National Fire Prevention Week, which is recognized October 6-12 this year, serves as a reminder to educate health care
personnel about fire risks and preventative measures for mitigating those risks. It also represents an opportunity to raise awareness among perioperative professionals about the uncommon yet destructive occurrence of surgical fires. Considered preventable medical errors, surgical fires still occur up to 650 times a year in the United States.1 The ECRI Institute receives at least one report of a surgical fire each week and considers surgical fires to be one of the top 10 health technology hazards for 2013.2
Preventing surgical fires is the top fire safety priority for every OR, supported by the U.S. Food and Drug Administration’s “Preventing Surgical Fires” initiative;3 however, perioperative personnel also need to be educated on effective fire response and management tactics, so that they are prepared to respond if a surgical fire occurs. A well-coordinated team response is critical for ensuring the most optimal outcome in the event of a surgical fire, thus, all perioperative team members should regularly participate in fire drills.
Effective fire drillsEffective fire response and management begins
with health care personnel understanding the scientific principle behind fire and each team member’s role related to mitigating fire risk. For a surgical fire to occur, the three elements of a “fire triangle” need to be present: an oxidizer (e.g., oxygen, nitrous oxide), an ignition source (e.g.,
lasers, electrosurgery units), and a fuel source (e.g., drapes, sponges).4 Each OR team member owns a part of the fire triangle; the RN circulator typically provides the fuel source, the surgeon commonly supplies the ignition source, and the anesthesia professional typically controls the oxidizer.5
Practicing unique scenariosWithin the OR, fires can be categorized as those
that occur on the patient and those that occur somewhere else within the OR environment. Most surgical fires involve the use of supplemental oxygen, which lowers the temperature at which a fuel will ignite. Alcohol-based preparation agents, electrosurgical tools, lasers, and surgical drapes are also common contributing factors to surgical fires. Sixty-eight percent of reported surgical fires
Preventing and managing OR fires requires complete team effortLeslie KnudsonManaging Editor
involved electrosurgical equipment and the most common sites of reported fires were the patient’s head, face, neck, and upper chest.5 Fire that occurs in the patient’s airway is another type of commonly reported surgical fire.
Because of the many distinct sources and types of surgical fires, fire drills and simulations should emulate the different types of fires that perioperative personnel may encounter. Each unique scenario warrants a specific response and thus, perioperative personnel should be educated on their expected role and contributions before drills begin. For example, in the event of an airway fire, personnel should remove the endotracheal tube and pour normal saline into the airway.4 The AORN “Recommended practices for a safe environment of care,”4 provide specific guidelines for fire risk assessment and fire response and management.
Hospital leaders from Greenville Hospital System, Greenville, S.C., implemented an 18-month fire drill program that consisted of weekly fire drills involving unique scenarios in their simulation center. All OR personnel participated in the program, which consisted of five main scenarios: laparoscopic surgery fires, electrical fires, airway fires, exploratory laparotomy fires, and Caesarean delivery fires for personnel in the labor and delivery unit. Each team member was assigned the role that he or she typically performed and participated in at least one scenario during the 18-month timeframe. “We have an entire OR setup in our simulation center, so everyone was in their actual roles, so that they would know what to do if a fire actually occurred,” said Sue Seitz, MSN, RN, CNS, CNOR, clinical nurse specialist at Greenville Hospital System, who was one of the fire drill coordinators. Seitz recommends involving staff members in planning the drills as much as possible. Specialty team members should create scenarios that could be something they would encounter (e.g., neurosurgical team members performing a craniotomy procedure) to keep the drills relevant and engaging.
Creating a sense of realismMaking fire drills as realistic as possible is an
important component of effective fire response and management skills. Greenville Hospital System facility leaders incorporated the use of orange lights and a smoke machine along with
a complete OR setup in their simulation center. Each simulation scenario involved team members in their gowns, gloves, and masks, and then at some point during the mock surgery, the orange lights and the smoke would be turned on to simulate fire. “The feedback from the staff is that the realism is really important and they realize the value of it,” said Seitz. “By actually having lights and smoke, they really focused a lot more than if they were in our regular ORs.”
Fire drills and simulation exercises should emphasize how quickly a fire can spread; fires burn hotter and faster in an oxygen-enriched environment.3 Perioperative personnel should be educated on the importance of a rapid response. Greenville Hospital System facility leaders designed their simulations based on the principle that the fire would double in size every 30 seconds and incorporated fire scenarios that called for evacuation. “When they did evacuate, it made them think about things like ‘What’s in the way between us and the door?’ or ‘Are there cords to run over?’ So it helped to stimulate a lot of thinking that they could take with them for their actual OR setup,” said Seitz.
Involving the entire OR teamBecause fire safety is the responsibility of every
team member and surgical fires can happen in different locations, personnel from anesthesia, surgery, surgical services, nursing, labor and delivery, facilities management, and safety departments should be involved in fire training exercises.5 Personnel should be familiar with their specific role related to fire prevention and management. “We used to do our fire drills with just nursing in the OR and we realized we were missing a huge part of the team,” said Seitz. “We felt it was very important to include our surgeons, anesthetists, nurses, surgical technicians, and even our orderlies and team technicians, so that they all knew how to function as a team.”
Team members should also participate in debriefs after each fire drill to discuss what went well and what could be improved. Video recording each drill and reviewing it during the team debriefing process is an effective means to stimulate team communication and identify areas for improvement. Greenville Hospital System facility leaders incorporated team meetings before and after each fire drill. “In the debriefing, we would show the video and we would go through
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the steps to see if they did them correctly or not,” said Seitz. “It helped them realize how fast a fire can spread and the importance of working together as a team.”
ConclusionHealth care facilities should schedule fire
drills on a recurring basis, in accordance with local authority requirements;4 the National Fire Protection Association recommends that fire drills occur at least quarterly on each shift.6 Facility leaders should also reference the AORN “Recommended practices for a safe environment of care,” for creating a written fire prevention and management plan and implementing a fire risk assessment process, which should be completed before every surgical procedure.4 Effective fire prevention and management is every team member’s responsibility; all OR team members should be aware of fire risks in the OR and their role in mitigating fire risk and responding to surgical fires.
Additional resourcesThe AORN Fire Safety Tool Kit contains a
variety of tools and resources for promoting fire prevention, planning fire response strategies, and
developing policies and procedures: https://www.aorn.org/FireSafety/. The Anesthesia Patient Safety Foundation has also produced a free video, “Prevention and Management of Operating Room Fires:” http://www.apsf.org/resources_video.php.
References1. Surgical Fire Prevention. ECRI Institute. https://www.ecri.org/Products/Pages/Surgical_Fires.aspx. Accessed September 2, 2013.
2. Top 10 health technology hazards for 2013. ECRI Institute; 2012;41(11).
3. Preventing surgical fires. U.S. Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/SafeUseInitiative/PreventingSurgicalFires/default.htm. Accessed September 2, 2013.
4. Recommended practices for a safe environment of care. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013:217–241.
5. Hart SR, Yajnik A, Ashford J, Springer R, Harvey S. Operating room fire safety. Ochsner J. 2011;11(1):37-42.
6. NFPA 101: Life Safety Code. Quincy, MA: National Fire Protection Association; 2012.
