Approximately 1 million persons in the United States receive long-term oxygen therapy (LTOT) annually through the Medicare program, most often for smoking-related lung disease. At 2:10 a.m. on December 14, 2007, a fire occurred in a public housing project for the elderly in Westbrook, Maine. Approximately 60 residents were evacuated; six were transported to a hospital for smoke inhalation. The fire was caused unintentionally by a woman aged 57 years who was an overnight guest of a relative who lived in the housing project. The visitor had ignited the fire while simultaneously smoking and using an oxygen concentrator. After this incident, the Maine Department of Health and Human Services, in collaboration with three other states, attempted to determine 1) how often this type of event results in fatalities and 2) factors common to these incidents that might be amenable to prevention. This report describes the results of that study, which found that, during 2000-2007, of the 38 deaths identified in the four states, 37 occurred in private residences, and the median age of the decedents was 67 years. Prevention of this type of fatality is dependent on smoking cessation, careful assessment of the need for LTOT, and strategies to prevent injuries from fires, such as smoke alarms and sprinklers.