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WSHA - Surgical FiresWSHA - Surgical Fires
The slides and pictures are the property of Russell Phillips & Associates, and are copyrighted, unless otherwise noted.
Presented by:Scott Aronson, Principal585-223-1130
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Life Safety Code Specialists Gowning up in 2012 Questions for surgical staff on fire prevention,
suppression & evacuation Fire Drills
Tracking of issues identified Drills in special care areas
JOINT COMMISSION SURVEY
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Tonsillectomy
Uncuffed ET Tube
Patient was receiving a mixture of oxygen and N2O
Surgeon cauterizes the tonsil bed
Pledget catches on fire and ignites in the airway!!
Case Study
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Case Study
Tonsillectomy
Prevention ?
Suppression ?
Evacuation ?
ECRI PHOTO
A California family is suing doctors and the makers of a surgical tool after a breathing tube caught fire and injured a boy during a routine tonsillectomy.California, Sept. 2008
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DRAPE FIRE!
Bowl of alcohol mistaken for saline
Connecticut, 2010
HEAD / NECK CASE FIRE!
During cyst removalFlorida, 2011Courtesy of “www.MSNBC.com”
EQUIPMENT FIRE!
Smoking and sparks from machine interrupts surgeryMassachusetts, 2010
SURGICAL FIRES
ECRI PHOTO
Surgeon sees black and then a flash –
ET Tube burns in patients throat!
Minnesota 2009
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OXYGEN
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Oxygen Enriched Atmospheres
Primary Issues: O2 and N2O
“Open” Delivery
Surgery above the
xiphoid
FiOFiO22< 30%= No Oxygen-enriched Flash Fires< 30%= No Oxygen-enriched Flash FiresCourtesy of http://www.westchesterasc.com
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Locations of Surgical Fires
ECRI 2009
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“The key change in the recommendations is that, with certain limited exceptions, the traditional practice of open delivery of 100% oxygen should be discontinued.”
Anesthesia Patient Safety Foundation and ECRI Institute, Feb 2010
During Head, Face, Neck, and Upper-Chest Surgery:
Note: There are exceptions to the above and patient safety must be reviewed at all times
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Communication between surgeon and anesthesia
Do not use electrosurgery to cut into the trachea (NY Case)'Coverup' investigation after city hospital patient 'set on fire' during surgery – New York Post, May 6 article / April 19 surgical fire
Two Key Risk Reduction Strategies
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Surgical Fire Risk Assessment
If you see something say something
ONLY YOU CAN PREVENT SURGICAL FIRES!!Surgical Team Communication is Essential!
Especially during open delivery oxygen and use of heat producing equipment above the xiphoid
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Risk Analysis Form
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FUELS
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PREPS IN ORDER OF FLAMMABILITY:1. Alcohol: 100%
2. Chloraprep / Duraprep: 60% – 76%
3. Prevail: 74%
4. Hibiclense: 4 % - Not Flammable
5. CHG: 4% - Not Flammable
6. Betadine: 0 % - Not Flammable
7. Techni-Care: 0 % Not Flammable
Alcohol based Preps – What do you use?
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Hair and Drapes
Patient Actions e.g. hairspray!
Coat hair with Water Soluble Gel
Flame Retardant Drapes: NOT in an Oxygen Enriched Atmosphere!
Keep drape and towel edges as far from the incision as possible.
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Gauze & Sponges
Keep moist near any heat source! For cleaning ESU Tip Around ET Tube Even for drying up site Surgical site manipulation Especially in oral and pulmonary
surgery
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HEAT
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Electrical Safety
Common causes of equipment fires: Short Circuits
Overloads
Condition of:CordsPlugsOther Connections
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October 13, 2011
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PREVENTION:
Conduct a fire risk assessment at the beginning of each procedure.
Use supplemental oxygen safely. Use alcohol-based (flammable) skin preparation
agents safely. Use devices and other surgical equipment safely. Encourage communication among members of your
surgical team.
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SUPPRESSION & EVACUATION:
Plan how to manage a surgical fire. For example, understand how to extinguish a fire burning on a patient, develop evacuation procedures, conduct fire drills, and keep saline handy to put out a fire.
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Crucial Actions…. RACE
escue those in immediate danger
larm by pulling the fire alarm
onfine the fire by closing doors
vacuate as directed by the Person-in-
Charge
RACE
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Circulator: Announce: “CODE RED” and Location by calling out and use intercom
Front Desk, or anyone hearing “CODE RED” called out - Pull Fire Alarm and Call x999
After Hours/Weekends – Call x999 and, following evacuation from room, Pull Fire Alarm
Crucial Actions…. RACE
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Endotracheal Tube/Laryngeal Mask Airway (Airway)
Oral Cavity/Oropharyngeal (Airway)
Surgical Site/Hair/Skin/Sponges
Drapes
Crucial Actions…. RACE
PARTICIPANTS PRACTICE FIRE SUPPRESSION
2010 AORN CONFERENCE
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Airway Fire – ET Tube
ECRI Photo
* Some steps occur simultaneously, but never extubate prior to disconnecting the breathing circuit
Shut Down Medical Gases & Disconnect Circuit
Remove ET Tube & Team Member extinguishes
- Remove cuff protecting devices
- Check for residual in throat Treat the Patient
- Consider Saline in the throat
- Re-establish airway (no burning)
- Transition from room air to O2
- Examine airway
ECRI Photo
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Oral Cavity/Oropharyngeal
* Some steps occur simultaneously, but never extubate prior to suppressing the fire
“FIRE! Shut Down Medical Gases” Squirt/Pour saline into mouth (bulb syringe) Remove extinguished materials Disconnect Circuit Extubate Treat Patient
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“FIRE, Shut Down Medical Gases” Pour saline / sterile water Remove drapes Search for additional flame
Surgical Site/Skin/ Hair/Sponges
* Some steps occur simultaneously
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“FIRE, Shut Down Medical Gases” Option A: Remove burning material to floor Option B: Pour saline / sterile water, remove
to floor Option C: Appropriate smothering technique, remove to floorAlways: Search for additional flame
Drape Fires
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Fire Extinguishers = COOP
For electrical, drapes (on the floor), etc. Suppress with extinguisher USE AS A LAST RESORT FOR FIRE ON THE PATIENT
ORs: CO2 / WATERMIST
HALLWAYS: ABC
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Evacuation – Myth or Reality?
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Room EvacuationRoles of Surgical Team
Anesthesia: Disconnect Patient / Ventilate / Meds
Circulator: Announce “CODE RED, Location” using the overhead intercom/Clear Path out of room & assist
Scrub Person: Pack Surgical Site / Bring Instruments
Surgeon: Stabilize Patient / Evacuate
Support Staff: Clear Hallways / Close Doors
Whoever hears “CODE RED”: Pull Fire Alarm
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Circulator:
Announce “CODE RED”
Obtain BVM
Assist Anesthesia Provider
Help move OR table
Clear path to door
Take patient chart
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Anesthesia Provider: Disconnect equipment
Shut down med gases Ventilate w/ BVM
Use room air if FIRE Take drugs to maintain patient
(as necessary) Ensure medical gases serving room are
shut off
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Stabilize Patient Protect Surgical Site Surgeon: Communicate
when to Evacuate
Surgeon/ Scrub Person:
Take Instruments to Stabilize/Close Patient
Assist in moving OR table
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Prone Position
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Fracture Tables
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Da Vinci Robotic Surgery
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Open Heart
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Last Person Out of the RoomLast Person Out of the Room Close Door and Close Door and DO NOT REOPENDO NOT REOPEN
Crucial Actions…. RACE
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Under auspices of Anesthesia Provider
Each OR has an Individual Shut-off
Only after the OR Room Only after the OR Room
Is evacuatedIs evacuated
Crucial Actions…. RACE
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Crucial Actions…. RACE
Other Other
ORs ?ORs ? Other Other
AREAS ?AREAS ?
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Fire is Out Smoke Free Corridor
Smoke In CorridorFire Still Burning
Crucial Actions…... RACE
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Area Evacuation
• Who Directs?
- Clinical Manager /
Clinical Leader
- Charge Nurse
- Fire Response Team
- Fire Department
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Role of OR Leadership Upon activation of the fire alarm, report immediately to the OR
Room to assess situation
Keep other OR Rooms informed of the situation, as applicable – i.e. Prepare to evacuate
Communication with rooms will be by phone, intercom. Person-in-Charge should take the Schedule, Phone List and Vendor List if forced from the OR Control Desk.
Upon arrival at the evacuation site, the Person-in-Charge will verify that all patients/staff are accounted for and report results to the Command Center, if activated.
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Evacuation Locations
ORs: ??PACU: ??
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Scenario-based Evolution
Roof deck fire Air handlers pull in smoke Positive pressure in Ors
What is the smoke doing?
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Scenario-based Evolution
24 ORs impacted Evacuation Required as rooms are
untenable
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Mark The Door
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Surgical Boom Fire
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Open area = full evacuation
Order of evacuation
12 3
Evacuation: PACU / PreOp Evacuation: PACU / PreOp
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Evacuation: PACU / PreOp
Use of Fire extinguisher may be necessary to buy time
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Properly Assigned Locations Use your Surge Capacity Plan Patient load will impact decisions Strategies for “clearing” receiving areas
must be in place 6 ORs and 10 PACU bays
Evacuate to a 20 bed Med/Surg Unit that runs an average daily census of 18Impact: 34 patients in 20 bed unit
Domino effect planning
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Add Endo / GI Report
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Future Considerations
Evacuation Drills with Open Heart / Robotics/ Jackson table (Neuro) team
Do You Have A Plan For Full Building Evacuation?
Conduct OR Fire Drills that Evolve into Functional / Full Scale Exercises
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Room Set-up &Room Management
Should be in OR.
Put “Patients” on table
Set up for cases
OR Fire Drills
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OR Fire Drills
Assign & Brief Observers on their Roles and expected actions
OR “Room of Fire Origin” Shadow the Person-in-Charge 1 or 2 adjacent ORs OR Evacuation Site
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Fire Department Training
45 minute to 1 hour sessionsSurgical Fire OverviewUnderstanding the OR – What really goes on?Tour the area (look in the windows)Fire Department Entry Points
Direct entry to appropriate smoke compartmentCommunication with Charge Nurse
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QUESTIONS?QUESTIONS?
Scott Aronson, MSScott Aronson, MS
PrincipalPrincipal
585-223-1130585-223-1130
[email protected]@phillipsllc.com
www.phillipsllc.comwww.phillipsllc.com
California ● Connecticut ● New York ● Ohio ● Rhode Island