This article will highlight the actions to take when your best fire prevention efforts don’t work. Even a small fire can be very dangerous. Patient lives have been entrusted to us for their protection and safety. We can jeopardize those lives by the actions we take… or our failure to act. A small fire can grow exponentially and place the lives of our patients in immediate danger with disastrous results. In this circumstance, we don’t have the luxury of taking the time for normal decision-making; actions need to be taken immediately.
REMEMBER - PATIENT SAFETY IS THE PRIORITY IN YOUR SURGICAL SUITE!
RESPONSE TO A SURGICAL FIRE
Any time a staff member smells or sees smoke, a
“Code Red” fire response should be initiated in the surgical suite. Every second counts in the surgical environment and staff can’t waste time trying to investigate a burning odor or try to determine what is smoking. Don’t wait for others to react - advise the other members of the surgical team that you smell smoke or see smoke. Begin the RACE process. Always transmit a fire alarm and call the switchboard to report the fire – even if it seems insignificant.
Airway Fires
Airway fires (occurring inside the patient’s airway) need to be handled quickly and safely. Fires involving an endotracheal tube can act like a flamethrower, sending flames, smoke and hot gases into the patient’s airway.
When an airway fire occurs:
· The anesthesiologist should shut-off the oxygen flow immediately.
· He or she should disconnect the breathing circuit from the endotracheal tube. The pilot tube and ties that are used to anchor the tube to the patient must be cut. The endotracheal tube should be removed.
· The tube should be handed to another staff member and extinguished. Remove any cuff protection devices and any pieces of the tube that might still be burning in the patient’s airway. Once the tube has been removed, examine it for burns which might help to determine where medical treatment is required inside the patient’s airway. Examine the airway for potential injury and treat the patient’s injury accordingly.
· Once the fire is extinguished, reestablish the airway until staff can determine that nothing is left burning inside the airway. If the fire is out, the anesthesiologist may consider initiating oxygen therapy once again.
Note: Risk management should be contacted immediately and the endotracheal tube should be secured for an investigation. As with any fire investigation, the room should be left undisturbed following the fire until risk management and/or administration permits the room to be cleaned and once again used.
Small Fires
Small fires occurring on the patient can be smothered easily by placing a wet, sterile towel over the fire. This could also include pouring sterile water or saline over the burning area.
Other tips for putting out small fires are:
· Remove any burning material from the patient.
· Disconnect all non-life support electrical equipment; remember to alert the surgeon and anesthesiologist before making this move.
· If the fire happens to involve oxygen, the anesthesiologist needs to stop the flow and ventilate the patient with air.
Note: If the fire involves ALCOHOL or ALCOHOL-BASED solutions or involves electricity, DON’T USE WATER OR SALINE SOLUTIONS to extinguish the fire. This could place the patient and yourself in a more dangerous situation. The nearest portable fire extinguisher should be used to extinguish these types of fires. If a portable fire extinguisher is not located inside the operating room, consider using a dry towel. If the fire involves electricity, pull the power supply cord to the device and then use a wet towel.
Some hospital fire procedures suggest the use of a gloved hand being placed over the fire to smother it in an emergency. While the fire will probably go out, the glove is combustible and could actually melt and/or stick to the burned area. This could result in further injury to the patient as well as injuries to the staff member.
Large Fires
Large fires on or near the surgical field will most likely make it necessary for the anesthesiologist to the stop the flow of oxygen to the patient. This should reduce the intensity of the fire, and may even cause the fire to go out. As with small fires, immediately remove any burning materials from the patient, drop it to the floor, and make sure the materials are completely extinguished.
Other tips for handling large fires:
· If you disturb the burned materials on the floor, it may re-ignite so have a fire extinguisher ready if you plan on removing this material from the room.
· Don’t forget normal patient care in the excitement.
· Breathing can be affected even in a small fire – it’s possible to restore breathing air to the patient but NOT OXYGEN FLOW.
· Finally, patient burns are very likely with a larger fire and will have to be addressed.
· If the fire can’t be extinguished immediately or the smoke condition within the room worsens, it may become necessary to evacuate the operating room. After leaving the room, do not forget to turn off the oxygen supply to the room, and close the door to the corridor. It may become necessary to place wet towels around the bottom of the door frame to limit smoke spread.