FIRE POTENTIAL, PREVENTION

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FIRE POTENTIAL, PREVENTION RESPONSEINOPERATING
ROOMS

• David M. Sine, CSP, OHST
• Vice President, Occupational Health and Safety
• Tenet Health System, Western Division
• 3 Imperial Promenade, Suite 600
• Santa Ana, CA 92707

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OR Fire Potential, Prevention Response

• Todays Objectives
• 1. Heighten awareness of O.R. fire issues
• 2. Discuss unique fire hazards in O.R. settings
  and fire prevention methods
• 3. Provide specific response protocols for the
  O.R. employees and staff

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Scope of OR Fire Problem in US Hospitals

• Fire erupts in 100 of the 25 million surgeries
  performed in the United States each year
• Those fires cause 2 to 3 patient deaths and 20
  serious injuries each year
• No national reporting system

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Unique OR Fire Related Concerns
1. Medical gas enriched environment (O2-
N2O) 2. Commonly used surgical instruments can
be sources of heat/ignition 3. Vulnerability of
patients Statistically speaking, the occurrence
of O.R. fires is not likely. However, the
magnitude of the consequences of an O.R. fire is
very significant Severe burns, gas inhalation,
trachea and lung damage, even death!
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Examples of Operating Room Fires

• 1. May 28, 1990 a fire occurred in O.R. 8 At
  UCLA hospital.
• The ignition source was a discarded surgical unit
  pencil (still connected to electrical power).
• Ambient O2 enhanced magnitude of flames.
• 2. Fire extinguished by O.R staff prior to
  arrival of FD
• 3. Patient declared dead after arrival of F.D.
• 4. Significant recommendations made after
  investigation

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Examples of Operating Room Fires

• 1. A patient was prepped for an emergency
  c-section using a mixture of Betadine and
  alcohol.
• 2. The solution, which had pooled in the
  patients navel, was ignited by an ECU. The
  burning liquid ignited the surgical drapes.
• 3. The fire was extinguished by staff. The
  patient received 2nd and 3rd degree burns. The
  infant was not harmed.

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Examples of Operating Room Fires

• 1. On October 6, 1988 a fire occurred in room
  4225 of the NICU at Cedars Sinai Medical Center
  during a surgical procedure.
• 2. A 19 day-old infant was killed when
  surgical drape coverings were ignited by the
  spark of an ECU.
• 3. Fire investigators believe that a flash
  fire occurred due to the oxygen enriched
  atmosphere beneath the surgical drape coverings

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Operating Room Fires What the Record Tells Us

• Lasers, cauteries, electronic scalpels and other
  devices could produce enough spark or arcs to
  ignite drapes, tubing, etc.
• If endotrach supplying oxygen is touched off with
  a hot instrument, the results could be likened to
  a flame being applied to the lungs
• Abundant fuel sources in the O.R. such as
  antiseptic agents, drapes, tubing, surgical glue,
  lanugo and other hair

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O.R. Fire Plans What the JCAHO tells us

• EC.1.7 requires education in specific roles and
  responsibilities of personnel, physicians, and
  other independent practitioners at a fires point
  of origin
• Same for drills, written plans, education
• Department Specific

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O.R. Fire Prevention Preoperative Procedures

• Assess flammability characteristics of all OR
  materials and products
• NFPA 702 applies to sleepwear
• Clear the the prepped area of all pooled
  solutions
• Avoid using plastic bags to cover the patient
• Place drapes in a manner that allows for the
  venting of oxidant and to prevent accumulation
• Place evacuation suction under drapes
• Have manageable extinguisher available (Halon or
  CO2) in OR
• Fire blankets available
• Humidity equilibrium

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O.R. Fire Prevention Intraoperative Procedures

• Activate ESU only after prep solutions are dry
• Laser switched to stand-by when not in use
• ESU pencils in holsters when not in use
• Non reflective instruments and protected ET tube
  when using lasers
• Water-soluble ointment applied to hair in the
  surgical field
• During local or IV sedation, turn off oxygen 60
  seconds prior to activation of ESU or Laser if
  ignition source is used in the head, neck or
  facial area
• Keep exit path clear

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O.R. Fire Plans The most practiced of drills

• Develop a department specific strategy for
• Extinguishment
• Evacuation
• Practice, Practice, Practice

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O.R Fire Procedures
If a fire is burning directly on a
patient as discussed earlier, in an O2 enriched
situation, FIRE SPREADS RAPIDLY, so, responders
MUST act quickly. 1. Immediately remove burning
materials from patient and.. 2. Shut off medical
gases manually ventilate, if necessary 3.
Disconnect patient from anesthesia in concert
with anesthesia personnel 4. If fire continues,
attempt to smother with linen, drapes, etc. 5.
Move patient to nearest area where o2 may be
administered safely
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Airway Fire What to do
To be performed in RAPID succession 1.
Disconnect breathing circuit from endotracheal
tube 2. Remove tube extinguish burning
material 3. Examine airway and remove any segment
or burnt tube (may smolder) 4. Re-establish
airway. Ventilate with air, initially 5. Examine
airway for damages treat injuries accordingly
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O.R. Fire Plans The most practiced of drills

• Anesthesiologist
• Turn off oxygen or nitrous
• Ventilate using air and use IV to maintain
  anesthesia
• Prepare to and maintain respiration during
  transport

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O.R. Fire Plans The most practiced of drills

• Primary Surgeon
• Responsible for giving final order to move
  patient.
• The surgeon is responsible for operative zone and
  control of the surgical wound.
• Surgeon directs and assists movement of the
  operating table and patient out of the OR to area
  of refuge

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O.R. Fire Plans The most practiced of drills

• Scrub Nurse
• Responsible for gathering necessary surgical
  instruments in a tray and placing tray on
  patient.
• Assists in the movement of the surgical table and
  patient out of the OR

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O.R. Fire Plans The most practiced of drills

• Circulating Nurse
• Disconnects anesthesia gas lines and unplug all
  electrically powered equipment and monitors
• Moves anesthesia machine out of room if this
  becomes necessary
• Disconnects patient leads, lines and gets IVs
  off poles
• Assists anesthesiologist with ventilation

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O.R. Fire Plans The most practiced of drills

• Assisting Surgeon (Resident, PA)
• Moves surgical table and patient at direction of
  surgeon

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Keys to Fire Safety in the O.R

• Recognition and regular discussion of unique
  hazards associated with O.R. and oxygen enriched
  environments
• Consistently practice good fire prevention
  techniques and precautions
• Become familiar with department specific fire
  plans roles of personnel, locations and
  operation of pull stations, extinguishers, exits,
  areas of refuge, etc.
• DRILL and PRACTICE!