Safety: Is Your Staff Prepared to Handle Surgical Fires?

Your staff must know how to immediately respond if a patient’s airway catches fire, surgical equipment starts to spark or flames erupt in the sterile field. It’s helpful to designate specific roles for each surgical team member during the three scenarios, so there’s no question about who does what when seconds count. Below are examples of responsibilities each team member can take on when the elements of the fire triangle combine unexpectedly. 

1. The patient’s airway
The anesthesia provider should immediately disconnect and remove the endotracheal tube and the breathing circuit, pour saline into the airway and turn off the flow of oxygen at the anesthesia machine. They must also reestablish the airway and resume ventilating the patient using room air until they are certain nothing is burning in the airway, and then switch to using 100% oxygen. The scrub nurse should pour saline or water from the back table onto the burning endotracheal tube, or drop a wet towel on it, and push the back table away from the field.

The circulating nurse should activate the emergency alert system and initiate a STAT page for additional help, assist in extinguishing burning materials, help the anesthesia provider with re-establishing the patient’s airway, and gather involved materials and supplies for filing an incident report. The charge nurse should pull the fire alarm and, in collaboration with anesthesia, close the OR’s oxygen shut-off valve. The nurse can also assign a staff member to stand at the entrance of the OR to direct the code red response team.

Your staff should be able to articulate how to manage specific types of surgical fires.

2. Surgical equipment 
The anesthesia provider should immediately inform the circulating nurse to close the oxygen shut-off valve and announce the need for evacuation, disconnect the breathing circuit from the patient, turn off the oxygen flow, convert to room/medical air and release the surgical drapes. If anesthesia techs are present, they can assist the anesthesia provider in ventilating the patient and obtain necessary vital signs and monitors, oxygen tanks and equipment needed to support the patient during evacuation. 

The surgeon, circulating nurse, scrub tech and other surgical team members should disconnect the patient from all surgical equipment (the insufflator or sequential compression unit, for example), cover the open wound with a sterile drape or sterile towels and transport the patient to the designated evacuation area (an empty OR or PACU bay could be used).

The circulating or charge nurse should activate the fire alarm or code system, communicate the status of the patient to the front desk, ensure the OR doors are closed and notify the departmental manger of the situation and possible evacuation of the patient. If the primary evacuation destination is not appropriate or prepared, the circulating or charge nurse should direct the surgical team to a secondary location and alert personnel there of the impending arrival of the patient.

3. Sterile field
The scrub nurse should immediately pour sterile saline or water from the back table onto the fire or smother the flames with wet towels and remove any burning material from the patient. The anesthesia provider must stop the flow of oxygen to the patient and convert to room air until the fire is under control. As with airway fires, the circulating nurse should activate the emergency alert system and initiate a STAT page for additional help, assist in extinguishing burning materials, help the anesthesia provider with re-establishing the patient’s airway and gather involved materials and supplies for filing an incident report. The circulating nurse or charge nurse should pull the fire alarm and in collaboration with anesthesia, close the oxygen shut-off valve outside of the OR. The circulating nurse can also unplug electrical devices in the room, retrieve a fire extinguisher, if needed, and coordinate communication with department heads and emergency response team members.

Develop a facility fire safety policy based on the input of a multidisciplinary team and conduct regular audits to measure your staff’s compliance. It’s also important to educate staff on the fundamentals of fire risk assessment and response protocols. The AORN Fire Safety Tool Kit is a good resource to use. Creating an education plan and using an evidence-based risk assessment process improves staff communication about the dangers of the fire triangle and their ability to minimize the likelihood of flames erupting during surgery.

Your staff should be able to articulate how to manage specific types of surgical fires, discuss evidence-based prevention interventions and actions, and clearly discuss with their colleagues during time outs before every case the fire risks associated with specific surgical supplies and equipment. Preparing your staff to handle fire emergencies develops skills they hopefully won’t have to use. But better knowledge and understanding of how to prevent surgical fires is essential, and leads to a safer surgical environment. OSM