the official daily publication of the AORN Congress

Preventing surgical fires takes a team

Fire safety is primarily a matter of prevention. But, when fires do flare up, every team member must respond quickly and precisely. On Tuesday at AORN’s 57th Congress, the education session “Surgical Fire Safety: The Best Response Is Prevention,” began with Dennis Parker, ChE, MBA, telling the story of his son, Doug, who died as a result of an airway fire during a surgery to repair vocal papylomas. Parker’s background is in the petroleum, nuclear, and chemical industries, which he said share many similarities with medicine, in that the people in each field are interested in high-quality, cost-effective practices that result in safe outcomes . . . and that sometimes, things go wrong. Parker emphasized the need to foster a culture of safety and accountability. He also stressed the importance of having management systems in place that focus on positive outcomes and include assessments and adjustments.

Firedemonstration

Scott Aronson talks Jane Keating through
how to extinguish a drape fire on a patient.

After Parker’s discussion, Scott Aronson, MS, principal, Russell Phillips & Associates LLC, talked about fire safety and prevention in the OR and announced that the ECRI Institute and American Patient Safety Foundation, in collaboration with the American Society of Anesthesiologists, are releasing a new video sometime in late March or early April with updated recommendations for the OR. Some of the recommendations that Aronson highlighted are the elimination of open delivery of supplemental oxygen during surgery and to secure the airway if it is needed. Furthermore, if greater than 30% oxygen is being used, practitioners should dilute it by flowing 5 L to 10 L per minute of air under the drapes. Also, use of 100% oxygen is being challenged across the board but is especially discouraged during head and neck procedures.

To lower the risk of fire, Aronson discussed some best practices, including performing a surgical site fire risk assessment; minimizing oxygen concentrations; draping so that oxygen can flow to the floor and dissipate (eg, use ioban/incise draping); and communicating fire risks and preventive measures among the entire surgical team.

In the event that fire does break out, the steps to take should be practiced and understood by the entire surgical team. To demonstrate, Aronson lit his assistant, Darren Osleger, a fire and emergency management consultant from Plainville, Conn, on fire and had one audience member follow his direction to stifle and sweep out the fire with a surgical towel. When fire is discovered, the phrase “Fire—shut of the gasses” or something similar should be spoken aloud to bring the situation to everyone’s attention and remind everyone of step No 1.

During the hands-on demonstrations after the lecture, Aronson talked attendees through putting out fires on a mannequin that was draped on an OR bed. On the other side of the room, Osleger talked about evacuation procedures in the event of a room fire. In both demonstrations participants yelled, “Fire—shut of the gasses” as they jumped to action to extinguish the fires or evacuate the patient.
Having a practiced evacuation plan in place is important in health care facilities because “the first zero to four minutes, you’re on your own,” Osleger said, noting that it takes fire departments four to nine minutes, on average, to respond. “Practice, go over the challenges, and iron them out. With continuing education, people become strong, efficient, and knowledgeable. It’s OK to be scared of fire, but there’s a difference between being scared and being knowledgeable.”

It’s important to practice correctly, Aronson added, showing attendees how to pour saline directly on top of a fire rather than tossing it over the general area. He also demonstrated how to tuck, tuck, and sweep for extremity fires, and how to properly place an arm to protect a patient’s face and airway while putting out a fire.

“I’ve never experienced a fire in the OR—which is one thing that we’re obviously very concerned about,” said Holly A. Johnson, RN, a nurse manager from Gibson Area Hospital, Gibson City, Ill, who attended one of the sessions. “Practicing this hands-on really helps to set it in your mind, to go through the motions. I will be going back to my hospital to do some hands-on fire demonstrations.”