FIRE IN THE OR

Frequency

2250 per year in the US

20 serious injuries 2 deaths per year 95% involved surgery of the

head and face

17% were MAC cases with nasal O2

100% of cases of airway burns hospitals paid out

FIRE TRIAD

Fuel

Oxygen

Ignition

FUEL

Paper drapes

Cleansing agents

Endo Tubes

OXYGEN

Oxygen enriched area

IGNITION

Cautery

Light sources

Lasers

Benefits alcohol

Inexpensive Readily available Most effective antiseptic

Alcohol-New rules

Wicking on hair lines and in drapes Prolonged drying time Draping before drying leads to vapor

pooling

Fire prevention

Packaged to avoid excess Supplier instructions and warnings No soaking or pooling Complete dryness before draping Time out to verify dryness

LASERS

High intensity at a point Can reflect off of metal Near flammable items

LASERS

5 Major laser hazards:

-eye injuries

-skin and tissue burns

-fire

-toxic fume and smoke inhalation

-electrical injuries

LASERS

Make fire safety part of the time out Be sure cautery devices / laser probes are

fully intact and clean (or can arc) Communicate with the surgeon as to when

O2 is in use near the laser O2 off at least 60 sec before the use of the

laser Non-functioning equipment out of service

PREVENTION

Lowest possible Oxygen concentration < 30% Don’t tent Non-flammable gasses Avoid endo tube leakage No pooling of liquids

PREVENTION

Avoid alcohol preps Light sources off when not using No lotions, make-up, or creams No hairspray Water based lubricant around hair Oxygen off if near bovie

PREVENTION

Audible cautery tones In the holder only

PREVENTION

Know where the pulls are Know where the extinguishers are Know where the Oxygen shut offs are Know the number to call

PREVENTION

Communication

Drills

Review Fire Policy

Reporting

Compliance line Risk management

FIRE POLICY

EOC MANUAL-LIFE SAFETY

RACE

R-Rescue

A- Alarm

C-Contain

E- Extinguish

Evacuation

O2 OFF IMMEDIATELY-TO ROOM AIR Close doors Mark area as searched Stop all elective surgery when alarm

sounds

Evacuation of Surgery in Progress

Stop all that can Base decisions on cases in progress Move with Diprivan drip if needed

Evacuation

Vertical Horizontal

PASS

Pull Aim Squeeze Sweep

Airway Fire

Laser surgery risk Fill cuff with methylene blue so detect

early rupture-see on laser beam O2 to < 30 % (N20 and 02 support

combustion)

Airway Fire

Disconnect O2 source Remove tube quickly:

-removes flame, retained heat

-interrupts O2 supply to patient

-keeps distal end of tube from collapsing

Airway Fire

Place burning tube into pre-established bucket of water

Mask ventilate with 100% O2 until able to re-intubate

Re-intubate with a smaller tube (laryngeal edema)

Maintain anesthetic state-possibly TIVA

Airway Fire

Stabilize once airway is reestablished Rigid bronchoscopy-remove large FB

and assess Saline lavage to mainstem bronchus

and trachea Flex bronch-smaller particles Direct laryngoscopy-fine FB

Airway Fire

May need tracheostomy- fear is laryngeal edema

30-60%O2 post-op that is humidified (loss of cilia & strong chance of mucous plug)

PEEP to decrease atelectasis from loss of surfactant

Airway Fire

ABGS CXR-to assess for lung damage Steroid inhalants-for smoke inhalation &

bronchospasm Bronchodilators Antibiotics ICU