ASA advisory addresses operating room fires
Educate, assess risk prior to surgery
The effects of operating room fires can be devastating. An estimated 50 to 100 surgical fires per year is one of the reasons that the American Society of Anesthesiologists (ASA) has developed a practice advisory to address the issue.
"The development of the advisory stems from ASA members personally involved in fire situations in the operating room [OR] and members who have dealt with the aftermath of catastrophic operating room fires," says Charles E. Cowles, MD, an anesthesiologist at the University of Texas — Houston and a member of the advisory development committee.
"The Practice Advisory for the Prevention and Management of Operating Room Fires" appears in the May 2008 issue of Anesthesiology and identifies situations that are conducive to fires, tips to reduce the risk of fires, techniques to reduce the adverse outcomes associated with OR fires, and elements of effective fire response. The advisory includes an algorithm that describes specific actions that an anesthesiologist can take to minimize the risk of fire and respond if a fire occurs, points out Robert A. Caplan, MD, anesthesiologist at Virginia Mason Medical Center in Seattle and chairman of the ASA Task Force on Operating Room Fires. "The algorithm is suitable for posting in ORs and procedure areas and was specifically designed for this use," he adds.
Because the use of oxygen increases the risk of fire, the task force looked closely at incidents involving OR fires and oxygen, says Cowles. "The task force reviewed many cases of injury to patients due to the unnecessary use of supplemental oxygen, especially in nonintubated, conscious patients," he says. "Many of these patients had no medical reason for needing oxygen supplementation, and the oxygen just contributed to making a perfect environment for fire to break out."
The best recommendation is to limit the use of oxidizers, except as medically necessary, and to restrict use of flammable prep solutions and allow adequate drying time if used, he explains. "If medical necessity mandates the use of oxidizers, use only the amount specifically needed to optimize patient care and allow adequate time for the oxidizers to dissipate prior to activating an ignition source," suggests Cowles.
Fire-specific training needed
One of the advisory's recommendations is that all anesthesia providers have training in OR fires, says Cowles.
"The general fire response training received in most facilities is not sufficient to address the specifics of dealing with high-risk situations presented in the operating room," he says. Several mediums are available for this education, Cowles says. "Both the Anesthesia Patient Safety Foundation and ECRI have videos and educational programs designed specifically for fires in the OR," he says.
The ASA annual meeting and other local anesthesiology association meetings also are outlets to feature presentations and clinical forums to educate anesthesia providers about the specifics of OR fire safety, he adds. "The advisory was written in such a manner that it is easily understood by anesthesia providers and others who work in the OR and one need not be an expert to create a lecture, grand rounds presentation, or CE module, which follows the advisory," he says.
Another key recommendation is that before a procedure, the risk of surgical fire should be determined by the OR team, Caplan says. The Joint Commission requires that the pre-procedure timeout include an understanding that all members of the team are empowered to act on behalf of patient safety, and that can include assessment of fire risk, he says. Since this is an advisory for anesthesiologists, this recommendation is addressed to the anesthesiologist, Caplan says. "However, the advisory recognizes that the anesthesiologist is a part of the OR team, and that all members of the OR team must work together," he says. From a practical standpoint, this is a recommendation for the anesthesiologist to take a proactive role, Caplan adds.
Cowles says, "I think the anesthesiologist is in a good position to oversee the process because we are with the patient at all times and can observe how the patient is prepped and positioned, which may contribute to creating a high-risk situation." The circulating nurse often is busy with room coordination and equipment issues, the surgical technologist is focused on anticipating the needs of the surgeon, and the surgeon often is focused on the complexity of a particular procedure, he says. Thus, the anesthesia provider should be focused on the patient, the OR environment, and the patient's well-being, Cowles says.
"I believe that providers become too complacent with respect to what could happen if case of fire," he says. It is exactly like finding the fire escape doors on your floor when you check into a hotel. Cowles says. Most people agree that this is a wise step, however, few people actually go to the effort to do so, he says.
"When a fire breaks out and you know how to escape, even when the smoke is very thick and other people are in panic mode, it pays off," Cowles says.
Resource
To download a copy of the "Practice Advisory for the Prevention and Management of Operating Room Fires," go to www.anesthesiology.org and select "Archive" from the navigational bar. Choose "May 2008" and scroll down to "CME Practice Advisory for the Prevention and Management of Operating Room Fires."
The effects of operating room fires can be devastating. An estimated 50 to 100 surgical fires per year is one of the reasons that the American Society of Anesthesiologists (ASA) has developed a practice advisory to address the issue.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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