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Surgical Fires

Surgical Fires. The basics of preventing and responding to fires in the operating room. Presented for:. Presented by: OmniSure Consulting Group Kathleen Fitzgerald, RN, BSN Risk Management Consultant. Identify the 3 elements necessary to create fire

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Surgical Fires

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  1. Surgical Fires The basics of preventing and responding to fires in the operating room

  2. Presented for: Presented by: OmniSure Consulting Group Kathleen Fitzgerald, RN, BSN Risk Management Consultant

  3. Identify the 3 elements necessary to create fire Discuss the specifics of the chemistry of fire in the surgical setting Identify methods of preventing surgical fires Review the basics of an adequate fire drill program in the surgical setting Objectives

  4. About 65 million surgical cases per year in the United States 550-600 surgical fires in the United States annually (comparable to wrong site surgeries) Surgical fires cause 2 to 3 patient deaths and approximately 20 serious injuries annually About 75% of surgical fires occur under local and are caused by oxygen trapped under the drapes The Stats

  5. THE FIRE TRIANGLE OXYGEN plus HEAT plus FUEL

  6. ALL THREE ELEMENTS MUST BE PRESENT TO CAUSE FIRE

  7. Anesthesia Providers: Oxidizers O2, N2O, medical compressed air, and ambient air Surgeons: Ignition Sources defibrillators, lasers, electrocautery units, and fiber-optic light sources, electronic scalpels Nurses: Fuels drapes and preps, gowns, towels and sponges (other fuels: hair, intestinal gases and body tissue) THE CHEMISTRY OF FIRE IN THE OR

  8. OR Fire PreventionDisrupting the Fire Triangle • Control Heat Sources • Follow laser and ESU safety practices • Manage Fuels • Allow prep to dry • Minimize Oxygen Concentration • Careful use of oxygen and avoid tenting drapes • Be Consistent • Prevention methods must be practiced and consistently used to • be effective.

  9. Develop a department-specific process Extinguish Evacuate Practice O.R. Fire PlansTHE 1, 2, 3

  10. R. A. C. E. • R= Rescue • A= Alert Staff & Activate Alarm • C= Confine Smoke & Fire • E= Evacuate

  11. EXTINGUISHERS CARBON DIOXIDE PREFERRED IN THE SURGICAL SETTING

  12. P. A. S. S. • P= Pull • A = Aim • S= Squeeze • S= Sweep

  13. Conduct fire drills Train staff in the location & use of fire-fighting equipment Identify the location of gas, ventilation, and electrical controls Define the operation of the center’s alarm system and the system for contacting the fire department Elements of an Effective Fire Plan

  14. Review and discuss unique hazards in surgical areas Practice fire prevention techniques and precautions Educate and re-educate staff to the OR-specific fire plan, the roles of personnel, the locations and operation of alarms, extinguishers, exits, etc. Elements of an Effective Fire Plan Continued

  15. Question the use of 100% O2 for open delivery during facial surgery Do not apply drapes until all flammable preps have completely dried. Elements of an Effective Fire Plan Continued

  16. Heat, Oxygen and Fuel are in Close Proximity Tonsillectomy Tracheostomy Laryngeal surgeries Mouth and nose surgeries Eye surgeries Head, neck, and facial surgeries Examples of High Risk Procedures

  17. SMALL FIRES Smother the fire and/or remove the burning material. LARGE FIRES Stop the flow of gases. Remove the burning materials. Extinguish the fire. Ventilate the patient. Call for help. Evacuate, if necessary. Examine and treat the patient. Don’t forget to save equipment, materials and devices for risk management/patient safety investigation Management of Fire on the Patient General Principles

  18. Keep ESU tips clean Holster the ESU when not in use Use nonflammable drapes and moist towels around a laser surgical site Deactivate lasers, etc. when not in use in the surgical field Controlling Heat

  19. Ensure preps are dry so that alcohol vapors will not collect under the drapes. Containers of volatile solutions (alcohol, acetone, etc.) should be closed soon as possible. Avoid petroleum-based ointments. During local or conscious sedation, turn off oxygen 60 seconds prior to activation of ESU or Laser if used on the head or neck Controlling Fuels

  20. Avoid using plastic bags to cover the patient Drape so as to allow for the venting of oxidant and to prevent accumulation Place evacuation suction under drapes Controlling Oxygen Concentration.

  21. What Do We Do If The Patient is on Fire? REMEMBER: FIRE SPREADS QUICKLY, SO YOU MUST RESPOND QUICKLY 1. Immediately remove burning materials from patient 2. Shut off medical gases; manually ventilate, if necessary 3. Anesthesia disconnects patient from oxygen source 4. Smother fire. Use fire blanket, if necessary. 5. Move patient to safe area where oxygen may be administered

  22. Airway Fire: What Do We Do? IN RAPID SEQUENCE: 1. Disconnect breathing circuit from endotracheal tube and stop the flow of airway gases 2. Remove tube & extinguish burning material 3. Examine airway and remove any debris & if necessary, pour saline down the airway 4. Re-establish airway. Ventilate with air 5. Examine airway and treat injuries

  23. ROLES OF OPERATING ROOM STAFF DURING FIRE IN AND/OR ON THE PATIENT

  24. Turns off oxygen or nitrous Ventilates using air Controls IV to maintain anesthesia Maintains ABC’s Anesthesiologist

  25. Manages moving the patient and controls the surgical site Surgeon

  26. Places surgical instruments in a tray and on patient Assists in moving patient out of the OR Scrub Nurse

  27. Disconnects patient leads, lines Disconnects anesthesia gas lines and unplugs equipment and monitors Assists anesthesiologist with ventilation Moves anesthesia machine if necessary Circulating Nurse

  28. Assists in moving patient out of the OR as directed by surgeon Assisting Surgeon and Others

  29. Understand the Fire Triangle (PREVENTION) Understand the chemistry of potential fires in the OR (INTERRUPTION) Know the roles of each team member in a fire emergency (RESPONSE) Practice Practice Practice KEY POINTS

  30. ECRI Joint Commission ANSI RESOURCES

  31. QUESTIONS

  32. Admiral’s Website Link –Surgery Centers Solutions www.omnisure.com/admiralins-asc.html

  33. Ms. Fitzgerald was awarded a Bachelor of Science in Nursing with honors from Indiana University Southeast in 1986. She was named Nursing Student of the Year in 1986. Her professional experience includes 24 years of nursing practice in clinical, leadership and management roles. This experience encompasses Healthcare Risk Management, Medical Liability Claims, Patient Safety, Legal Nurse Consulting, In-house Defense Medical Malpractice, Operating Room Nursing, Dialysis, Labor and Delivery, Hospice and Psychiatry.  Ms. Fitzgerald also designs and presents risk management training programs for healthcare providers. She has worked for hospitals, long term care providers insurance companies, law firms, individual attorneys, and claims managers. Her work has allowed her to attend and assist in the preparation for trials, mediations and depositions. Proactively, she has assisted healthcare providers to promote Patient Safety, and to successfully identify, address and manage risks. Kathy’s Bio

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