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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TABLE 1
Chain of Command

1. Authority having
jurisdiction (eg, fire
chief upon arrival)

2. Security supervisor,
RN in charge, or
anesthesia care
provider in charge

3. Chief of surgery or
director of perioperative
services

TABLE 2
Responsibilities of Personnel During a Fire Emergency *

Clinical leader or charge nurse

* Gather the OR schedule, staffing plan, sales
representative log book, and anesthesia
attendance sheet to determine the number of
people in the area.

* Assign a dispatch person (ie, communication
officer).

* Communicate with the fire chief or safety
supervisor regarding the fire location.

* Instruct visitors to leave the area.

* Assess each OR in progress to determine the
time required to complete the procedure.

* Communicate with each OR in progress every
five minutes regarding the plan of action.

* Send additional help where needed.

* Make decisions with the anesthesia care
provider in charge regarding triage priorities
for evacuation and placement of each patient.

* Note the time the fire began to determine
the length of time it will be safe for personnel
to remain in the rooms.

* Direct the holding area RN to evacuate, if
evacuation becomes necessary.

* Notify gastrointestinal (GI) patient care unit
staff members that a fire emergency exists in
the OR and to prepare for the potential
arrival of patients.

* Direct staff members to evacuate patients
who have been sedated, have had a regional
block, or have had lines placed to the GI
patient care unit.

Traffic control person

* Assist the clinical leader in directing traffic
flow.

* Remain with the clinical leader until the
order to evacuate is given.

* Notify the emergency room of any injuries
requiring attention.

* If evacuation is ordered, report to the GI
patient care unit and assist staff members
in preparing to receive patients.

* Remain in the GI patient care unit to coordinate
patient activities.

RNs and scrub persons

* The circulating RN completes the fire plan
and evacuation check sheet.

* Remain with, protect, and reassure the
patient.

* Identify a fire-flee escape route.

* If the fire is small, extinguish it by dousing
it with water or using a hand-held extinguisher.

* Remove burning material from the patient
or sterile field and place it on the floor to
extinguish. Avoid stamping on burning
material because it could stick to shoe covers
and ignite surgical attire.

* If fire is electrical in origin, disconnect
equipment if this can be done safely.

* Save all fire materials for later inspection by
the safety officer.

Surgeons

* Quickly remove any burning material from
the patient.

* Assist in extinguishing the fire.

* Control bleeding and attempt to complete
the surgical procedure as quickly as possible.

* Be prepared to assist if evacuation of the
patient is required.

Anesthesia care providers

* Stop the flow of gases if the fire is located on
the patient or drapes covering the patient.

* Shut off the oxygen flowing directly to
patient (ie, not the main shut off valve to the
room) and ventilate the patient with room air.

* Instruction to turn off the emergency gas
shut-off valves will be determined by the
anesthesia care provider in charge or the
authority having jurisdiction.

* The anesthesia technologist will assist with
obtaining portable oxygen canisters, suction
machines, and other needed equipment.

OR orderlies

* Ensure hallways, evacuation routes, and
exits are unobstructed.

* Report to the OR main desk for Instructions.

* Obtain additional equipment and supplies as
necessary and as directed by the clinical
leader.

Secretaries/equipment coordinators

* Implement the procedure to report a fire.

* Keep telephone lines open.

* Refer to the clinical leader for further
instructions.

* When a fire in the OR is announced, all staff members not
involved in patient care are to report to the clinical
leader at the main desk.

TABLE 3
Fire Plan and Evacuation Check Sheet

--Check sheet completed by the circulating nurse before a
patient is evacuated when a fire emergency is declared by
the authority having jurisdiction.

--The charge nurse or anesthesia care provider in charge
verifies that the check sheet is complete, including supplies
and equipment needed for patient care after evacuation.

OR # --

Surgeon: -- Surgical procedure: --

Estimated time for completion of the procedure: --

Gastrointestinal nursing unit notified of patient transfer: --

All nursing documentation to accompany the patient during evacuation

-- Preoperative nursing record -- -- --
-- Intraoperative nursing record -- -- --
-- Anesthesia record -- -- --
-- Physician order sheets -- -- --

Names of personnel in the room

Surgeon -- Anesthesia care provider --
Circulating nurse -- Scrub person --
Other -- Other --

List supplies and equipment needed to complete the procedure
(eg, OR and anesthesia supplies)

-- -- --

TABLE 4
Fire Safety and .
Evacuation Plan Scenarios

1. Electrosurgical unit not holstered, causing surgical
drapes to ignite.

2. Prep solution pooled, causing fire when in contact
with fiberoptic cord.

3. Explosion outside of room during construction.
causing fire and smoke within OR suites.

All of the patients were intubated surgical wounds were
open, and all required evacuation under the direction of
the authority having jurisdiction.