Engine Company EMS: Polymer Fume Fever

By Mick Messoline

On March 13, 2012, the Thornton (CO) Fire Department responded to a report of a chemical odor in an apartment. They arrived to find the occupant feeling poorly, reporting that she had boiled all of the water out of a Teflon® pan, resulting in the pan becoming severely overheated. The following includes the company officer’s notes as well as some additional information on Polymer Fume Fever and the kinds of presentations you might expect to find.

Engine 72 Narrative Entry

Engine (E) 72, E73, and Battalion Chief 71 were dispatched to an odor investigation inside of a residence. Medic 72 was then dispatched to the address for a party feeling ill. E72 arrived on the scene of a two-story apartment building with no smoke or flames showing and established command. The reporting party was sitting outside of her apartment and stated that she had fallen asleep while boiling water on the stove. The water had evaporated, and she thought she had burned the Teflon from the pan. She stated that this happened around 6:00 p.m. that night (about three hours before); a strong chemical odor remained in her apartment. She then opened the windows for ventilation. Within the past hour, she noticed that one of her birds was dead; she removed a second live bird to another apartment.

The inside of the apartment was evaluated with our detectors; no hazards were found. Additional resources were canceled. The patient was evaluated by fireEMS crew members while additional investigation took place. A dead bird was verified in one of the bedrooms. A smoke ejector was placed at the front door for ventilation of the apartment. It was recommended that the patient be evaluated at the hospital. The patient was then transported by the medic unit to the emergency department (ED) for further evaluation.

Information

Polymer fume fever was first described in 1951. It is also informally known as the “Teflon Flu.” It is caused by the inhalation of fumes resulting from overheating a Teflon-covered pan. Products of pyrolysis released at temperatures between 300°-450º C are the most common cause of the condition. If the product is heated to temperatures above 450º C, acute pulmonary injury is possible (including non-cardiogenic pulmonary edema and significant lung injury). Studies have shown that preheating a Teflon pan can create surface temperatures as high as 736º C in as little as three minutes and 20 seconds.

Polymer fume fever is usually a self- limited systemic illness, presenting with only minor respiratory symptoms. Symptoms usually begin well after the exposure. It is not uncommon for delay of symptom onset to reach the eight-hour mark.1,3 The extent to which the Teflon was heated is a significant determining factor of the extent and danger of symptoms. The most common complaints, however, are flu-like symptoms with typical onset between four to eight hours after exposure.1,2

Symptoms may include the following:

  • Fever
  • Chills
  • Nausea
  • Headache
  • Fatigue
  • Muscle pain
  • Sweating
  • Cough
  • Malaise
  • Joint pain
  • Chest tightness

Symptoms usually resolve within 24 to 48 hours. This short duration results in many patients being misdiagnosed and may result in multiple trips to the ED before a proper diagnosis is reached.1-3

The incidence of Polymer Fume Fever can be significantly higher in cigarette smokers. In one case, a regular cigarette smoker was transported 40 times over a nine-month period for the same complaint. It was finally determined that each incident was preceded by an exposure to superheated Teflon.

With limited exposure, treatment should be supportive, addressing the presenting symptoms. In higher temperature exposures that result in significant symptoms of pulmonary injury, a patient may present with non-cardiogenic pulmonary edema. In these situations, treatment is focused on the presenting condition; follow local treatment guidelines.

Though the incidence of Polymer Fume Fever is low, it is always wise to have a little additional information available when the situation arises. Incidents involving a burnt pot may not appear to require respiratory protection. However, subsequent flu-like symptoms in crew members should be considered signs and symptoms associated with exposure.

This is yet another example of the dangers associated with a “food on the stove” scenario. Special attention should be given to the use of respiratory protection on every one of these incidents.

References

1.    Shusterman, DJ. “Polymer fume fever and other fluorocarbon pyrolysis-related syndromes,” Occup Med. 1993 Jul-Sep;8(3):519-31.

2.    Rask-Anderson A. “Inhalation Fever.” On-line, accessed September 15, 2012 at www.haz-map.com/inhalati.htm.

3.    “Right Diagnosis. Polymer Fume Fever.” On-line, accessed September 15, 2012 at www.rightdiagnosis.com/p/polymer_fume_fever/intro.htm.

 

Mick Messoline has been in the fire service since 1985. A paramedic and an educator, he has worked for the Denver Paramedics, Sacramento (CA) Fire Department, and Sacramento State University. He is a firefighter in Thornton, Colorado.

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