WSHA - Surgical FiresWSHA - Surgical Fires

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Presented by:Scott Aronson, Principal585-223-1130

Life Safety Code Specialists Gowning up in 2012 Questions for surgical staff on fire prevention,

suppression & evacuation Fire Drills

Tracking of issues identified Drills in special care areas

JOINT COMMISSION SURVEY

Tonsillectomy

Uncuffed ET Tube

Patient was receiving a mixture of oxygen and N2O

Surgeon cauterizes the tonsil bed

Pledget catches on fire and ignites in the airway!!

Case Study

Case Study

Tonsillectomy

Prevention ?

Suppression ?

Evacuation ?

ECRI PHOTO

A California family is suing doctors and the makers of a surgical tool after a breathing tube caught fire and injured a boy during a routine tonsillectomy.California, Sept. 2008

DRAPE FIRE!

Bowl of alcohol mistaken for saline

Connecticut, 2010

HEAD / NECK CASE FIRE!

During cyst removalFlorida, 2011Courtesy of “www.MSNBC.com”

EQUIPMENT FIRE!

Smoking and sparks from machine interrupts surgeryMassachusetts, 2010

SURGICAL FIRES

ECRI PHOTO

Surgeon sees black and then a flash –

ET Tube burns in patients throat!

Minnesota 2009

OXYGEN

Oxygen Enriched Atmospheres

Primary Issues: O2 and N2O

“Open” Delivery

Surgery above the

xiphoid

FiOFiO22< 30%= No Oxygen-enriched Flash Fires< 30%= No Oxygen-enriched Flash FiresCourtesy of http://www.westchesterasc.com

Locations of Surgical Fires

ECRI 2009

“The key change in the recommendations is that, with certain limited exceptions, the traditional practice of open delivery of 100% oxygen should be discontinued.”

Anesthesia Patient Safety Foundation and ECRI Institute, Feb 2010

During Head, Face, Neck, and Upper-Chest Surgery:

Note: There are exceptions to the above and patient safety must be reviewed at all times

Communication between surgeon and anesthesia

Do not use electrosurgery to cut into the trachea (NY Case)'Coverup' investigation after city hospital patient 'set on fire' during surgery – New York Post, May 6 article / April 19 surgical fire

Two Key Risk Reduction Strategies

Surgical Fire Risk Assessment

If you see something say something

ONLY YOU CAN PREVENT SURGICAL FIRES!!Surgical Team Communication is Essential!

Especially during open delivery oxygen and use of heat producing equipment above the xiphoid

Risk Analysis Form

FUELS

PREPS IN ORDER OF FLAMMABILITY:1. Alcohol: 100%

2. Chloraprep / Duraprep: 60% – 76%

3. Prevail: 74%

4. Hibiclense: 4 % - Not Flammable

5. CHG: 4% - Not Flammable

6. Betadine: 0 % - Not Flammable

7. Techni-Care: 0 % Not Flammable

Alcohol based Preps – What do you use?

Hair and Drapes

Patient Actions e.g. hairspray!

Coat hair with Water Soluble Gel

Flame Retardant Drapes: NOT in an Oxygen Enriched Atmosphere!

Keep drape and towel edges as far from the incision as possible.

Gauze & Sponges

Keep moist near any heat source! For cleaning ESU Tip Around ET Tube Even for drying up site Surgical site manipulation Especially in oral and pulmonary

surgery

HEAT

Electrical Safety

Common causes of equipment fires: Short Circuits

Overloads

Condition of:CordsPlugsOther Connections

October 13, 2011

PREVENTION:

Conduct a fire risk assessment at the beginning of each procedure.

Use supplemental oxygen safely. Use alcohol-based (flammable) skin preparation

agents safely. Use devices and other surgical equipment safely. Encourage communication among members of your

surgical team.

SUPPRESSION & EVACUATION:

Plan how to manage a surgical fire. For example, understand how to extinguish a fire burning on a patient, develop evacuation procedures, conduct fire drills, and keep saline handy to put out a fire.

Crucial Actions…. RACE

escue those in immediate danger

larm by pulling the fire alarm

onfine the fire by closing doors

vacuate as directed by the Person-in-

Charge

RACE

Circulator: Announce: “CODE RED” and Location by calling out and use intercom

Front Desk, or anyone hearing “CODE RED” called out - Pull Fire Alarm and Call x999

After Hours/Weekends – Call x999 and, following evacuation from room, Pull Fire Alarm

Crucial Actions…. RACE

Endotracheal Tube/Laryngeal Mask Airway (Airway)

Oral Cavity/Oropharyngeal (Airway)

Surgical Site/Hair/Skin/Sponges

Drapes

Crucial Actions…. RACE

PARTICIPANTS PRACTICE FIRE SUPPRESSION

2010 AORN CONFERENCE

Airway Fire – ET Tube

ECRI Photo

* Some steps occur simultaneously, but never extubate prior to disconnecting the breathing circuit

Shut Down Medical Gases & Disconnect Circuit

Remove ET Tube & Team Member extinguishes

- Remove cuff protecting devices

- Check for residual in throat Treat the Patient

- Consider Saline in the throat

- Re-establish airway (no burning)

- Transition from room air to O2

- Examine airway

ECRI Photo

Oral Cavity/Oropharyngeal

* Some steps occur simultaneously, but never extubate prior to suppressing the fire

“FIRE! Shut Down Medical Gases” Squirt/Pour saline into mouth (bulb syringe) Remove extinguished materials Disconnect Circuit Extubate Treat Patient

“FIRE, Shut Down Medical Gases” Pour saline / sterile water Remove drapes Search for additional flame

Surgical Site/Skin/ Hair/Sponges

* Some steps occur simultaneously

“FIRE, Shut Down Medical Gases” Option A: Remove burning material to floor Option B: Pour saline / sterile water, remove

to floor Option C: Appropriate smothering technique, remove to floorAlways: Search for additional flame

Drape Fires

Fire Extinguishers = COOP

For electrical, drapes (on the floor), etc. Suppress with extinguisher USE AS A LAST RESORT FOR FIRE ON THE PATIENT

ORs: CO2 / WATERMIST

HALLWAYS: ABC

Evacuation – Myth or Reality?

Room EvacuationRoles of Surgical Team

Anesthesia: Disconnect Patient / Ventilate / Meds

Circulator: Announce “CODE RED, Location” using the overhead intercom/Clear Path out of room & assist

Scrub Person: Pack Surgical Site / Bring Instruments

Surgeon: Stabilize Patient / Evacuate

Support Staff: Clear Hallways / Close Doors

Whoever hears “CODE RED”: Pull Fire Alarm

Circulator:

Announce “CODE RED”

Obtain BVM

Assist Anesthesia Provider

Help move OR table

Clear path to door

Take patient chart

Anesthesia Provider: Disconnect equipment

Shut down med gases Ventilate w/ BVM

Use room air if FIRE Take drugs to maintain patient

(as necessary) Ensure medical gases serving room are

shut off

Stabilize Patient Protect Surgical Site Surgeon: Communicate

when to Evacuate

Surgeon/ Scrub Person:

Take Instruments to Stabilize/Close Patient

Assist in moving OR table

Prone Position

Fracture Tables

Da Vinci Robotic Surgery

Open Heart

Last Person Out of the RoomLast Person Out of the Room Close Door and Close Door and DO NOT REOPENDO NOT REOPEN

Crucial Actions…. RACE

Under auspices of Anesthesia Provider

Each OR has an Individual Shut-off

Only after the OR Room Only after the OR Room

Is evacuatedIs evacuated

Crucial Actions…. RACE

Crucial Actions…. RACE

Other Other

ORs ?ORs ? Other Other

AREAS ?AREAS ?

Fire is Out Smoke Free Corridor

Smoke In CorridorFire Still Burning

Crucial Actions…... RACE

Area Evacuation

• Who Directs?

- Clinical Manager /

Clinical Leader

- Charge Nurse

- Fire Response Team

- Fire Department

Role of OR Leadership Upon activation of the fire alarm, report immediately to the OR

Room to assess situation

Keep other OR Rooms informed of the situation, as applicable – i.e. Prepare to evacuate

Communication with rooms will be by phone, intercom. Person-in-Charge should take the Schedule, Phone List and Vendor List if forced from the OR Control Desk.

Upon arrival at the evacuation site, the Person-in-Charge will verify that all patients/staff are accounted for and report results to the Command Center, if activated.

Evacuation Locations

ORs: ??PACU: ??

Scenario-based Evolution

Roof deck fire Air handlers pull in smoke Positive pressure in Ors

What is the smoke doing?

Scenario-based Evolution

24 ORs impacted Evacuation Required as rooms are

untenable

Mark The Door

Surgical Boom Fire

Open area = full evacuation

Order of evacuation

12 3

Evacuation: PACU / PreOp Evacuation: PACU / PreOp

Evacuation: PACU / PreOp

Use of Fire extinguisher may be necessary to buy time

Properly Assigned Locations Use your Surge Capacity Plan Patient load will impact decisions Strategies for “clearing” receiving areas

must be in place 6 ORs and 10 PACU bays

Evacuate to a 20 bed Med/Surg Unit that runs an average daily census of 18Impact: 34 patients in 20 bed unit

Domino effect planning

Add Endo / GI Report

Future Considerations

Evacuation Drills with Open Heart / Robotics/ Jackson table (Neuro) team

Do You Have A Plan For Full Building Evacuation?

Conduct OR Fire Drills that Evolve into Functional / Full Scale Exercises

Room Set-up &Room Management

Should be in OR.

Put “Patients” on table

Set up for cases

OR Fire Drills

OR Fire Drills

Assign & Brief Observers on their Roles and expected actions

OR “Room of Fire Origin” Shadow the Person-in-Charge 1 or 2 adjacent ORs OR Evacuation Site

Fire Department Training

45 minute to 1 hour sessionsSurgical Fire OverviewUnderstanding the OR – What really goes on?Tour the area (look in the windows)Fire Department Entry Points

Direct entry to appropriate smoke compartmentCommunication with Charge Nurse

QUESTIONS?QUESTIONS?

Scott Aronson, MSScott Aronson, MS

PrincipalPrincipal

585-223-1130585-223-1130

saronson@phillipsllc.comsaronson@phillipsllc.com

www.phillipsllc.comwww.phillipsllc.com

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