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Surgical Fires. The basics of preventing and responding to fires in the operating room. Presented for:. Presented by: OmniSure Consulting Group Kathleen Fitzgerald, RN, BSN Risk Management Consultant. Identify the 3 elements necessary to create fire

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surgical fires

Surgical Fires

The basics of

preventing and responding to

fires in the operating room

presented for
Presented for:

Presented by:

OmniSure Consulting Group

Kathleen Fitzgerald, RN, BSN

Risk Management Consultant

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

Objectives
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

The Stats
the fire triangle
THE FIRE TRIANGLE

OXYGEN plus

HEAT plus

FUEL

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)

THE CHEMISTRY OF FIRE IN THE OR
or fire prevention disrupting the fire triangle
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.
r a c e
R. A. C. E.
  • R= Rescue
  • A= Alert Staff & Activate Alarm
  • C= Confine Smoke & Fire
  • E= Evacuate
extinguishers
EXTINGUISHERS

CARBON DIOXIDE PREFERRED IN THE SURGICAL SETTING

p a s s
P. A. S. S.
  • P= Pull
  • A = Aim
  • S= Squeeze
  • S= Sweep
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 center’s alarm system and the system for contacting the fire department

Elements of an Effective Fire Plan
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.

Elements of an Effective Fire Plan Continued
elements of an effective fire plan continued15
Question the use of 100% O2 for open delivery during facial surgery

Do not apply drapes until all flammable preps have completely dried.

Elements of an Effective Fire Plan Continued
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

Examples of High Risk Procedures
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.

Don’t forget to save equipment, materials and devices for risk management/patient safety investigation

Management of Fire on the Patient General Principles
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

Controlling Heat
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

Controlling Fuels
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

Controlling Oxygen Concentration.
slide21

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

slide22

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

anesthesiologist
Turns off oxygen or nitrous

Ventilates using air

Controls IV to maintain anesthesia

Maintains ABC’s

Anesthesiologist
circulating nurse
Disconnects patient leads, lines

Disconnects anesthesia gas lines and unplugs equipment and monitors

Assists anesthesiologist with ventilation

Moves anesthesia machine if necessary

Circulating Nurse
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

KEY POINTS
resources
ECRI

Joint Commission

ANSI

RESOURCES
admiral s website link surgery centers solutions
Admiral’s Website Link –Surgery Centers Solutions

www.omnisure.com/admiralins-asc.html

kathy s 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.

Kathy’s Bio