My neighbor was burned when she being operated on in a hospital. How did that happen? Can these type of fires be prevented?
Approximately 600 – 650 people are injured each year in operating room fires. Consequences of a surgical fire can be deadly or leave people with horrible pain and disfiguring scars. Fires can occur in any setting where invasive surgical procedures are performed. Experts indicate that the basic principle to remember is that people start most fires, and people can prevent them.
This has been a problem for many years. This article from a 1994 edition of Today’s OR Nurse tells us that (1) Every operating room has the elements necessary to start a fire: oxidants (O2, N2O), ignition sources, and fuel; (2) A team approach, including nursing, anesthesia and surgery members, should be used in assessing fire safety in the operating room; (3) Staff knowledge of fire safety can be assessed by written tests. An appropriate fire safety program can be developed based on the test results; (4) Fire evacuation drills and hands-on use of fire extinguishers should be included in any OR fire safety program. Now, almost 20 years later, fires continue to occur.
In October 2011 the FDA launched a new initiative to prevent surgical fires, noting that though these are rare events, they are also highly preventable. The agency convened a special workshop to look for ways to stop fires from ever happening and to give medical personnel the tools and knowledge needed to deal with a fire if one occurs.
The FDA reports that
The Anesthesia Patient Safety Foundation (APSF) says the vast majority of these fires are preventable. With the assistance of ECRI Institute, APSF recently produced a video about why operating room fires occur and the "best practices" to keep them from happening. The video describes the "Surgical Fire Triangle", when an ignition source, a fuel, and oxygen come together.
APSF says that the majority of OR fires occur when high oxygen concentrations are present, particularly in procedures involving the head, neck and upper chest.
An enriched oxygen environment occurs when the concentration of oxygen exceeds that of ordinary room air. APSF says that it is vital for OR personnel to consider whether supplemental oxygen is really necessary for each patient, and describes precautions to take if it is. For example, avoid using an open delivery source such as a nasal cannula.
Ignition sources, like electrosurgical pencils and lasers, form another leg of the "Surgical Fire Triangle". Fuel sources, such as drapes and alcohol-based prep solutions, complete the triangle.
The Anesthesia Patient Safety Foundation (ANSF) has produced an 18-minute long video, Prevention and Management of Operating Room Fires, which was released in February 2010. Watch the video here.
The ANSF says as follows:
The most notable finding when cases of operating room fires are reviewed is that most if not all are preventable! This video is intended to promote the best practices known to prevent the potentially devastating complication of a fire in the operating room. Each member of the operating room care team has a role to play in preventing operating room fires. The following commentaries are intended to put the recommendations in the video into the context of current practice.
The ANSF tells anesthesia professionals that:
Minimizing or eliminating enriched oxygen delivery is fundamental to preventing operating room fires. An increased oxygen concentration in the surgical field is either a direct cause or a significant factor in many operating room fires – particularly procedures involving the head, neck, and upper chest.
The recommendation to eliminate open delivery of oxygen when sedating patients is the most striking practice change advocated in the fire prevention video. This is particularly a consideration for anesthesia professionals since they typically control oxygen administration. For most anesthesia professionals, oxygen administration by nasal cannula or mask (open oxygen delivery) is routine when providing sedation, and is a fundamental strategy for preventing hypoxemia. The recommendations in the video can help the anesthesia professional balance the risks and benefits of oxygen delivery for the individual patient. For patients in whom an increased oxygen concentration cannot be avoided, the video describes strategies that can minimize the risk of an operating room fire.
Surgeries performed by ENTS (otolaryngologists) are associated with the greatest risk of fire. Why? The ANSF says that "[m]ost procedures by otolaryngologists are associated with a fire risk due to the close proximity to the airway where oxygen enriched gases and/or nitrous oxide are often present, and the use of surgical devices which can ignite a fire. Endoscopic airway surgery, oropharyngeal surgery, cutaneous surgery of the head and neck and tracheostomy all present a risk of operating room fire for the Otolaryngologist." The ANSF has provided ENTS with tips on how to avoid burn injuries to patients.
It is important for anyone who receives serious burn injuries as a result of a operating room fire to seek the advice of an experience burn injury lawyer as soon as possible. Our office offers free consultation in burn injury cases (as well as all types of personal injury and wrongful death cases) and will accept cases on a contingent fee basis. You can contact me at 615.742.4880 or toll-free at 877.812.8787.