I’ve seen surgeons blow up in the operating room but never saw an operating room blow up. But according to the Wall Street Journal, it’s not that rare for them to catch fire and sometimes worse. Operating rooms are full of flammable gases and materials and oxygen. Moreover it isn’t just a matter of taking a fire extinguisher off the wall or dumping a pail of water on the patient. There is the little matter of sterile procedures. So I was quite taken aback by a figure given in the article of 650 surgical suite fires each year in the US and maybe four times that number of “almost” fires (e.g., smoldering surgical drapes immediately extinguished). Apparently people are paying attention:
Patient-safety groups and medical specialty organizations are stepping up efforts to raise awareness of risks and provide guidelines for prevention. Hospitals are conducting operating-room fire drills that teach how to fight fires that break out on the drapes, gowns or skin of surgical patients and extinguish flames inside a patient’s airway or tracheal tube. They’re also developing training programs to educate staffers on the dangers of burns from medical equipment and procedures. (Laura Landro, WSJ)
I haven’t been in an operating room for a long time (excepting the birth of my daughter and my own kidney stones), but I when I was scrubbing regularly I don’t remember anyone mentioning what to do if there was a fire and certainly no training. Now a lot of surgery is being done as day surgery in outpatient surgical facilities. The way to enforce attention to safety is through reimbursement and a new federal law will require safety plans and reporting or suffer a reduction in Medicare reimbursement. The reduction is so small (2%) and levels of reimbursement also ridiculously inadequate I’m not sure how effective this will be, but it’s the right idea. The objective is to reduce scalding, fire, chemical, radiation and electrical burns from warmers, prep solutions and various instruments like lasers and electrical cauterizers.
While the use of flammable anesthetic gases like ether are no longer much of a problem, there are a whole host of new hazards to take their place: all sorts of coils, sensors, magnets, fiber-optic light sources, electric blankets, etc. The results can be terrible:
ECRI [a safety advocacy group] earlier this month recommended the removal of a series of infant warmers after an investigation showed that a baby caught fire in a bassinet at Mercy Hospital in Coon Rapids, Minn., most likely because a hot particle fell from the warmer’s assembly into the area near the baby’s head where oxygen was being delivered. Though nurses quickly extinguished the fire, the baby sustained burns. The warmers in question were last manufactured in 1998 but are still in use in some hospitals, and ECRI says several other models with similar heater assemblies may present the same risk.
Interaction of different kinds of new medical devices and treatments are another difficult problem. I learned in the article that nicotine or fentanyl patches (for pain) used by many patients can heat up in an MRI and burn the patient. Some tattoos have iron in them and can heat up. Surgery is done by teams, and often one person (the surgeon) will employ the heat source while others are working with anesthetics or oxygen or disinfectants. If they aren’t coordinated, bad things can happen.
Because each member of the team may be focusing on his own role in a procedure, “the No. 1 cause of fires is lousy communication” says Patricia Seifert, editor-in-chief of AORN Journal, the monthly publication of the Association of periOperative Registered Nurses. AORN developed a fire-safety tool kit that it sent to 13,000 operating-room directors and managers around the country, and it is now offering the kit free to its 42,000 members.
Fire in the OR is like (or worse) than fire aboard a ship. You want to avoid it at all costs, and strict training, regulation and sanctions for infractions are the best way. It’s not the job of the patient, despite what M. Christine Stock, head of anesthesiology services at Northwestern University’s medical school suggests: Before surgery, ask what fire-prevention strategies are in use.
Sure. Just what I want to do before being rolled into the OR. Ask if they have made sure the place won’t blow up while I’m lying there unconscious or a fire won’t flash down into my lungs through the endotracheal tube keeping me breathing. And what if they say, “Gee, we don’t have a plan”?
Or more likely, “Don’t worry. Everything will be fine. Now count backwards from ten.”