Fire Safety in the OR
Franklin L. Scamman
Reference
• Practice Advisory for the Prevention and
Management of Operating Fires
• Anesthesiology 2008; 108:786-801 (May
2008)
Triangle of Fire
Types of Fuel
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Type A: wood, paper
Type B: oil, grease, alcohol, ether, benzoin
Type C: electrical
Type D: nuclear
Types of Oxidizer
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Oxygen
Nitrous Oxide
Potassium Permanganate
Ammonium Nitrate
Types of Heat
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Electrosurgical Unit (Bovie)
Fiberoptic light cables
Laser
Hot-wire cautery
Sparks
Types of OR Fires
• Surgical fire – on or in a patient
• Airway fire
• Circle fire
High Risk Procedure
• All 3 elements are in proximity
– tonsillectomy, tracheostomy, removal of
laryngeal papillomas, cataract or other eye
surgery, burr hole surgery, or removal of
lesions on the head, neck, or face.
OR Fire Drill
• A formal and periodic rehearsal of the
OR team’s planned response to a fire
• It takes place during dedicated
education time, not during patient care
• Every anesthesiologist should have
knowledge of institutional fire safety
protocols for the OR, and should
participate in OR fire safety education
Advisory Statement
• All anesthesiologists should have fire
safety education, specifically for OR
fires, with emphasis on the risk created
by an oxidizer- enriched atmosphere
Advisory Statement
• Anesthesiologists should periodically
participate in OR fire drills with the
entire OR team. This formal rehearsal
should take place during dedicated
educational time, not during patient
care.
Advisory Statement
• For every case, the anesthetist should
participate with the entire OR team in
determining whether a high-risk situation
exists. All team members should take a joint
and active role in agreeing on how a fire
will be prevented and managed. Each team
member should be assigned a specific firemanagement task and do that task
immediately if fire occurs.
Advisory Statement
• There should be free discussion to
minimize the presence of an oxidizerenriched atmosphere to an ignition source.
• Surgical drapes should minimize the
accumulation of oxidizer.
• Flammable skin prepping solutions should
be allowed to dry prior to draping.
• Gauze and sponges should be moistened
when used in proximity to an ignition
source.
Management of Fire
(Per Fire Department)
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RACE
Remove the patient from the fire
Alarm - call 195 or pull a fire alarm
Contain the fire if conditions permit (close
doors)
• Extinguish the fire if conditions permit
Management of Airway Fire
(Per ASA)
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Announce “Fire” and halt procedure.
Remove burning endotracheal tube
Stop the flow of all airway gases
Remove all flammable and burning
materials from the airway
• Pour saline into airway to extinguish
embers
• Consider rigid bronchoscopy
Management of OR Fire
Elsewhere
• Remove burning materials and extinguish
fire with saline
• Team members should perform
predetermined tasks without waiting for
others to act
• If fire not extinguished, consider use of
CO2 fire extinguisher, activating alarm,
evacuating patient, closing OR door and
turning off medical gas supply
Types of Fire Extinguishers
• Pressurized Water
– Good for type A fuels: wood, paper
• Dry Chemical
– Good for type B and C fuels: oil, grease,
electrical
• Carbon Dioxide
– Good for type A, B, and C fuels
Location of OR Fire
Extinguishers
• Behind the main doors to each OR
• Exception is OR 14 where they are on the
north wall
Location of fire extinguishers in OR
What is in a Fire Cabinet?
• Pressurized Water Extinguisher
• Carbon Dioxide Extinguisher
• Fire hoses were eliminated 6 years ago
because they were never used and
expensive to maintain