Surgical fires—learn not to burn

AORN Journal,  July, 2004  by Carol Smith

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The article "Surgical fires--Learn not to burn," is the basis for this AORN Journal independent study. The behavioral objectives and examination for his program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, BC, education program professional, Center for Perioperative Education.

Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is July 31, 2007.

Complete the examination answer sheet and learner evaluation round on pages 39-40 and mail with appropriate fee to

AORN Customer Service

c/o Home Study Program

2170 S Parker Rd, Suite 300

Denver, CO 80231-5711

or fax the information with a credit card number to (303) 750-3212.

You also may access this Home Study via AORN Online at http://www.aorn.org/journal/homestudy/default.htm.

BEHAVIORAL OBJECTIVES

After reading and studying the article on surgical fires, nurses will be able to

1. explain why surgical fires may not be reported,

2. discuss the effect of human complacency on the fire triad in the OR,

3. describe the benefits of performing fire drills, and

4. identify the most important action to take if an airway fire occurs.

The term fire is defined as "the phenomenon of combustion manifested in light, flame, and heat." (1) Humans did not invent fire; it has been on the planet for at least 400 million years. (2) People in early civilizations used fire to cook, stay warm, and provide light. Fire continues to be essential to humans today. It is a basic, everyday element in people's lives, from heating their homes to cooking with gas-fired kitchen appliances. Fire can bring meaning to a romantic, candlelit dinner or to Girl Scouts singing songs around a campfire. Fire also can be dangerous and destructive, causing injury and death. The basic principle to remember is that people start most fires, and people can prevent them.

Surgical fires can occur in any setting where invasive procedures are performed, including ORs, ambulatory surgery centers, and even physicians' offices. People often choose not to think about surgical fires. When they occur, however, they can cause devastating consequences, including

* patient injury or death;

* potential legal ramifications;

* psychological trauma to staff members, patients, and family members; and

* unfavorable public relations.

More than 23 million inpatient surgeries and 27 million outpatient surgeries are performed each year. (3) Although exact numbers are not available, estimates indicate that approximately 100 surgical fires occur each year, resulting in up to 20 serious injuries and one or two patient deaths. (3) This number is believed to be only a small percentage of the actual fires hat occur annually, however. (3) There may be several reasons why more fires are not reported, including the following.

* Magnitude of the fire situation--some fires are small and are extinguished by staff members before flames spread or patient injury occurs. No evacuation is required, so reporting the fire is considered unnecessary.

* Close call--potentially disastrous situations exist, such as a fiberoptic cable or electrosurgical unit (ESU) tip burning a hole in the drape. No flame or smoke results, however. Although the situation could have resulted in serious injury, because none occurred, it is not reported.

* Lack of a reporting mechanism--no centralized reporting mechanism exists, and staff members believe that a fire needs to be reported only if the fire department responds.

* Fear--staff members and administrators fear that blame, legal consequences, and public relations issues may result if a fire situation is reported.

Virtually all fires ignite on or in the patient. (4) The most common fire locations are the airway (ie, 34%) and the head or face (ie, 28%). (3) Thirty-eight percent of fires occur elsewhere on or inside the patient. (3) Common injuries that result are airway burns, skin or internal burns, and burns to patients' unprotected eyes during laser surgery. Threats from fire (ie, heat, flames, smoke, toxic fumes and byproducts) can affect how staff members respond. Flames consisting of volatile gases develop when materials ignite. Most flames have a temperature of approximately 1,200[degrees]C (2,192[degrees]F). (4) Smoke (ie, the soot particles given off by fire) can fill a room in approximately three minutes. Smoke floats to the ceiling, obliterating overhead ceiling lights. This puts the room into virtual darkness, which creates confusion and panic. Toxic fumes and byproducts are produced as synthetic materials melt. These toxic fumes are caustic to the skin and eyes and can be lethal if inhaled.

UNDERSTANDING AND RECOGNIZING FIRE HAZARDS

Fire is a result of a rapid chemical reaction between a fuel and oxygen. A fire can start when a fuel becomes so hot that it releases sufficient flammable gases for combustion to occur. (6) Fires occur in any setting where the three elements that form the fire triad (ie, fuel, oxygen, heat) come together. The components are considered safe when separate but are a hazard when they unite (Figure 1).