police Officers on scene? YiJ .._ : . . . _ Hydrant problems? itme (Broken stem, tight. cap, stripped threads, parked cars} . - . fifes Siamese or'P.1. problems? . (Plugged, tight cap, stripped streads., etc.) SECURITY OF BUILDING

. .---

. iere did you initially gain entry?-- 42 &or - ..j , .'Was forcible entry necessary? ,N3 -.- - Was door,(window) damaged? '

-

Location of window aid doors you entered or opened for access or ventilation (were they locked, standing open? broken? etc.) 5, J,& ~M~LJ d -d& 10,~ /?&ti, &.& ,--.:-be - d . - ioc Art J s 3~ 4 44 &.A~ (d 2kedJ ~.a P"-qg+F rC4wN.r -tc 4&f &;o* -42 flfCfb I I

-

. h?- m :‘;ri~ f Fze unuscall&esy o r d i f f i c u l t to extin&h? Explain. co w._-

Ed-- . c.

. . . . \:cry bri ci’ly d e s c r i b e - Wh’x’ d i d you-do during the fire? Use this s p a c e a l s o t o n o t e a n y *-‘*.3r c5ecrx*ations y c u f e e l inportant w h i c h a r e n o t n o t e d above. c ..;. This material will b e !Ypt for.your lnfomation i n the f u t u r e rnd es ‘an pid i n t h e i n v e s t i g a t i o n o f t h i s f i r e .

Rtxeived Ert’cer-ed Dispatched En t-au-l-e or!sc~rI~ Closed

1 &q,3/94 1 2/c:t3/94 12/1:,3/94 12,-fr:,3/94

23:44:41 23 : 47 : (59 23:47:21 23:49: I?

B Y DT03 BY fiTCt3 EY llT(:12

TSCl9 TSCl9 TSC 10

?2/2:j:3/94
1 2/‘i:,4,/‘~4

23:52: 19 (:I1 :43:2i=J

Irlitial T y p e : FIRRES Initial A l a r m L e v e l : 1 F i n a l Alarm L e v e l : 1 F in a’1 Typs: FIRRES ( F I R E R E S I D E N T I A L ) Pri: 1 Dispo: L pf33y F’ Q ; i 112 3 L i::: ; F i p e B L t::: : -Id.. -8 L F 10 0 M a p F’age: Grwp: FS Beats: 81 L,_7c: ( $1 i.j )

Src: . 9

Addr: HII& E C)N F I R E , G F L A M E S VISIE:LE ? F’EOF’LE EVACUATIi

, N E I G H B O R . A D V I S E S ’ T H R E E S M A L L CHILEiREP? I N T H E OUSE LVI

Lnrm wJ-v -4. L -.. ,
803 I S COMMAfW

.,En-'isred
I2ispa’~che.d

12/03/?4
12,,'i:i3/$4

En route Cll35tt2lTE
Closed

.

12/c‘,3/94 12/q!3/94

23 : 47: 40 23:45:54 23:48:54 23: 56: 22

BY IIT BY DT(:)2

TSCi9 TSC 10

n/04/94

01:54:37

Ini’iial T y p e : FIREAS Ini+:ial Gl.wrn L e v e l : F i n a l Alarm L e v e l f F in.3 1 T y p e : F I REAS ( A N Y ASS-T T O F I R E DEPT) .F’ri: 3 Dispo: 3

Addi-: ,NO M O R E I N F O R M A T I O N #L j=94c:s!:)22!59 #3L24 JEbJE L L 9 M I KE #3L3? CALDWELL, .EIL.L

Phone :

7

THERE I S CF’Fi I N F’ROGRESS ,?T T H I S YOci . T E L L GME: T O AFPZOACH O N 1 AND W I L L LEAD T H E M I N

gj c;+. E N r!

[ST JOHNS1 CST JOHNS]
T H E M O T H E R O F T H E KIL!S I S O U T ANI; I TGE GKANLrfF$ I IL ;NTS L I V E I N F’ORTLAND L ‘-. -? T

, THE MOTHER HFsS JEST ARRIVET! HGME? CGP1FIRMETr T E B O Y I S TEEING F L O W N T O EMMAUNCSL BURN C E N T E R I N PORTLAND [ST JOHNS]

8 .,\L@ ,u**.b..r ---w . . . . . . w-..
.Jent Location

++I I\ s b\CQE _t;i-,L’L,
~'13~~T *,3

. \ ,.ncident Number Oat; of Fire I>- lc Qd -. . i . . T 7; L 4 . .!eport Witer . -Date /d-& q(/ - - . . . * W- --RESPONDIN . . . . . m PosItIon apparatusVehjcle responded dith- . wivate, engine or truck) I . Final approach r&e . Nere you first to arrivk &3cene? u6 If not, who uas? Kl/ , !ylL, weq .(flrst, decond, thi$d) v . . . Obstruction to response or buildjng access? (Parked or stalled vehxles,traffx,road repair) . .
l l .

UO
. .

.

.

- APPROACHING THE SCENE /& F rm - where? . . 8 .'

.

Colo'k

. -

Visible flame'? Visible'snoke?

. C o l o r b?-DK ' \I!?“5 f <p-&t‘ by-) it . i&-- S&&q~. & beg= Locations from which smoke was enftting L (!iindows, do=s, chimney, roof, etc.) i-5;: i T> i {A)&.t, _ Persons or vehicles leaving scene , . s l&g kJF f .. .

-[Color, type, mode!, license, 0; physigal description of persons) . . .. ARRIVAL AT SCENE . . r.*tr Recognize anyone .or anyone acting unusually? * 19pproximate number of spectators 1~ . .
. . . . .

I I [Name, address, sex, race, age, height, weight, build-xipn, hair color, etc.)

.

Did anyone offer their hel? hJ\r> e Who? IDescription of individual) . .- . . -,,I F w-5 who? . * (?Jgz;c & yyy!&b7&~ - PoGce Ofjicers on scene? !- _ .. . . . -- . . . Hydrant problems? )$10 (Broken stern, tight. cap, stripped threads, parked cars)
.

.

. -

ljiamese or P.I. sproblems?

w. (Plugged, tight cap, stripped streads.. etc.) SECURITY OF BUILDING )q?&%+ . - &Jog T

-

.

--

-

.-2-

.

Idhere did .you initially gain entry?-.

'Was f'orci ble ehtry necessary ,?

.

6

J IJ r-

--\las door (window) damaged? .

Locat ion of window a;d doors you entere-er opeled for locke 'd, s#tanding open? broke n? etc;) 7" g% &\A. : '-. '& j-?;(- b; fl

? QCil i rc n o f r,iass from b r o k e n window3 (t:hir.h window and ws it iAside o r o u t s i d e ) ? ..N -. .;
l

?V!%3ATTVB -w-m

. .

hxy b=icXy d e s c r i b e i tJh'3i ciid you'd0 durin g t h e f i r e ? U s e t h i s s p a c e a l s o t o n o t e a n y c ::;:;--r o5scrvstions ycu f e e l i m p o r t a n t prhich a r e n o t n o t e d a b o v e . T h i s m a t e r i a l vi11 be !.-cpt for y o u r i n f o r m a t i o n I n t h e f u t u r e e n d a s ' a n Pid i n t h e i n v e s t i g a t i o n o f t h i s f i r e . : .a -

-

Position Vehicle responded with- . \ . St. \ _ ,)rivate, engine or trrrc'k) - .
l

a p p a r a t u s ' &.re fnfid .

. .

Final approach r o u t e

.

.

%)b Were you first to arrive ht:.Jcene? $6 If not, who was? srl $0 ,(first, second, third) . . Obstruction to response 3r building access? . (Parked or stalled vehicles,trafflc,road repair) . . APPROACHING THE SCENE . . I * 'Coloi . Visible flame?-' &QQ From where? Visible smoke?
: ‘&s . .-

Color

/&dc '

Locations from which smoke was I Persons or vehicles leaving scene
.

A/e/K

6-)iCSCB
..

(Color, type, model,

license, or physical description of persons) . .
ARRIVAL AT SCENE

Approximate number of spectators ! 2 Recognize anyone or anyone acting unusually? * x/&J . .
.

.

(Name, address, sex, race, age, height, weight, build, complexion, hair color, etc.) . Did anyone offer theirhel? No- Who?' (Description of individual) . . Police Officers on scene?-y&'iho? . ,)e&.\ . do&G * ' : *. . .* Hydrant problems? (Broken stem, tight. cap, stripped threads, parked cars) . . . Siamese or P.I. . problems? (Plugged, tight cap, stripped streads., etc.) . SECURITY OF BUILDING iWhere did you initially gain entry?-* &a& Was forcible entry necessary?-]0 '
. -

. .-- - -

DooC

- k/as door (window) damaged? . Location of window a& doors YOU entered or opened for access or ventilation (were they locked, standing open? broken,? etc.)&-& boct ~c\Q.~ j&Jr -Qafic qc;c.k& o,y) . I , . si/* . -

X-7

Ikrbcr ;;22 sq

Pate of

19cci~fx-1 of giass from broken windows (t:hich window and 1:~s i t inside o r outsldc)?

zrcribc, a r e a first e x t i n g u i s h e d t o a r e a lest c::tFnguir.l:ed

‘7-m

h\Ld

cr~lc; fize u n u s u a l l y e a s y o r d i f f i c u l t t o extingukh? E x p l a i n . .. - ..- .a03x-z mything w.ususl 33l~out t h i s . f i r e ? Esplzin;-' ' .
+* l

INCrnENT NUMBER lzzs‘/ 1 TIITLE OF CASE LOCATION 44

INVESTIGAT~IJ BY:
i

- - - - -

h,lC k1 ‘,, /,t ‘V

II

ROLL NUMBER i
IF-

I

1 PHOTO NUMBER-f A @&.-.

DESCRIWION

-

I

ROLL NUMBER i
PHOTO NUMBER t tk; ’

7<

INCIDENT NuMBERIZt’-;rl( TITLE OF CASE LOCATION i __~,

D E S - O N

.

INCIDENT NUMBER[m[
.

UWESTIGATEDBY:

* PMcysy .

=OFCASE LOCATION

DESCRIP'IION

ROLL NUMBER PHOTO NUMBER
DESCRJPTION

XERDETL
.

Cowlitz County LIVE RMS E)hWT~~ Page 1 Longview Police Department qyl2jQ&&Q-p& 01/17/1gg5 EVENT DETAILS
***jr+ Incid&nt +++*+

-----------------------------------------------------------------_________.I -_-__--------___________________________------------------------~--------------.

Report # 94-28955

Reported Date 12/03/1994 Time 23:47:40 Call Disposition 3 Location GE0 -> P p Di-- LP325 .st Map Coord / From -> Date 12/03/1994 Time 23:47 To.-> Date 12/03/1994 Time 23:47 Ci ***** REPORTING OFFICERS ***** Date 12/W/1994 12/03/1994 12/03/1994 Role INVEST ASSIST ASSIST DeptID 3L24 _ JEWELL, MIKE' 3L39 CALDWELL, BILL 3LlO JONES, ED Name

***** STATISTICAL CLASSIFICATION ***** Offense CALL TYPE A/C Cnt Ale Drg Lot Type C ,lN N Clearance' Frc Date Method N

Cowlitz ,Counlzy LIVE RMS Page 2 '"iy I-j t,'; L$!J‘cC ?,? -- 01/17/1995 Longview Police Department .Zvt,:Q~.' pt '4 EVENT DETAILS --------------------------------------------------------------~-------------.---------------------------------------------------------------- __-_-.-___-----at++*+ Incident +e++*

.XZRDETL

Report # 94-28955 Location

Reported Date 12/03/1994 Time 23:47:40 Call Disposition 3
+***rk NAMES +++++ *

-Role: DECEASED Name: DOB Age Ident Nmbr Note HOME Role: WITNESS Name DOB Age Ident Nmbr Note HOME Role: WITNESS Name: DOB .Age Ident Nmbr' Note HOME . Role: WITNESS Name: DOB 11/04/1981 Age 1 Ident Nmbrw Note HOME

es Caution

Hgt

wt

Race W Sex M Skin Weapon 12/03/1994

Caution

wt

wt

Race W Sex F Skin Weapon 12/03/1994

Caution

-

Hgt

Race W Sex M Skin . wt Weapon 12/03/1994

Caution

Race W Sex M Hgt 411/4ll Wgt 92/ 92 Skin MED Weapon 12/03/1994 ers HOM 120394

Y

.'

*

XERDETL

Cowlitz County LIVE RMS Page * Longview Police Department ~(Lff~~~q;LQ~z~:-~ 01/17/199i EVENT DETAILS p,y12:;;f + cl ------------------------------------------------------------~~---~----------------_-________________________----------------------~---o-------_
++*** Incident +++**

rjzed Date 12/03/1994 Time 23:47:40 Call Disposition 3

+f+++ PROPERTY ++f+f
Status EVID Type PE/OTHERI Make Desc LIGHTER Serial # Property-Value $ Recovery -> Date Value $ Model OAN Number of Like Items Color PLE 1

Status EVID Type Y /MISCEL Make Model Color Desc NOTES AND DIAGRAM ORIGINAL INTERVIEW NOTES AND HOUSE DIAGRAM Serial # OAN Property Value $ Number of Like Items . 3 Recovery 4 Date Value $

--

-f--

__,_,-_- _ ._ ”

-

^

Cowlitz County LIVE RMS Page 4 *i~Ir;s~;'twIz-~=-~- ()1/17/1gg5 Longview Police Department . EVENT DETAILS &-r'\~~~ Al --------------------------------------------------------------~-------,-.--. ------------------------------------------------------------------- ip -__,-___ ***** Incident 'Report'# 94-28955 Locatio
Tag #
*****

XtiRDETL

Reported Date 12/03/1994 Time 23:47:40 Call Disposition 3

***** EVIDENCE (PROPERTY IN POLICE CUSTODY) ***** 1 Status EVID Type Y /MISCEL Make Desc 1 PURPLE LIGHTER Serial # Model OAN Color .OAN Color

I Tag '# 2 Status EVID Type Y /MISCEL Make Model Desc ORIGINAL INTERVIEW NOTES AND HOUSE DIAGRAM Serial #
.

Cowlitz County LIVE RMS Page 5 'ilf

~,~;~l~;l~~'Yl~~Longview Police Department 01/17/1995 L. . EVENT DETAILS cyK49T A q -----------------------------------------------------------------------,--------------------------------------------------------------------.------~----~-------. ++++* Incident +*++*

XERDETL

Report #'94-28955 'Locatio

Reported Date 12/03/1994 Time 23:47:40 Call Disposition 3

+f+*+ NmmT1V.E ID +f+++
DOCSOl 12/04/1994 DOCUMEXT ATTACHBD TO REPORT NARROl 12/04/1994 OFFICER JEWELL'S ORIGINAL REPORT SUPPO1 12/04/1994 OFFICER JBWELL'S SUPPLEMEN!X!AL REPORT
*+*k+* NARRATIVE +++++ .

.DOCSOl 12/04/1994 DOCUMENT ATTACHED TO REPORT The following documents are attached to the paper copy. of this report: +.- . . 1. Copy of drawing of residence drawn by2. Copy of interview notes of COOLEY by JEWELL. NARROl 12/04/1994 OFFICER JEWELL'S ORIGINAL REPORT Writer, Officer JEWELL, was dispatched along with other officers to a reported house fire with children still inside at Upon arrival, writer learned from bystanders that there was a possibility that there were 3 children.inside. Writer observed flames inside of the residence through an open front door. Writer used the fire extinguisher from the patrol unit and attempted to enter the residence, but couldn't get beyond the front door due to the smoke. From the front door, writer was able to extinguish the flames for a short time, but the fire would flare up again. After the extinguisher ran out, writer left the front porch and.began to contact bystanders while waiting for the Fire .Department. It was finally determined that the only child in the residence was an 8 year old boy. The other children were all accounted for. Writer requested that an ambulance be dispatched to stand byin case it was needed after a rescue. Longview Fire arrived on the scene and writer advised the firemen of the situation and two possible locations of where the child might be so that a rescue attempt could be made. The firemen entered the residence, and a short time later, came door carrying a small child. The child was placed on the front was begun as there were no signs of life. There appeared to be burns of the skin on the back of his hands and his face, and his to be singed on top. out the front porch and CPR someminor hair looked

.A short time later the ambulance arrived and assisted in the CPR. The child 'was then placed on a stretcher and transported to St. John's Hospital with ,writer and Toby Holburn of L.F.D. continuing the CPR in the ambulance. Once at the hospital, the child was turned over the Emergency Department staff. 'Writer then returned to the scene of the fire for investigation. Writer learned that a 13-year-old neighbor boy had been babysitting the children for

7 '+i i!~~,2ll-‘,~-So-~~~- Page Cowlitz County LIVE RMS 6 01/17/1995 Longview Police Department * y?-f&.~ 3 y . EVENT DETAILS c I __________--___--__------------------------------------------------------------____________________----------------------------------------.-------------------XERDETL ***** Incident Report # 94-28955 Location ***** NARRATIVE
***** ***.**

Reported Date 12/03/1994 Time 23:47:40 Call Disposition 3

nterviewed concerning the incident. He was I the evening. He was Be provided the following information: identified as Kenneth e that was involved in the fire. He has He lives next door to been friends with the family for some time and babysits for them on a regular basis. if he could r the evening

dvised that all of them were sitting in the living room watching on Channel 16. After the first l/2 hour one was over of a show This called 'Snick", Donald decided to go to bed, so he went to h.is room. left the others still in the living room watching Television. After the second l/2 hour cartoon was over, everyone else fell asleep. B was on the couch in the living room, the couch where it appears the fire started. Bethany was seated in a swivel chair an-was in a recliner chair. / aught Eddie playing with a lighter 3 times Earlier in the evening, away from him, but would put it on a table in and each time he,would t the living room where it was plain view. Apparently, Eddie has had some problems with setting fires in the past, according todvised that there were two of them. When asked about the lighter, They were the plastic disposable type, with one of them being purple and the other green. Tonight, after m fell asleep in his chair, he was awakened by smoke'and flames. He saw that Eddie was awake and that the couch he was sitting on was on fire as f re coming out of it at the opposite end that Eddie was . . yelled at Eddie and Bethany to get out of the house, sitting on. which they d then attempted to put the flames out by beating them with his coat. hat didn't work, he ran to the kitchen and got a large container of water, which he dumped on the fire. It almost put it out, so he went back into the kitchen to get some more. By the time he got back, he observed that ut it the fire was out of controlas it had flared up again. He ecided . out with water again, but it wouldn't go out. At this time to get Donald and get out of the residence). use the smoke was so thicl J1m went to Donald's room and ye by the leg. m then he could see him. Donald awoke.and he took a "head carried him out of the house. After count" and found that everyone had gotten out of the residence. Eddie then asked the back of the inside could get
i

about a dog, and- told him to go around to ce and open the back door so that a dog which was hen ran next door to his residence to contact

.XGRDETL

Cowlitz County LIVE RMS Longview Police Department

Page 7 ? 14 ! . " /&I. ~;~;~!.L~Y~~~q~ 01/17/1gg5
.

EVENT DETAILS rs;

Related Interests

b\; $ q . . ---------------------------------------------------------------------.-------.------------------------------------------------------------------.---------------

***** Incident .' Report # 94-28955 Locatio
***** NARRATIVE

*****

Reported Date 12/03/1994 Time 23:47:40 Call Disposition 3
*****

his own dad and get some help. (Writer later located a Black Lab dog tied to a doghouse in the backyard which is believed to the dog referred to by Eddie.)

d

then returned to the front of theresidence and discovered'that Eddie was missing. He either assumed or was told by someone that he had gone into the residence, so he went to the front-door and tried to gain entry. , He couldn't get it open, but finally was able to get it partially o some reason the door was pushed closed, so he made a second attempt Eddie. Thinking that maybe Eddie was on the floor behind the door, got down on his hands & knees and reached in behind the door. He couldn't feel anything and had to retreat because of the fire. Writer then had -draw a picture of the interior of the residence and 11 of the.furniture was and where everyone was. Writer also asked about smoke detectors. He advised that he didn't know if there were the residence, but he didn't hear one when he was awakened by the Eddie's Mother, Dawn, arrived on the scene and writer contacted her. Writer advised her of some of the information that was available, which included the fact that Eddie was being flown by Lifeflight to the burn center in Portland, Oregon. Writer then returned to St. John's Hospital just as Eddie was being airlifted There Dr. SCHNEIDER, the treating Emergency Department physician, was contacted and asked for an update. He advised that a heart beat had been .established and that Eddie was trying to breath on his own, but at this time was being assisted by a ventilator. He further advised that burns received in the fire-were minor, and that the main cause of his condition was smoke . inhalation. L.F.D. had removed all of the Writer then returned to the scene of the fire. living room furniture. In examining it, it appeared as though the couch that Eddie was sleeping on was the most seriously damaged piece. Writer then looked in the front room of the residence and observed that the most serious burn patterns in the carpet were at the end of the same couch. The couch was sitting in the middle of-the living room with no obvious ignition sources by :c
ALo 1 -

L.F.D. personnel tooks several pictures of the scene for their investigation;
, .

Writer also learned that Eddie was found by L.F.D lying on the floor by the door which goes into the laundry room on the back porch, just inside the back door. . ers. The purple one was Writer and L.F.D. personnel searched for dvised he had put it on located on the floor under the table that ouldn't be found. The after he took it away from Eddie. evidence. purple one was later seized and logged into ,

Cowlitz County LIVE RMS Page 8 "uq \qJ; ;q &2yzL Longview Police Department 01/17/1995 . EVENT DETAILS s< H, Lp, LT Irj;q -----------------------------------------------------------~-------~----------------------------------------------------------------------~--~---------.------. *+~t+* Incident +++** Report # 94-28955 Location Reported Date 12/03/1994 Time 23:47:40 Call Disposition 3

*XkRDETL

At this point in the investigation, it is believed that the couch was set on fire, possibly with the green lighter by Eddie, as there is no other explanation for the source of ignition. Respectfully submitted, Michael R. JEWELL, Patrol Longview Police Department SUPPOl 12/04/1994 OFFICER JEWELL'S SUPPLEMENTAL REPGRT . . a

Writer, Officer JEWELL, received information from-Dave ENGEBO, Emergency Department Nurse from St. John's Hospital, that he had been called by one of the Doctors at Emmanual Hospital in Portland at 0940 hours this morning that had died. Respectfully submitted, Michael R. JEWELL, Patrol Longview Police Department

N ..

Exhibit # 5

941215HWE5022

Photo ## 3:

View of the interior of the couch.

.

Photo # 4:

View of the interior of the .couch. .

. c

Exhibit # 5

941215HWE5022

Photo # 5:

View of the front of the lighter.

Photo # 6:

View of the back of the lighter.

.

.

, . .

d7FEB 1995

FIELD ACTIV’ITY COVERSHEET
1. BEGIONfSTATE 3. OPEPATION(Chcck One)

FOWR

( ) Inspection
( ) TclephoncContrct ( 1 other c

.3. DATE ( ) (X EstrblishrentV5sit ) Invedgation 3

02-08-95

-

4. NVHBER(ForP0 Use)

941215HWE5022
5. BSTABLXSEYENT N&me [

unknown

3

3 s-c 1
6. RELATED FIRM Name [ - ( ) Parent

tiP[

- 1 Tekphoee~

3

/ - ]
( 1 other

( ) Eeadqtautcrs

I cw c

( ) subsidiary

l-4

I

7. PRODUCTSCOVERED

[ upholstered furniture [ cigarette lighter

I

I

I c.

R.OTEERCONSVYERPRODVCTS

*

I

I
I
J

9. ESTABLISEYENTTYPE ( ) Manufecturcr ( ) lholesder ( ) Retailer ( ) other L II. X.6. BUSINESS XReccived [: ]

( 1 I-port( ) Own Label Distn~butor ( > RepacWer *I

lo. AHNVALPRODVCTION . . Product covered $ units [ OtherPxmducts $ . unit6 [

lf.SAYPLES COLLECTED

13. MIS CODE

14. HOURS

none

12165

Actitity

%Shipped c 1
15. REASON FORACTIVITY (AmzignrentReference)

[ 16 ] Ihrvel [2 J

regional initiated investigation-FY 95 fire program
( ) RationaleforAnno~nccdInspection 16. ANNOUNCED UNANNOUNCED ( ) n/a 17. EMPLOYEE'S NAME TXTLE SIGNATURE

Joseph S; Burchyski
( 1, REMA.RKS ( )

SRI

IS. ( x> ENDORSEYENT

SUMMARY

( )

OTHER

ID1 conducted in response to a newspaper account of a fatality associated with a residential fire. A 7 year old boy died when he re-entered the home to save his dog. Fire officials concluded the victim used a cigarette lighter to ignite asofa'bed. The lighter is not equipped with a child resistant feature. We are attempting to determine when and where the lighter was purchase. Siblings of the Victim contend a candle ignited the sofa.
19. REVIE~ER'SNAYE TITLE

James P. DiGrazia
20. RE VIETDATE

Supervisor 'cc c/s: LGC, LDB.
LQ-1070.Printor IO/931

il. DISTRIBUTION

2/14/95

0: EPDS cc: SFRO

+sc FORM No. 1 6 7 [ R e v . 8/86J[wtod f o r wp Uindous.4/93](Epsocr

z.

CASB NUHRBR

2, INVBSTIGATOR'S ,8953

ID

BPIDBHIOLOGIC =BSTIGATION

950103HWB5001
3 .

OFFICB
8 6

CODE
0

4.

DATB OF ACCIDENT

5. DATB INITIATRD

RBPORT

941211

950105

6. SINOPSIS OF ACCIDBNT OR COKPLAINT four year old boy was playing with-a disposable butane cigarette lighter, when he ignited the sofa. He escaped to safety with his mother, and there were no injuries. The fire department extinguished the flames, but did not conduct an investigation. The sofa and lighter were totall,y destroyed in the fire.

7.

LOCATION(Home,School,etc.)

8. C I T Y

9 .

STATE

home
10A. FIRST PRODVCT

1 0 Premont
1OB. TRADB/BRAl?D NAKB

California

C

J

lOC- HODBL NUKBBR

sofa
1OD.

0 6 7 9 unknown
HANUFACTURER NAHB AND ADDRBSS ,

unknown
11A. SBCOND PRODUCT 1lB. TRADB/BRAND NAHB

lilt_

disposable butane cigarette lighter

1604

unknown

110. HANUFACTURER NAHB AND ADDRESS

unknown
12. AGE OF VICTIH 13. SBX 14. DISPOSITION 15. INJURY DIAGNOSIS

no injury
16. BODY

999
17. RESPONDENT.
3

0
18. TYPE OF INVBSTIGATION 19 TIHB SPBNT (Operational
3 22. SAKPLB 0 5

7

c

PART(S) IUVOLVBD

hours)

9 9 2nd hand info
20, CATBWRP ID 2 3 . 21, CASB SOURCB

other -

04 . 0
COLLECTION N&BR

B U N N 2 5 newspaper

---

-m-e
N O : X X

PBRXISSION ~0 DISCLOSB WAKES (Non Neiss Cases Only) PES: 2 5 . RBVIBW 26. REGIONAL

24. R B V I B W D A T B

BP - - - -

OFFICB DIRECTOR
---

- - - w - 27, DISTRIBUTION

CPSC FORM 182 (REVISED 03/94)

950103HwE5001

The following information was obtained from a telephone conversation with the fire official at the incident scene, along with the fire incident report. A fire investigation was not conducted. Photographs were taken of the exterior of the residence only, and not of the sofa or butane cigarette lighter involved in the incident. If follow-up information is received as a result of a letter sent to the residence, it will be forwarded as an addendum. PRE-INCIDENT: The incident involved a single family residence, a mother, and her four year old son. There is no background information known about the sofa or cigarette lighter involved in the incident. INCIDENT: The date of the incident was Sunday, December 11, 1994. The time was shortly before 10 am. The son was in the family room. The mother was in the next room decorating the Christmas tree. The mother reported to the fire officials that her son came into the' room that she was in and said, Yrm sorry." When the mother turned around to look at him and inquire as to what he was sorry about, she observed a fire in the family room, specifically she saw that the sofa was on fire. She tried to extinguish the flames. Unable to do so, she called 911 and evacuated the residence with her son. POST INCIDENT: The fire department arrived on the scene and extinguished the fire. Based on statements made by the mother and son at the incident scene, along with a cursory check of the scene, arson as -. the cause of the fire was ruled out, and a fire investigation was not conducted. The child reported that he had been playing with a cigarette
2

.-

950103HwE5001

lighter when the sofa started on fire. Thenewspaper artidle (attached to assignment) -erroneously states that'the child had been playing with matches. The exact point of fire ignition on the sofa is unknown. There were no injuries. Fire structure damage is listed at $20,000, and contents damage at $IO,OOO. The fire official stated that he was on the scene, and all that remained of the sofa were the springs. The fabric was totally consumed by the flames. ' The butane cigarette lighter was not found at the scene. The fire official did not know if the disposable butane cigarette lighter was child-resistant. The fire report reveals that the smoke detector in the room alerted, and that there was no detector failure. PRODUCT IDENTIFICATION: The only information known about the sofa is that the fabric consisted of a cotton/rayon blend, as reported by the consumer at the fire scene. However, it is not known if this fabric was upholstery fabric or a slipcover. The remains of the sofa, as observed bythe fire official, consisted of only the springs. The fire official was unable to offer aldescription or product identification, based on the remains. of the sofa. All that is known about the cigarette lighter is that it was a disposable.butane lighter, from statements made by the mother. The cigarette lighter was destroyed in the fire. EXEIBITS: --_ 1. 2. Fire report. Data Recording Sheet for Upholstered Furniture Fires.

.

3

January 5, 1995

Dear Ms. The U.S. Consumer Product Safety Commission was alerted to an upholstered furniture fire which occurred in your home on 12/11/94. The U.S. Consumer Product Safety Commission is a federal agency responsible for reducing accidents in the home.' . As part of this responsibility, we are conducting a special .. study on open flame ignitions of upholstered furniture in order to determine if additional safety standards need to be -addressed. I would like to ask you questions about the incident, particularly about the sofa involved. Pleasecomplete the bottom portion of this letter indicating a date and time that is convenient for us to talk. Also, please include a daytime telephone number where I can reach you. I have enclosed an "AUTHORIZATION FOR RELEASE OF NAME". Please complete that form, and return all information in the envelope provided. Thank you for your cooperation. Sincerely, Joy Rizzitello Product Safety Investigator
------------------------------------------------o------------

-

- RETURN THIS PORTION - ' ------------------------------------------------o-----------Case #950103HWE5001 Please call between the hours of the following days at telephone number Signed and on one --dateof

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INVESTIGATION GUIDELINE

Attachment A DATA RECORDING SHEET FOR UPHOLSTERED FURNITURE FIRES (To be attached to CPSC Form 182, Epidemiologic Investigation Report along -with a copy of the Fire Incident Report)

lb

Task Number

y50/ 03&K500(

Incident Date L Chair

I

A. PRODUCT DESCRIPTION: r;$ Sofa/Couch

0 Sofa bed I Other /1 N o B;f U n k n o w n

1. Was upholstered furniture slipcovered? L Yes 2. Had it been reupholstered? / Yes 3. Manufacturer/Distributor/Brand 4. Purchased: 0 New

/ I N o ,@ U n k n o w n (1 fl &n J d

0 Used

Unknown

If used, specify how obtained (e.g., garage sale, etc.) 5. Date Furniture Purchased:
WK l

Furniture Age

6. Standard Certification Labeling; e.g., UFAC or California standard: (Copy) Ll/I/i&a d B. POINT OF FIRE IGNITION ON FURNITURE: Describe where fire started on upholstered furniture. 0 Skirt U Back m Welt Cord 0 Seat cushion 0 Side 0 Tuft. r”7 Inside back / Underside Other 4zc( 0 / Inside arm 0 Crevice

I C. AGE (IN YEARS) OF PERSON INVOLVED IN IGNITION (if appropriate): 0 5-14 0 15-64

/

0

65 +

D. PRODUCT INVOLVED AS HEAT SOURCE AND TYPE (Check):

-3

tighter

. Match

Candle

,

H e a t e r

F i r e p l a c e

Other (specify) Unknown

Page

11

INVESTIGATIONGUIDELINE

.

If lighter, specify typ,e: If match, specify type:

0

Child-resistant

0 Not child-resistant 0 Box

&

Unknown. Unknown

0 Book

0

If heater, specify fuel source and distance from furniture: Fuel source E. DETECTION OF FIRE 7. Detector 6moke heat, c.o., sprinkler) present? -2 4 YeS Distance from furniture

0

No

ir Unknown

If yes, specify type: 8.

s/-rnkR-

Detecter went off (alarmed)? 4 YeS

0

No

0 Unknown

9.

If no, do you know any reason why not; e.g., unpowered, fire too small, etc.?

10. About how soon was the fire discovered after it started? F. VICTIM(S) Number of Deaths d G. Socio-Economic Data: 11.

lNMOU I -

d Number of Injuries

Education lever of head of household: 0 Less than high’school
l

cz/LL. 0 High school

y 0 Some College

12. Total household income: 0 LT $15,000 13. 0 $15,000 - $34,999 0 $35,900 + &q/t: 0

Approximate home market value: 0 Rent Own

General Description: Provide general description, including all other relevant factors and information . on the investigation form.

Page

11

of 11

/ I
DATE: REPLY TO AT7N OF:

/

UNITED STATES GOVER NMENT

memorandum

SUBJECT:

-

OPTIONAL FORM NO. 10 (REV. l-80) GSA FPMR (41 CFR) 101-l 1 .S 501&114
0U.S. GPO: 1986-4q!246f29604

*. .

Hayward, CA (Alademda Co.) Review ‘- (Cir. D. 48,575) (Cir. S. 50,500)

i ,

.

DEC 1 2 1994

rant, -46850 Warm Springs Bhrd., A’four- .l:found a man rummaging through a ‘: back offike around 1:30 p.m.; in ihe Jjniddle.of a brisk lunch htiur;-poljce Sunday m&ning while hii mother- : .:. .- said. They followed the mai out to the.wking lot, where he jumped into ii white Chevrglet Cimero . ’ c driven by a‘second &an. The&r es,$apecl under a:ha;il’of pots-and-pans, -=I saidI%mont poli&i ‘Of&r Mark $W~n.*jameS-McCo$%;+nd - : &v@Bkrhe, 19, both of Oakland, . .-$&e stopped bypOlice as they _. _ CrujsednorthInterstate6I3O. .: . fhkway just short of Sunol. M&oy - ‘wasfoundwith $1!50 in dollaibills, thti same amount reported n&sing from the office safe, W-n L. said. The Tsanns &&l~ identi. : _ . :&tip& u:. - fi&l the men $;a -wIice t&k them lnto.custody. Police will recommend &afg~ofburglaryfo;b&~m~ : . ~OSll&%!3have::~hsrrestedh‘ - -?r-.connection with a burglary Siurday TRcMsrMFREFam , afternoon at a Warm Springs res-

.

I

: four&& old female, a three year old male and a five year old male died of injuries sustained in a ire at thier apartment. The children’s father escaped without serious injury. The cause of the ire appears to be a result of the three year old playing with a non-child resistant lighter. An .pholstered love seat located in the: area of origin was completely consumed by the fire. nvestigators were unable to determine the exact first material ignited.

SYHOPSIS PA INCIDENT OR COMPLAINT

b LOCAROW (t+oro, -1, ok&)

,ome interior

[l J[O ] Wtisonville

a crry

Oregon [OR]

3.8TATE

36. SECOND PRODUCT

we seat

14 IEO I[5 I[2 3

.
LAGEOFYICTIM
18, SEX (USE NUMERICML MALE -1 FEMALE - 2 UNKNOWN- 3 CODE)

f2

If0 I[4 3

12

I

died at scene
I8

14.

DISPOSRfON

15.

anoxia

INJURY DIAGNOSIS

I
- 2

16 115 I [l 114 3s I

3. BODY PART

U parts [g 115 I

fire investigators
13

17. RESPONDENT(S) (Llafhw, F-cl)

I

,

18. T Y P E INVESlIGARON 1 3 . TIME SPENT
ONSmE - 1 OTGR TELEPHONE3

[3 I

YR

MO

DAY

I91KlPlMm2J
b PERMISSIDN TO DISCLOSE NAMES (#UN-NEISS CASES OMV) CPSC MAY DISCLOSE MY NAME [ 1. NARRATIVE (Sa &~sh#ctdw on Page 21 ] CPSC WAY MOT DISCLO8E WY WAME [ ] ’ DATi

25. REGXONAL OFFICE DIRECTOR REVIEW .

‘he respondents were the Deputy Fire Marshal who investigated the fire for the responding fire’ iepartment, and the private investigator who investigated the fire for the insurance company.

.

(USE ADDJROMAL SHEETS IF NECESSARY)
SC FOR 10. 182 (Roviti lO/B3)(Adwt.d for W f u r Wi- & Efkiim .

7. PRODUCTSCOVBRED

[ cigarette lighter, [ smoke detectgr

&OTBBECONSUYBRPRODUCTS

3 3

c I
10. ANHUALPRODUCTION Prodoctcovamd $ . otber~aactp$ .

3 3

9. BSTARLISEMBWT TYPB ( ) MansuhctU~ ( )Vbchder ( ) Retailer (h-d 11. I.S.BUSINBSS XP--vcd[ J xswv=d

( ) 1-m ( ) Own Label Distributor ( 1 -pr4i!r3

unh [ unitsi:

3 J .

It.SAYPLBSCOLLBCTED

none
3

II. 8OURS Activity [

14 ] Travel [ 2 J

15. RBASONPORACTIVITY (AssignmentReference)

FY 95 Upholstered Furniture Fire Program

16.

ANHOUWCBD ( ) -f~AanoadI~~ UNAXUOUNCBD ( )

IS. (X) ZNDORSBMBNT ( ) RBMAUKS ( ) SUMMART( ) OTBBR

ID1 conducted as part of a special study of residential fires associated with upholster4 Local furniture. Three children, ages 5 years ? yeam and 4 months died in the fire. fire authorities concluded the 13 year old started the fire with a non child-resistant cigarette lighter. The parents did not admit ownership. A private fire investigator located an exemplar. We have visited the retailer and id latter appears out of business. No further follow up.
19. RBVIRFBR’S NAMB TITLB

James P. DiGrazia
20. RBVIBT DATE 21. DISTRIBUTION

Supervisor cc c/s: LGC, LDB

5/2/95

'1 0: EPDS cc: CERM, CECA, CHIRO, SFRO

PSC FOtU MO. 1 6 7 [ R e v . 1/86][Adaptod f o r UJ Windws 4/03](Epwrr L o - 1 0 7 0 Printor 10/33]

8

a

950123HWE5026

Pre-Event
The fire occurred in a suburban apartment complex. The complex contained 42 apartments which are contained in two story wood _ framed buildings which were constructed -in 1988. The value of building involved in the fire was approximately $300,000 according to the fire report. _ The apartment where the fire originated was a three bedkoom'ground level apartment. The apartment was protected by an ionization type * smoke detec.tor which was located in the hall outside the -bedrooms. The detector was hard wired to a 120 volt AC branch circuit and contained a standard 9 volt battery as a backup power source. .
(fi;e

.

The apartment was occupied by a married couple with three chi year old male, a three yea,r old male, anthe The father works for a freight company. the victims. The investigating official did not identify drugs' alcohol, physical impairments or pre-existing medical conditions as contributing factors. !rhe Deputy Fire Marshal said that the three ' year old apparently had played with a cigarette lighter three weeks before the fire.

The Deputy Fire Marshal said that the family moved into the apartment during October 1994, approximately three months before the fire. A private investigator said that the family members indicated that they smelled an odor of something overheating in the hall of the apartment after moving in. He said that they subsequently traced the odor to the smoke detector. The private investigator said that the apartment maintenance staff _ replaced the smoke detector with a new unit and battery during November 1994. He said that the father said that the‘five year old had received--fire safety training at his school so the family ' tested the smoke.detector each night before the children went to bed. He said that the father tested the smoke detector by pushing the test button.' He said. that the father did not report any problems with the operation of the smoke detector before the fire. He said that the father did not report any deviation from the usual routine the night before the fire occurred. The Deputy Fire Marshal said that the father and mother each possessed a cigarette lighter. He said that the mother carried her cigarette lighter in he:r purse. He said that the father indicated that he usually stored the lighter with his cigarettes in the-night stand next to his bed. He said that the father indicated that he sometimes placed his lighter-on the top of.the microwave oven in the kitchen. . 1

c

950123HWE5026 . The Deputy Fire Marsh'al said that the fire occurred during the early evening. He said that the mother indicated that she needed to make a quick trip to a store. He said that she informed him that the three year old wanted to go with her but she was in a hurry and the three year old was not-dressed to go outside. He said that she left the children in the care of the father. He said that the parents informed him that the ,thr'ee year old was upset about not being allowed to go to the store with his mother. The Deputy Fire Marshal saidthat the father apparently was alone with the three children immediately before the fire. He said that the four month old female was in a play pen in the living room. He said that the five year old male apparently was sleeping in the top bunk of a bunk bed in the boy's bedroom. He said that the three year old was awake and was last seen sitting' in the love seat in .the,living room. He sa.id that the father apparently was tired from working and fell asleep in a recliner chair in the living room.
Event -

The Deputy Fire Marshal said that the father stated that he was awakened by radiant heat from the fire. He said that the father reported seeing the fire burning in the area of the love seat in the living room. He said that the father stated that the flames extended to the ceiling and were rolling across the room. He said that the father stated that he could see the baby in the play pen under the smoke and flames. He said that the father stated that he opened the sliding patio door which was adjacent to the recliner chair and pushed through the screen door to get away from the heat 'and smoke. He said that the father ran around to the front door of the apartment and entered the front door to try to rescue the hap in the play pen. He said that the father was unable to reach th&> 9 rom the front door because of the heat and intensity of the fire. . e The private investigator said that the neighbor who lives above the victims heard noise and looked out of her patio door. -He said that she reported seeing the father exit. He said that she reported seeing flames roll out of the patio door behind the father. He said that the room may have flashed over when the father'exited. The fire was reported by neighbors at 7:16 p.m. according to the The private investigator said that neighbors fire report. attempted to rescue the! children by entering bedroom windows but were unsuccessful. The Deputy Fire Marshal said that the first engine called a second alarm as it approached the apartment because of the severity of the fire. 2

*

950123HWE5026 The -Deputy Fire Marshal said that the crew of the first engine did not activate the button which recorded the arrival time. He said that the arrival time of the first engine was not identified on the fire report. The arrival time listed onthe fire report was listed as 7:23 p.m. The Deputy Fire Marshal said that the five year old male was found deceased in the top bunk of the bunk b&d. He said that the three year old w-as found deceased in the lower bunk of the bunk bed. He said that the three year old'was positioned face down as if he may have been attempting to hide from the fire. He said that the , remains of the infant were found at the location of'the play pen . after the fire was extinguished. The fire burned up through the apartments above the victim's apartment. Occupants of the other apartments escaped with out injuries. Total fire damage was estimated at $255,000 according to the fire report. -

Post

Event

The cause of the fire was investigated by the local Fire Marshal's office. The Deputy in charge of the fire investigation said that the burn patterns were consistent with a fire starting in the living room in the area of the love seat. He said that the love seat was almost completely consumed by the fire. He said that damage to other items in the room decreased as the distance from the love seat increased. He said that the love seat upholstery material was completely consumed by the fire. The Deputy Fire Marshal said that the mother's cigarette lighter was found in her purse after the fire. He said that investigator's did not find the father's cigarette lighter in the bedroom nightstand or the kitchen location where the father said that the lighter was usually stored. He said that a fire damaged lighter was found in the living room near the area of origin of the fire. The Deputy said that the investigator's eliminated other causes of the fire and concluded that the most probable cause of the fire was the three year old son playing with the lighter. He said that the love seat appeared to be the point of origin of the fire. He said that the first material ignited at the point of origin was completely consumed and there were no surviving witnesses to - identify the exact point of origin on the love seat. He said the parents did not know if a pillow, paper or some other object was located on the love seat at the time the fire started.

3

950123HWE5026 The private investigator said that he examined the wall heater, and electrical cords in the living room. He said that he di'd not find any evidence of the heater or electrical equipment being involved in the cause of the fire. He said that the heater and electrical equipment were eliminated as causes of the fire. The private investigator said that he was involved in the search for evidence at the faire scene. He said that the parents indicated that the three year old frequently played at a sewing machine table in the living room. He said that a careful search of the table top revealed the fire damaged remains of a cigarette lighter. * He said the table was located on the route between the area of origin and the bed room where the three year old was found. He said that the parents did not recognize the lighter found on the table. He said that they did not know the source of the lighter found on the sewing machine table. _ The Deputy Fire Marshal and private investigator said that the father stated that he did not hear the smoke detector sound an .alarm. The private investigator said that neighbors also indicated that they did not hear the smoke detector sound an alarm in the apartment where the fire started. He said that witnesses said that they heard smoke detectors sounding in other apartments as the fire spread through the building. The private investigator collected the remains of the smoke detector as evidence. He said that the remains of the smoke detector were submitted to a forensic engineer for examination. He said that parts were missing and the smoke detector sustained too much damage for analysis of it's ability to function. He said that the smoke detector battery was found connected to the terminals. He said that a testwith a volt meter immediately after the fire found a small electrical charge remaining in the battery.
l

First Product Identification
County of Origin: Thailand

The product identification information was obtained from the lighter. The subject cigarette lighter is a disposable butane fueled lighter with a wheel and striker ignition mechanism, The lighter is non- child resistant. The private investigator said that the flame height control was set at the highest setting. He said that the parents stated that they did not know the source of . the lighter.

-

950123HWE5026

.

The private investigator said that he visited numerous retailers looking for the type of lighter found at the fire scene. He said that he found and purchased a similar lighter at 'a rural gas He said that the lighter station-mini mart while traveling. purchased at the gas station has the identical brand name and country of origin printed on the top of the lighter. He said that the ignition mechanism, flame height control and top of the lighter is an identical match with the lighter found at the fire scene. Photographs of the lighter found at the fires scene and the exemplar are attached to this report as exhibits.

Second Product Identification
Manufactur Model: Unknown An upholstered love seat was identified as the product in the area The Deputy Fire Marshal obtained the of origin of the fire. identification information from the victim's mother and father. The seat was approximately six years old and covered with a' corduroy type fabric according to information obtained by the Deputy Fire Marshal. The upholstery material was completely consumed by the fire and only a portion of the wood frame remained according to the The exact point of origin and the first fire investigators. material ignited are not known according to the investigators. The remains of the love seatare shown in photographs attached to this 8 report as exhibits.

Third Product.

Model: PX1218 Lot Number:9 4 2 5 2 ,

5

.

.N

950123HWE5026

The product identification information was obtained from an exemplar smoke detector collected by the private investigator. The private investigator said that the exemplar smoke detector was collected from the building management who said that the exemplar was from the same lot of smoke detectors as the unit located in the victim's apartment. The smoke detector is a hard wired 120 volt AC powered ionization detector. The smoke detector is equipped with a standard 9 volt battery as 'a back-up power supply. Photographs of the remains of the detector and exemplar are attached to this report as exhibits.

Standards Information
The cigarette lighter is subject to mandatory standards if imported after 07-12-94. The origin of the lighter is under investigation and the applicability of standards is not known at the writing of this report. The love seat is subject to voluntary standards. Information concerning compliance with standards is not known at this time. The smoke detector is subject to voluntary standards. The smoke detector label bears Underwriter’s Laboratories listing information.

Attachmentrs
Attachment A: Data Sheet Exhibit # 1: Exhibit # 2: Exhibit # 3: Exhibit # 4: Fire Department Diagrams Fire Department Report Medical Examiner's ReportPhotographs
--

6

. . . . . _-. : . -_

I IlBlaze$lr@ghter feels ‘deep grief Inside’ , G
. ‘..(

* Staropoli was on the first engtne to reach the scene. The building was full of flames that she and a nozzle man attacked with a hoso they dragged through the m front door., i First they hit the entryway, then the bedroom, where tire on the walls and ceiling was dumping debris onto them and there was too much smoke apartments.- At least three of the R HOUSEHoLD l?EMS: Tualatin Valley to see the boys’ bodies, which other children dis‘placed by the fhw attend Fire and Rescue stations will be acceptArefighters later found. the school and many students saw ing items for the displaced fa@lies Staro 11 and another firefighter the fire as they left school ac$!fties ,..through the weekend. found 4iiibm s remains on the Uv* . V.. .,,I.. a. . . . w . .’ : Thursday night. ing room floor. Following orders, ’ ~un~lo~ &d teach& . q& W FUND-RAISER The b%XflV~l!e ROkIfy she stayed with the remains for 8 or tnuch of Friday trying to tend to the Is organizing a breakfast to raise money 10 mtnutes making sure the body for the displaced families from 8 am. to fears and anxieties of students. . . was not disturbed. “It’s something they probably 2 p.m. Jan. 22 at the Wilsonville Senior Staropolf has been a firetighter for never dealt with before and so that’s Center. six months and it was her first fatal why we’re ‘spending a lot ‘of’ time fire. Throughout most of the’ eve1 SCHOOl HEW The Wodd Middle ning, she said, “I was OK,” even School Parent Group is working to help through a grief session for firefight.. “..: .

1 don’t think he should :! have died He didn’t do.. :S nothing wrotig. ; .’ E

: . . . wanted to speak with him alone. .I: T h e n t h e teat% came,. she said:’ adding that the fire had 1eeR her At like so many others whose Jives ic II touched - with a lot of pain. “There is,” Staropoli s&i, :#a r&P . 0 deep grief inside.” Also contrfbutirjg b thb i&G bi$’ Holly Danks and Jim Kadera of Thg Oregonian’s stajjI ’ . . ’ I. *.er .- 4 . . .

,..

.

. . , . - JRN-18-1995 13: 41

JNVESTIGATXONGUIDELINE

,

-

-

Atmchment A _DATARECORDlNGSHEET FORUPH0LSTEREDFURNlTURE FIRES (To be attached to CPSC F arm 182, Epidemiologic lnvestigation Report _ along with a copy of the Fire Incident Repon)

Task Number

qs .

0123wJsK& Incident
0 Chair 0

Date

\- wB-4

A. eRODUCT DESCRIPTION: EfSofa/Couch

Sofa b e d I Other

l- W a s upholstered fur&e slipcovered? I YGS 2. Had it been reupholstered? D Yus 3. Manufacturer/Distributor/Brand
NCW fd

m U n k n o w n oR\Q\**x c onawq C&J D Unknown

No &

?L P

-

4. Purchased:

If used, specify how obtained (e.g., garage sale, etc.) 5. Date Furniture Purchased.*x&s? F u r n i t u r e A g e 6 ‘c;(eau 6. Standard Cenification Labeling: e.g., WAC or California standard; {Copy)

UMJ
B. POINT OF FIRE IGNITION ON FURNITURE: Describe where fire started on upholstered furniture. . * / I Skin
Back

U Seat cushion D Side n Tuft

El Inside back m Underside Other d

17 Inside arm 0 Crevice

0

U fi d eT*Rp, :&a I ’ C. AGE (IN YEARS) OF PERSON INVOLVED IN IGNITION (H approprime): 3 yg c - PIfiLe _ 3 LT -cs/ 5 yrs.

L Welt C o r d

old

-

0 5-14

r”l 1 5 - 6 4

.D65+
- -1.

0. PROD&l INVOLVEI AS HEAT SOURCE AND TyPq (Check):
d ugmef Other (specify) . Match C a n d l e H e a t e r F i r .e p l a c e \

U n k n o w n

Page 10 of 11

. a

JtW-18-1995

13:41

P.03

If lighter, specify type: If match, specify type;

- I Child-resistant r) Book

I/

Not child-resistant /7 Unknown

/ Box

ff heatef, spec’ify fuel source and distance from furniture: Fuel source __ E. DETECTiON OF FIRE Distance from furniture

7.

GO., sprinkler) present?
17 Unknown .

8.

Detester went off (alarmed)? . I Yes’

0 No

9.

If no, do you know any reason why not; e.g., unpowered, fire too small, etc.?

10. Aboln how soon was the fire discovered rfrer it started? w \xjp1 .
F. VlCTlfWS[

$ -

fiI:!mes

A!11.

Number of Deaths

Number of Injuries

. \

t. Socio-Economic Data: . Education level of head of household; High &l school 17 Some College

D Less than high school . 12. Total household income: D LT S15,OqO

$15,000 - 334,399 id
?‘.

I $35,000 +
(I-sc9-. ‘--

--

13.

Approximate home market value:J%o cp,o30

& .&l&AAtL I

. .

I OwlI

_

HOhGbW

fmu-r

.’

gs60

General Doscriprion: Provide general description, ‘mcluding all o’ther relevant factors and information on the investigation form. .

Page

11 of 11 -

001
I

.

; Di; of l,ti,,URLATIN URLLEY FIRE

-

.UI

cc&LACKRI;IIIS

- -&&&c&Lt~lRiIH WiEY FIRE S RESl

AlARM

_-12

. 0 .

. . : 64 --

.
~OFWCINESResPONDED

I
IoFAERlALAPPARkTuslusPONDm _

‘_ .
IcnwBRvEHlcLpsILEEpoNDBD (&I sol iI+& PAW -’

0 ~OFFIRESERVlCEPSRSONNEL -NDgD

. . . .

:o

-_-.

# 11
w

TYPEOFSI’KJATIONFOUND

TYPEOFACTIONTAKEN

STRUCTURE

FIRE

1 EXTIHGUISIMEHT

._.-. - :

_
.

.. .

MEI’HODOF

EXTINGUISHMENT 11 FIXEDPROPERTYUBB.

6 PRE-CONNECT HOSE/HYDRRKI, SJRNDPIPE
PROPER7YCOMPLEX(lfqqhab&)

.lZl -._. _ .’ .T ;__ _ . . .- -. . ..

.

MOBILEPROPJiXTY(bqhut,Y)

42 (7 THROUGH 20 OPTSi ’ .’ ‘.I- : Y MOBILE
PROPERTY

42

APRRTHEKT
MODEL

COfIPLEX

’ .i. 08 HOT APPiICQBLE
SERIALI. * . ._ _. :

YEAR

--MAKB

WcRNsEj

14LOUN6EfiREfl B

INVOLVED IN IGNITION

EQUIPMEKT

*. YEAR

.. MAKE.

-

-‘.

i

98MODEL

HO

EPUIPHEKT’IHUOLUED
--I :.
I

‘_' .. I

VOLTAGE - .

u lcNmoNFAm% CHILORED YITH, CHILD PLRYING love seat uas determined to have been the point of
U FORMOFHEATOFlGNTTlON
U LZVELOFFlREORlCIN .. -_ .m

Fire originated in the living row of Ppt # 1. The . origin, 1111 other sources of .ignition inre - ’ - eliminated
.~(rmdFmsr~cNrmrk~. . _* .- . . . ;#, .:*‘. m7AL Do

.

/YATER~ALH~ECM~EOWASMADEOF

46 LIGHTER (FLAtfE TYPE) --

. 1 . 71 HRN-HRDE FCIBRIC .
. . Gmtenir m

c
O-..

- 121 UPHOLSTER SOFA,CHAIR,UEH SECIT
. .;’ : . m _.*.

VALUE

- ,

V&kkMdcaatst8

$320,000
$170,000 ?’ .

$100.0d0
$85.000 m

: .

.::-

-

m
. 1 .

.

6420,000 m . 4?&0#0 m I

17

NUMBER OF SroRlEs BUlLDING SIZE (Grad Flf only)

. .
16 BUlLDfNC ACE (la Ym) 2

H CONSTRUCIIONTYPE 8 UNPROTECTED UODD FRCIHE U-NR

(.OOO-4999 SQ ti) .
DETECTQR PF.RFORhtANCE

.

.

a JWENTOF DAMAGECONFINED To. Flame S m o k e

SPRlNKLW

PERKSUANCE

4 CONFINED TO FIRE-RRTED COtlPIlRTHENT 4 CONFINED TO FIRE-RATED CMIPRRTI’IENT

0 UNDETERMNED 8 HO EPUlPf!ENT PRESENT

(

~kncovrdld Fin:

#dNdDc@ld

.

820-03-I OT _

‘.

. .

. .

-,*-

-v---y

I

.,r

1-b

CWlLlANCASUALTYREPOii

OFFICE OF STATE FIRE MARSHAL
. FIRE OEPARTMENT MO DAY YEAR A ,ol I I \ 1alqs T-bRj GA I 9ll IG DAY OF WEEK ALARM TIME

GB GC

. =*

I FAhllLlAFUW WiTH STRUCTURE 1. 0 LEssnlwlDAY
2 0 10 4. II 17OfMYS 8To3oDAYs 1T02h4ormis STO8MONTHS 7TQl2h4OUMS OVERlYEAR WTASRUCTUE FAMUARfWWmrTHES7REME lJmmERmNEDoRNcJ7m .

5x 6. 0
7. 0 a. 0

a D

CONDfIlON BEFORE INJURY 1. AsEEP* 3 tOBa=uxancER-* 3.0 wmREDBYMKIcs.~ 4 . 0 uJoERREsRAN7. 5 . 0 TooYomlGToAc7. a0 MENTALLY -.sEEIILEa 0 AW~~NIMPAIRED. 9.0 cuancwBEFmEmkuwNoT ass=EDmcnE cLdcu4una4BwREE -mNoTREpoRTED. aD 0. 0 0. 0

GE

CONDITION PREVENTING ESCAPE
1.0 K)fMETOESCAPE;~OS0t4ORFRE PRoGREssED7cmRAP6xY.

ACTM-W AT TIME OF INJURY I. D
20 a0 c o

CAUSE OF lNJURY 1 . 0 cMKiwTyuNDERBEnvE&TIuppED By.
2

20 RRE BEIwEENcAsuALTYAmmJT. s.0 InacEDmoK~
4 . 0 LLKiKGATEsLocxs s 0 aonwoN-~Buu9yG. 6 . 0 MovEDToosLMY. HQu#DAREFAuREs ToFaLmvca2REa w- -. 7.0 WCTiMNCAPACllATED#wRrO6.X No ~PREENEDESMPEORNOTA FACTOR 6. 0 cotawN PlmENmGEscApENQT CussmmABovE 3.OczoNcmxPREVPTTYJC~ ~ORNmllwcmED.

x -AREFLAM&HEAT,SMCXEL

-7oFuEpRo#IcTs

SO

h”w 7. 0
aD 0. 0 0.0

a PART OF BODY INJURED

0 c~~cs~o~~~~~~u4mmw~u7
NmREFmTED.

GF

NATURE OF WJURY
1.0 2 0 6. 1.% 5.0 wRNs6AspHmursMoKT -oNl.Y. ALSPHYXUlSMOKE WLY. wouND,cm.BEamG. asLocA~FRAcfuRE

6 . 0 Wffi’m NamEDHEARTATwJacs AImsmoKEs. 7.0 8.0 bTRApssmAN 0 . 0 ruTuREoiNJuRYbRLLNEssNQTcLAssBIED ABOVE a 0 NAnJFEffwuRYoRLwEssMoETERMwED oRNmEPoaTEo. 0 SEE REMARKS ON BACK . 8!444O-WC (R-8/92) I

8 . 0 MlknPLEPNqs. 9.0 PAmFEIooYNlllREDNoTcussmED
0 . 0 PAmofBawtumED~oR ruTEPomED. I_*

0 SEE ADDITIONAL REPORT (bL44E.PcxmoN.Icss~ CL \lQQQv MEMBERU4KJtdGREPORT (IF tnFFERENTFRoMABovE) . a. DATE

.

.

CIVILIAN CASUALTY

REPORT

r

FIRE DEPARTMENT MO DAY YEAR A orI1 I rmr~ -rkA~S GJ CASUALTY NAME (LAST, FIRST, MI) I ’ . DOB TIME OF INJURY . DAY OF WEEK AtARM TiME

GE Gc

n*E CAswTyl

I

GD
UEsTHMloAY 2 0 lTo?MYs 3 . 0 6ToJODAYs .I 0 lTO2MoNlw 5.3iq3T06htotms 6. 0 7TO12MONTHS 7- 0 OVER l.YEAR 6. 0 NoTAsRucnJRE 0 . 0 FwwKHTHEm lmETERwNEDoRNuTREpoRTED

LOCATION AT K;NmON 1.0

CONDITION BEFORE LNJURY
1.0 IQ.

2osarzrooPs-P
4.0 s-0 6.0 6.0 s.*fi UcERREslRmK. Ta3YousToAcr.

-. 3 . 0 DAPmEDEwoRlss.McoHoc

J

MEF4lM.Y -.sEaE Aw~wwPuREo. --KlwnNoT -ABOVE aoccluMmuBEFoffErunn ~oRNoT-.

GE

CONDmON PRNENTING ESCAPE
1.0 20 LO L 0 LGGaGATEs,LccKs LO cLomNGW~WB(RMNG. L 0 MOVEOlOOSLowLY. NCLKEDAREFAILURES ToFbuow -(AvAILABLqr. 0 tmxtMNcAPAaTATEoPGulRToLpI\K)coNDmoNs mEvENEoEscAfJEmNOTA FAcroft L O ca+almN Fw3ENwGmNoT QlrssmDmovE LOax-motJW& voRNoTm. MON*(ETO~DFLDBLOSK)NORF~RE PRoGREssp>tooRAPfoLY. FRE BEnnEENcauAL7YMDDcTT. -LOWEDOOOR

ACTlVrrY AT TIME OF 1NJURY

1. 0 20 3. 0 1. 0

ESCAPNG. RESCUEA1TEMFT ‘F#EcoNTRcL -. 5. 0 C SALVAGE MOP-UP. 5. 0 aEEPlNG. . r. 0 UNABLE TO ACX. i. 0 RRATm4MAcTKN. )*‘k AC~W~~YATTWEOFWUWNOT~ 1. 0

Gf

SATURE OF INJURY :D BURNS&V _ 0 BURNS ONLY. ” a ASPHYXUfiMOKE ONLY.
L O wwrm.aJT.aEEtwG. i. cl asLKNloN,aAcwRE i. 0 VofPAN NauDEDHEARTATrAcxs ANosiRouEs. ‘-0 SHOCK LO sTRAm.ciPRmJ. ‘- 0 NATUREOFNURYOR-NOf-IED . MOVE. ! 0 NA~EOFlN.AJRYOR~~~~~ OR NOT REPORTED.

‘ART OF BODY INJURED 0 HEAD.NEcK l o 6ooY.lRuqBAcK b. 0 ARM. LO LEG. LO HANO. I. 0 m.
NlERNAL HcLuoEDAREREspQuToRy ‘-lk nsrEMu4oHEmT. I. 0 I.0 ! MULWLEPARTS. PARTOFBOOY?UW4EDNOTQAsslFEED MOVE 0 PARTofBmYm.nJREDuNoElDuQMDoR NOT REPORTED.

0 SEE REMARKS ON BACK

yy?i2~~wm~wJ
. .

7.7.1 -c

.

CIVILIAN CASUAL-W REPORT OFFICE OF STATE FIRE MARSHAL
FIRE DEPARTMENT

CASUALTY NAME (LAST, FIRST, MI)

.

DOB

1 AGE

TJME OF INJURY

GE GC

1

GC

FAhMLlARITY Wm-l STRUCTURERECEMD,WU 1 . 0 LEssTHMlMY
2 0 1107DAYs 1102MoNrHs 7mi2OvERlYEAR NOTASMJCRHE F~wrlHTHEsTRucTwIE -NEooRtJoT-

FIRE cwa&LTY) I LOCATION AT IGNITION
FlREcxaJaTYwTaMATELYHvoLvEDw7m GMlXM.WWDED~E-Of aonaNGoNA PERSONaGMmNw 8EDCXNGORFURMWREON-APERSON lsslnwGoRLnNG. 2% f%2ECCLSUMlYNTHEROOMORSPAUZO6 FIREORGN 3 . 0 4.0 5 . 0 6 . 0 8.0 FlR&cGuMlYoNsuAEnooRALSORK;PIff 1.0

CONDlTJON 1. 0
2 0

BEFORE INJURY

s 0 am3ooAys
4. 0 6. 0 7 . 0 8. 0 0 . 0 5.x JTOUMOUlnS

\

3. 0
4. 0 5-x 6. 0 8. 0 0. 0

FlRE
FVZECMULlYNYjAE OFFRE BlJuDwGAsoRK;(H

flRECASWLlYWlSDEOF~OFRRE oRmNEufoNPRoPERrf~ FtRECASJMlYoFF PRoPEmYoFFlREoRsN ATIIMEOFtSMlCN NOTARRECGUMW. LO~~~~~~F~~~ALTYAT~ME~K;~ON NoTcLFLsgFiEoA5ovE LOCXTGtdOFCXSULTYATTWEOfKXflkX -oRNoT-.

0. 0

0.0
0 . 0

L

_

.

GE

:ONDlTlON PREVENTING ESCAPE I. 0 LO CO .O .O .O

ACTiVl7Y AT TlME OF INJURY
1.0 ESCAPNG. RESCUEATl-EhPT.

CAUSE OF INJURY
1 . 0 cAuGHTYuNoEsBRwEDI;-

2 0 3 . 0 4.0 5 . 0

8Y.

FIRECONIR~ REB CLEANUP. SALVAGE MOfWP. B.0 m. 7. I+ UNABlETOACl. B. .IRRAllot4M AcruxiD. 0 ACTMWAT~~FN~RYNOT~LA~~FIE~) ABOVE 3.0 MMWATTlME&UWRYuNoETezMlMD ORNOT-.

M#)SEDmFtREPRooutxs. 6 WCUQEDARERAMEHEAT.SMOKE~

LO
L 1. L lo

awxamO(R(rCKS.~nora -AREnflEPROOUClS~.. WERmEmm Rtm6EDBY.cmflAcTw7ni. SmwxBY.

O FELLOR -ON.OVRNl0. 0

5 . 0 10

O NoTPPLKxaE ausEOFruRYNoTclAsmED

GF

JA-iURE OF lNJURY . O BURNS&LO WRNsmLY. . I. ASPMXUISMO)(E u&Y. 3 woum.cm.sLEEaNG.
‘. 0

PART OF BODY lNJU&D
1.0 2 0 3. 0 4.0 5.0 5. 0 HUD.NECK eooY,lRwYEAcx

DlSPOSrnON I. 0 RsusEobELP.
L 0 L 0 I. 0 TREATEDATSCENEMDRQEGED. T~TOHOSPfTALBY~DEm- - - - TAKOIm-MBY-EDEm.

ARM.
LEG. +uNo. Km-f.

DIsLocAtlcwJ.-

-0 .O .O .O .O

-ffPAN. HQWEDHURTATTACKS ANDsTRcxEs sTRAIN.sPRAN. WUREOfWURYORUESKITbSJf&~ ABOVE KA7uREofNJuF?YoRuNEsslJmEERMtNED OR NOT REPORTED.

I.& MERNM NCUJDEDARERES’iRAToRY SYSIEM AND HEART. 9.0 ?. 0 I.0 MULTUXEPARTS. PARTOFWOYN.WREDNoTcLELsslFlED ABOVE PAJ7TwBooYNJuREo~oR NOT REPORTED.

iJ SEE REMARKS ON BACK .

0 SEE ADDITIONAL REPORT OFFICER IN CHARGE (NAME, f’OSITK)N. ASSGNMENT) ~4 & NG REPORT

DJITE ’

###BOT_TEXT###gt;QQw
(lF

\-r3+047-E

DPFERENT

F R O M ABOVE)

~944Gr0~ (R-fKQ)

I

Sure ol orcpon
OREGOY HEALTH DIVISlON Dqmmcnl of Human Resources

MO-95 00 STATE MEDICAL EXAMINER OHSIJ TOXICOLOGY BLOOD ALCOHOL TEST REPOR;
O.RS. 1M.i 13

MAIL REPORT TO:
.

JRESL’L7S: for lab use

only

r

1

Test Drrte i \: .r,l .r( n, . \T G,qLq 1 1 The concentration of ethy alcohol in this blc c sample is: ,

L

3. Name of person drawing and sending sample 1. Ordered by Dr. 5. J -- Fire (Brief Description) e r Auto - Other (Explain)

-Traffic Fatality D r i v

-Passenger

-Tnrck -Cycle:

6.

Carbori Monoxide anal@

DRUG SCREENS REQUESTED ON THIS FORM WILL BE DISREGARDED. REQUESTS FOR SUCH TESTS -MUST GO THROUGH
THE STATE MEDICAL EXAMINER5 OFFICE.
-REMEMBER - . . Use - Red stoppered tubes for urine; gray - stoppered tubes for blood. Label - Tubes with correct first and last names and date drawn. Mail - Put tubes in metal mailing canister and tighten lid. Wrap form around canister and place in cardboard mailing canister.

.

-

i

MEDICAL EXAMINER .LCOHOL TEST REPORT
. MAIL REPORT TO:
O.R.S. 146.113

OHSU

TOXICOLOGY Ir

*

.

r

L

5.

-Traffic Fatality

. - Fire (Brief Description) J -Other (Explain) -Jlat&e h.&

- Driver
-Passenger

-Auto -Tmck -Cycle

.

6.
l

Perform Carbon Monoxide analysis

THE STATE MEDICAL EXAMINERS OFFICE.
.

DRUG SCREENS REQUESTED ON THIS FORM WILL BE DISREGARDED. REQUESTS FOR SUCH TESTS MUST GO THROUGH

-;

- REMEMBER Use - Red stoppered tubes for urine; gray - stoppered tubes for blood. Label - Tubes with correct first and last names and date drawn. Mail - Put tubes in metal mailing canister and tighten. lid. Wrap form around canister and place in cardboard mailing canister.

, I

.

EXTERNAL EXAMINATION:
I

BY: Edward F. Wilson, M.D. AT: 301 N.E. Knott Street, Portland, Oregon 97212 ON: Friday, January 13, 1995 - 1125 p.m.

-.

CAUSE OF DEATH:

INHALATION OF SMOKE CONTAtNlNG TOXIC GASES INCLUDING CARBON MONOXIDE (62.3% CARBOXYHEMOGLOBIN)

INTRODUCTION: This is a fire.-related death. CLOTHING ON BODY: 1. Blue jeans with fly zipped to the top, waist properly buttoned and no belt in the loops. The sides and backs of the legs and seat of the jeans are absent due to the fire. 2. Brief white underpants. . . . :.

EXTERNAL EXAMINATION: Body is that of a blackened and browned but not charred white. male child, measuring 3’3” in length, weighing approximately 35 to 40 pounds and appearing the listed age of three years.
. . .--

Blackened and browned but not charred skin covers the right side of the face, sides’ and back of the head, sides and back of the trunk of the body, circumferences of the

.

I

arms, (sparing the back of the right hand and left palm), circumstances of both legs

with sparing of the underpants area.

.

Scalp hair on the back and sides is blackened and burned down to a l/16”. stubble. The only hair that remains is in the midline of the front of the top of the head and it is blond, straight and approximately 2” in length. Eye color is blue. Petechial hemorrhages are absent from the white of the eyes, lining of the eyelids and skin of the eyelids. Whites of the eyes are congested. Nose is normally formed, symmetrical and uninjured. Rightmostril contains a plug of moist black soot . Lips are healthy and uninjured. Lining of the lips is without petechial hemorrhage. Teeth are natural and in good repair. Distal I” of tongue is clenched tightly between natural teeth. Upper and lower frenulum are healthy and uninjured. Neck, chest and abdomen are normally formed, symmetrical, uninjured and unscarred. I Genitalia are those of a circumcised normal male child. .

.

Arms including hands and fingers are normally formed, symmetrical and uninjured. Fingernails are natural, healthy, uninjured and extend just beyond the tips of the I fingers. Both palms appear uninjured.

_.

^_“.

- x_----”

-

.

._-

.

.

. - .

Legs including feet and toes are normally formed and symmetrical. Toenails are natural, healthy, uninjured and they extend almost to the tips of the toes. Soles are healthy. On the back of the body, skin is blackened except for the underpants area. opening and skin around the anal opening are healthy and uninjured.
TOXICOLOGY:

Anal

Blood is drawn from the heart through the chest and submitted for analysis.
_.

EFW:clg

Slate of Oregon OREGO HEALTH DIVISION D~JvM~~ of Humian Rruxuces

STATE MEDICAL EXAMINER BLOOD ALCOHOL TEST REPOR i
0.R.S. lM.llj -

OHS” roWCoLow e
for*a~useonly

MAIL REPORl TO:

JRESULTS:

i n. .I
G r 1

WI5

The concentkion of ethyl alcohol in this blood -_ sample is: 0 1 . 9i tpms./lOO cc. 1

J
c

Carbon Monoxide % Saturation._-. I 1 7 i,c,c; r( J 13 ,I L

2. Dale of Deat

5.

-Traffic Fatality ,-. Driver Passenger Pedestrian -Auto -Truck -Cycle .

v - Fire (Brief Description) -Other (Explain)

6.

Perform Carbon Monoxide analysis J

DRUG SCREENS REQUESTED ON THIS FORM WILL BE DISREGARDED. REQIJESTS FOR SUCH TESTS MUST GO THROUGH . 1 THE STATE MEDICAL EXAMINER’S OFFICE.
- REMEMBER Use - Red stoppered tubes for urine; gray - stoppered tubes for blood. Label - Tubes with correct first and last names and date drawn. Mail - Put tubes in metal mailing banister and tighten lid. Wrap form around canister and place in cardboard mailing canister.

. ’ I

.

.

ClACKAMAS COUNTY

EXTERNAL EXAMINATION:-

BY: AT: ON:

Edward F. Wilson, M.D. 301 NE. Knott Street, Portland, Oregon 97212. Friday, January 13, 1995 - I:10 p.m.

CAUSE OF DEATH:

INHALATION OF SMOKE CONTAINING TOXIC GASES INCLUDING CARBON MONOXIDE (48.4% CARBOXYHEMOGLOBIN)

INTRODUCTION:

This is a fire-related death.
CLOTHING ON BODY: 1.

Around the left shoulder and upper arm is a blackened, charred remnant of maroon baby clothing;

EXTERNAL EXAMINATION:

.

Body is that of a browned, blackened and charred infant female, measuring 20-l /2” in length, weighing an estimated 8 pounds and with the listed age of four months. Black, charred skin covers the back and sides of the head except for a 3” x 2” area of scalp and skuli in back absent clue to incineration allowing the brain to herniate, back and sides of the neck, back and sides of the trunk of the body exposing the shoulder blades, ribs, iliac crests and allowing herniation of a large portion of small and large intestines, circumference of the arms, (the hands of which are probably absent), and the circumference of the legs, (the toes of which are probably absent).

l

AUTOPSY PERFORMED: BY:

AT: ON:

Edward F. Wilson; M.D. 301 N.E. Knott Street, Portland, Oregon 97272 Friday, January 13, 1995 - 10122 a.m.

CAUSE OF DEATH:

INHALATION OF SMOKE CONTAINING TOXIC GASES INCLUDING CARBON MONOXIDE (50% CARBOXYHEMOGLOBIN) . .

ANATOMIC DIAGNOSES: I.

Inhalation of smoke containing toxic gases including carbon monoxide A. B. C. Body and clothing charred Airway from larynx to lung coated by soot (+2/4) Esophagus and stomach coated by soot (+0.5/4)

II. ._

Natural disease
A-

Absent

.

I . .

i,

I’ ) , )

BxhibL # 4

950123CWE5026

.

Photo # 1:

Fire Dept. photo of the apartment during.the fire..

Photo # 2:

Fire Dept. photo of the apartment a'fter the fire.

e

Exhibit # 4

950123CWE5026

Photo # 3:

Fire Dept. photo of the remains of the love seat.

Photo # 4:

Fire Dept. photo of the remains of the lighter.

Exhibit # 4
,

950123CWE5028

Phbto # 5:

View of the lighter with an exemplar.

Photo # 6:

View of the lighter with the exemplar.

Exhibit # 4

950123CWE5026

Photo # 7:

Close-up view of the tops of the lighters.

Photo # 8:

Close-up view of the tops of the lighters.

L

*

Exhibit # 4

950123CWE5026

.

.

..

Photo # 9:

View of the remains of the smoke detector.

Photo # 10: View of the remains of‘the smoke detector.

Exhibit # 4

950123CW5026

Photo # 11: Close-tip showing the battery connected to the terniinals.

Photo # 12:

View of other parts of the smoke detector.

Exhibit # 4

950123cwE5026

Photo # 13: Close-up of the remains.

Photo # i4:

qiew of the exemplar smoke detector.

,

m

Exhibit # 4

950123CWE5026

.

l

Photo # 15:

View of the red plastic lever in the battery compartment.

. Photo # 16:. View of what appears to be the remains of’the red plastic lever in the battery compartment.

Exhibit # 4

950123CWE5026 . . .

ISSUENO. 43821

s1966

'=+,

-,

Photo # 17:

Close-up of the.exemplar label.

Photo # 18:

View of the exemplar exterior cover.

Related Interests

~,~;~l~;l~~'Yl~~Longview Police Department 01/17/1995 L. . EVENT DETAILS cyK49T A q -----------------------------------------------------------------------,--------------------------------------------------------------------.------~----~-------. ++++* Incident +*++*

XERDETL

Report #'94-28955 'Locatio

Reported Date 12/03/1994 Time 23:47:40 Call Disposition 3

+f+*+ NmmT1V.E ID +f+++
DOCSOl 12/04/1994 DOCUMEXT ATTACHBD TO REPORT NARROl 12/04/1994 OFFICER JEWELL'S ORIGINAL REPORT SUPPO1 12/04/1994 OFFICER JBWELL'S SUPPLEMEN!X!AL REPORT
*+*k+* NARRATIVE +++++ .

.DOCSOl 12/04/1994 DOCUMENT ATTACHED TO REPORT The following documents are attached to the paper copy. of this report: +.- . . 1. Copy of drawing of residence drawn by2. Copy of interview notes of COOLEY by JEWELL. NARROl 12/04/1994 OFFICER JEWELL'S ORIGINAL REPORT Writer, Officer JEWELL, was dispatched along with other officers to a reported house fire with children still inside at Upon arrival, writer learned from bystanders that there was a possibility that there were 3 children.inside. Writer observed flames inside of the residence through an open front door. Writer used the fire extinguisher from the patrol unit and attempted to enter the residence, but couldn't get beyond the front door due to the smoke. From the front door, writer was able to extinguish the flames for a short time, but the fire would flare up again. After the extinguisher ran out, writer left the front porch and.began to contact bystanders while waiting for the Fire .Department. It was finally determined that the only child in the residence was an 8 year old boy. The other children were all accounted for. Writer requested that an ambulance be dispatched to stand byin case it was needed after a rescue. Longview Fire arrived on the scene and writer advised the firemen of the situation and two possible locations of where the child might be so that a rescue attempt could be made. The firemen entered the residence, and a short time later, came door carrying a small child. The child was placed on the front was begun as there were no signs of life. There appeared to be burns of the skin on the back of his hands and his face, and his to be singed on top. out the front porch and CPR someminor hair looked

.A short time later the ambulance arrived and assisted in the CPR. The child 'was then placed on a stretcher and transported to St. John's Hospital with ,writer and Toby Holburn of L.F.D. continuing the CPR in the ambulance. Once at the hospital, the child was turned over the Emergency Department staff. 'Writer then returned to the scene of the fire for investigation. Writer learned that a 13-year-old neighbor boy had been babysitting the children for

7 '+i i!~~,2ll-‘,~-So-~~~- Page Cowlitz County LIVE RMS 6 01/17/1995 Longview Police Department * y?-f&.~ 3 y . EVENT DETAILS c I __________--___--__------------------------------------------------------------____________________----------------------------------------.-------------------XERDETL ***** Incident Report # 94-28955 Location ***** NARRATIVE
***** ***.**

Reported Date 12/03/1994 Time 23:47:40 Call Disposition 3

nterviewed concerning the incident. He was I the evening. He was Be provided the following information: identified as Kenneth e that was involved in the fire. He has He lives next door to been friends with the family for some time and babysits for them on a regular basis. if he could r the evening

dvised that all of them were sitting in the living room watching on Channel 16. After the first l/2 hour one was over of a show This called 'Snick", Donald decided to go to bed, so he went to h.is room. left the others still in the living room watching Television. After the second l/2 hour cartoon was over, everyone else fell asleep. B was on the couch in the living room, the couch where it appears the fire started. Bethany was seated in a swivel chair an-was in a recliner chair. / aught Eddie playing with a lighter 3 times Earlier in the evening, away from him, but would put it on a table in and each time he,would t the living room where it was plain view. Apparently, Eddie has had some problems with setting fires in the past, according todvised that there were two of them. When asked about the lighter, They were the plastic disposable type, with one of them being purple and the other green. Tonight, after m fell asleep in his chair, he was awakened by smoke'and flames. He saw that Eddie was awake and that the couch he was sitting on was on fire as f re coming out of it at the opposite end that Eddie was . . yelled at Eddie and Bethany to get out of the house, sitting on. which they d then attempted to put the flames out by beating them with his coat. hat didn't work, he ran to the kitchen and got a large container of water, which he dumped on the fire. It almost put it out, so he went back into the kitchen to get some more. By the time he got back, he observed that ut it the fire was out of controlas it had flared up again. He ecided . out with water again, but it wouldn't go out. At this time to get Donald and get out of the residence). use the smoke was so thicl J1m went to Donald's room and ye by the leg. m then he could see him. Donald awoke.and he took a "head carried him out of the house. After count" and found that everyone had gotten out of the residence. Eddie then asked the back of the inside could get
i

about a dog, and- told him to go around to ce and open the back door so that a dog which was hen ran next door to his residence to contact

.XGRDETL

Cowlitz County LIVE RMS Longview Police Department

Page 7 ? 14 ! . " /&I. ~;~;~!.L~Y~~~q~ 01/17/1gg5
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b\; $ q . . ---------------------------------------------------------------------.-------.------------------------------------------------------------------.---------------

***** Incident .' Report # 94-28955 Locatio
***** NARRATIVE

*****

Reported Date 12/03/1994 Time 23:47:40 Call Disposition 3
*****

his own dad and get some help. (Writer later located a Black Lab dog tied to a doghouse in the backyard which is believed to the dog referred to by Eddie.)

d

then returned to the front of theresidence and discovered'that Eddie was missing. He either assumed or was told by someone that he had gone into the residence, so he went to the front-door and tried to gain entry. , He couldn't get it open, but finally was able to get it partially o some reason the door was pushed closed, so he made a second attempt Eddie. Thinking that maybe Eddie was on the floor behind the door, got down on his hands & knees and reached in behind the door. He couldn't feel anything and had to retreat because of the fire. Writer then had -draw a picture of the interior of the residence and 11 of the.furniture was and where everyone was. Writer also asked about smoke detectors. He advised that he didn't know if there were the residence, but he didn't hear one when he was awakened by the Eddie's Mother, Dawn, arrived on the scene and writer contacted her. Writer advised her of some of the information that was available, which included the fact that Eddie was being flown by Lifeflight to the burn center in Portland, Oregon. Writer then returned to St. John's Hospital just as Eddie was being airlifted There Dr. SCHNEIDER, the treating Emergency Department physician, was contacted and asked for an update. He advised that a heart beat had been .established and that Eddie was trying to breath on his own, but at this time was being assisted by a ventilator. He further advised that burns received in the fire-were minor, and that the main cause of his condition was smoke . inhalation. L.F.D. had removed all of the Writer then returned to the scene of the fire. living room furniture. In examining it, it appeared as though the couch that Eddie was sleeping on was the most seriously damaged piece. Writer then looked in the front room of the residence and observed that the most serious burn patterns in the carpet were at the end of the same couch. The couch was sitting in the middle of-the living room with no obvious ignition sources by :c
ALo 1 -

L.F.D. personnel tooks several pictures of the scene for their investigation;
, .

Writer also learned that Eddie was found by L.F.D lying on the floor by the door which goes into the laundry room on the back porch, just inside the back door. . ers. The purple one was Writer and L.F.D. personnel searched for dvised he had put it on located on the floor under the table that ouldn't be found. The after he took it away from Eddie. evidence. purple one was later seized and logged into ,

Cowlitz County LIVE RMS Page 8 "uq \qJ; ;q &2yzL Longview Police Department 01/17/1995 . EVENT DETAILS s< H, Lp, LT Irj;q -----------------------------------------------------------~-------~----------------------------------------------------------------------~--~---------.------. *+~t+* Incident +++** Report # 94-28955 Location Reported Date 12/03/1994 Time 23:47:40 Call Disposition 3

*XkRDETL

At this point in the investigation, it is believed that the couch was set on fire, possibly with the green lighter by Eddie, as there is no other explanation for the source of ignition. Respectfully submitted, Michael R. JEWELL, Patrol Longview Police Department SUPPOl 12/04/1994 OFFICER JEWELL'S SUPPLEMENTAL REPGRT . . a

Writer, Officer JEWELL, received information from-Dave ENGEBO, Emergency Department Nurse from St. John's Hospital, that he had been called by one of the Doctors at Emmanual Hospital in Portland at 0940 hours this morning that had died. Respectfully submitted, Michael R. JEWELL, Patrol Longview Police Department

N ..

Exhibit # 5

941215HWE5022

Photo ## 3:

View of the interior of the couch.

.

Photo # 4:

View of the interior of the .couch. .

. c

Exhibit # 5

941215HWE5022

Photo # 5:

View of the front of the lighter.

Photo # 6:

View of the back of the lighter.

.

.

, . .

d7FEB 1995

FIELD ACTIV’ITY COVERSHEET
1. BEGIONfSTATE 3. OPEPATION(Chcck One)

FOWR

( ) Inspection
( ) TclephoncContrct ( 1 other c

.3. DATE ( ) (X EstrblishrentV5sit ) Invedgation 3

02-08-95

-

4. NVHBER(ForP0 Use)

941215HWE5022
5. BSTABLXSEYENT N&me [

unknown

3

3 s-c 1
6. RELATED FIRM Name [ - ( ) Parent

tiP[

- 1 Tekphoee~

3

/ - ]
( 1 other

( ) Eeadqtautcrs

I cw c

( ) subsidiary

l-4

I

7. PRODUCTSCOVERED

[ upholstered furniture [ cigarette lighter

I

I

I c.

R.OTEERCONSVYERPRODVCTS

*

I

I
I
J

9. ESTABLISEYENTTYPE ( ) Manufecturcr ( ) lholesder ( ) Retailer ( ) other L II. X.6. BUSINESS XReccived [: ]

( 1 I-port( ) Own Label Distn~butor ( > RepacWer *I

lo. AHNVALPRODVCTION . . Product covered $ units [ OtherPxmducts $ . unit6 [

lf.SAYPLES COLLECTED

13. MIS CODE

14. HOURS

none

12165

Actitity

%Shipped c 1
15. REASON FORACTIVITY (AmzignrentReference)

[ 16 ] Ihrvel [2 J

regional initiated investigation-FY 95 fire program
( ) RationaleforAnno~nccdInspection 16. ANNOUNCED UNANNOUNCED ( ) n/a 17. EMPLOYEE'S NAME TXTLE SIGNATURE

Joseph S; Burchyski
( 1, REMA.RKS ( )

SRI

IS. ( x> ENDORSEYENT

SUMMARY

( )

OTHER

ID1 conducted in response to a newspaper account of a fatality associated with a residential fire. A 7 year old boy died when he re-entered the home to save his dog. Fire officials concluded the victim used a cigarette lighter to ignite asofa'bed. The lighter is not equipped with a child resistant feature. We are attempting to determine when and where the lighter was purchase. Siblings of the Victim contend a candle ignited the sofa.
19. REVIE~ER'SNAYE TITLE

James P. DiGrazia
20. RE VIETDATE

Supervisor 'cc c/s: LGC, LDB.
LQ-1070.Printor IO/931

il. DISTRIBUTION

2/14/95

0: EPDS cc: SFRO

+sc FORM No. 1 6 7 [ R e v . 8/86J[wtod f o r wp Uindous.4/93](Epsocr

z.

CASB NUHRBR

2, INVBSTIGATOR'S ,8953

ID

BPIDBHIOLOGIC =BSTIGATION

950103HWB5001
3 .

OFFICB
8 6

CODE
0

4.

DATB OF ACCIDENT

5. DATB INITIATRD

RBPORT

941211

950105

6. SINOPSIS OF ACCIDBNT OR COKPLAINT four year old boy was playing with-a disposable butane cigarette lighter, when he ignited the sofa. He escaped to safety with his mother, and there were no injuries. The fire department extinguished the flames, but did not conduct an investigation. The sofa and lighter were totall,y destroyed in the fire.

7.

LOCATION(Home,School,etc.)

8. C I T Y

9 .

STATE

home
10A. FIRST PRODVCT

1 0 Premont
1OB. TRADB/BRAl?D NAKB

California

C

J

lOC- HODBL NUKBBR

sofa
1OD.

0 6 7 9 unknown
HANUFACTURER NAHB AND ADDRBSS ,

unknown
11A. SBCOND PRODUCT 1lB. TRADB/BRAND NAHB

lilt_

disposable butane cigarette lighter

1604

unknown

110. HANUFACTURER NAHB AND ADDRESS

unknown
12. AGE OF VICTIH 13. SBX 14. DISPOSITION 15. INJURY DIAGNOSIS

no injury
16. BODY

999
17. RESPONDENT.
3

0
18. TYPE OF INVBSTIGATION 19 TIHB SPBNT (Operational
3 22. SAKPLB 0 5

7

c

PART(S) IUVOLVBD

hours)

9 9 2nd hand info
20, CATBWRP ID 2 3 . 21, CASB SOURCB

other -

04 . 0
COLLECTION N&BR

B U N N 2 5 newspaper

---

-m-e
N O : X X

PBRXISSION ~0 DISCLOSB WAKES (Non Neiss Cases Only) PES: 2 5 . RBVIBW 26. REGIONAL

24. R B V I B W D A T B

BP - - - -

OFFICB DIRECTOR
---

- - - w - 27, DISTRIBUTION

CPSC FORM 182 (REVISED 03/94)

950103HwE5001

The following information was obtained from a telephone conversation with the fire official at the incident scene, along with the fire incident report. A fire investigation was not conducted. Photographs were taken of the exterior of the residence only, and not of the sofa or butane cigarette lighter involved in the incident. If follow-up information is received as a result of a letter sent to the residence, it will be forwarded as an addendum. PRE-INCIDENT: The incident involved a single family residence, a mother, and her four year old son. There is no background information known about the sofa or cigarette lighter involved in the incident. INCIDENT: The date of the incident was Sunday, December 11, 1994. The time was shortly before 10 am. The son was in the family room. The mother was in the next room decorating the Christmas tree. The mother reported to the fire officials that her son came into the' room that she was in and said, Yrm sorry." When the mother turned around to look at him and inquire as to what he was sorry about, she observed a fire in the family room, specifically she saw that the sofa was on fire. She tried to extinguish the flames. Unable to do so, she called 911 and evacuated the residence with her son. POST INCIDENT: The fire department arrived on the scene and extinguished the fire. Based on statements made by the mother and son at the incident scene, along with a cursory check of the scene, arson as -. the cause of the fire was ruled out, and a fire investigation was not conducted. The child reported that he had been playing with a cigarette
2

.-

950103HwE5001

lighter when the sofa started on fire. Thenewspaper artidle (attached to assignment) -erroneously states that'the child had been playing with matches. The exact point of fire ignition on the sofa is unknown. There were no injuries. Fire structure damage is listed at $20,000, and contents damage at $IO,OOO. The fire official stated that he was on the scene, and all that remained of the sofa were the springs. The fabric was totally consumed by the flames. ' The butane cigarette lighter was not found at the scene. The fire official did not know if the disposable butane cigarette lighter was child-resistant. The fire report reveals that the smoke detector in the room alerted, and that there was no detector failure. PRODUCT IDENTIFICATION: The only information known about the sofa is that the fabric consisted of a cotton/rayon blend, as reported by the consumer at the fire scene. However, it is not known if this fabric was upholstery fabric or a slipcover. The remains of the sofa, as observed bythe fire official, consisted of only the springs. The fire official was unable to offer aldescription or product identification, based on the remains. of the sofa. All that is known about the cigarette lighter is that it was a disposable.butane lighter, from statements made by the mother. The cigarette lighter was destroyed in the fire. EXEIBITS: --_ 1. 2. Fire report. Data Recording Sheet for Upholstered Furniture Fires.

.

3

January 5, 1995

Dear Ms. The U.S. Consumer Product Safety Commission was alerted to an upholstered furniture fire which occurred in your home on 12/11/94. The U.S. Consumer Product Safety Commission is a federal agency responsible for reducing accidents in the home.' . As part of this responsibility, we are conducting a special .. study on open flame ignitions of upholstered furniture in order to determine if additional safety standards need to be -addressed. I would like to ask you questions about the incident, particularly about the sofa involved. Pleasecomplete the bottom portion of this letter indicating a date and time that is convenient for us to talk. Also, please include a daytime telephone number where I can reach you. I have enclosed an "AUTHORIZATION FOR RELEASE OF NAME". Please complete that form, and return all information in the envelope provided. Thank you for your cooperation. Sincerely, Joy Rizzitello Product Safety Investigator
------------------------------------------------o------------

-

- RETURN THIS PORTION - ' ------------------------------------------------o-----------Case #950103HWE5001 Please call between the hours of the following days at telephone number Signed and on one --dateof

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INVESTIGATION GUIDELINE

Attachment A DATA RECORDING SHEET FOR UPHOLSTERED FURNITURE FIRES (To be attached to CPSC Form 182, Epidemiologic Investigation Report along -with a copy of the Fire Incident Report)

lb

Task Number

y50/ 03&K500(

Incident Date L Chair

I

A. PRODUCT DESCRIPTION: r;$ Sofa/Couch

0 Sofa bed I Other /1 N o B;f U n k n o w n

1. Was upholstered furniture slipcovered? L Yes 2. Had it been reupholstered? / Yes 3. Manufacturer/Distributor/Brand 4. Purchased: 0 New

/ I N o ,@ U n k n o w n (1 fl &n J d

0 Used

Unknown

If used, specify how obtained (e.g., garage sale, etc.) 5. Date Furniture Purchased:
WK l

Furniture Age

6. Standard Certification Labeling; e.g., UFAC or California standard: (Copy) Ll/I/i&a d B. POINT OF FIRE IGNITION ON FURNITURE: Describe where fire started on upholstered furniture. 0 Skirt U Back m Welt Cord 0 Seat cushion 0 Side 0 Tuft. r”7 Inside back / Underside Other 4zc( 0 / Inside arm 0 Crevice

I C. AGE (IN YEARS) OF PERSON INVOLVED IN IGNITION (if appropriate): 0 5-14 0 15-64

/

0

65 +

D. PRODUCT INVOLVED AS HEAT SOURCE AND TYPE (Check):

-3

tighter

. Match

Candle

,

H e a t e r

F i r e p l a c e

Other (specify) Unknown

Page

11

INVESTIGATIONGUIDELINE

.

If lighter, specify typ,e: If match, specify type:

0

Child-resistant

0 Not child-resistant 0 Box

&

Unknown. Unknown

0 Book

0

If heater, specify fuel source and distance from furniture: Fuel source E. DETECTION OF FIRE 7. Detector 6moke heat, c.o., sprinkler) present? -2 4 YeS Distance from furniture

0

No

ir Unknown

If yes, specify type: 8.

s/-rnkR-

Detecter went off (alarmed)? 4 YeS

0

No

0 Unknown

9.

If no, do you know any reason why not; e.g., unpowered, fire too small, etc.?

10. About how soon was the fire discovered after it started? F. VICTIM(S) Number of Deaths d G. Socio-Economic Data: 11.

lNMOU I -

d Number of Injuries

Education lever of head of household: 0 Less than high’school
l

cz/LL. 0 High school

y 0 Some College

12. Total household income: 0 LT $15,000 13. 0 $15,000 - $34,999 0 $35,900 + &q/t: 0

Approximate home market value: 0 Rent Own

General Description: Provide general description, including all other relevant factors and information . on the investigation form.

Page

11

of 11

/ I
DATE: REPLY TO AT7N OF:

/

UNITED STATES GOVER NMENT

memorandum

SUBJECT:

-

OPTIONAL FORM NO. 10 (REV. l-80) GSA FPMR (41 CFR) 101-l 1 .S 501&114
0U.S. GPO: 1986-4q!246f29604

*. .

Hayward, CA (Alademda Co.) Review ‘- (Cir. D. 48,575) (Cir. S. 50,500)

i ,

.

DEC 1 2 1994

rant, -46850 Warm Springs Bhrd., A’four- .l:found a man rummaging through a ‘: back offike around 1:30 p.m.; in ihe Jjniddle.of a brisk lunch htiur;-poljce Sunday m&ning while hii mother- : .:. .- said. They followed the mai out to the.wking lot, where he jumped into ii white Chevrglet Cimero . ’ c driven by a‘second &an. The&r es,$apecl under a:ha;il’of pots-and-pans, -=I saidI%mont poli&i ‘Of&r Mark $W~n.*jameS-McCo$%;+nd - : &v@Bkrhe, 19, both of Oakland, . .-$&e stopped bypOlice as they _. _ CrujsednorthInterstate6I3O. .: . fhkway just short of Sunol. M&oy - ‘wasfoundwith $1!50 in dollaibills, thti same amount reported n&sing from the office safe, W-n L. said. The Tsanns &&l~ identi. : _ . :&tip& u:. - fi&l the men $;a -wIice t&k them lnto.custody. Police will recommend &afg~ofburglaryfo;b&~m~ : . ~OSll&%!3have::~hsrrestedh‘ - -?r-.connection with a burglary Siurday TRcMsrMFREFam , afternoon at a Warm Springs res-

.

I

: four&& old female, a three year old male and a five year old male died of injuries sustained in a ire at thier apartment. The children’s father escaped without serious injury. The cause of the ire appears to be a result of the three year old playing with a non-child resistant lighter. An .pholstered love seat located in the: area of origin was completely consumed by the fire. nvestigators were unable to determine the exact first material ignited.

SYHOPSIS PA INCIDENT OR COMPLAINT

b LOCAROW (t+oro, -1, ok&)

,ome interior

[l J[O ] Wtisonville

a crry

Oregon [OR]

3.8TATE

36. SECOND PRODUCT

we seat

14 IEO I[5 I[2 3

.
LAGEOFYICTIM
18, SEX (USE NUMERICML MALE -1 FEMALE - 2 UNKNOWN- 3 CODE)

f2

If0 I[4 3

12

I

died at scene
I8

14.

DISPOSRfON

15.

anoxia

INJURY DIAGNOSIS

I
- 2

16 115 I [l 114 3s I

3. BODY PART

U parts [g 115 I

fire investigators
13

17. RESPONDENT(S) (Llafhw, F-cl)

I

,

18. T Y P E INVESlIGARON 1 3 . TIME SPENT
ONSmE - 1 OTGR TELEPHONE3

[3 I

YR

MO

DAY

I91KlPlMm2J
b PERMISSIDN TO DISCLOSE NAMES (#UN-NEISS CASES OMV) CPSC MAY DISCLOSE MY NAME [ 1. NARRATIVE (Sa &~sh#ctdw on Page 21 ] CPSC WAY MOT DISCLO8E WY WAME [ ] ’ DATi

25. REGXONAL OFFICE DIRECTOR REVIEW .

‘he respondents were the Deputy Fire Marshal who investigated the fire for the responding fire’ iepartment, and the private investigator who investigated the fire for the insurance company.

.

(USE ADDJROMAL SHEETS IF NECESSARY)
SC FOR 10. 182 (Roviti lO/B3)(Adwt.d for W f u r Wi- & Efkiim .

7. PRODUCTSCOVBRED

[ cigarette lighter, [ smoke detectgr

&OTBBECONSUYBRPRODUCTS

3 3

c I
10. ANHUALPRODUCTION Prodoctcovamd $ . otber~aactp$ .

3 3

9. BSTARLISEMBWT TYPB ( ) MansuhctU~ ( )Vbchder ( ) Retailer (h-d 11. I.S.BUSINBSS XP--vcd[ J xswv=d

( ) 1-m ( ) Own Label Distributor ( 1 -pr4i!r3

unh [ unitsi:

3 J .

It.SAYPLBSCOLLBCTED

none
3

II. 8OURS Activity [

14 ] Travel [ 2 J

15. RBASONPORACTIVITY (AssignmentReference)

FY 95 Upholstered Furniture Fire Program

16.

ANHOUWCBD ( ) -f~AanoadI~~ UNAXUOUNCBD ( )

IS. (X) ZNDORSBMBNT ( ) RBMAUKS ( ) SUMMART( ) OTBBR

ID1 conducted as part of a special study of residential fires associated with upholster4 Local furniture. Three children, ages 5 years ? yeam and 4 months died in the fire. fire authorities concluded the 13 year old started the fire with a non child-resistant cigarette lighter. The parents did not admit ownership. A private fire investigator located an exemplar. We have visited the retailer and id latter appears out of business. No further follow up.
19. RBVIRFBR’S NAMB TITLB

James P. DiGrazia
20. RBVIBT DATE 21. DISTRIBUTION

Supervisor cc c/s: LGC, LDB

5/2/95

'1 0: EPDS cc: CERM, CECA, CHIRO, SFRO

PSC FOtU MO. 1 6 7 [ R e v . 1/86][Adaptod f o r UJ Windws 4/03](Epwrr L o - 1 0 7 0 Printor 10/33]

8

a

950123HWE5026

Pre-Event
The fire occurred in a suburban apartment complex. The complex contained 42 apartments which are contained in two story wood _ framed buildings which were constructed -in 1988. The value of building involved in the fire was approximately $300,000 according to the fire report. _ The apartment where the fire originated was a three bedkoom'ground level apartment. The apartment was protected by an ionization type * smoke detec.tor which was located in the hall outside the -bedrooms. The detector was hard wired to a 120 volt AC branch circuit and contained a standard 9 volt battery as a backup power source. .
(fi;e

.

The apartment was occupied by a married couple with three chi year old male, a three yea,r old male, anthe The father works for a freight company. the victims. The investigating official did not identify drugs' alcohol, physical impairments or pre-existing medical conditions as contributing factors. !rhe Deputy Fire Marshal said that the three ' year old apparently had played with a cigarette lighter three weeks before the fire.

The Deputy Fire Marshal said that the family moved into the apartment during October 1994, approximately three months before the fire. A private investigator said that the family members indicated that they smelled an odor of something overheating in the hall of the apartment after moving in. He said that they subsequently traced the odor to the smoke detector. The private investigator said that the apartment maintenance staff _ replaced the smoke detector with a new unit and battery during November 1994. He said that the father said that the‘five year old had received--fire safety training at his school so the family ' tested the smoke.detector each night before the children went to bed. He said that the father tested the smoke detector by pushing the test button.' He said. that the father did not report any problems with the operation of the smoke detector before the fire. He said that the father did not report any deviation from the usual routine the night before the fire occurred. The Deputy Fire Marshal said that the father and mother each possessed a cigarette lighter. He said that the mother carried her cigarette lighter in he:r purse. He said that the father indicated that he usually stored the lighter with his cigarettes in the-night stand next to his bed. He said that the father indicated that he sometimes placed his lighter-on the top of.the microwave oven in the kitchen. . 1

c

950123HWE5026 . The Deputy Fire Marsh'al said that the fire occurred during the early evening. He said that the mother indicated that she needed to make a quick trip to a store. He said that she informed him that the three year old wanted to go with her but she was in a hurry and the three year old was not-dressed to go outside. He said that she left the children in the care of the father. He said that the parents informed him that the ,thr'ee year old was upset about not being allowed to go to the store with his mother. The Deputy Fire Marshal saidthat the father apparently was alone with the three children immediately before the fire. He said that the four month old female was in a play pen in the living room. He said that the five year old male apparently was sleeping in the top bunk of a bunk bed in the boy's bedroom. He said that the three year old was awake and was last seen sitting' in the love seat in .the,living room. He sa.id that the father apparently was tired from working and fell asleep in a recliner chair in the living room.
Event -

The Deputy Fire Marshal said that the father stated that he was awakened by radiant heat from the fire. He said that the father reported seeing the fire burning in the area of the love seat in the living room. He said that the father stated that the flames extended to the ceiling and were rolling across the room. He said that the father stated that he could see the baby in the play pen under the smoke and flames. He said that the father stated that he opened the sliding patio door which was adjacent to the recliner chair and pushed through the screen door to get away from the heat 'and smoke. He said that the father ran around to the front door of the apartment and entered the front door to try to rescue the hap in the play pen. He said that the father was unable to reach th&> 9 rom the front door because of the heat and intensity of the fire. . e The private investigator said that the neighbor who lives above the victims heard noise and looked out of her patio door. -He said that she reported seeing the father exit. He said that she reported seeing flames roll out of the patio door behind the father. He said that the room may have flashed over when the father'exited. The fire was reported by neighbors at 7:16 p.m. according to the The private investigator said that neighbors fire report. attempted to rescue the! children by entering bedroom windows but were unsuccessful. The Deputy Fire Marshal said that the first engine called a second alarm as it approached the apartment because of the severity of the fire. 2

*

950123HWE5026 The -Deputy Fire Marshal said that the crew of the first engine did not activate the button which recorded the arrival time. He said that the arrival time of the first engine was not identified on the fire report. The arrival time listed onthe fire report was listed as 7:23 p.m. The Deputy Fire Marshal said that the five year old male was found deceased in the top bunk of the bunk b&d. He said that the three year old w-as found deceased in the lower bunk of the bunk bed. He said that the three year old'was positioned face down as if he may have been attempting to hide from the fire. He said that the , remains of the infant were found at the location of'the play pen . after the fire was extinguished. The fire burned up through the apartments above the victim's apartment. Occupants of the other apartments escaped with out injuries. Total fire damage was estimated at $255,000 according to the fire report. -

Post

Event

The cause of the fire was investigated by the local Fire Marshal's office. The Deputy in charge of the fire investigation said that the burn patterns were consistent with a fire starting in the living room in the area of the love seat. He said that the love seat was almost completely consumed by the fire. He said that damage to other items in the room decreased as the distance from the love seat increased. He said that the love seat upholstery material was completely consumed by the fire. The Deputy Fire Marshal said that the mother's cigarette lighter was found in her purse after the fire. He said that investigator's did not find the father's cigarette lighter in the bedroom nightstand or the kitchen location where the father said that the lighter was usually stored. He said that a fire damaged lighter was found in the living room near the area of origin of the fire. The Deputy said that the investigator's eliminated other causes of the fire and concluded that the most probable cause of the fire was the three year old son playing with the lighter. He said that the love seat appeared to be the point of origin of the fire. He said that the first material ignited at the point of origin was completely consumed and there were no surviving witnesses to - identify the exact point of origin on the love seat. He said the parents did not know if a pillow, paper or some other object was located on the love seat at the time the fire started.

3

950123HWE5026 The private investigator said that he examined the wall heater, and electrical cords in the living room. He said that he di'd not find any evidence of the heater or electrical equipment being involved in the cause of the fire. He said that the heater and electrical equipment were eliminated as causes of the fire. The private investigator said that he was involved in the search for evidence at the faire scene. He said that the parents indicated that the three year old frequently played at a sewing machine table in the living room. He said that a careful search of the table top revealed the fire damaged remains of a cigarette lighter. * He said the table was located on the route between the area of origin and the bed room where the three year old was found. He said that the parents did not recognize the lighter found on the table. He said that they did not know the source of the lighter found on the sewing machine table. _ The Deputy Fire Marshal and private investigator said that the father stated that he did not hear the smoke detector sound an .alarm. The private investigator said that neighbors also indicated that they did not hear the smoke detector sound an alarm in the apartment where the fire started. He said that witnesses said that they heard smoke detectors sounding in other apartments as the fire spread through the building. The private investigator collected the remains of the smoke detector as evidence. He said that the remains of the smoke detector were submitted to a forensic engineer for examination. He said that parts were missing and the smoke detector sustained too much damage for analysis of it's ability to function. He said that the smoke detector battery was found connected to the terminals. He said that a testwith a volt meter immediately after the fire found a small electrical charge remaining in the battery.
l

First Product Identification
County of Origin: Thailand

The product identification information was obtained from the lighter. The subject cigarette lighter is a disposable butane fueled lighter with a wheel and striker ignition mechanism, The lighter is non- child resistant. The private investigator said that the flame height control was set at the highest setting. He said that the parents stated that they did not know the source of . the lighter.

-

950123HWE5026

.

The private investigator said that he visited numerous retailers looking for the type of lighter found at the fire scene. He said that he found and purchased a similar lighter at 'a rural gas He said that the lighter station-mini mart while traveling. purchased at the gas station has the identical brand name and country of origin printed on the top of the lighter. He said that the ignition mechanism, flame height control and top of the lighter is an identical match with the lighter found at the fire scene. Photographs of the lighter found at the fires scene and the exemplar are attached to this report as exhibits.

Second Product Identification
Manufactur Model: Unknown An upholstered love seat was identified as the product in the area The Deputy Fire Marshal obtained the of origin of the fire. identification information from the victim's mother and father. The seat was approximately six years old and covered with a' corduroy type fabric according to information obtained by the Deputy Fire Marshal. The upholstery material was completely consumed by the fire and only a portion of the wood frame remained according to the The exact point of origin and the first fire investigators. material ignited are not known according to the investigators. The remains of the love seatare shown in photographs attached to this 8 report as exhibits.

Third Product.

Model: PX1218 Lot Number:9 4 2 5 2 ,

5

.

.N

950123HWE5026

The product identification information was obtained from an exemplar smoke detector collected by the private investigator. The private investigator said that the exemplar smoke detector was collected from the building management who said that the exemplar was from the same lot of smoke detectors as the unit located in the victim's apartment. The smoke detector is a hard wired 120 volt AC powered ionization detector. The smoke detector is equipped with a standard 9 volt battery as 'a back-up power supply. Photographs of the remains of the detector and exemplar are attached to this report as exhibits.

Standards Information
The cigarette lighter is subject to mandatory standards if imported after 07-12-94. The origin of the lighter is under investigation and the applicability of standards is not known at the writing of this report. The love seat is subject to voluntary standards. Information concerning compliance with standards is not known at this time. The smoke detector is subject to voluntary standards. The smoke detector label bears Underwriter’s Laboratories listing information.

Attachmentrs
Attachment A: Data Sheet Exhibit # 1: Exhibit # 2: Exhibit # 3: Exhibit # 4: Fire Department Diagrams Fire Department Report Medical Examiner's ReportPhotographs
--

6

. . . . . _-. : . -_

I IlBlaze$lr@ghter feels ‘deep grief Inside’ , G
. ‘..(

* Staropoli was on the first engtne to reach the scene. The building was full of flames that she and a nozzle man attacked with a hoso they dragged through the m front door., i First they hit the entryway, then the bedroom, where tire on the walls and ceiling was dumping debris onto them and there was too much smoke apartments.- At least three of the R HOUSEHoLD l?EMS: Tualatin Valley to see the boys’ bodies, which other children dis‘placed by the fhw attend Fire and Rescue stations will be acceptArefighters later found. the school and many students saw ing items for the displaced fa@lies Staro 11 and another firefighter the fire as they left school ac$!fties ,..through the weekend. found 4iiibm s remains on the Uv* . V.. .,,I.. a. . . . w . .’ : Thursday night. ing room floor. Following orders, ’ ~un~lo~ &d teach& . q& W FUND-RAISER The b%XflV~l!e ROkIfy she stayed with the remains for 8 or tnuch of Friday trying to tend to the Is organizing a breakfast to raise money 10 mtnutes making sure the body for the displaced families from 8 am. to fears and anxieties of students. . . was not disturbed. “It’s something they probably 2 p.m. Jan. 22 at the Wilsonville Senior Staropolf has been a firetighter for never dealt with before and so that’s Center. six months and it was her first fatal why we’re ‘spending a lot ‘of’ time fire. Throughout most of the’ eve1 SCHOOl HEW The Wodd Middle ning, she said, “I was OK,” even School Parent Group is working to help through a grief session for firefight.. “..: .

1 don’t think he should :! have died He didn’t do.. :S nothing wrotig. ; .’ E

: . . . wanted to speak with him alone. .I: T h e n t h e teat% came,. she said:’ adding that the fire had 1eeR her At like so many others whose Jives ic II touched - with a lot of pain. “There is,” Staropoli s&i, :#a r&P . 0 deep grief inside.” Also contrfbutirjg b thb i&G bi$’ Holly Danks and Jim Kadera of Thg Oregonian’s stajjI ’ . . ’ I. *.er .- 4 . . .

,..

.

. . , . - JRN-18-1995 13: 41

JNVESTIGATXONGUIDELINE

,

-

-

Atmchment A _DATARECORDlNGSHEET FORUPH0LSTEREDFURNlTURE FIRES (To be attached to CPSC F arm 182, Epidemiologic lnvestigation Report _ along with a copy of the Fire Incident Repon)

Task Number

qs .

0123wJsK& Incident
0 Chair 0

Date

\- wB-4

A. eRODUCT DESCRIPTION: EfSofa/Couch

Sofa b e d I Other

l- W a s upholstered fur&e slipcovered? I YGS 2. Had it been reupholstered? D Yus 3. Manufacturer/Distributor/Brand
NCW fd

m U n k n o w n oR\Q\**x c onawq C&J D Unknown

No &

?L P

-

4. Purchased:

If used, specify how obtained (e.g., garage sale, etc.) 5. Date Furniture Purchased.*x&s? F u r n i t u r e A g e 6 ‘c;(eau 6. Standard Cenification Labeling: e.g., WAC or California standard; {Copy)

UMJ
B. POINT OF FIRE IGNITION ON FURNITURE: Describe where fire started on upholstered furniture. . * / I Skin
Back

U Seat cushion D Side n Tuft

El Inside back m Underside Other d

17 Inside arm 0 Crevice

0

U fi d eT*Rp, :&a I ’ C. AGE (IN YEARS) OF PERSON INVOLVED IN IGNITION (H approprime): 3 yg c - PIfiLe _ 3 LT -cs/ 5 yrs.

L Welt C o r d

old

-

0 5-14

r”l 1 5 - 6 4

.D65+
- -1.

0. PROD&l INVOLVEI AS HEAT SOURCE AND TyPq (Check):
d ugmef Other (specify) . Match C a n d l e H e a t e r F i r .e p l a c e \

U n k n o w n

Page 10 of 11

. a

JtW-18-1995

13:41

P.03

If lighter, specify type: If match, specify type;

- I Child-resistant r) Book

I/

Not child-resistant /7 Unknown

/ Box

ff heatef, spec’ify fuel source and distance from furniture: Fuel source __ E. DETECTiON OF FIRE Distance from furniture

7.

GO., sprinkler) present?
17 Unknown .

8.

Detester went off (alarmed)? . I Yes’

0 No

9.

If no, do you know any reason why not; e.g., unpowered, fire too small, etc.?

10. Aboln how soon was the fire discovered rfrer it started? w \xjp1 .
F. VlCTlfWS[

$ -

fiI:!mes

A!11.

Number of Deaths

Number of Injuries

. \

t. Socio-Economic Data: . Education level of head of household; High &l school 17 Some College

D Less than high school . 12. Total household income: D LT S15,OqO

$15,000 - 334,399 id
?‘.

I $35,000 +
(I-sc9-. ‘--

--

13.

Approximate home market value:J%o cp,o30

& .&l&AAtL I

. .

I OwlI

_

HOhGbW

fmu-r

.’

gs60

General Doscriprion: Provide general description, ‘mcluding all o’ther relevant factors and information on the investigation form. .

Page

11 of 11 -

001
I

.

; Di; of l,ti,,URLATIN URLLEY FIRE

-

.UI

cc&LACKRI;IIIS

- -&&&c&Lt~lRiIH WiEY FIRE S RESl

AlARM

_-12

. 0 .

. . : 64 --

.
~OFWCINESResPONDED

I
IoFAERlALAPPARkTuslusPONDm _

‘_ .
IcnwBRvEHlcLpsILEEpoNDBD (&I sol iI+& PAW -’

0 ~OFFIRESERVlCEPSRSONNEL -NDgD

. . . .

:o

-_-.

# 11
w

TYPEOFSI’KJATIONFOUND

TYPEOFACTIONTAKEN

STRUCTURE

FIRE

1 EXTIHGUISIMEHT

._.-. - :

_
.

.. .

MEI’HODOF

EXTINGUISHMENT 11 FIXEDPROPERTYUBB.

6 PRE-CONNECT HOSE/HYDRRKI, SJRNDPIPE
PROPER7YCOMPLEX(lfqqhab&)

.lZl -._. _ .’ .T ;__ _ . . .- -. . ..

.

MOBILEPROPJiXTY(bqhut,Y)

42 (7 THROUGH 20 OPTSi ’ .’ ‘.I- : Y MOBILE
PROPERTY

42

APRRTHEKT
MODEL

COfIPLEX

’ .i. 08 HOT APPiICQBLE
SERIALI. * . ._ _. :

YEAR

--MAKB

WcRNsEj

14LOUN6EfiREfl B

INVOLVED IN IGNITION

EQUIPMEKT

*. YEAR

.. MAKE.

-

-‘.

i

98MODEL

HO

EPUIPHEKT’IHUOLUED
--I :.
I

‘_' .. I

VOLTAGE - .

u lcNmoNFAm% CHILORED YITH, CHILD PLRYING love seat uas determined to have been the point of
U FORMOFHEATOFlGNTTlON
U LZVELOFFlREORlCIN .. -_ .m

Fire originated in the living row of Ppt # 1. The . origin, 1111 other sources of .ignition inre - ’ - eliminated
.~(rmdFmsr~cNrmrk~. . _* .- . . . ;#, .:*‘. m7AL Do

.

/YATER~ALH~ECM~EOWASMADEOF

46 LIGHTER (FLAtfE TYPE) --

. 1 . 71 HRN-HRDE FCIBRIC .
. . Gmtenir m

c
O-..

- 121 UPHOLSTER SOFA,CHAIR,UEH SECIT
. .;’ : . m _.*.

VALUE

- ,

V&kkMdcaatst8

$320,000
$170,000 ?’ .

$100.0d0
$85.000 m

: .

.::-

-

m
. 1 .

.

6420,000 m . 4?&0#0 m I

17

NUMBER OF SroRlEs BUlLDING SIZE (Grad Flf only)

. .
16 BUlLDfNC ACE (la Ym) 2

H CONSTRUCIIONTYPE 8 UNPROTECTED UODD FRCIHE U-NR

(.OOO-4999 SQ ti) .
DETECTQR PF.RFORhtANCE

.

.

a JWENTOF DAMAGECONFINED To. Flame S m o k e

SPRlNKLW

PERKSUANCE

4 CONFINED TO FIRE-RRTED COtlPIlRTHENT 4 CONFINED TO FIRE-RATED CMIPRRTI’IENT

0 UNDETERMNED 8 HO EPUlPf!ENT PRESENT

(

~kncovrdld Fin:

#dNdDc@ld

.

820-03-I OT _

‘.

. .

. .

-,*-

-v---y

I

.,r

1-b

CWlLlANCASUALTYREPOii

OFFICE OF STATE FIRE MARSHAL
. FIRE OEPARTMENT MO DAY YEAR A ,ol I I \ 1alqs T-bRj GA I 9ll IG DAY OF WEEK ALARM TIME

GB GC

. =*

I FAhllLlAFUW WiTH STRUCTURE 1. 0 LEssnlwlDAY
2 0 10 4. II 17OfMYS 8To3oDAYs 1T02h4ormis STO8MONTHS 7TQl2h4OUMS OVERlYEAR WTASRUCTUE FAMUARfWWmrTHES7REME lJmmERmNEDoRNcJ7m .

5x 6. 0
7. 0 a. 0

a D

CONDfIlON BEFORE INJURY 1. AsEEP* 3 tOBa=uxancER-* 3.0 wmREDBYMKIcs.~ 4 . 0 uJoERREsRAN7. 5 . 0 TooYomlGToAc7. a0 MENTALLY -.sEEIILEa 0 AW~~NIMPAIRED. 9.0 cuancwBEFmEmkuwNoT ass=EDmcnE cLdcu4una4BwREE -mNoTREpoRTED. aD 0. 0 0. 0

GE

CONDITION PREVENTING ESCAPE
1.0 K)fMETOESCAPE;~OS0t4ORFRE PRoGREssED7cmRAP6xY.

ACTM-W AT TIME OF INJURY I. D
20 a0 c o

CAUSE OF lNJURY 1 . 0 cMKiwTyuNDERBEnvE&TIuppED By.
2

20 RRE BEIwEENcAsuALTYAmmJT. s.0 InacEDmoK~
4 . 0 LLKiKGATEsLocxs s 0 aonwoN-~Buu9yG. 6 . 0 MovEDToosLMY. HQu#DAREFAuREs ToFaLmvca2REa w- -. 7.0 WCTiMNCAPACllATED#wRrO6.X No ~PREENEDESMPEORNOTA FACTOR 6. 0 cotawN PlmENmGEscApENQT CussmmABovE 3.OczoNcmxPREVPTTYJC~ ~ORNmllwcmED.

x -AREFLAM&HEAT,SMCXEL

-7oFuEpRo#IcTs

SO

h”w 7. 0
aD 0. 0 0.0

a PART OF BODY INJURED

0 c~~cs~o~~~~~~u4mmw~u7
NmREFmTED.

GF

NATURE OF WJURY
1.0 2 0 6. 1.% 5.0 wRNs6AspHmursMoKT -oNl.Y. ALSPHYXUlSMOKE WLY. wouND,cm.BEamG. asLocA~FRAcfuRE

6 . 0 Wffi’m NamEDHEARTATwJacs AImsmoKEs. 7.0 8.0 bTRApssmAN 0 . 0 ruTuREoiNJuRYbRLLNEssNQTcLAssBIED ABOVE a 0 NAnJFEffwuRYoRLwEssMoETERMwED oRNmEPoaTEo. 0 SEE REMARKS ON BACK . 8!444O-WC (R-8/92) I

8 . 0 MlknPLEPNqs. 9.0 PAmFEIooYNlllREDNoTcussmED
0 . 0 PAmofBawtumED~oR ruTEPomED. I_*

0 SEE ADDITIONAL REPORT (bL44E.PcxmoN.Icss~ CL \lQQQv MEMBERU4KJtdGREPORT (IF tnFFERENTFRoMABovE) . a. DATE

.

.

CIVILIAN CASUALTY

REPORT

r

FIRE DEPARTMENT MO DAY YEAR A orI1 I rmr~ -rkA~S GJ CASUALTY NAME (LAST, FIRST, MI) I ’ . DOB TIME OF INJURY . DAY OF WEEK AtARM TiME

GE Gc

n*E CAswTyl

I

GD
UEsTHMloAY 2 0 lTo?MYs 3 . 0 6ToJODAYs .I 0 lTO2MoNlw 5.3iq3T06htotms 6. 0 7TO12MONTHS 7- 0 OVER l.YEAR 6. 0 NoTAsRucnJRE 0 . 0 FwwKHTHEm lmETERwNEDoRNuTREpoRTED

LOCATION AT K;NmON 1.0

CONDITION BEFORE LNJURY
1.0 IQ.

2osarzrooPs-P
4.0 s-0 6.0 6.0 s.*fi UcERREslRmK. Ta3YousToAcr.

-. 3 . 0 DAPmEDEwoRlss.McoHoc

J

MEF4lM.Y -.sEaE Aw~wwPuREo. --KlwnNoT -ABOVE aoccluMmuBEFoffErunn ~oRNoT-.

GE

CONDmON PRNENTING ESCAPE
1.0 20 LO L 0 LGGaGATEs,LccKs LO cLomNGW~WB(RMNG. L 0 MOVEOlOOSLowLY. NCLKEDAREFAILURES ToFbuow -(AvAILABLqr. 0 tmxtMNcAPAaTATEoPGulRToLpI\K)coNDmoNs mEvENEoEscAfJEmNOTA FAcroft L O ca+almN Fw3ENwGmNoT QlrssmDmovE LOax-motJW& voRNoTm. MON*(ETO~DFLDBLOSK)NORF~RE PRoGREssp>tooRAPfoLY. FRE BEnnEENcauAL7YMDDcTT. -LOWEDOOOR

ACTlVrrY AT TIME OF 1NJURY

1. 0 20 3. 0 1. 0

ESCAPNG. RESCUEA1TEMFT ‘F#EcoNTRcL -. 5. 0 C SALVAGE MOP-UP. 5. 0 aEEPlNG. . r. 0 UNABLE TO ACX. i. 0 RRATm4MAcTKN. )*‘k AC~W~~YATTWEOFWUWNOT~ 1. 0

Gf

SATURE OF INJURY :D BURNS&V _ 0 BURNS ONLY. ” a ASPHYXUfiMOKE ONLY.
L O wwrm.aJT.aEEtwG. i. cl asLKNloN,aAcwRE i. 0 VofPAN NauDEDHEARTATrAcxs ANosiRouEs. ‘-0 SHOCK LO sTRAm.ciPRmJ. ‘- 0 NATUREOFNURYOR-NOf-IED . MOVE. ! 0 NA~EOFlN.AJRYOR~~~~~ OR NOT REPORTED.

‘ART OF BODY INJURED 0 HEAD.NEcK l o 6ooY.lRuqBAcK b. 0 ARM. LO LEG. LO HANO. I. 0 m.
NlERNAL HcLuoEDAREREspQuToRy ‘-lk nsrEMu4oHEmT. I. 0 I.0 ! MULWLEPARTS. PARTOFBOOY?UW4EDNOTQAsslFEED MOVE 0 PARTofBmYm.nJREDuNoElDuQMDoR NOT REPORTED.

0 SEE REMARKS ON BACK

yy?i2~~wm~wJ
. .

7.7.1 -c

.

CIVILIAN CASUAL-W REPORT OFFICE OF STATE FIRE MARSHAL
FIRE DEPARTMENT

CASUALTY NAME (LAST, FIRST, MI)

.

DOB

1 AGE

TJME OF INJURY

GE GC

1

GC

FAhMLlARITY Wm-l STRUCTURERECEMD,WU 1 . 0 LEssTHMlMY
2 0 1107DAYs 1102MoNrHs 7mi2OvERlYEAR NOTASMJCRHE F~wrlHTHEsTRucTwIE -NEooRtJoT-

FIRE cwa&LTY) I LOCATION AT IGNITION
FlREcxaJaTYwTaMATELYHvoLvEDw7m GMlXM.WWDED~E-Of aonaNGoNA PERSONaGMmNw 8EDCXNGORFURMWREON-APERSON lsslnwGoRLnNG. 2% f%2ECCLSUMlYNTHEROOMORSPAUZO6 FIREORGN 3 . 0 4.0 5 . 0 6 . 0 8.0 FlR&cGuMlYoNsuAEnooRALSORK;PIff 1.0

CONDlTJON 1. 0
2 0

BEFORE INJURY

s 0 am3ooAys
4. 0 6. 0 7 . 0 8. 0 0 . 0 5.x JTOUMOUlnS

\

3. 0
4. 0 5-x 6. 0 8. 0 0. 0

FlRE
FVZECMULlYNYjAE OFFRE BlJuDwGAsoRK;(H

flRECASWLlYWlSDEOF~OFRRE oRmNEufoNPRoPERrf~ FtRECASJMlYoFF PRoPEmYoFFlREoRsN ATIIMEOFtSMlCN NOTARRECGUMW. LO~~~~~~F~~~ALTYAT~ME~K;~ON NoTcLFLsgFiEoA5ovE LOCXTGtdOFCXSULTYATTWEOfKXflkX -oRNoT-.

0. 0

0.0
0 . 0

L

_

.

GE

:ONDlTlON PREVENTING ESCAPE I. 0 LO CO .O .O .O

ACTiVl7Y AT TlME OF INJURY
1.0 ESCAPNG. RESCUEATl-EhPT.

CAUSE OF INJURY
1 . 0 cAuGHTYuNoEsBRwEDI;-

2 0 3 . 0 4.0 5 . 0

8Y.

FIRECONIR~ REB CLEANUP. SALVAGE MOfWP. B.0 m. 7. I+ UNABlETOACl. B. .IRRAllot4M AcruxiD. 0 ACTMWAT~~FN~RYNOT~LA~~FIE~) ABOVE 3.0 MMWATTlME&UWRYuNoETezMlMD ORNOT-.

M#)SEDmFtREPRooutxs. 6 WCUQEDARERAMEHEAT.SMOKE~

LO
L 1. L lo

awxamO(R(rCKS.~nora -AREnflEPROOUClS~.. WERmEmm Rtm6EDBY.cmflAcTw7ni. SmwxBY.

O FELLOR -ON.OVRNl0. 0

5 . 0 10

O NoTPPLKxaE ausEOFruRYNoTclAsmED

GF

JA-iURE OF lNJURY . O BURNS&LO WRNsmLY. . I. ASPMXUISMO)(E u&Y. 3 woum.cm.sLEEaNG.
‘. 0

PART OF BODY lNJU&D
1.0 2 0 3. 0 4.0 5.0 5. 0 HUD.NECK eooY,lRwYEAcx

DlSPOSrnON I. 0 RsusEobELP.
L 0 L 0 I. 0 TREATEDATSCENEMDRQEGED. T~TOHOSPfTALBY~DEm- - - - TAKOIm-MBY-EDEm.

ARM.
LEG. +uNo. Km-f.

DIsLocAtlcwJ.-

-0 .O .O .O .O

-ffPAN. HQWEDHURTATTACKS ANDsTRcxEs sTRAIN.sPRAN. WUREOfWURYORUESKITbSJf&~ ABOVE KA7uREofNJuF?YoRuNEsslJmEERMtNED OR NOT REPORTED.

I.& MERNM NCUJDEDARERES’iRAToRY SYSIEM AND HEART. 9.0 ?. 0 I.0 MULTUXEPARTS. PARTOFWOYN.WREDNoTcLELsslFlED ABOVE PAJ7TwBooYNJuREo~oR NOT REPORTED.

iJ SEE REMARKS ON BACK .

0 SEE ADDITIONAL REPORT OFFICER IN CHARGE (NAME, f’OSITK)N. ASSGNMENT) ~4 & NG REPORT

DJITE ’

###BOT_TEXT###gt;QQw
(lF

\-r3+047-E

DPFERENT

F R O M ABOVE)

~944Gr0~ (R-fKQ)

I

Sure ol orcpon
OREGOY HEALTH DIVISlON Dqmmcnl of Human Resources

MO-95 00 STATE MEDICAL EXAMINER OHSIJ TOXICOLOGY BLOOD ALCOHOL TEST REPOR;
O.RS. 1M.i 13

MAIL REPORT TO:
.

JRESL’L7S: for lab use

only

r

1

Test Drrte i \: .r,l .r( n, . \T G,qLq 1 1 The concentration of ethy alcohol in this blc c sample is: ,

L

3. Name of person drawing and sending sample 1. Ordered by Dr. 5. J -- Fire (Brief Description) e r Auto - Other (Explain)

-Traffic Fatality D r i v

-Passenger

-Tnrck -Cycle:

6.

Carbori Monoxide anal@

DRUG SCREENS REQUESTED ON THIS FORM WILL BE DISREGARDED. REQUESTS FOR SUCH TESTS -MUST GO THROUGH
THE STATE MEDICAL EXAMINER5 OFFICE.
-REMEMBER - . . Use - Red stoppered tubes for urine; gray - stoppered tubes for blood. Label - Tubes with correct first and last names and date drawn. Mail - Put tubes in metal mailing canister and tighten lid. Wrap form around canister and place in cardboard mailing canister.

.

-

i

MEDICAL EXAMINER .LCOHOL TEST REPORT
. MAIL REPORT TO:
O.R.S. 146.113

OHSU

TOXICOLOGY Ir

*

.

r

L

5.

-Traffic Fatality

. - Fire (Brief Description) J -Other (Explain) -Jlat&e h.&

- Driver
-Passenger

-Auto -Tmck -Cycle

.

6.
l

Perform Carbon Monoxide analysis

THE STATE MEDICAL EXAMINERS OFFICE.
.

DRUG SCREENS REQUESTED ON THIS FORM WILL BE DISREGARDED. REQUESTS FOR SUCH TESTS MUST GO THROUGH

-;

- REMEMBER Use - Red stoppered tubes for urine; gray - stoppered tubes for blood. Label - Tubes with correct first and last names and date drawn. Mail - Put tubes in metal mailing canister and tighten. lid. Wrap form around canister and place in cardboard mailing canister.

, I

.

EXTERNAL EXAMINATION:
I

BY: Edward F. Wilson, M.D. AT: 301 N.E. Knott Street, Portland, Oregon 97212 ON: Friday, January 13, 1995 - 1125 p.m.

-.

CAUSE OF DEATH:

INHALATION OF SMOKE CONTAtNlNG TOXIC GASES INCLUDING CARBON MONOXIDE (62.3% CARBOXYHEMOGLOBIN)

INTRODUCTION: This is a fire.-related death. CLOTHING ON BODY: 1. Blue jeans with fly zipped to the top, waist properly buttoned and no belt in the loops. The sides and backs of the legs and seat of the jeans are absent due to the fire. 2. Brief white underpants. . . . :.

EXTERNAL EXAMINATION: Body is that of a blackened and browned but not charred white. male child, measuring 3’3” in length, weighing approximately 35 to 40 pounds and appearing the listed age of three years.
. . .--

Blackened and browned but not charred skin covers the right side of the face, sides’ and back of the head, sides and back of the trunk of the body, circumferences of the

.

I

arms, (sparing the back of the right hand and left palm), circumstances of both legs

with sparing of the underpants area.

.

Scalp hair on the back and sides is blackened and burned down to a l/16”. stubble. The only hair that remains is in the midline of the front of the top of the head and it is blond, straight and approximately 2” in length. Eye color is blue. Petechial hemorrhages are absent from the white of the eyes, lining of the eyelids and skin of the eyelids. Whites of the eyes are congested. Nose is normally formed, symmetrical and uninjured. Rightmostril contains a plug of moist black soot . Lips are healthy and uninjured. Lining of the lips is without petechial hemorrhage. Teeth are natural and in good repair. Distal I” of tongue is clenched tightly between natural teeth. Upper and lower frenulum are healthy and uninjured. Neck, chest and abdomen are normally formed, symmetrical, uninjured and unscarred. I Genitalia are those of a circumcised normal male child. .

.

Arms including hands and fingers are normally formed, symmetrical and uninjured. Fingernails are natural, healthy, uninjured and extend just beyond the tips of the I fingers. Both palms appear uninjured.

_.

^_“.

- x_----”

-

.

._-

.

.

. - .

Legs including feet and toes are normally formed and symmetrical. Toenails are natural, healthy, uninjured and they extend almost to the tips of the toes. Soles are healthy. On the back of the body, skin is blackened except for the underpants area. opening and skin around the anal opening are healthy and uninjured.
TOXICOLOGY:

Anal

Blood is drawn from the heart through the chest and submitted for analysis.
_.

EFW:clg

Slate of Oregon OREGO HEALTH DIVISION D~JvM~~ of Humian Rruxuces

STATE MEDICAL EXAMINER BLOOD ALCOHOL TEST REPOR i
0.R.S. lM.llj -

OHS” roWCoLow e
for*a~useonly

MAIL REPORl TO:

JRESULTS:

i n. .I
G r 1

WI5

The concentkion of ethyl alcohol in this blood -_ sample is: 0 1 . 9i tpms./lOO cc. 1

J
c

Carbon Monoxide % Saturation._-. I 1 7 i,c,c; r( J 13 ,I L

2. Dale of Deat

5.

-Traffic Fatality ,-. Driver Passenger Pedestrian -Auto -Truck -Cycle .

v - Fire (Brief Description) -Other (Explain)

6.

Perform Carbon Monoxide analysis J

DRUG SCREENS REQUESTED ON THIS FORM WILL BE DISREGARDED. REQIJESTS FOR SUCH TESTS MUST GO THROUGH . 1 THE STATE MEDICAL EXAMINER’S OFFICE.
- REMEMBER Use - Red stoppered tubes for urine; gray - stoppered tubes for blood. Label - Tubes with correct first and last names and date drawn. Mail - Put tubes in metal mailing banister and tighten lid. Wrap form around canister and place in cardboard mailing canister.

. ’ I

.

.

ClACKAMAS COUNTY

EXTERNAL EXAMINATION:-

BY: AT: ON:

Edward F. Wilson, M.D. 301 NE. Knott Street, Portland, Oregon 97212. Friday, January 13, 1995 - I:10 p.m.

CAUSE OF DEATH:

INHALATION OF SMOKE CONTAINING TOXIC GASES INCLUDING CARBON MONOXIDE (48.4% CARBOXYHEMOGLOBIN)

INTRODUCTION:

This is a fire-related death.
CLOTHING ON BODY: 1.

Around the left shoulder and upper arm is a blackened, charred remnant of maroon baby clothing;

EXTERNAL EXAMINATION:

.

Body is that of a browned, blackened and charred infant female, measuring 20-l /2” in length, weighing an estimated 8 pounds and with the listed age of four months. Black, charred skin covers the back and sides of the head except for a 3” x 2” area of scalp and skuli in back absent clue to incineration allowing the brain to herniate, back and sides of the neck, back and sides of the trunk of the body exposing the shoulder blades, ribs, iliac crests and allowing herniation of a large portion of small and large intestines, circumference of the arms, (the hands of which are probably absent), and the circumference of the legs, (the toes of which are probably absent).

l

AUTOPSY PERFORMED: BY:

AT: ON:

Edward F. Wilson; M.D. 301 N.E. Knott Street, Portland, Oregon 97272 Friday, January 13, 1995 - 10122 a.m.

CAUSE OF DEATH:

INHALATION OF SMOKE CONTAINING TOXIC GASES INCLUDING CARBON MONOXIDE (50% CARBOXYHEMOGLOBIN) . .

ANATOMIC DIAGNOSES: I.

Inhalation of smoke containing toxic gases including carbon monoxide A. B. C. Body and clothing charred Airway from larynx to lung coated by soot (+2/4) Esophagus and stomach coated by soot (+0.5/4)

II. ._

Natural disease
A-

Absent

.

I . .

i,

I’ ) , )

BxhibL # 4

950123CWE5026

.

Photo # 1:

Fire Dept. photo of the apartment during.the fire..

Photo # 2:

Fire Dept. photo of the apartment a'fter the fire.

e

Exhibit # 4

950123CWE5026

Photo # 3:

Fire Dept. photo of the remains of the love seat.

Photo # 4:

Fire Dept. photo of the remains of the lighter.

Exhibit # 4
,

950123CWE5028

Phbto # 5:

View of the lighter with an exemplar.

Photo # 6:

View of the lighter with the exemplar.

Exhibit # 4

950123CWE5026

Photo # 7:

Close-up view of the tops of the lighters.

Photo # 8:

Close-up view of the tops of the lighters.

L

*

Exhibit # 4

950123CWE5026

.

.

..

Photo # 9:

View of the remains of the smoke detector.

Photo # 10: View of the remains of‘the smoke detector.

Exhibit # 4

950123CW5026

Photo # 11: Close-tip showing the battery connected to the terniinals.

Photo # 12:

View of other parts of the smoke detector.

Exhibit # 4

950123cwE5026

Photo # 13: Close-up of the remains.

Photo # i4:

qiew of the exemplar smoke detector.

,

m

Exhibit # 4

950123CWE5026

.

l

Photo # 15:

View of the red plastic lever in the battery compartment.

. Photo # 16:. View of what appears to be the remains of’the red plastic lever in the battery compartment.

Exhibit # 4

950123CWE5026 . . .

ISSUENO. 43821

s1966

'=+,

-,

Photo # 17:

Close-up of the.exemplar label.

Photo # 18:

View of the exemplar exterior cover.

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