Operating Room Fires

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Most people are aware of some of the common risks of surgery, and hospital informed consent forms routinely warn of the danger of infection, pain, blood clots and the like. With the increase in the use of technology like electrocautery and lasers, however, a new danger is beginning to garner attention: operating room fires.

A recent study determined that surgical fires rank third among the most common types of technology hazards in the OR, and occur between 550 and 650 times each year in the United States. These fires regularly have catastrophic consequences because the most common sites of fires are the head, face, neck, and upper chest areas. Some patients recover with scarring and emotional damage. Others are not so lucky. Every year, 20 to 30 patients suffer serious, disfiguring burns. One or two patients a year die from operating room fires. Despite these numbers, many surgeons and anesthesiologists remain unaware of this potentially devastating surgical complication.

The reason that surgical technology like electrocautery can be so dangerous is that it is an ignition source, and forms one part of the “fire triangle.” As discussed below, the other parts of the triangle – oxygen and fuel – are routinely present during most surgeries. When all three elements combine, disaster can result.

The Fire Triangle
An oxidizer-enriched environment occurs when there is an increase in oxygen concentration above room level, and/or with the presence of a concentration of nitrous oxide. Because oxygen is heavier than air, it can accumulate under a drape and serve as an oxidizing source. Doctors are therefore encouraged to use the least amount of oxygen possible.

When it comes to fuel, the OR is full of options. Drapes, antiseptic skin agents, endotracheal tubes, unshaved hair, masks, and a host of other supplies can easily ignite. Drapes are implicated most often as fuels in OR fires because they are extremely combustible.

In addition to an oxidizer and a fuel source, for an OR fire to start there must also be an ignition source. Electrocautery devices are the most common ignition source as the temperature at the tip of a cautery instrument can reach several hundred degrees. Other ignition sources include lasers, overhead and fiberoptic light sources, drills, and burrs. About seventy percent of OR fires are ignited by electrocautery devices, twenty percent are ignited by hot wires, light sources, burrs or defibrillators, and about ten percent are ignited by lasers.

Preventing Operating Room Fires
There is little doubt that OR fires can easily be prevented. To minimize the risk of these potentially catastrophic fires, hospitals must establish OR fire protocols which educate healthcare professionals regarding the potential of OR fires, require OR fire drills, train healthcare providers to recognize high risk procedures and what must be done to prevent fires during these procedures, and instruct healthcare providers on what must be done to manage an OR fire once one ignites. To be sure, careful coordination and continuous training for all healthcare professionals is required to minimize the possibility of OR fires.

To improve fire safety awareness, anesthesiologists and surgeons must be trained to understand the concepts of fire potential and use techniques to minimize oxidizer-enriched atmospheres, safely manage ignition sources, and safely manage fuel sources. Good communication between surgeons and anesthesiologists regarding the timing and use of the electrocautery or other ignition sources is crucial to allow adequate time for excess oxygen to be eliminated from the surgical field.

The modern OR has a dizzying array of technology that can make surgery more efficient and effective. Without proper precautions, however, that technology can lead to disaster. Fortunately, if all of the members of the health care team work together, operating room fires can be prevented.

© 2013 Robins, Kaplan, Miller & Ciresi L.L.P.

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