Risk Of Surgery: Fire

Patients worry about many things as they head into surgery. Will the procedure work? What if something goes wrong? What if I wake up during surgery? What if I don’t wake up ever? But of all the things that run through your head when you are having a surgical procedure done, seldom is catching on fire one of them. Yet, surgical fires are not unheard of.

“Surgical fires are fires that occur in, on or around a patient who is undergoing a medical or surgical procedure,” according to the Council on Surgical and Perioperational Safety. Surgical fires can occur when all the elements of a “fire triangle” are present. The three elements needed for a surgical fire to occur are: an ignition source, a fuel source, and an oxidizer. An ignition source can be instruments like electrosurgical units, lasers, or fiber optic light sources. Fuel sources may be items such as alcohol-based skin preparations, surgical drapes, or even the patient’s hair or body. Oxygen, nitrous oxide, or room air are examples of oxidizers. Many surgical fires occur in an oxygen-enriched environment, which can cause fires to burn hotter and faster.

The ECRI Institute estimates that between 200 and 240 surgical fires occur nationwide every year. This is down from previous estimates of 600 surgical fires per year. News stories from around the country have reported on such incidents.

• In Chicago, Joe DiMaria, a firefighter, was burned while undergoing surgery to have a catheter placed in his chest.
• Rita Talbert went in for thyroid surgery and was burned after an “electrosurgical tool had ignited oxygen inside a mask under surgery drapes during the operation.”
• An Oklahoma woman, Connie Plumlee, suffered burns after going in for reconstructive surgery on her breasts, which had been removed due to breast cancer.
• Lauren Wargo suffered burns on her face after going in for surgery to remove some irregular moles.

The Council of Surgical and Perioperative Safety offers some recommendations to healthcare professionals in order to prevent surgical fires. These recommendations include:

• Conduct a fire risk assessment prior to every surgical procedure.
• Determine whether supplemental oxygen is needed. If oxygen is needed, then it is recommended to use the minimum concentration of oxygen needed, use a closed oxygen delivery system, or if using an open system, then take precautions to prevent an accumulation of oxygen in the surgery field.
• If using alcohol-based skin preparations, do so safely by allowing the preps time to dry, prevent pooling of the antiseptic, and remove “alcohol-soaked materials from the prep area.”
• If using an ignition source where supplemental oxygen was administered, allow time for the oxygen concentration levels to decrease and do not place ignition sources on the patient or surgical drapes.

Surgical fire burns can be difficult and devastating. The surgical team must make sure to take proper precautions to prevent these kinds of incidents from occurring. There are already enough complications that can occur during surgical procedures. No one should have to worry about being burned and potentially permanently disfigured as well.