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Don’t get burned: make surgical fire drills a priority

Ambulatory Safety Monitor, December 23, 2004

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Safety officers at Caritas Norwood (MA) Hospital wanted to test staff's reaction time under the pressure of a real fire but realized the impossibility of staging such a drill in the hospital. They settled for the next best thing and corralled OR staff into an outdoor tent. There, fire safety specialists from a Rochester, NY-based firm ignited a pile of wet hay that they had placed inside a metal pail.

Supervising them closely, the specialists from Russell Phillips & Associates, LLC, instructed staff to remain kneeling until the smoke had mushroomed across the top half of the tent. Then they told the staffers to evacuate in an orderly manner. 

"It helps to build people's confidence when you have a hands-on drill like that," says Dolores Vieira, RN, BS, director of surgical services at Caritas Norwood. "If you haven't been in a fire, you don't know how you'll react. It helped alleviate some of that fear."

Beginning in 2005, the JCAHO, as part of its National Patient Safety Goals, will require ambulatory settings and office-based surgery facilities to educate staff about how to control heat sources, manage fuels, and establish guidelines to minimize oxygen concentration under drapes.

Three actions to take in case of fire

Fire risks in the OR typically involve a patient, medical device, or trash can. In case of a fire involving a patient, Albert de Richemond of the nonprofit healthcare research firm ECRI says that the surgical team must immediately:

1. Disconnect the patient's breathing gases and ventilate the patient with air until the fire is completely extinguished

2. Remove burning materials from the patient, such as tubes, towels, drapes, gauze, and gown

3. Care for the patient

Consider taking a longer time-out

The JCAHO's Universal Protocol requires surgical teams to take a time out prior to surgery to verify the correct patient, procedure, and site.

Consider requiring your surgical teams to take an additional 15 seconds to inform each other about ventilation, tools, preparation solution, and drapes. This can minimize the risk of surgical fire and patient injury.

Delaware-based Christiana Care Health System is implementing this process on its four campuses and 48 open ORs, where more than 45,000 surgeries are conducted each year, says Barbara Eaton, RN, BSN, accreditation and performance improvement coordinator.

Prior to surgery, the surgical teams determine high-risk factors, such as an open source of oxygen and an ignition source, and whether the surgical site is above the xiphoid process.

Using a checklist, the OR nurse marks down one point per high-risk factor. If the score is three or higher, the team follows a fire safety protocol that's listed on pocket-sized cards. The protocol includes placing wet sponges and a basin or syringe of sterile water close by, ensuring that the prep solution drying time will last at least three minutes (as the alcohol vapors are combustible), using modified anesthesia equipment, and protecting the heat source by placing it in its holster when not in use.

Editor's note: Learn more ways to train staff about OR fire safety with the HCPro video, OR Surgical Fire Training: How to prevent and respond to surgical fires. Call 800/650-6787 for more information.

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