AORN Fire Safety Tool Kit Extinguishing a Fire

AORN Fire Safety Tool Kit Extinguishing a Fire in the Perioperative Practice Setting

Goals After completing this learning activity, perioperative team members will have increased knowledge of appropriate actions to take to extinguish an OR fire and protect patients and personnel.

Learning Outcomes After completing this activity, the participant will be able to: 1. Identify types of fires 2. Discuss the steps to extinguish a fire in perioperative areas 3. Describe how to smother a fire 4. Identify evacuation routes

Fire Facts Estimated Frequency • 200 to 240 per year in the United States o 44% head, neck, or upper chest o 26% elsewhere on the patient o 21% in the airway o 8% elsewhere in the patient

Patient Injuries Of the 200 to 240 OR fires per year, • 20 to 30 are serious and result in disfiguring or disabling injuries • 1 to 2 are fatal

Location • Ambulatory surgery centers • Hospitals • Physicians’ offices

Patients All patients 7

Types of Fires • ON the patient • IN the patient o Includes airway fires • ON or IN a piece of equipment

Team Effort • • Nurses Surgical technologists Surgeons Assistants Environmental Services associates Administration team members Everyone else not mentioned

Fighting Fires on a Patient • Alert the team that there is a fire. • Assist the anesthesia professional and turn off/stop the flow of gases. • Remove burning materials from the patient. • Have another team member extinguish the fire. o Extinguish with water or saline. o Use a fire extinguisher as the last response. o Extinguish the fire (burning materials) on the floor. • Care for the patient. • Save all involved materials.

Fighting Fires on or in a Patient • Assess the surgical field for a secondary fire on the underlying drapes or towels. • Assess the patient for injury. • Report injuries to the physician. • Document the assessment. • Activate alarms if necessary. • Notify the appropriate chain of command.

Fighting Fires Involving an Endotracheal Tube • Alert the team that there is a fire. • Assist the anesthesia professional. o Immediately and simultaneously remove the endotracheal tube and any segments of the burned tube and disconnect and remove the breathing circuit. o Pour saline or water into the airway. o Turn off the flow of gases. o Care for the patient. - Reestablish the airway. - Ventilate with air until certain there is no material still burning or smoldering, then switch to 100% oxygen. - Examine the airway.

Fighting Fires on or in Equipment • Alert the team that there is a fire. • Disconnect equipment from its electrical source. • Shut off electricity to the piece of equipment at the electrical panel if unable to disconnect. • Shut off gases to equipment, if applicable. • Assess the size of the fire and determine if equipment can be removed safely or if evacuation is needed. • Extinguish the fire with a fire extinguisher, if appropriate. • Activate alarms if necessary. • Notify the appropriate personnel.

How to Extinguish a Fire Using a Solution • Use a nonflammable liquid such as saline or water. • Aim at the base of the fire. • Remember: drapes may be impermeable.

How to Smother a Fire • Hold towel between the fire and the patient’s airway. • Drop the end of the towel closest to the patient’s head. • Drop the other end of the towel over the fire. • Sweep your hand over the towel from the patient’s head toward the feet. • DO NOT PAT. • Raise the towel. • Keep your body away from the fire.

How to Handle a Fire in Other Parts of the Building • The charge nurse should notify team members when procedures are in progress. • Do not start elective procedures. • All personnel should prepare to evacuate.

Fire Blankets Not for Patient Fires! Fire Blankets Are Not Recommended! • Fire may be sustained by oxygen delivered to the patient. • Blankets may burn in oxygen-enriched atmospheres. • Using a fire blanket o may trap fire next to or under the patient. o may displace instruments.

NFPA* Fire Classification • Class A: wood, paper, cloth, and most plastics (eg, combustible materials) • Class B: flammable liquids or grease • Class C: energized electrical equipment • Combination: ABC, AC * NFPA = National Fire Protection Association

Recommended Fire Extinguisher • ECRI: Carbon dioxide-based o Water-based and halon-replacement not recommended • NFPA: Class A, B, C, or AC • Our authority having jurisdiction (eg, local fire marshal) says >>>>>>.

Fire Extinguisher: Use “PASS” P Pull the pin. A Aim the nozzle at the base of the fire. S Squeeze the handle. S Sweep the stream over the base of the fire.

Shutting Off Gases • • Valve location Valve operation When to shut off gases Who can shut off gases

Sprinklers and Smoke Detectors • Sprinkler o Activated by heat o Must be unobstructed • Smoke detector o Sounds alarm

Evacuation Types and Areas • • • Who determines when to evacuate Lateral, horizontal, or vertical evacuation Fire doors Smoke compartments Evacuation floor plan maps

Evacuation Steps: Use “RACE” R A C E Rescue Alarm/Alert Confine/Contain Evacuate

Summary To take appropriate actions during a fire, you must 1. Know methods to extinguish a fire 2. Know how use an extinguisher 3. Know how to evacuate

References Clarke JR, Bruley ME. Surgical fires: trends associated with prevention efforts. Pa Patient Saf Advis. 2012; 9(2): 130 -135. Guideline for a safe environment of care, In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc. Lucas SR. Surgical Fire Prevention and Extinguishment. AORN Webinar. October 2016. https: //www. aorn. org/Member_Apps/Product/Detail? produc t. ID=9715 26

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