Safety & Security
Page 5
Surgical fires can pose complex problems for staff to deal with for a variety of reasons. Surgical fires can involve the patient skin or body tissue, airway maintenance devices and patient’s surgical garb. They can involve an oxygen-enriched atmosphere where almost anything burns -including metals. Flammable liquids, adhesives and aerosols may also add to the fire load.
Let’s look at a 2003 U.S. News & World Report article, I’m on Fire, by Kit Roane. According to the article, Melanie Allen walked into the Montclair Baptist Medical Center in Birmingham, Alabama in June to have several benign tumors removed from her head and back. The operation was relatively simple: Electro-surgical instruments were used to cut away the tumors and cauterize blood vessels. Allen, 40, should have been ready to return to her job as a grocery clerk the next day. Instead, she woke up in the intensive care unit with first and second degree burns to her face, neck and chest.
Allen was the victim of a flash fire during surgery. The fire apparently was caused when an electro-cauterizing instrument ignited her surgical covers in an oxygen-enriched environment. “My lips were cooked, and my sinuses burnt up,” Allen says. She remembers being jolted awake by severe pain in her head, then screaming, “I’m on fire, I’m on fire!” She says she still can’t smell or taste and faces months of reconstructive surgery.
A surgical fire can last seconds and be termed a flash fire. Others can grow exponentially; a spark occurring in an oxygen enriched atmosphere can grow to a fire in nanoseconds that will challenge even the best-trained surgical staff. Fires involving oxygen enriched atmospheres have been known to explode into flames. Once any fire begins to develop and gains headway it will be capable of producing hot toxic gases and copious amounts of choking smoke. A growing fire of this magnitude will limit the staff’s breathing and visibility. As hot toxic gases and smoke are produced, panic and confusion by any surgical staff is a real possibility.
Fuels, oxygen and heat sources can be found in any operating room setting. Let’s look at the example provided below.
Fuel sources inside the surgery suite are everywhere within the room. Typical fuel sources include but are not limited to: skin preparations, bone adhesives, aerosols, ointments, drapes, scrubs, gowns, mattress pads, plastic bag, suction canisters, tubing, sponges, tapes, dressings, gloves, suture supplies, wiring and airway maintenance devices. Staff must understand that any material or item with a carbon chemical base can be ignited and will burn. Some of the skin-prepping agents and bone adhesives can be extremely flammable, and vapors can pool unnoticed underneath a patient.
Fuel sources inside the surgery suite also include patient-related items like body hair, fatty tissue, and gastrointestinal gases, such as hydrogen and methane.
Oxygen sources inside the surgery suite include ambient air, medical air, nitrous oxide and enriched oxygen atmosphere. If an oxygen-fed fire occurs in the operating room, staff should anticipate a hot, rapidly intensifying and spreading fire. Any fire that involves an oxygen enriched atmosphere will be difficult to extinguish. Staff should also understand that nitrous oxide, when subjected to a fire, can liberate oxygen to support combustion.
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