Fire Safety in the OR

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					Fire Safety in the OR

  Franklin L. Scamman
• Practice Advisory for the Prevention and
  Management of Operating Fires
• Anesthesiology 2008; 108:786-801 (May
Triangle of Fire
               Types of Fuel
•   Type A: wood, paper
•   Type B: oil, grease, alcohol, ether, benzoin
•   Type C: electrical
•   Type D: nuclear
           Types of Oxidizer
•   Oxygen
•   Nitrous Oxide
•   Potassium Permanganate
•   Ammonium Nitrate
               Types of Heat
•   Electrosurgical Unit (Bovie)
•   Fiberoptic light cables
•   Laser
•   Hot-wire cautery
•   Sparks
           Types of OR Fires
• Surgical fire – on or in a patient
• Airway fire
• Circle fire
        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.
            OR Fire Drill
• A formal and periodic rehearsal of the
  OR team’s 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
        Advisory Statement
• All anesthesiologists should have fire
  safety education, specifically for OR
  fires, with emphasis on the risk created
  by an oxidizer- enriched atmosphere
        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
         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.
         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
         Management of Fire
        (Per Fire Department)
• Remove the patient from the fire
• Alarm - call 195 or pull a fire alarm
• Contain the fire if conditions permit (close
• Extinguish the fire if conditions permit
     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
• Consider rigid bronchoscopy
      Management of OR Fire
• 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
   Types of Fire Extinguishers
• Pressurized Water
  – Good for type A fuels: wood, paper
• Dry Chemical
  – Good for type B and C fuels: oil, grease,
• Carbon Dioxide
  – Good for type A, B, and C fuels
        Location of OR Fire
• Behind the main doors to each OR
• Exception is OR 14 where they are on the
  north wall
Location of fire extinguishers in OR
     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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