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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After the first drill, the fire evacuation plan and evacuation check sheets were reviewed with staff members. Subsequent drills revealed 100% compliance.

In the second drill, during which a fiberoptic cord ignited pooled prep solution and the drapes caught on fire, the in-room senior observer also declared that the anesthesia care provider was engulfed in flames. Staff members quickly responded to the patient situation but had to be alerted by the senior observer that the anesthesia care provider also had been affected, although in a real-life situation, it would have been obvious. When alerted, staff members addressed this additional situation (Figure 1) but then were confronted by the scenario that the anesthesia care provider no longer could continue to administer anesthesia. The patient was intubated and on the ventilator, but several minutes elapsed before the room staff members notified the front desk that anesthesia help was needed. In the evaluation session, staff members believed that in the future, they would be more alert and respond appropriately now that a more complicated scenario had been enacted.

In the third drill the scenario included an explosion in the OR hallway during construction. Two workers were declared on fire and burst into separate ORs. Staff members reacted quickly, and the safety of the workers was ensured. Again, the AHJ declared that the entire OR needed to be evacuated. Before the drill, signs had been placed along the primary evacuation route indicating that it was closed due to construction. Additionally, OR equipment was placed randomly along the secondary route, blocking that escape route. Staff members were experienced with evacuation by this time (Figure 2) and were not thrown by the blockage of the primary route. They quickly make the adjustment to the secondary evacuation route but found that having to remove the scattered equipment was frustrating and causing delays. This was discussed in the debriefing session and staff members agreed that securing OR equipment in its appropriate place was vital to ensure that access was clear.

CONCLUSION

Fortunately, fires in the OR occur infrequently; however, fires that have occurred were tragic and have resulted in patients suffering severe burns and even death. Additionally, it is possible that surgical fires may be underreported. AORN recently has developed a web-based, system titled SafetyNet for reporting safety incident near misses. Consistent reporting will improve accuracy and central identification of safety problems, including fires in the perioperative area.

Nurses should review their facility's existing fire plan carefully and ask whether they believe it is adequate and appropriately addresses such issues as

* the chain of command during a fire emergency,

* clearly delineated staff member responsibilities, and

* primary and secondary evacuation routes to an evacuation destination point beyond a fire wall.

Developing a plan specific to the facility is imperative. The plan should include