Fire in the OR—Developing a fire safety plan - Home Study Program

AORN Journal, March, 2004 by Patricia M. McCarthy, Kenneth A. Gaucher

ABSTRACT

* APPROXIMATELY 100 OPERATING ROOM fire occur each year in the United States. Although rare, fire in a perioperative setting can be disastrous for both patients and staff members.

* IT IS CRUCIAL that all perioperative departments have a well thought out and previously rehearsed fire plan in place. Multidisciplinary planning and implementation of regularly scheduled and scripted fire drills are essential to prevent adverse outcomes.

* FIRE DRILLS ENSURE that all staff members are familiar with the use and location of fire pull stations, fire extinguishers, and fire blankets. Fire drills also prepare staff members to evacuate the OR area if necessary.

* THIS ARTICLE provides the information and framework necessary to develop and implement comprehensive OR fire safety plans that could make the difference between life and death in a fire emergency. AORN J 79 (March 2004) 588-600.

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Approximately 100 OR fires occur every year in the United States. (1) Although OR fires are infrequent, they can be deadly for both patients and staff members. Unique safety concerns in the OR (eg, lasers, electrosurgery, oxygen-enriched atmosphere, flammable solutions, anesthetized patients) require specific types of solutions and preparedness. (2) The decision to review and augment the fire safety plan for Faulkner Hospital, Boston, was made after recent facility renovations and the addition of new OR staff members and a large anesthesia group that rotates to 12 separate facilities. The purpose of this article is to provide a framework for developing a comprehensive, facility specific, fire safety plan for the perioperative area that culminates in mock fire drills. (2)

PURPOSE

Five years ago, Faulkner Hospital merged with a much larger metropolitan hospital. The other hospital was in need of more OR space, and Faulkner Hospital's ORs were being underused. Since that time, many surgeons from the other facility have obtained privileges at Faulkner Hospital, which necessitated adding more OR space. Two more OR suites were built within the existing OR space by altering its configuration. As a result, a small 150-bed community hospital with seven OR suites has now expanded to contain nine OR suites with a new architectural configuration. The merger increased the number of medical personnel in the OR and added medical students' OR rotations and surgical residents to an already transient population of anesthesia care providers, nursing students, and student technologists.

Although there was a fire safety plan in place, the OR director, nurse practitioner, and clinical educator/systems coordinator thought that the plan as it existed was far too generic and did not adequately address the many complex issues that could develop during a fire in a multifaceted environment such as the OR. The question of how to evacuate an intubated patient with an open incision, for example, had never been addressed adequately. It was very important that a simple, safe, and straightforward plan clearly defining the roles and expectations of all staff members be developed.

PLANNING

After identifying the need for a plan, the nurse practitioner and clinical educator/systems coordinator began organizing support for the project. Meetings were held with the OR nursing director, chief of anesthesia, director of security, and, eventually, the hospital emergency management committee (EMC). The EMC consists of security personnel, hospital department directors, and local fire and police representatives. Dialogue with the EMC was advantageous. It was discovered that two departments within the hospital had assigned the same evacuation route and triage areas. Discussion prevented a potential logistical problem.

Cooperation among the aforementioned groups proceeded without problems. The few barriers encountered were logistical in nature rather than ideological. For example, the anesthesia group that covers the hospital employs more than 100 professional personnel. When could the entire staff meet? How would the mock drills be implemented and when?

AUTHORITY HAVING JURISDICTION. The goal was to write the plan to include specific tasks and priorities for each team member. An "authority having jurisdiction" (AHJ) was central to the plan (Table 1) Authority having jurisdiction is a nationally recognized fire safety term that denotes the person designated to have overall authority in a particular situation. It was important that the lead authority be clearly defined at all times and that this person would make all key decisions with clinical input from the departments of nursing and anesthesia. Every team member, including surgeons, had to understand and be able to identify the chain of command. The AHJ was central to ensuring successful implementation and ongoing operation of The plan. (2)

JOB DESCRIPTIONS. A plan was written to describe responsibilities for each staff member's role (eg, circulating nurse, scrub person, anesthesia care provider, surgeon) in the OR (Table 2). The basics of the fire triangle, which consists of three legs or sources--oxygen, fuel, and ignition--were introduced. (3) Fire alarms, extinguishers, and fire blankets were located, and evacuation routes were delineated. Architectural schematics detailing these features were placed in every OR suite, corridor, and lounge. All primary and secondary evacuation routes were color coded to assist team members in the event that evacuation becomes necessary. (3)