Code red in the OR—implementing an OR fire drill

AORN Journal, April, 2004 by Jane Flowers

A fire in the OR is one of the most frightening events that a surgical team can experience. Team members have to be acutely aware of the types of fires that can erupt, procedures for handling each type of fire, processes for informing others without creating a panic, the location of fire fighting equipment and how to operate the equipment effectively, and, most importantly, how to prevent fires from erupting in the first place. For a surgical team the first question may be "what is burning--the inside of the patient or the outside?" (1) With this question in mind, fire safety takes on new meaning.

On June 24, 2003, the Joint Commission on Accreditation of Healthcare Organizations published a Sentinel Event Alert regarding fires in the OR. This document references the ECRI recommendation that

   training on the use of fire-fighting
   equipment; proper methods for rescue
   and escape; the identification and location
   of medical gas, ventilation, and
   electrical systems and controls, as well
   as when, where, and how to shut off
   these systems; and the use of the hospital's
   alarm systems and system for
   contacting the local fire department (2)

should be conducted in the OR. Managers are responsible for keeping staff members up-to-date on the various aspects of fire safety.

Peninsula Regional Medical Center, Salisbury, Md, holds yearly instruction on fire safety. Staff members have been taught how to use fire extinguishers using the PASS method:

* pull the pin,

* aim the nozzle,

* squeeze the handle, and

* sweep at the base of the fire.

No fire drill, however, had ever been held in the OR. The time had come to determine OR staff members' strengths and weaknesses during a fire drill.

Policy Review

A fire safety committee, led by time manager for perioperative education and consisting of OR education coordinators, the OR clinical manager, and the director of surgical services, formed to update the OR fire safety plan. The committee members' first major activity was to search the Internet for the latest information on handling fires in the OR. Next, they conducted a complete review of facility-wide and OR fire safety plans. The OR fire safety plan was revised and expanded to adhere to the facility-wide guidelines and to incorporate information from other sources, such as ECRI, to establish a complete and comprehensive plan of action.

The original fire plan was short and lacked specific information. It stated that patients would be transferred laterally and that one of the prime functions of the charge nurse was to designate someone to answer the telephones. The revised OR fire safety plan is specific regarding the roles and responsibilities of all members of the surgical team. The plan lists many of the activities to be performed by managers and the charge nurse, as well as the duties of staff members caring for patients. The plan also instructs staff members who are not directly caring for patients at the time of a fire where to wait for instructions. It is important that every team member knows what his or her job would be in the event of a fire.

The plan divides fire control into two categories involving patients--a small fire that can be extinguished easily and a larger, more involved fire. The plan also details equipment, supplies, and supply packaging material that must be isolated and saved for use in the fire investigation that will ensue. The plan stresses continued care and management of patients during the fire.

The fire plan includes evacuation steps and designates the facility personnel who will authorize evacuation and the evacuation routes. In the event of a single room evacuation, the location of choice may be as close as the nearest safe room or the next available operating suite. Evacuation occurs first in a lateral movement and can extend to areas outside of the surgical services department.

After the OR fire plan was revised and approved by the hospital-wide facilities management fire team, the first OR fire drill was planned. Planning for the drill required coordination among many individuals. The committee met with the facilities management team and set a date in October to conduct the fire drill. The fire department was contacted in advance to prevent them from responding to the drill. The facilities management safety officer gave the fire safety committee permission to call a code red in the OR at this time. The protective services department and the telephone switchboard operators also were notified. The date selected allowed the perioperative educators time to educate staff members about the updated fire policy.

Program Roll Out

An hour-long educational program was presented at a staff meeting in early August. The manager for perioperative education began the program by discussing ways that perioperative nurses can prevent OR fires and reviewing the components of the fire triangle--heat, fuel, and oxygen. The OR environment is rich in all of these elements.

According to ECRI, electrosurgical units (ESUs) and lasers are among the most common ignition sources for fires. (3) Both require a heat exchange to produce desired results. Use of ESU holsters to prevent accidental discharge of electrical energy was discussed, as was the importance of ensuring that the laser is placed in stand-by mode. Another source of fires in the OR are fiber-optic headlights and endoscopes that commonly are used for many different procedures. It is important never to leave a lighted endoscope or light source lying on surgical drapes. This is a fire waiting to happen.