Never say never. Negligible carboxyhemoglobin in the victim of a smoldering mattress fire

For many years, a high blood carboxyhemoglobin concentration has been used as a criterion for determining that a victim of conflagration was alive in the fire. We report a case in which a man died from the combined effects of burns and hypertensive cardiovascular disease. He had a negligible blood carboxyhemoglobin concentration, but the environmental evidence and autopsy findings are indicative of life in the fire, which arose in a smoldering mattress. We conclude that uncritical, rigid adherence to the requirement that fire victims have high carboxyhemoglobin concentrations can be misleading.