Fire Safety in the OR

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Fire Safety in the OR

• Franklin L. Scamman

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Reference

• Practice Advisory for the Prevention and
  Management of Operating Fires
• Anesthesiology 2008 108786-801 (May 2008)

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Triangle of Fire
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Types of Fuel

• Type A wood, paper
• Type B oil, grease, alcohol, ether, benzoin
• Type C electrical
• Type D nuclear

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Types of Oxidizer

• Oxygen
• Nitrous Oxide
• Potassium Permanganate
• Ammonium Nitrate

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Types of Heat

• Electrosurgical Unit (Bovie)
• Fiberoptic light cables
• Laser
• Hot-wire cautery
• Sparks

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Types of OR Fires

• Surgical fire on or in a patient
• Airway fire
• Circle fire

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High Risk Procedure

• All 3 elements are in proximity
• tonsillectomy, tracheostomy, removal of laryngeal
  papillomas, cataract or other eye surgery, burr
  hole surgery, or removal of lesions on the head,
  neck, or face.

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OR Fire Drill

• A formal and periodic rehearsal of the OR teams
  planned response to a fire
• It takes place during dedicated education time,
  not during patient care
• Every anesthesiologist should have knowledge of
  institutional fire safety protocols for the OR,
  and should participate in OR fire safety education

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Advisory Statement

• All anesthesiologists should have fire safety
  education, specifically for OR fires, with
  emphasis on the risk created by an oxidizer-
  enriched atmosphere

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Advisory Statement

• Anesthesiologists should periodically participate
  in OR fire drills with the entire OR team. This
  formal rehearsal should take place during
  dedicated educational time, not during patient
  care.

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Advisory Statement

• For every case, the anesthetist should
  participate with the entire OR team in
  determining whether a high-risk situation exists.
  All team members should take a joint and active
  role in agreeing on how a fire will be prevented
  and managed. Each team member should be assigned
  a specific fire-management task and do that task
  immediately if fire occurs.

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Advisory Statement

• There should be free discussion to minimize the
  presence of an oxidizer-enriched atmosphere to an
  ignition source.
• Surgical drapes should minimize the accumulation
  of oxidizer.
• Flammable skin prepping solutions should be
  allowed to dry prior to draping.
• Gauze and sponges should be moistened when used
  in proximity to an ignition source.

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Management of Fire(Per Fire Department)

• RACE
• Remove the patient from the fire
• Alarm - call 195 or pull a fire alarm
• Contain the fire if conditions permit (close
  doors)
• Extinguish the fire if conditions permit

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Management of Airway Fire(Per ASA)

• Announce Fire and halt procedure.
• Remove burning endotracheal tube
• Stop the flow of all airway gases
• Remove all flammable and burning materials from
  the airway
• Pour saline into airway to extinguish embers
• Consider rigid bronchoscopy

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Management of OR Fire Elsewhere

• Remove burning materials and extinguish fire with
  saline
• Team members should perform predetermined tasks
  without waiting for others to act
• If fire not extinguished, consider use of CO2
  fire extinguisher, activating alarm, evacuating
  patient, closing OR door and turning off medical
  gas supply

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Types of Fire Extinguishers

• Pressurized Water
• Good for type A fuels wood, paper
• Dry Chemical
• Good for type B and C fuels oil, grease,
  electrical
• Carbon Dioxide
• Good for type A, B, and C fuels

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Location of OR Fire Extinguishers

• Behind the main doors to each OR
• Exception is OR 14 where they are on the north
  wall

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Location of fire extinguishers in OR
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What is in a Fire Cabinet?

• Pressurized Water Extinguisher
• Carbon Dioxide Extinguisher
• Fire hoses were eliminated 6 years ago because
  they were never used and expensive to maintain

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