Appendix D.

Case Study

By Jackie Moore, MPH


The population that I worked with was the Eastern band of Cherokee Indians. It's located in the western part of North Carolina in the Great Smoky Mountains National Park. It borders the park basically. The population is about 9,000 that we serve.

We got interested in doing this particular project on fire burn injuries because we know that in North Carolina, burn injuries are a problem, but more importantly we looked at our local data. In the four year period from 1986 to 1990 we had approximately 1,006 fire burn related injuries present in the local hospital emergency room. We also did a door to door study where we found that there were 80 percent of the homes heated with wood burning stoves-their main source of heat in the winter months was utilization of wood burning stoves which created also a house fire problem. There was a lot of creosote build-up in the chimneys and those sort of things that wasn't cleaned out so we know that we had the fires located from the wood burning stoves.

Specific activities

I think it's important to start before we started any activities - we got a local coalition started. We used the volunteers from the community from every resource we had. From hospitals to day cares, to fire departments, police departments, all entities, anyone that was interested. Senior citizens, head start centers, schools, there were a lot of representatives from the park service, for example. Local businesses even participated. But we got the coalition going and we looked at three different components to the program.

We looked at the environmental modifications. That was one of the main things that we did and we went into the homes and we made sure that all the homes had working, operable smoke detectors, many of the homes did not have them and we made sure that they were installed appropriately and the ones that did have the smoke detectors we made sure that the batteries were working.

After the smoke detectors we also installed fire extinguishers because many of the homes at one point had one entrance. They were saltbox type houses that had two stories but one entrance and one exit-there was no back door. So before we could do our main modification, we installed the extinguishers in the homes and then we worked with the housing and a lot of different resources to go in and re-vamp these homes to make secondary escape routes. Also some of the building materials that were in the stairwells were modified for the structure to be more fire proof.

This is where we went into the schools and worked with the children. There are a lot of really great programs on the market to raise the education and the awareness. The "Learn not to Burn" programs, we utilized the children's fire safety house.

We also used a lot of marketing techniques as far as putting public service announcements (PSAs) together. The local youth at the high schools got together and developed their own PSA for these type of programs that we were having. Before we could do the initial modification of changing the secondary escape routes, we had escape ladders. And the high school students, a really fun thing that they did, was that there was a window developed that was a standard window that fit all the homes and they had the parents come by and before you could receive your escape ladder you had to climb up this ladder and demonstrate how to install one of these escape ladders and climb through the window and the senior high SADD chapter, and some of the high school students participated in this, made a PSA and aired it on a local cable vision network. That was kind of neat.

Environmental Modifications

I think one of the most successful strategies that we used -- all three were very successful but one of them that made a difference -- was the environmental modification. We made sure that the houses were equipped with operable, working smoke detectors.

Also, a lot of the newer homes that were built had electrically wired smoke detectors. In the part of the area, especially in the winter months, the power goes out quite a bit. So we also put in secondary smoke detectors that were battery operated-it was important to have these we felt because of the power surges and the power outages many of the times. We also made sure that the houses had fire extinguishers as well as escape ladders. The escape ladders because several of the homes were two story type homes that did not have a secondary escape route. There was the front door and that was entrance and the exit, that was it.

Later on in the program we were able to do a modification of the individual homes where we were able to look at the stairwell material, which was substandard and we were able to put in better material for the stairwells with a longer burn time and also the houses were modified and the housing code to have a secondary escape route. In other words a secondary door was placed upstairs with a stairwell along the side of the home.

We also had chimneys that were cleaned and this was a main source of the problem as far as the wood stove fires, the creosote build-up was a major problem in the chimneys. So the fire department went around with their volunteers, cleaned the chimneys free of charge and community members gave small donations and it kept them furnished with the brushes and tools that they needed to go around the community and do this. Those were the main environmental modifications over a period of time that we covered.


We used marketing techniques to get the awareness level up n the community. We used public service announcements developed by the students and aired them on the television. We used various fact sheets and flyers and we also made an appearance at seven different community clubs. The reservation itself is divided amongst seven areas. We know the culture that if we go when people are having a community meal that we can present a program and as part of the culture we presented ourselves at that meeting when they had their community meal and everybody was there to listen and to learn something new.

And it worked very well. Everybody was very open minded and interested in what we had to say. But we performed educational programs and awareness programs at the various community clubs. And we also went into the schools as well as head start systems and utilizes the junior high and the high school students in our endeavors to raise the awareness. So basically all entities from the very young to the elders were involved in this project.


Basically the housing code was modified with the substandard materials that were being used and also making sure that we had different escape routes; a secondary exit mainly. The tribe passed what was called a tribal resolution. This is very similar to a state law; they have a tribal council that vote on this particular issue and if passed and approved by the chief as the president, then it is passed and it is sort of the law for the reservation. There was a tribal resolution passed to support this particular project in all entities and all avenues.


When we went in and evaluated the program from 1986 to 1990, we looked at the reported house fire calls and we found that the house fire calls had been reduced about 21.8% and we also looked at the burn rates from the four year period. We found that the burns had reduced about 26%. So we found the program, we felt, very effective, utilizing the three strategies: environmental modifications, education and policies that we used in the housing codes.

The small success that we had in the community -- where you could start small and build the momentum -- led people to larger and larger projects. We have been involved in a variety of other things from pedestrian projects and walkway systems to child passenger safety initiatives. Tribes have gotten the belt use over 90% for adult occupants. On the reservation, this was quite a leap for the state, before the state caught up. The tribe feels that these short successes really allowed us the stepping stones for further things and that nothing was too great for them to tackle after this.

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