Fire in ot


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Fire in ot

  1. 1. Explosion & Fire Safety in Operation theatre Moderator: Dr Jesni Joseph Speaker: Dr Gagan Brar
  2. 2. Contents <ul><li>Fire triad </li></ul><ul><li>Products of combustion </li></ul><ul><li>Prevention </li></ul><ul><li>Management </li></ul><ul><ul><li>Type of fire </li></ul></ul><ul><ul><li>Fire safety education </li></ul></ul>
  3. 3. FIRE TRIAD <ul><li>Fuel </li></ul><ul><li>Oxidizer </li></ul><ul><li>Source of heat/ ignition </li></ul><ul><li>Must be present simultaneously & in correct proportions </li></ul><ul><li>So, fires can be prevented/ controlled by removing any one of these elements </li></ul>
  4. 4. Typical coexisting ingredients that could cause an OR fire
  5. 6. Products of combustion <ul><li>Depend upon: </li></ul><ul><ul><li>Temperature of fire </li></ul></ul><ul><ul><li>Nature </li></ul></ul><ul><ul><li>Proportions of the fuel & oxidizer </li></ul></ul><ul><li>Complete combustion : water, CO 2 , other oxides </li></ul><ul><li>Incomplete combustion : variety of by products </li></ul>
  6. 7. Products of combustion <ul><li>Specific combustion products: PVC, silastic, plastics (produce acids such as HCl & hydrogen sulphide, cyanides, CO & phenols) </li></ul><ul><li>Potentially hazardous </li></ul>
  7. 8. Pulmonary toxicity of combustion products Consumption of oxygen by fire Reduced oxygen availability, d/t CO
  9. 10. <ul><li>MOST EFFECTIVE METHOD </li></ul><ul><li>Keep the elements of FIRE TRIAD separated </li></ul><ul><li>Follow basic Laser & Electrical safety guidelines </li></ul><ul><li>Minimize presence of flammable materials </li></ul>
  10. 11. Sources of Heat & Ignition <ul><li>Electrosurgical units </li></ul><ul><ul><li>Audible warning tones (shouldn’t be disabled) </li></ul></ul><ul><ul><li>Foot switches should be assigned; & disconnected when not in use </li></ul></ul><ul><ul><li>Placing probe in insulated, non flammable Holster </li></ul></ul>
  11. 12. Sources of Heat & Ignition <ul><li>Cardiac defibrillators </li></ul><ul><ul><li>Electrodes to make direct contact without intervening wires, linen, clothing </li></ul></ul><ul><ul><li>Alcohol or alcohol soaked pads, nitroglycerine patches, ointments should never be used as conducting medium </li></ul></ul>
  12. 13. Sources of Heat & Ignition <ul><li>Laser : Energy source; very high power density </li></ul><ul><ul><li>Incidentally pressing the laser control trigger, tissue damage outside the surgical site </li></ul></ul><ul><ul><li>Drape fire </li></ul></ul><ul><ul><li>Eye (patient or other medical staff) </li></ul></ul><ul><ul><li>Endotracheal tube fires </li></ul></ul>
  13. 14. Endotracheal tube fires <ul><li>Direct laser illumination </li></ul><ul><li>Reflected laser light </li></ul><ul><li>Incandescent particles of tissue blown from the surgical site </li></ul>
  14. 15. Prevention <ul><li>Reduce the flammability of the endotracheal tube </li></ul><ul><li>Use of Laser resistant ET tubes </li></ul><ul><li>Use Venturi ventilation </li></ul><ul><li>Use intermittent apnea technique </li></ul>
  15. 16. Sources of Heat & Ignition <ul><li>Electrical fires in anesthetic monitors have been reported </li></ul><ul><li>NaCl contamination of the interior of monitors resulted in electrical short circuits which led to over heating & ignition of monitors </li></ul>
  16. 17. Fuel <ul><li>Flammable anesthetic agents </li></ul><ul><li>Flammable disinfecting & degreasing solutions : alcohol & acetone, must evaporate & fumes eliminated before surgery begins </li></ul><ul><li>Surgical drapes & dressings free of disinfectants </li></ul>
  17. 18. Fuel <ul><li>Tissue contents such as bowel gas </li></ul><ul><li>Contains: hydrogen + methane </li></ul><ul><li>Laparoscopy : insufflation with air </li></ul><ul><li>Colonoscopy </li></ul><ul><li>Preventive measures </li></ul><ul><ul><li>Unprepared colon is discouraged </li></ul></ul><ul><ul><li>Low residue diet </li></ul></ul><ul><ul><li>Pre op fasting for 12 hrs </li></ul></ul>X
  18. 19. Fuel <ul><li>Electrosurgery in airway: Dangerous </li></ul><ul><ul><li>ET tubes, oesophageal steth, nasogastric tubes  PVC  inflammable with high oxygen conc. </li></ul></ul><ul><li>Preventive measures: </li></ul><ul><ul><li>Lowest power for cautery </li></ul></ul><ul><ul><li>Bipolar cautery </li></ul></ul><ul><ul><li>Helium- oxygen mixture </li></ul></ul><ul><ul><li>Jet ventilation without tracheal intubation </li></ul></ul><ul><ul><li>Laser resistant ET tubes </li></ul></ul>
  19. 20. Fuel <ul><li>Forced air patient warming blankets: Once ignited  rapid combustion (fuel source: drape material, oxidizer: forced air) </li></ul>
  20. 21. Oxidizer <ul><li>Decrease escape of oxygen & nitrous oxide </li></ul><ul><li>Lowest inspired oxygen conc. that ensures adequate oxygenation, to minimize O 2 accumulation </li></ul><ul><li>Selective use of supplemental oxygen </li></ul><ul><li>Avoid use of ESU in and around trachea & pharynx </li></ul><ul><li>Addition of inert gases (He) to O 2 </li></ul>
  21. 22. MANAGEMENT
  22. 23. TYPES OF FIRE <ul><li>Class A: wood, paper, cloth & most plastic </li></ul><ul><li>Class B: flammable liquids & grease </li></ul><ul><li>Class C: fire involving electricity </li></ul>
  23. 24. Small, light, no residue/ toxicity Leaves residue, damages equipments, ? toxicity Heavy bulky devices Heavy bulky devices, risk of electric shock Inexpensive, non toxic Notes Interrupts oxidation, disperses heat Interrupts oxidation, disperses heat Interrupts oxidation, disperses heat Interrupts oxidation, disperses heat Interrupts oxd Mechanism Class A/B/C Class A/B/C Class B/C small A Class A/ some B Small class A Type of fire Halon Dry chemical CO 2 Water Fire blanket
  24. 25. Use of Fire Extinguishers <ul><li>PASS: </li></ul><ul><ul><li>Pull the Pin to activate </li></ul></ul><ul><ul><li>Aim at the base of the fire </li></ul></ul><ul><ul><li>Squeeze the trigger </li></ul></ul><ul><ul><li>Sweep the extinguisher back & forth across the base of fire </li></ul></ul>
  25. 26. Fire safety education <ul><li>Activation of alarm & communication system </li></ul><ul><li>Location & use of fire fighting tools </li></ul><ul><li>Management of small fire, to prevent spread </li></ul><ul><li>Appropriate responses when fire spread beyond control </li></ul>
  26. 27. Fire safety education <ul><li>When & how to evacuate a room, even when it is crowded with equipments & people </li></ul><ul><li>Appropriate routes to take for evacuation, esp when smoke/ flames block normal entry/ exit </li></ul><ul><li>Location of ‘safety zones’ inside & outside the building where patients/ personnel can be evacuated </li></ul>
  27. 28. Summary <ul><li>Fire triad </li></ul><ul><li>Prevention: Keep them separated </li></ul><ul><li>Management: Depends on type of fire </li></ul><ul><li>Safety education for all </li></ul>Fuel Oxidizer Source of ignition
  28. 29. Responding to FIRE <ul><li>RACE : </li></ul><ul><ul><li>Rescue </li></ul></ul><ul><ul><li>Alarm </li></ul></ul><ul><ul><li>Confine </li></ul></ul><ul><ul><li>Extinguish </li></ul></ul>
  29. 30. THANK YOU