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Preventing Surgical Fires with a Surgical Fire Risk Assessment

Darren Osleger

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Aug 8, 2019

Many of us have had surgeries or know someone who has. But did you know that those surgeries can also be conducive for a fire? ECRI Institute estimates around 90-100 surgical fires occur each year in the United States. Surgical fires, though rare, can have devastating consequences for patients, staff, and the reputation of the healthcare facility. However, these fires are preventable. In addition, most healthcare Authorities Having Jurisdiction (AHJ’s) have adopted the 2012 Edition of NFPA 99 that requires hazard assessments and mandatory training for all OR personnel.

Understanding Surgical Fires

Surgical fires are defined as fires that happen in, on or around the patient during a medical or surgical procedure. Some surgical fires last only seconds. Others can grow exponentially occurring in an oxygen-enriched atmosphere, which leads to the many of cases of hospital fires. These fires occur when all three elements of the “fire triangle” are present, including:

  • High concentrations of oxygen (or nitrous oxide)
  • An ignition source (e.g. electrocautery devices, lasers, fiber-optics)
  • A fuel source (e.g. alcohol-based agents, surgical drapes, hair, tissue or skin).

Although rare, these fires can result in severe burns, disfigurement or even death.

How Can Surgical Teams Prevent Fires During Surgery?

Before beginning a procedure and prior to a single incision, the surgical team should conduct a Surgical Fire Risk Assessments (FRA). FRAs can help identify the presence of the three critical elements and easily be incorporated into routine processes that are already in place to identify other perioperative assessments and concerns. For example, after a team has verified the correct surgical site, patient identification and allergies, the Surgical FRA will assess the specific risk factors and include a scoring mechanism to identify the surgery’s fire risk as “high,” “medium,” or “low” risk. The scoring is an important instrument to initiate open communication between the team to ensure the proper fire prevention procedures and risk mitigation strategies are in place.

How Else Can Teams Manage Surgical Fires?

Hospitals and surgery centers need to invest time in education and training in order to ensure staff, surgeons and anesthesia providers are prepared to handle such an event. Different members of the surgical team should know how to suppress various types of surgical fires. For example, an airway fire is almost always handled by the anesthesia provider in the room. The anesthesia provider must stop the flow of oxygen prior to extubating the patient. Failure to do so and extubating prior to stopping the flow of oxygen can cause the fire to burn all the way up the patient’s airway and continue to burn inside the Operating Room.

Facilities should have a process in place to handle the suppression of airway fires, drape fires, prep solution fires and even equipment fires that can occur inside the room. All facilities should train and practice these techniques within their organization.

Evacuation and emergency procedures should have clearly defined roles and responsibilities for each surgical team member to identify how they will assist in the evacuation of the operating room should a fire occur. Proper evacuation sites should be identified and comparable to the operating room environment. For example, if a patient is taken off oxygen, suctioning or monitoring, they need an evacuation site that can accommodate oxygen, suctioning and monitoring.

Surgical fires are a life-changing event; not only for patients but for the staff involved as well. Surgical teams need to know and understand the dangers that surround them during surgery. In this type of fire emergency, surgical staff are truly the first line of defense.

Learn about our surgical fire programs and how to prepare your surgical teams for a fire emergency.