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Surgical Fires: 5 Life-Saving Steps

Publish Date: 10/9/2013

Each year, there are 550-650 surgical fires in the United States, a figure comparable to other surgical accidents such as wrong-site surgery or retained instruments, according to the ECRI Institute. These fires can cause serious patient injury and disfigurement, and even death.

To raise awareness of the risk of surgical fires, FDA and partners launched the "Preventing Surgical Fires" initiative last year. The initiative is celebrating its second anniversary during National Fire Prevention Week, taking place October 6-12.

National Fire Prevention Week provides an opportunity to bring attention to what perioperative professionals need to know to help prevent fires and, if necessary, respond effectively if a fire starts. Here are five critical steps for perioperative professionals to take, according to Byron Burlingame, MS, RN, CNOR, perioperative nursing specialist in AORN's Center for Nursing Practice.

1. Understand the components of fire safety. "Fire safety as a whole consists of three different portions," Burlingame says. "The first portion is prevention. If that fails, then extinguishment is required. If that fails, then evacuation is required." 

2. Conduct an assessment. Prevention of surgical fires should always be the prime objective. The key to prevention is performing an assessment, Burlingame says. "The assessment assists with determining the presence of various risk factors and helps to determine interventions that should be taken to prevent a fire. The risk factors have historically been categorized into a diagram called the 'Fire Triangle.' The three risk factors (with each coordinating to a side of the triangle) are oxygen/oxidizer, fuel and heat/ignition source — the ingredients needed to have a fire."

An example of a fuel risk factor is the presence of an alcohol-based skin prep solution. "The interventions that perioperative professionals should take with this risk factor are remove any of the excess prep solution after completion of the prep process, and to be certain the prep solution is dry before the drapes are applied," Burlingame says.

While the assessment can be accomplished in various ways, it must be completed on every case. "There are a few cases in which one side of the fire triangle is missing and therefore a fire could not start, but they are few and far between. For the sake of safety, the assessment should be accomplished before every case," he says. Note: To view examples of assessment tools and forms, see "Surgical Fire Prevention Resources" to the right. 

3. Know the process for extinguishing a fire. If a surgical fire starts, the surgical team must know how to respond quickly and properly. "The first step in this process is to alert all of the team that a fire is present," Burlingame says. "Then the person closest to the fire should extinguish the fire. The method chosen to extinguish the fire may include placing a towel over the fire and smoothing the towel out using your hand to smother the fire, or using saline or water from the back table."

4. Be prepared to evacuate. If it is determined that the fire is too large to extinguish, the team needs to make the decision to evacuate the OR. "This step is rarely needed, but all members of the team should be prepared if necessary," Burlingame says. "The evacuation may involve just moving to a different OR or it may involve moving to a different location within the facility. When evacuation is required, your top priority is to find a location where the surgery can be completed or the patient can be stabilized and the incision closed with a plan for surgery completion at a later time."

5. Make education a priority. The most important step for a perioperative professional to take to prevent and properly respond to a fire is to receive and provide education. "This education should be delivered to all team members because, as we all know, if you are prepared, the entire team can work together more effectively," Burlingame says. "This leads to a better outcome for the patient and the perioperative team as a whole."

Surgical Fire Prevention Resources

An example of a surgical fire assessment tool is available in the AORN Fire Safety Tool Kit and in the AORN Recommended Practices for a Safe Environment of Care.

Other examples of assessment forms are available from on the FDA's Preventing Surgical Fires initiative website.

Guidelines for Perioperative Practice


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