In my first article in the May issue of Risk Review, I proposed the premise that the actual number of surgical near-miss fires and surgical fires occurring in healthcare settings (e.g., operating room, surgicenter, endoscopy unit, or physician office) are grossly under-reported. Therefore, the problem with analyzing reported surgical fires data is like looking at the night sky through a telescope. Only a small segment of the night sky is visible to the viewer at a single instant, but the universe is vast and limitless. Most surgical near-miss fires and some actual fires are not included in any formal national reporting process and therefore go undocumented. Unfortunately, unless the reporting process changes at some point in the future, we will never have an accurate picture of the real surgical fire problem. The lack of available data today continues to lull us into a false sense of security. Regardless of the reporting process, the bottom line is this: any surgical near-miss fire or actual fire can have a devastating effect on the patient, staff and healthcare facility.
Our surgical patients put their trust and well-being in our hands and expect to be safe no matter what the situation. A patient undergoing a surgical procedure is under anesthesia and incapable of self preservation. As healthcare providers, we are well aware that even a minor surgical fire can develop into a life-threatening situation for these patients in seconds. It then becomes our responsibility to protect our patients from a surgical fire. One of the best prevention methods is to educate and train every member of the surgical team (e.g., surgeon, surgical resident, anesthesiologist, scrub nurse, circulating nurse, charge nurse, surgical technician, and students).
Education and training
Most surgical fire education and training is directed at a limited audience of the healthcare team, the nursing staff. While the nursing staff usually controls the fuel sources, this audience doesn’t include some of the other key players such as the surgeon who typically controls the heat source and the anesthesiologist who typically controls the oxygen sources. It’s also important to note that there is always the potential for these activities to overlap in a surgical setting.
We can prevent a surgical fire from occurring if we understand the basic elements that make-up a surgical fire. Before any fire can ignite, there must be three primary elements – fuel, oxygen, and heat – in the proper relationship, which then sustains a chemical reaction. The three elements are readily available in the surgical setting, and we can reduce the potential for a surgical fire by controlling any one of the three. This makes up the content of any good education program.
Minimizing Heat Sources
Let’s first look at heat sources found inside the surgical setting. Typical heat sources involve some form of electrically powered equipment which can vary from facility to facility. This list may include but is not limited to: electrosurgical and electrocautery units, fiberoptic light sources, laser units, defibrillators, drills, saws, burrs, other electrical equipment and cords.