Background Sweden has a national vision zero policy on fire. Nobody should be killed or seriously injured from fires. Despite this, some 100 people are killed annually with most victims being of poor health, elderly or disabled. A recently completed multi-center project 2014–2017 aimed to investigate why these groups are at excessive risk in case of residential fires, and to explore further preventative possibilities with regard to these vulnerable groups.

Methods The project included seven work packages related to a generic model of the residential fire process. Quantitative and qualitative approaches were applied.

Results By January 31 the project has yielded 10 international scientific publications, plus 5 submitted. Main results indicate:

A declining long-term trend in fire fatalities is underway, both in Sweden and globally.

Residential fires are common, usually extinguished by the residents themselves. Deaths and serious injuries from these are proportionally rare.

Groups at risk are characterized by impaired capacity to respond to and escape fires, not by elevated frequency of fires.

Injury and death occur rapidly, usually due to intoxication in case of deaths. Even minor fires cause fatalities (e.g. in clothing and furniture).

Rescue services have limited possibilities to intervene in time.

Smoking, alcohol and medicines are associated factors. Self-extinguishing cigarettes are shown ineffective.

Conclusions Crucial for survival in case of residential fire is the individual’s own capacity to respond properly, leaving vulnerable groups with little or no protection. Since vulnerability due to age, illness and disability is a growing concern in modern societies, the development of innovative fire safety systems and safer housing solutions for people with special needs appears urgent.