Surgical Fires

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Surgical Fires

• The basics of
• preventing and responding to
• fires in the operating room

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Presented for
Presented by OmniSure Consulting
Group Kathleen Fitzgerald, RN, BSN Risk
Management Consultant
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Objectives

• Identify the 3 elements necessary to create fire
• Discuss the specifics of the chemistry of fire in
  the surgical setting
• Identify methods of preventing surgical fires
• Review the basics of an adequate fire drill
  program in the surgical setting

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The Stats

• About 65 million surgical cases per year in the
  United States
• 550-600 surgical fires in the United States
  annually (comparable to wrong site surgeries)
• Surgical fires cause 2 to 3 patient deaths and
  approximately 20 serious injuries annually
• About 75 of surgical fires occur under local and
  are caused by oxygen trapped under the drapes

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THE FIRE TRIANGLE
OXYGEN plus HEAT plus FUEL
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ALL THREE ELEMENTS MUST BE PRESENT TO CAUSE FIRE
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THE CHEMISTRY OF FIRE IN THE OR

• Anesthesia Providers Oxidizers
• O2, N2O, medical compressed air, and
  ambient air
• Surgeons Ignition Sources
• defibrillators, lasers, electrocautery
  units, and fiber-optic light sources, electronic
  scalpels
• Nurses Fuels
• drapes and preps, gowns, towels and sponges
  (other fuels hair, intestinal gases and body
  tissue)

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OR Fire PreventionDisrupting the Fire Triangle

• Control Heat Sources
• Follow laser and ESU safety
  practices
• Manage Fuels
• Allow prep to dry
• Minimize Oxygen Concentration
• Careful use of oxygen and avoid
  tenting drapes
• Be Consistent
• Prevention methods must be
  practiced and consistently used to
• be effective.

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O.R. Fire PlansTHE 1, 2, 3

• Develop a department-specific process
• Extinguish
• Evacuate
• Practice

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R. A. C. E.

• R Rescue
• A Alert Staff Activate Alarm
• C Confine Smoke Fire
• E Evacuate

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EXTINGUISHERS

• CARBON DIOXIDE PREFERRED IN THE SURGICAL SETTING

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P. A. S. S.

• P Pull
• A Aim
• S Squeeze
• S Sweep

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Elements of an Effective Fire Plan

• Conduct fire drills
• Train staff in the location use of
  fire-fighting equipment
• Identify the location of gas, ventilation, and
  electrical controls
• Define the operation of the centers alarm system
  and the system for contacting the fire department

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Elements of an Effective Fire Plan Continued

• Review and discuss unique hazards in surgical
  areas
• Practice fire prevention techniques and
  precautions
• Educate and re-educate staff to the OR-specific
  fire plan, the roles of personnel, the locations
  and operation of alarms, extinguishers, exits,
  etc.

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Elements of an Effective Fire Plan Continued

• Question the use of 100 O2 for open delivery
  during facial surgery
• Do not apply drapes until all flammable preps
  have completely dried.

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Examples of High Risk Procedures

• Heat, Oxygen and Fuel are in
• Close Proximity
• Tonsillectomy
• Tracheostomy
• Laryngeal surgeries
• Mouth and nose surgeries
• Eye surgeries
• Head, neck, and facial surgeries

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Management of Fire on the Patient General
Principles

• SMALL FIRES
• Smother the fire and/or remove the
  burning material.
• LARGE FIRES
• Stop the flow of gases.
• Remove the burning materials.
• Extinguish the fire.
• Ventilate the patient.
• Call for help.
• Evacuate, if necessary.
• Examine and treat the patient.
• Dont forget to save equipment, materials and
  devices for risk management/patient safety
  investigation

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Controlling Heat

• Keep ESU tips clean
• Holster the ESU when not in use
• Use nonflammable drapes and moist towels around a
  laser surgical site
• Deactivate lasers, etc. when not in use in the
  surgical field

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Controlling Fuels

• Ensure preps are dry so that alcohol vapors will
  not collect under the drapes.
• Containers of volatile solutions (alcohol,
  acetone, etc.) should be closed soon as possible.
  
• Avoid petroleum-based ointments.
• During local or conscious sedation, turn off
  oxygen 60 seconds prior to activation of ESU or
  Laser if used on the head or neck

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Controlling Oxygen Concentration.

• Avoid using plastic bags to cover the patient
• Drape so as to allow for the venting of oxidant
  and to prevent accumulation
• Place evacuation suction under drapes

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What Do We Do If The Patient is on Fire?
REMEMBER FIRE SPREADS QUICKLY, SO YOU MUST
RESPOND QUICKLY 1. Immediately remove burning
materials from patient 2. Shut off medical gases
manually ventilate, if necessary 3. Anesthesia
disconnects patient from oxygen source 4. Smother
fire. Use fire blanket, if necessary. 5. Move
patient to safe area where oxygen may be
administered
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Airway Fire What Do We Do?
IN RAPID SEQUENCE 1. Disconnect breathing
circuit from endotracheal tube and stop the flow
of airway gases 2. Remove tube extinguish
burning material 3. Examine airway and remove any
debris if necessary, pour saline down the
airway 4. Re-establish airway. Ventilate with
air 5. Examine airway and treat injuries
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ROLES OF OPERATING ROOM STAFF DURING FIRE IN
AND/OR ON THE PATIENT
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Anesthesiologist

• Turns off oxygen or nitrous
• Ventilates using air
• Controls IV to maintain anesthesia
• Maintains ABCs

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Surgeon

• Manages moving the patient and controls the
  surgical site

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Scrub Nurse

• Places surgical instruments in a tray and on
  patient
• Assists in moving patient out of the OR

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Circulating Nurse

• Disconnects patient leads, lines
• Disconnects anesthesia gas lines and unplugs
  equipment and monitors
• Assists anesthesiologist with ventilation
• Moves anesthesia machine if necessary

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Assisting Surgeon and Others

• Assists in moving patient out of the OR as
  directed by surgeon

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KEY POINTS

• Understand the Fire Triangle (PREVENTION)
• Understand the chemistry of potential fires in
  the OR (INTERRUPTION)
• Know the roles of each team member in a fire
  emergency (RESPONSE)
• Practice
• Practice
• Practice

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RESOURCES

• ECRI
• Joint Commission
• ANSI

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QUESTIONS
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Admirals Website Link Surgery Centers Solutions

• www.omnisure.com/admiralins-asc.html

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Kathys Bio

• Ms. Fitzgerald was awarded a Bachelor of Science
  in Nursing with
• honors from Indiana University Southeast in 1986.
  She was named
• Nursing Student of the Year in 1986.
• Her professional experience includes 24 years of
  nursing practice in clinical,
• leadership and management roles. This experience
  encompasses Healthcare
• Risk Management, Medical Liability Claims,
  Patient Safety, Legal Nurse
• Consulting, In-house Defense Medical Malpractice,
  Operating Room Nursing,
• Dialysis, Labor and Delivery, Hospice and
  Psychiatry. 
• Ms. Fitzgerald also designs and presents risk
  management training programs for
• healthcare providers. She has worked for
  hospitals, long term care providers
• insurance companies, law firms, individual
  attorneys, and claims managers.
• Her work has allowed her to attend and assist in
  the preparation for trials, mediations
• and depositions. Proactively, she has assisted
  healthcare providers to promote
• Patient Safety, and to successfully identify,
  address and manage risks.