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

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

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In this facility, intubated patients are transported on the OR bed, with a bag-valve mask. (3) Open incisions are packed with sterile, saline-soaked laparotomy sponges and then covered with sterile drapes. Enough instrumentation to close the incision is taken with the patient, but the plan also provides for sterile instruments to be available at the evacuation site. This may vary from facility to facility. The anesthesia machine does not need to be transported with the patient, although the machines all are battery operated in case of a power failure and are equipped with cylinders of oxygen and nitrous oxide; again, this may vary from facility to facility.

DEBRIEFING SESSION. A total of three mock fire drills were implemented during a six-week period. A debriefing session was held after each drill, the purpose of which was to evaluate the success of the plan. Some of the following problems were noted.

* Evacuations did not always proceed in an orderly fashion.

* Overhead pages were not clearly heard.

* No one was sure how communication would occur in the event that the telephone/paging system became inoperable.

* Staff members were not certain how to use the fire plan evacuation check sheet.

* There was a delay in calling for anesthesia backup in the scenarios in which both the patient and the anesthesia care provider were declared injured.

It became obvious during the first fire drill that orders to evacuate required specific directives and that overhead pages sometimes were unclear. This forced staff members to call the front desk or even leave the safety of their room to clarify instructions. Each room now is individually notified by the charge nurse or his or her designee. A messenger position was created and appointed by the charge nurse. This person's role is to keep each room informed of the ongoing situation by updating them every five minutes, thereby disseminating appropriate information and decreasing staff member anxiety. The use of walkie talkies that are independent of the hospital telephone system in the event of a system-wide failure also is being investigated.

During a debriefing session, one anesthesia care provider explained that she would evacuate the patient out the back door of the OR suite if there were a fire. Although this door is accessible, it opens onto a very steep incline next to a road. No area capable of supporting an intubated patient is accessible easily and quickly from that route. This provided an opportunity to clarify why the primary and secondary routes had been chosen.

At Faulkner Hospital, the gastrointestinal patient care unit is the destination for evacuated patients when their surgical procedure cannot be completed before evacuation. This area was chosen because it is located on the same level as the OR, is beyond a fire wall from the OR, and has similar rooms that have suction, oxygen, and electrosurgical units. Several other staff members asked questions that were discussed, and rationales were given. When these issues were be clarified, implementation became easier.