BACKGROUND Fires are a leading cause of death, but non-fatal injuries from residential fires have not been well characterised. METHODS To identify residential fire injuries that resulted in an emergency department visit, hospitalisation, or death, computerised databases from emergency departments, hospitals, ambulance and helicopter services, the fire department, and the health department, and paper records from the local coroner and fire stations were screened in a deprived urban area between June 1996 and May 1997. RESULT There were 131 fire related injuries, primarily smoke inhalation (76%), an incidence of 36 (95% confidence interval (CI) 30 to 42)/100,000 person years. Forty one patients (32%) were hospitalised (11 (95% CI 8 to 15)/100,000 person years) and three people (2%) died (0.8 (95% CI 0.2 to 2.4)/100,000 person years). Injury rates were highest in those 0-4 (68 (95% CI 39 to 112)/100,000 person years) and > or = 85 years (90 (95% CI 29 to 213)/100,000 person years). Rates did not vary by sex. Leading causes of injury were unintentional house fires (63%), assault (8%), clothing and nightwear ignition (6%), and controlled fires (for example, gas burners) (4%). Cooking (31%) and smoker's materials (18%) were leading fire sources. CONCLUSIONS Because of the varied causes of fire and flame injuries, it is likely that diverse interventions, targeted to those at highest risk, that is, the elderly, young children, and the poor, may be required to address this important public health problem.