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Medical Center fire safety guidelines

Specific fire safety precautions and guidelines for operating rooms and patient care areas including information on patient evacuation.

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Operating room fire prevention practices

Operating Room fires are defined as a fire that occurs at or near patients who are under anesthesia care, including surgical fires and airway fires. Surgical fires are a fire that occur on or in a patient and airway fires occur in a patient’s airway or a fire that may be the attached breathing circuit. To have a fire you need three (3) elements: heat + fuel + oxidizers.

Heat: electro surgery probes, electrocautery tools, lasers and fiber optic light sources

Fuel: prep ointments, drapes, gauze, mattresses, tubes and body hair

Oxidizers: oxygen and nitrous oxide

  1. Keep oxygen as low as possible, preferably under 30 percent. Where oxygen is controlled through a tube it is often safer. Patients can still get burned without an oxygen rich environmental but not as seriously.
  2. Allow prep solutions to completely evaporate before the team drapes the patient, administers oxygen or turns on the electro surgery device or laser. Make sure the prep solution has not pooled under patient or towards the drape. Soak up excess with sterile towels and remove it.
  3. Don’t allow oxygen to get trapped under the drape. There is no such thing as a non-combustible drape. Several drapes that are flame-resistant are plastic coated and shrink away. When exposed to heat and oxygen over 80%, the plastic melts off and can singe the patient. Use ignition resistant drapes (such as polypropylene).
  4. Do not use “blow by” oxygen.
  5. Know how to put out fires and where the exits are. Make sure there are water basins in reach during laser surgery. Know how to remove burned material from the patient and how/where to evacuate patients in case of a fire.
  6. Polyvinyl chloride ET tubes are extremely combustible. Use a laser resistant ET tube.

Operating room fire suppression

  1. If you can remove what is burning on the patient, then remove it and put it in a water basin. Save the burned items for investigation.
  2. Fires are categorized as follows:
    1. Class A = ordinary combustibles (wood/paper/cloth/plastics)
    2. Class B = flammable liquids (gasoline/kerosene/oils)
    3. Class C = energized electrical equipment (lasers/fiber-optic head lights/equipment
  3. Fire extinguishers are of little value to fires on the operating tables because by the time an extinguisher is retrieved, the patient would already be severely injured from the fire. Should you decide to use a fire extinguisher, you should be aware of their consequences:
    • Dry Chemical Extinguishers (ABC or BC) leave a residue on the patient or medical device that could corrode the equipment, infect the wound or cause lung irritation.
    • Carbon Dioxide Extinguishers (BC) are the preferred extinguisher for the ORs since they do not leave a residue. At close range they can cause frostbite on exposed skin. Use a sweeping motion to reduce CO2 exposure.
    • Water Mist Extinguishers (AC) use de-mineralized water that lack organic growth making it safer near surgical incisions; however, the water in the extinguisher is not sterile so there still is a concern of infection. The water comes out in a broken spray pattern that does not allow the electric current to pass back to to the user. Water pooled near electrical equipment could still cause an electrocution hazard.
    • Pressured Water Extinguishers (A) use standard tap water and discharge the water at a significant force. Since the water is a straight pattern, there is an electrocution hazard and is not rated to be used for electrical equipment fires. The water in the extinguisher is not sterile so there is a concern of infection.
  4. Fire blankets are not recognized by the AORN as approved for OR fire suppression. Fire can still happen if a blanket is used improperly. They are located in each OR in a special identified cabinet.

Patient evacuation

If you are responsible for patient care you are expected to assist in the safe evacuation of the patient. If the patient is to be evacuated you may use one the following techniques for removing limited mobility patients.

For one-person carries:

  • Cradle Drop
    1. Fold a blanket in half lengthwise and place it on the floor beside the bed.
    2. Slide one arm under the patient’s neck and shoulder and the other under the patient’s back.
    3. Pull the patient to the end of the bed, drop down to one knee and lower the patient so that your knee supports the patient’s back.
    4. Let the patient slide gently to the blanket and pull the patient headfirst from the room.

For two-person carries:

  • Swing Carry
    1. The first person raises the patient to a sitting position at the edge of the bed and places one arm behind the patient’s shoulder and the other arm under the patient’s knee.
    2. The second person places one arm behind the patient and grasps the first person’s shoulder, then places his/her other arm under the patient’s knees and grasps the first person’s wrist.
    3. The patient sits on the rescuers’ clasped hands and wrists and leans back against their arms.
  • The Extremity Carry
    1. The first person raises the patient to a sitting postion; then, from behind, reaches under the patient’s armpits and grasps his/her own wrists in front of the patient’s chest.
    2. The second person moves between the patient’s legs with his/her back to the patient and encircles the patient’s legs at the knees with each arm.
    3. The first person hugs and lifts while the second carries the patient’s legs and the patient is moved feet first.

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