Where There's Smoke, There's.…
Article Outline
According to ECRI, an independent, nonprofit, health services research agency, approximately 100 surgical fires occur each year, resulting in up to 20 serious injuries and one or two deaths annually.1 These numbers may seem small compared to the number of procedures performed, and the possibility of a fire may seem remote from our clinical practice. After all, if we are expert clinicians, it cannot happen to us, right?
Well, last year, our hospital experienced a fire in the OR. Fortunately, no patient or staff member was harmed. The fire was caused by an electrical short in a surgical column (ie, boom) that was located next to the anesthesia machine—close to where the patient's head would have been, close to where the anesthesia care provider would have been standing, and closer yet to the oxygen supply. No one was in the room at the time, so no one was injured. We were fortunate.
Because this is a level I trauma center, running 24 hours a day, seven days a week, we could easily have had a patient and personnel in that room. If we had, the unthinkable could have happened. Instead, the room was seriously damaged and placed out of service for weeks, but this was a small price to pay for a very valuable learning experience.
This experience heighted everyone's awareness and made us feel especially vulnerable to the possibility of a very serious, life-threatening event. We also recognized that it is human nature to be complacent when you don't feel vulnerable. We challenge all of you, our colleagues, to think through a mental checklist before and after you enter an OR, considering what you would do in the event of a fire. This extra attention could save a patient's life or even your own.
Questions to Ask Outside the OR
Before entering an OR, survey the hallway. Ask yourself the following questions:
Is the hallway free of clutter?
Hallways in ORs are notorious for being cluttered with patient transport carts, case carts, and equipment needed for the next procedure. This equipment can easily block the access to a fire alarm, extinguisher, oxygen shut-off valve, or fire doors. If your patient or a patient in another OR needs to be evacuated, clutter in the hallway can prevent a timely exit. You may actually need to evacuate in the dark or through smoke, so having the hallway clear is extremely important. If the fire door is blocked, the door will not shut when the alarm sounds, and the benefit of this protection will be gone.
Where is the oxygen shut-off valve?
You may need to find this through a cloud of dense smoke. Medical gas valves may be located together in a hallway near the OR suite or separately located near each OR. Knowing the location can allow you to feel your way to the valve in an emergency. Knowing which valve is for the oxygen and how to turn it off is important. Typically, the valve is turned off by rotating it toward you.
Where is the fire alarm?
Know where it is, so that you can find it in the dark. Know your hospital protocol for communication of a fire, including what number to call and what information to report (eg, Who? What? Where?). You will need to give your name and the event being reported (eg, odor, smoke, flames). Most hospitals require that you state the room number. This may be different from “operating room 3,” because this is not meaningful to emergency responders. The specific number should be located over the door.
Where is the hallway fire extinguisher, and what type is it?
Know whether the fire extinguisher can be used for an electrical fire. Fire hoses are rarely kept in OR suites. Carbon dioxide and water extinguishers are preferred.
Questions to Ask in the OR
After you enter the OR, think through the fire triangle (ie, oxidizers, ignition sources, and fuels) and determine how you would put out a fire in this room and evacuate if necessary. Ask yourself the following questions:
Where is the fire extinguisher in the OR, and what type is it?
Know what type of fire extinguisher you have and whether it can be used for an electrical fire. The extinguishers in most ORs are carbon dioxide or water. Carbon dioxide can be used for class A fires (eg, drapes) as well as class C fires (ie, electrical fires). Water extinguishers cannot be used on electrical equipment that is on fire (eg, electrosurgical units, lasers).
How do you operate the fire extinguisher?
The acronym PASS is sometimes used for
Is the path to the extinguisher accessible?
During procedures, ORs contain a tremendous amount of fixed and portable equipment. Electrical cords often cross over traffic pathways. Fire extinguishers are usually located inside a wall cabinet. Equipment or cords blocking the path to the extinguisher can cause you to be injured or lose precious moments while you are trying access this emergency equipment. Equipment preventing the cabinet door from opening will also cause a delay.
Is there saline on the sterile field?
Twenty-six percent of surgical fires occur on the patient surface.1 In case of these and other fires on the surgical field, quick action on the part of the scrub person will help to reduce injury and further complications. Saline should be available on the sterile field before the surgery starts. Pouring this saline on a nonelectrical fire is the first step toward containing it. Twenty-one percent of surgical fires involve the airway or oropharynx.1 Saline drawn up in a syringe before these procedures can be used to rapidly extinguish a fire in this location. Eight percent of surgical fires are actually inside the patient.1 Having the saline readily available can minimize patient injury.
Where is the self-inflating ambu bag?
This emergency equipment may be needed if you turn off the oxygen to the room or evacuate.
Where is the flashlight?
If you are evacuating through smoke, you will need to be able to find the flashlight without seeing it.
How would you evacuate from this OR?
Think about changing the patient's position to evacuate. For positions other than supine, this may be complex. Determine whether you will use the transport cart or the surgical bed to transport the patient. Locate your nearest exits. The smoke resulting from burning surgical drapes may be very dense and could hinder even the smallest actions. Consider where to go, and know where the staging area is.
Be Prepared
It is so easy to be cavalier—and so dangerous. Our recent experience has provided us with valuable insight into our own vulnerability. The experience also has enhanced our collaboration with personnel in other disciplines to improve our fire safety program and the interdisciplinary nature of our fire drills. Thinking through the emergency response to a fire should be an automatic process for every perioperative nurse as he or she walks to and enters an OR.
Reference
Resources
- AORN guidance statement: Fire prevention in the operating room . In: Perioperative Standards and Recommended Practices . Denver, CO: AORN, Inc; 2009;p. 195–203
- Fire safety in perioperative settings [OR Product Directory] . AORN J . 2007;86(Suppl 1):S141–S145
- Fire Safety Toolkit. AORN, Inc . http://www.aorn.org/PracticeResources/ToolKits/FireSafetyToolKit Accessed March 6, 2009.
- . Fire in the OR—developing a fire safety plan . AORN J . 2004;79(3):588–600
- . Fire in the OR—prevention and preparedness . AORN J . 2004;80(1):42–54
PII: S0001-2092(09)00261-0
doi:10.1016/j.aorn.2009.04.003
© 2009 AORN, Inc. Published by Elsevier Inc All rights reserved.
