A preliminary investigation found that a fire in an ambulance outside a Kailua hospital, killing a patient and injuring a paramedic, was an accident and was probably caused by an oxygen explosion, city officials said Wednesday.

The patient, Waimanalo resident Fred Kaneshiro, died in the fire, trapped inside the ambulance.

On the evening of Aug. 24, two city paramedics were transporting Kaneshiro to Adventist Health Castle Hospital by ambulance. He was receiving oxygen treatment. The ambulance was parked in the driveway outside the hospital and health workers were in the process of transferring Kaneshiro into the emergency room when the explosion erupted.

Ambulance Fire Review, Ambulance Oxygen equipment, Honolulu EMS Director Dr. Jim Ireland, Honolulu Police Chief Arthur "Joe" Logan and Ocean Safety Lifeguard Deputy Director Ian Santee, explain the Oxygen equipment found in Honolulu EMS ambulances
Jim Ireland, Honolulu emergency services director, right, Police Chief Joe Logan, center, and Ocean Safety Lifeguard Deputy Director Ian Santee, left, explain the ambulance oxygen system. David Croxford/Civil Beat/2022

Jim Ireland, director of the Honolulu Emergency Services Department, said that investigators spoke to the two paramedics and both mentioned a “sound described as a pop, followed by a bright flash of light” and said that the back of the ambulance immediately filled with smoke and fire.

Investigators believe the explosion occurred when the paramedics were transferring the oxygen line from a unit inside the ambulance to a portable oxygen cylinder, which was needed to maintain the patient’s steady supply of oxygen. They identified the oxygen regulator assembly as the likely cause of the conflagration.

Once the fire broke out, there was no containing it, they said.

“It was an overwhelming fire beyond fire extinguisher capabilities,” Ireland said.

Paramedic Jeff Wilkinson was badly injured in the fire but is recovering, Ireland said.

There are no indications that staff actions contributed to the fire, Ireland said. He said that emergency workers typically check their equipment for safety issues on a daily basis.

The exact cause of the explosion remains unknown, officials said.

The Honolulu Police Department and Fire Department have collaborated on the investigation, which is ongoing.

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