Fire prevnting in the operating room

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guias para prevencion de incendio en planta quirurgica

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  • Very useful information. Thanks for sharing.

    How about some guidelines on what types of hospital doors are recommended
    in the different hospital areas eg. Operating theatres, Ambulatory care, radiology and wards.

    Thanks.

    Jasmine
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Fire prevnting in the operating room

  1. 1. AORN Guidance Statement: Fire Prevention in the Operating Room Introduction produces heat includes, but may not be limited to, fiberoptic light cables and light source boxes; drills, AORN recognizes that fire is an inherent risk in ORs. saws, and burrs; hand-held electrocautery devices; Fire is an ever-present danger and poses a real haz- argon beam coagulators; and defibrillators.4 ard to patient and health care worker safety. In 2003, Almost everything in the perioperative arena can the Joint Commission on Accreditation of Healthcare be a fuel source, especially when an accelerant, Organizations (JCAHO) issued a sentinel event alert such as oxygen, is present. The items used to set up related to fires that occur during operative and inva- the sterile field and protect the patient (eg, linens, sive procedures. The bulletin raised the level of drapes, gowns, supplies, preps, gauzes, clothes) awareness about the dangers of surgical fires. The should all be considered fuel sources. The patient’s Joint Commission recommends that health care body hair and body gases also can be fuel sources.5 organizations prevent surgical fires by providing edu- The primary oxidizers in the surgical environment cation and training for perioperative practitioners.1 In are oxygen and nitrous oxide. Fires can occur when July 2004, surgical fire prevention was added to the the oxygen level in the atmosphere rises above the 2005 National Patient Safety Goals for ambulatory level of ambient air (ie, 21%). Oxygen can escape and office-based surgical facilities.2 into the air when patients are given mask or nasal The approach to developing policies and proce- oxygen. A level above 21% should be treated as an dures to reduce fire risk should be multidisciplinary oxygen-enriched environment.6 and involve all professionals who provide patient Guideline care. Facilities are encouraged to report surgical fires to JCAHO, ECRI, or the US Food and Drug Adminis- Education tration (FDA). Systematic reporting of fires can help Education and training in fire risk reduction strategies educate care providers about how and why fires for perioperative RNs, surgical technologists, anesthe- occur and can help prevent fires in the future.1 sia care providers, surgeons, and other personnel is essential to promote and maintain a fire-safe perioper- Background ative environment. Health care industry representa- Fires involving surgical patients have been reported tives and students should be included in fire drill edu- by hospitals and ambulatory surgical centers; some cation. Each perioperative team member is responsible medical device manufacturers, and other experts, for promoting a culture of fire safety. Preparation is the such as ECRI, for many years. There is no centralized key to ensuring readiness for preventing fires in the database being collected by any agency at present on OR. Recommendations from ECRI include that ♦ perioperative team members participate in the total number of surgical fires;3 however, data from ECRI and the FDA estimate that approximately 100 fire drills; ♦ team members receive training on the use of surgical fires occur each year, resulting in approxi- mately 20 patient injuries that are serious, with one to fire fighting equipment, rescue methods, and two deaths per year.1,4 The overriding consideration evacuation; ♦ staff members know where medical gas pan- with surgical fires is that they are 100% preventable.1,4 Fires occur when the elements that support els and ventilation and electrical systems are combustion—an ignition source, a fuel source, and located, which personnel are permitted to an oxidizer—come together. These three elements shut them off, and when; ♦ staff members in the perioperative care set- are referred to as the “fire triangle.” All three ele- ments are present in abundance during operative ting be shown how to initiate a “Code Red” and invasive procedures4 (Tables 1-3). Operating or fire alarm at their facility; ♦ staff members know specific protocols to rooms in hospitals and ambulatory surgery suites, physicians’ offices, and endoscopy suites are some contact the local fire department;4 ♦ students rotating through the perioperative area of the critical areas where fires occur, and they contain all the elements that support combustion. are included in fire education and training; and ♦ health care industry representatives are edu- Ignition sources are anything that produces heat; the two most common sources are the electrosurgi- cated on fire safety hazards in the periopera- cal unit (ESU) and the laser. Other equipment that tive area during their credentialing process. 143 2005 Standards, Recommended Practices, and Guidelines
  2. 2. Fire Prevention Table 1 FIRE RISK—IGNITION Ignition sources Strategies to manage ■ Use the lowest possible power setting. Electrosurgical unit (ESU) ■ Place the patient return electrode on a large muscle mass close to the surgical site. ■ Large reusable return electrodes should be used according to the manufacturer’s instructions. ■ Always use a safety holster. ■ Do not coil active electrode cords. ■ Inspect the active electrode to ensure integrity. ■ Do not use ESU in the presence of flammable solutions. ■ Ensure that cords and plugs are not frayed or broken. ■ Do not place fluids on top of the ESU. ■ Do not use the ESU near oxygen or nitrous oxide. ■ Ensure that the ESU active electrode tip fits securely into the active electrode hand piece. ■ Ensure that any connectors and adaptors used are intended to connect to the ESU and fit securely. ■ Do not bypass ESU safety features. ■ Ensure that the alarm tone is always audible. ■ Remove any contaminated or unused active accessories from the sterile field. ■ Keep the active electrode tip clean. ■ Use wet sponges or towels to help retard fire potential. ■ Never alter a medical device.1 ■ Do not use rubber catheters or protective covers as insulators on the active electrode tip.2 ■ Use cut or blend instead of coagulation when possible. ■ Do not open the circuit to activate the ESU. ■ Ensure that the active electrode is not activated in close proximity to another metal object that could conduct heat or cause arcing.3 ■ After prepping, allow prep to dry and fumes to evaporate. Wet prep and fumes trapped beneath drapes can ignite.4 ■ Provide multidisciplinary inservice programs on the safe use of ESUs based on the manufacturer’s instructions. ■ Argon beam coagulators combine the ESU spark with argon gas to concentrate Argon beam coagulator and focus the ESU spark. Argon gas is inert and nonflammable, but because it is used with an ESU, the same precautions as with an ESU should be taken. ■ Always use a safety holster. ■ Ensure that the active electrode is not activated in close proximity to another metal object that could conduct heat or cause arcing.1 ■ Use a laser-specific endotracheal tube (ie, a tube that has laser-resistant coating Lasers or contains no material that will ignite) if head, neck, lung, or airway surgery is anticipated.5 ■ Wet sponges around the tube cuffs may provide extra protection to help retard fire potential. Moist towels around the surgical site also may retard fires. ■ Do not use liquids or ointments that may be combustible. ■ Inflate cuffed tube bladders with tinted saline (eg, methylene blue) so that inadvertent rupture may be detected during chest or upper airway surgery. ■ Do not use uncuffed, standard endotracheal tubes in the presence of a laser or the ESU. ■ If an endotracheal tube fire occurs, oxygen administration should be stopped, and all burning or melted tubes should be removed from the patient immediately. ■ Prevent pooling of skin prep solutions. 144 2005 Standards, Recommended Practices, and Guidelines
  3. 3. Fire Prevention Table 1, continued FIRE RISK—IGNITION Ignition sources Strategies to manage (continued) ■ Drapes that will resist ignition should be used close to the area being lased. ■ Have water and the correct fire extinguisher type available in case of a laser fire.6 ■ Ensure that the light source is in good working order. Fiber optic light sources ■ Place the light source in standby, or turn it off when the cable is not connected. Fiber optic light cables ■ Place the light source away from items that are flammable. ■ Do not place a light cable that is connected to a light source on drapes, sponges, or anything else that is flammable. ■ Do not allow cables that are connected to hang over the side of the sterile field if the light source is on. ■ Ensure that light cables are in good working order and do not have broken light fibers.7 ■ Instruments/equipment that move rapidly during use generate heat. Always ensure Power tools/drills/burrs that they are in good working order. ■ A slow drip of saline on a moving drill/burr helps to reduce heat buildup. ■ Do not place drills, burrs, or saws on the patient when they are not in use. ■ Remove instruments/equipment from the sterile field when not in use.8 ■ Select paddles that are the correct size for the patient (eg, pediatric paddles Defibrillator paddles on a child). ■ Ensure that the gel recommended by the paddle manufacturer is used. ■ Adhere to appropriate site selection for paddle placement. ■ Contact between the paddles and the patient should be optimal and no gaps should be present before activating the defibrillator.9 ■ Ensure that all equipment is periodically inspected by biomedical personnel for Electrical equipment proper function. ■ Check biomedical inspection stickers on the equipment; they should be current. ■ Do not use equipment with frayed or damaged cords or plugs. ■ Remove any equipment that emits smoke during use.10 NOTES 1. “Recommended practices for electrosurgery,” in 7. “Recommended practices for endoscopic minimally Standards, Recommended Practices, and Guidelines invasive surgery,” in Standards, Recommended Practices, (Denver: AORN, Inc, 2004) 245-259. and Guidelines (Denver: AORN, Inc, 2004) 267-271. 2. “A clinician’s guide to surgical fires: How they 8. ECRI, “The patient is on fire! A surgical fire primer,” occur, how to prevent them, how to put them out,” Health Medical Device Safety Reports 21 (January 1992) 19-34. Devices 32 (January 2003) 1-24. Also available at http://www.mdsr.ecri.org/summary/ 3. Fire Safety Self Study Guide (Denver: HealthStream, detail.aspx?doc_id=8197&q=%22The+patient+is 2004). +on+fire%22 (accessed 12 Jan 2005). 4. “Recommended practices for skin preparation of 9. ECRI, “Fires from defibrillation during oxygen admin- patients,” in Standards, Recommended Practices, and istration,” Health Devices 23 (July 1994) 307-308. Also Guidelines (Denver: AORN, Inc, 2004) 357-360. available at http://www.mdsr.ecri.org/summary/detail.aspx 5. K A Ball, Lasers: The Perioperative Challenge (Den- ?doc_id=8128&q=%22Fires+from+Defibrillation%22 ver: AORN, Inc, 2004) 145. (accessed 12 Jan 2005). 6. “Recommended practices for laser safety in practice 10. “Recommended practices for safe care through settings,” in Standards, Recommended Practices, and identification of potential hazards in the surgical environ- Guidelines (Denver: AORN, Inc, 2004) 319-324. ment,” in Standards, Recommended Practices, and Guide- lines (Denver: AORN, Inc, 2004) 301-307. 145 2005 Standards, Recommended Practices, and Guidelines
  4. 4. Fire Prevention Table 2 FIRE RISK—FUEL Strategies to manage Fuel sources ■ Assess the flammability of all materials used in, on, or around the patient. Patient and staff linens Linens and drapes are made of synthetic or natural fibers. They may burn or Drapes melt depending on the fiber content.1 Gowns ■ Do not allow drapes or linens to come in contact with activated ignition sources Towels (eg, laser, electrosurgical unit [ESU], light sources).2-4 Lap pads ■ Do not trap volatile chemicals or chemical fumes beneath drapes.5 Sponges ■ Moisten drapes, towels, and sponges that will be in close proximity to ignition Dressings sources (eg, laser, ESU).2,3 Tapes ■ Ensure that oxygen does not accumulate beneath drapes. Bed linens ■ If drapes or linens ignite, pat out small fires with a wet sponge or towel. Remove Caps/hats burning material from the patient. Shoe covers ■ Extinguish any burning material with the appropriate fire extinguisher or water, if appropriate.6 ■ Use flammable prep solutions with caution. Prep solutions ■ Do not allow prep solutions to pool on, around, or beneath the patient. ■ After prepping, allow prep to dry and fumes to evaporate. Wet prep and fumes trapped beneath drapes can ignite. ■ Do not activate ignition sources in the presence of flammable prep solutions. ■ Do not allow drapes that will remain in contact with the patient to absorb flammable prep solutions.5 ■ These products may be used before skin prep to degrease or clean the skin or as Skin degreasers, part of the dressing. These products may contain chemicals that are flammable tinctures, aerosols (eg, ether in collodian). Allow all fumes to evaporate before surgery. The laser or ESU should not be used after the dressing is in place.3 ■ The patient’s own body can be a fuel source. Coat any body hair that is in close Body tissue and proximity to an ignition source with a water-based jelly to retard ignition.4 patient hair ■ Ensure that surgical smoke from burning patient tissue is properly evacuated. Surgical smoke can support combustion if allowed to accumulate in a small or enclosed space (eg, the back of the throat).3 ■ Patient intestinal gases are flammable. Electrosurgery or laser should be used with Intestinal gases caution whenever intestinal gases are present. Do not open the bowel with the laser or ESU when it appears gas is present. ■ Use suction during rectal surgery to remove any intestinal gases that may be present.3 NOTES 1. “Recommended practices for product selection in 4. “Recommended practices for endoscopic minimally perioperative practice settings,” in Standards, Recom- invasive surgery,” in Standards, Recommended Practices, mended Practices, and Guidelines (Denver: AORN, Inc, and Guidelines (Denver: AORN, Inc, 2004) 267-271. 2004) 347-350. 5. “Recommended practices for skin preparation of 2. “Recommended practices for laser safety in practice patients,” in Standards, Recommended Practices, and settings,” in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2004) 357-360. Guidelines (Denver: AORN, Inc, 2004) 319-324. 6. “A clinician’s guide to surgical fires: How they 3. “Recommended practices for electrosurgery,” in occur, how to prevent them, how to put them out,” Health Standards, Recommended Practices, and Guidelines Devices 32 (January 2003) 1-24. (Denver: AORN, Inc, 2004) 245-259. 146 2005 Standards, Recommended Practices, and Guidelines
  5. 5. Fire Prevention Table 3 FIRE RISK—OXIDIZERS Strategies to manage Oxidizers ■ Oxygen should be used with caution in the presence of ignition sources. Oxygen Oxygen (O2) is an oxidizer and is capable of supporting combustion.1 ■ Ensure that anesthesia circuits are free of leaks. ■ Pack wet sponges around the back of the throat to help retard oxygen leaks. ■ Inflate cuffed tube bladders with tinted saline (eg, methylene blue) so that inadvertent ruptures can be detected. ■ Use suction to help evacuate any accumulation of O2 in body cavities, such as the mouth or chest cavity. ■ Do not use the laser or electrosurgical unit (ESU) near where O2 is flowing. ■ Use a pulse oximeter to determine the patient’s oxygenation level and the need for oxygen. ■ Allow O2 fumes to evaporate before using the laser or ESU. ■ When using mask or nasal O2, ensure that fumes do not accumulate under the drapes. ■ Ensure that drapes are tented to help prevent oxygen accumulation when mask or nasal O2 is used.2-4 ■ The strategies to manage O2 also should be used to manage risks associated with Nitrous oxide nitrous oxide.2-4 ■ Temperatures greater than 200º F (99.33º C) may result from the degeneration Sevoflurane of sevoflurane by desiccated absorbents (eg, soda lime). This can result in a fire in the anesthetic circuit. Scheduled replacement of the absorbent or pouring water into the absorbent may prevent temperature buildup. Oxygen left running at the end of the procedure dries out the absorbent. Remind the anesthesia care provider to turn off the O2 at the end of each procedure.5 NOTES 1. “A clinician’s guide to surgical fires: How they occur, 4. “Recommended practices for endoscopic minimally how to prevent them, how to put them out, Health Devices ” invasive surgery,” in Standards, Recommended Practices, 32 (January 2003) 1-24. and Guidelines (Denver: AORN, Inc, 2004) 267-271. 2. “Recommended practices for electrosurgery,” in 5. M Laster, P Roth, E I Eger, “Fires from the interaction Standards, Recommended Practices, and Guidelines of anesthetics with desiccated absorbent,” (Technology, (Denver: AORN, Inc, 2004) 245-259. Computing, and Simulation) Anesthesia and Analgesia 99 3. “Recommended practices for laser safety in practice (September 2004) 769-774. settings,” in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2004) 319-324. ♦ Use of the acronym RACE as the response A health care facility’s fire plan should be reviewed and actively discussed, and the use of fire component of the fire safety plan: extinguishers should be demonstrated when staff – R—Rescue the individual that is involved members are hired and at least annually. Peri- in the fire. operative clinical leaders must take additional – A—Alarm should be sounded as soon as action to keep patients and staff members safe. Fire possible. drills should be conducted regularly based on – C—Confine the fire. local, state, and JCAHO guidelines. Fire drills – E—Extinguish the fire and evacuate if should include the following. required.5 147 2005 Standards, Recommended Practices, and Guidelines
  6. 6. Fire Prevention ♦ Use of National Fire Protection Association ♦ choosing a date and time; ♦ developing a well-thought-out scenario(s); (NFPA) standards for classification of the dif- ♦ obtaining the facility fire drill evaluation ferent types of fire extinguishers, including – Class A: for use on wood, paper, cloth, and form, and modifying it where necessary; ♦ completing a fire drill record, and noting all most plastics (eg, combustible materials); – Class B: for use on flammable liquids or participants and pertinent details; ♦ identifying observers and their locations; grease; and ♦ designating surgical team members who will – Class C: for use on energized electrical equipment.4 participate in the event and briefing them on ♦ The acronym PASS should be reviewed to the scenario; ♦ reviewing fire safety/drill policy and proce- operate the fire extinguisher. – P—Pull the pin. dures and their roles with staff members; ♦ notifying facility administrators of the upcom- – A—Aim nozzle at the base of the fire. – S—Squeeze the handle. ing fire drill and posting signs; ♦ including the facility safety officer as a resource – S—Sweep the stream over the base of the fire.7 and advisor; ♦ discussing the drill in a debriefing session; To enhance user skill and confidence, allow ♦ evaluating the effectiveness of the staff mem- every staff member time to practice handling the fire extinguisher. Teach staff members to use the bers and equipment used; and ♦ identifying areas for improvement and areas fire extinguisher with their back toward an escape exit for easier access. Labels on the fire extin- of strength.8 guisher should be checked for color, size, and Every fire drill should be considered a forum for shape of the extinguisher to prevent personnel learning. Perioperative staff member preparedness assisting in extinguishing fires from using the will ensure an effective and efficient response to a wrong extinguisher (eg, water on an electrical fire). fire in a smooth and coordinated manner (Sample The following information will help staff members Forms 1 and 2). become more competent. ♦ Staff members should be shown where fire Evacuation plan extinguishers are located in the perioperative All perioperative departments should develop and setting. implement a well-rehearsed and well-thought-out ♦ Operating room doors should be able to fire evacuation plan. Evacuation plans help ensure open completely without equipment blocking that all staff members are familiar with the proper them. evacuation routes and equipment that may be used ♦ Staff members should know the location of before or during an evacuation. In the event a fire all fire exits and ensure that these exits are occurs in the perioperative area, personnel should clear and accessible at all times. follow the standard fire emergency response proce- ♦ Surgical team members should know where dure and activate RACE. Surgical team duties in a fire evacuation. Each the medical gas shutoff valves are and their facility’s policy on who should turn them off surgical suite should have designated fire responder and when. teams with defined responsibilities to take if a fire ♦ Review roles of every staff member at the occurs in the surgical suite. There should be a chain point of the fire’s origin and away from the of command that includes an authority who has immediate area. jurisdiction to manage the incident. If the OR must ♦ Take staff members through evacuation be evacuated, several steps should be taken by per- routes, both primary and secondary, to an sonnel responsible for the care of the patient in the evacuation location point beyond a firewall.4 OR. First, surgical team members should become Depending on the size of the perioperative set- oriented in relation to where they are located, the ting, planning for an initial fire drill may take up to proximity of the nearest exit, and how to safely three months.5 Key points in planning a fire drill evacuate to that destination. The roles of the surgical include team may be as follows. 148 2005 Standards, Recommended Practices, and Guidelines
  7. 7. Fire Prevention Sample Form 1 PERIOPERATIVE SERVICES OR CODE RED FIRE DRILL EVALUATION FORM Fire drill date: ____________________________________ Designated observer: __________________________________ Criteria: Yes No Comments ■ Evacuation plan is posted. ■ Randomly chosen staff member(s) describes evacuation routes, knows how to report a fire, and knows location of extinguisher. ■ Fire extinguishers in place, seal intact, charged, properly mounted; labeled as to type and class of fire; serviced within past 12 months; checked monthly; and staff member describes how to operate fire extinguisher by using PASS method. ■ Fire exits free and unobstructed, and marked with working illuminated signs. ■ Corridors of egress are free of equipment/obstructions. ■ Fire/smoke barrier doors closed during activation of pull station. ■ Staff members activated RACE, the standard fire emergency response procedure. ■ Staff members use proper body mechanics to transport patients. ■ Staff members close all doors. ■ Nursing leader/designee shuts off medical gases. ■ All patients are accounted for with medical records intact. Response evaluated: ■ Did staff members act in a calm and organized manner? ■ Did staff members perform as a cohesive team? Opportunities for improvement: ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ Staff member (observer) signature: __________________________________________________________________________ ♦ The perioperative registered nurse in charge/ – assign personnel to assist where needed; designee should – ask visitors to leave if necessary; and – notify the safety officer, telephone operator, – evacuate patients who may need to be or designated person of a fire and its location; moved immediately. ♦ The perioperative RN circulating should – document the time the fire started; – establish how many people are in the – ensure the patient’s safety by remaining department; with him or her and comforting him or her; – set up a communication point and identify – activate the fire alarm system and call the a person to staff it; fire code to alert all necessary personnel; – determine the state of ongoing surgery/ – extinguish small fires or douse them with procedures in each area; liquid if appropriate; – consult with the anesthesia care provider – remove any burning material from the patient in charge on how to handle each patient; or sterile field, and extinguish it on the floor; 149 2005 Standards, Recommended Practices, and Guidelines
  8. 8. Fire Prevention Sample Form 2 PERIOPERATIVE SERVICES OR CODE RED FIRE DRILL RECORD Fire drill date: ____________________________________ Shift: ________________________________________________ Fire drill start time: ________________________________ Finish time: __________________________________________ Designated observers: ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ List fire drill participants and titles: Participant Title ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ Planned scenario: ________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ Time and individual who pulled fire alarm: __________________________________________________________________ Patient evacuation times: __________________________________________________________________________________ Other remarkable events: __________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ Individual completing form: ________________________________________________________________________________ – prevent fire from spreading to shoes or sur- – help the anesthesia care provider disconnect gical clothing by not stepping on it; any leads, lines, or other equipment that may – provide the scrub person and anesthesia be needed for transporting the patient; and care provider with needed supplies; – not delay leaving the OR suite. ♦ The scrub person should – collaborate with the anesthesia care provider on the need to turn off the med- – remove from the patient materials that may ical gas shutoff valves; be on fire and help put out the fire, – carefully unplug all equipment if the fire is – obtain sterile towels or covers for the sur- electrical; gical site and instruments, – be aware of the safest route for escape; – gather a minimal number of instruments – obtain a transport stretcher if necessary; onto a tray or basin and place them with – remove IV solutions from poles and place the patient for transport, and them with the patient for transporting out – assist with patient transfer from the OR table of the OR; to a stretcher/bed for transport out of the OR. 150 2005 Standards, Recommended Practices, and Guidelines
  9. 9. Fire Prevention ♦ The surgeon should Risk reduction strategies – remove from the patient materials that may Risk reduction strategies involve educating surgical be on fire and help put out the fire; team members about the components of the fire – control bleeding and prepare the patient triangle and developing policies and procedures for evacuation; that will prevent surgical fires. Fuel sources must be – place sterile towels or covers over the sur- managed in a way that will prevent fires, ignition gical site; sources must be controlled so that they do not – conclude the procedure as soon as possible, come in contact with fuels, and oxidizers must be if the patient is not in immediate danger; and contained or properly vented so that they do not – help move the patient if necessary. come in contact with fuels or ignition sources. ♦ The anesthesia care provider should Keeping the sides of the fire triangle apart is critical. – shut off the flow of oxygen/nitrous oxide to NOTES the patient or field and maintain breathing 1. “Preventing surgical fires,” Sentinel Event Alert 29 for the patient with a valve mask respirator (June 24, 2003). Also available at http://www.jcaho (ie, ambu bag); .org/about+us/news+letters/sentinel+event+alert/print – collaborate with the circulating nurse on the /sea_29.htm (accessed 12 Jan 2005). need to turn off the medical gas shutoff 2. “2005 Ambulatory care National Patient Safety Goals,” Joint Commission on Accreditation of Healthcare valves; Organization, http://jcaho.org/accredited+organizations/ – disconnect all electrically powered equip- patient+safety/05+npsg/05_npsg_amb.htm (accessed 12 ment on the anesthesia machine; Jan 2005). – disconnect any leads, lines, or other 3. ECRI, “Surgical fires,” Operating Room Risk Man- equipment that may be anchoring the agement 2 (November 2004) 6. 4. “A clinician’s guide to surgical fires: How they patient to the area; occur, how to prevent them, how to put them out,” – maintain the patient’s anesthetic state and Health Devices 32 (January 2003) 1-24. collect the necessary medications to con- 5. ECRI, “The patient is on fire! A surgical fire primer,” tinue anesthesia during transport; and Medical Device Safety Reports 21 (January 1992) 19-34. – place additional IV fluids on the bed for Also available at http://www.mdsr.ecri.org/summary/ detail.aspx?doc_id=8197&q=%22The+patient+is+on+fire transport with the patient, if time permits. %22 (accessed 12 Jan 2005). ♦ Ancillary personnel should 6. C Smith, “Surgical fires: Learn not to burn,” AORN – help clear corridors for evacuation, Journal 80 (July 2004) 25-26. – secure equipment for transporting the 7. L Salmon, “Fire in the OR: Prevention and pre- patient as directed by the circulating nurse, paredness,” AORN Journal 80 (July 2004) 42-54. 8. D Stewart, “Fire and life safety for surgical serv- – follow instructions for evacuating the ices: What’s new and what to review,” SSM 9 (April patient if needed, and 2003) 26-31. – assist where directed. 9. P M McCarthy, K A Gaucher, “Fire in the OR: Patients should be evacuated horizontally to a safe Developing a fire safety plan,” AORN Journal 79 (March area on the same floor. It is very important to main- 2004) 588-600. tain an accurate count of all patients and staff mem- Scheduled for publication in the AORN Journal in bers during the evacuation. After evacuation of the room, the last person to leave the room should close 2005. the doors and place a wet towel at the base of them. After the fire, everything should be left in place so the safety officer and the fire department can con- duct a thorough investigation of the cause of the fire.9 151 2005 Standards, Recommended Practices, and Guidelines

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