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Surgical Fires

Nebraska Medical Malpractice Attorney

Imagine! You are anxiously awaiting word of the conclusion of an expected 1 hour outpatient surgery of your loved one. You expect to be home together in by mid-afternoon. An alarm! What? A fire alarm? … in an Ambulatory Surgery Center? A door crashes open…. That looks like somebody from the surgery team. A siren sounds. Firemen … yes firemen…go in the door that just crashed open.

And your family member is inside! "The Operating Room is on fire!" You hear it from a volunteer who looks scared to death. No one is walking. Now it's running. Smoke slowly shows itself. Not a lot but far too much for the time and place. Should you run in to see where your spouse is? "What is going on?" No one seems sure. Finally, a bed rolls out of the OR. Your spouse is on it… alive, but not conscious.

The surgeon is with her, wearing surgical greens that are torn and charred. What in the….? It Happens.

How Common are Surgical Fires?

Maybe the best statistics are from the Emergency Care Research Institute (ECRI). The report states that in the U.S., there are roughly 550 to 650 occurrences of surgical fires each year. This means OR fires share the same commonality as wrong-sided surgeries. Electrosurgical equipment was involved in surgical fires roughly 68% of the time and the most common sites were the upper body including the neck, upper chest, head, and face.

The happen at the best of medical centers, too. In 2011, the Centers for Medicare & Medicaid Services stopped surgical operations at the Cleveland Clinic due to 6 different fires in operating suites; three involved patients. Hospitals and ambulatory surgery centers are supposed to have adequate protection in place. Operating room fires are events that never should occur.

ECRI Institute has recommended updates to fire safety, including the following:

  • Fire risk assessment checklist
  • Updated sample fire safety policy and procedure
  • Expanded fire drill scenarios for hospital and ambulatory settings
  • New fire safety presentation to be used by staff members
  • Updated fire safety competency evaluation tool
  • Links to new fire safety resources
  • Updated bibliography

Communication among members of the surgery team is the key to preventing OR fires. For example, the surgeon should be told by anesthesiology when the patient is receiving open O2 and told again and whenever anesthesia oxygen flow above 30%. The surgeon must communicate too, to notify anesthesia when electro surgery is about to be used.

Some basics are in order. Consider the fire safety triangle: oxygen + heat + fuel = fire. This paradigm led in Hawaii to develop a risk scoring system from 4 (high) to 1 (low) fire risk using this system:

  • Any procedure above the base of the sternum: 1 pt
  • Use of cautery or a light cord (surgeon influence) 1 pt
  • Open O2 (anesthesia influence) 1 pt
  • Skin prep with alcohol and/or disposable drapes 1 pt

Surgeries including all 4 elements are high risk. Most of cases are probably a 2-3. Charting this and speaking of it heightens awareness, focus, and makes successful prevention more likely. So do fire and fire safety drills. And, firefighting substances and tools are essential; they must be available and functional. AORN's Fire Safety Tool Kit includes tools designed to tailor detailed fire scenarios into mock drills.

For example, one of the new tool kit scenarios is in an ambulatory setting where a laparoscopic cholecystectomy is occurring. A fire ignites on the drapes caused by the light cord being on and secured to the drapes. The scrub yells out fire, grabs the saline from the back table and pours it on the fire. Simultaneously the anesthesia care provider unhooks the drapes and switches the patient to room air. The surgeon then grabs the drape and removes it. The circulator checks the drape to be certain the fire is extinguished. The scenario continues to address further steps every member of the surgical team takes in managing the fire.

It is common to use of the acronym RACE as the response component of the fire safety plan:

  • R—Rescue the individual involved in the fire.
  • A—Alarm should be sounded as soon as possible.
  • C—Confine the fire.
  • E—Extinguish the fire and evacuate if required.

Fires should not occur AORN's Guidance Statement on Fire Prevention in the OR makes this clear. When they do occur, someone is at fault and a remedy is available. At Domina Law Group pc llo, we know how to find the remedy.

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