Education and training is the most important aspect of your surgical fire response plan. EVERY MEMBER OF THE SURGICAL TEAM NEEDS TO RECEIVE ANNUAL EDUCATION AND TRAINING – NO EXCEPTIONS. The facility could make this a part of the annual staff competency requirement. This annual education and training process needs to also involve a post-test that measures the effectiveness of the information presented.  

The surgical fire response plan should address each element of the fire triangle (fuel, oxygen, and heat). The surgical fire plan should establish at the beginning of each surgery which staff member will be in command if a fire occurs during surgery. The role of each member should be designated and identified on a pre-fire safety check sheet. Any fire safety questions related to the procedure should be discussed prior to commencing any surgical procedure.

Surgeons have primary responsibility for minimizing the hazards associated with heat sources. However, the nursing staff should act as a back-up in this capacity to ensure that:

·         Each piece of medical equipment that is going to be used in the surgical suite has a current preventative maintenance sticker.  Electrical cords and cables are free of visible defects. If a vendor owned piece of medical equipment is to be trialed in the surgical suite it should be inspected by the biomedical engineering department prior to use.  

·         Heat sources are used as per the manufacturer’s operating guidelines and methods/techniques. That safety protocols are followed in their entirety.

·         Any piece of medical equipment that emits a burning odor or shows other physical signs of malfunctioning is turned off and replaced. The device should be removed from the surgical suite, tagged out of service and biomedical engineering department called for corrective action.  

Nursing staff have primary responsibility for minimizing the hazards associated with fuel sources. However, the surgeon should also act as a back-up in this capacity to ensure that:

·         Any flammable liquids or glues used for skin preparations are given a significant drying period prior to the activation of a heat source.  Pooling of flammable liquids under the patient is anticipated and addressed.

·         Draping materials is fire resistant and appropriate for the case.

Anesthesiologists and their staff have primary responsibility for minimizing the hazards associated with oxidizing sources. However, the surgeon should also act as a back-up in this capacity to ensure that oxygen concentrations above 21% are minimized. Stop the flow of oxygen to the surgical site at least one minute prior to the use of a heat source.

Specific fire response roles are described below but your facility’s surgical fire response may differ and each facility should develop their own individual surgical fire response plan. You need to keep in mind that while the following response procedures appear to be a sequential step by step action plan, in reality these actions occur almost simultaneously using the “RACE” acronym as a guide.

The circulating nurse or their designee should initiate the surgical fire response plan by either pulling the nearest fire alarm pull station or calling the switchboard to report the fire. Remember seconds count; call the facility’s fire emergency number. Valuable time can be wasted if you dial “O” for the operator and get a busy signal. Have someone alert the nurse’s station inside the surgical suite.

If the patient is on fire the surgeon should assist with extinguishing the fire if possible. He or she should evaluate bleeding, prepare the patient for evacuation and place sterile towels or covers over the surgical site. If there is immediate danger to the patient, he or she should assist with moving the patient to a safe area. If there is no immediate danger to the patient, he or she should conclude the procedure as soon as is safely practical.

The anesthesiologist or their designate should shut-off the oxygen or nitrous oxide flow to the patient. He or she should maintain patient breathing during this process. Note: an ambu-bag should be located on each anesthesia machine. Monitor the patient’s anesthetic state and assemble those medications needed to move the patient. This may involve the use of IV agents.

If the room needs to be evacuated, the anesthesiologist or the circulating nurse should disconnect the medical gas lines to the anesthesia machine and should disconnect all power supply cords to the machine. He or she can assist the anesthesiologist in moving the machine out of the room.

The circulating nurse or their designee should disconnect all other power supply cords, lines, leads or anything else that would not permit the patient to be moved from the area. Take any IV solution bags off of IV poles and place them on the bed.

The scrub nurse or their designee should gather the minimum number of medical instruments necessary and prepare them to be moved with the patient. The scrub nurse or their designee should also assist with the evacuation if the patient is to be evacuated out of the suite.

Other surgical staff members not working in the room of fire origin or on a case should report to a nearby location, so they can assist where directed. Any medical equipment needed to transport patients and to maintain life support should be assembled at a staging area where it can be moved rapidly to assist with patient evacuation.

Summary

Each member of the surgical fire response team plays an important role in the surgical fire response plan. When confronted by a fire in the surgical setting each second counts. Quick and effective action needs to be taken. Before surgery begins, review the roles and responsibilities of each team member. Remember the patient lying on the surgical table has put their wellbeing and safety in your hands. We hope that you never have to initiate the Code Red and RACE procedures, but should your fire prevention efforts fail, you can feel confident that your surgical fire training and experience will help you to make the correct decisions and save lives.