1. FIRE IN THE OR

2. Frequency n 2250 per year in the US n 20 serious injuries n 2 deaths per year n 95% involved surgery of the head and face 17% were MAC cases with nasal O2

3. n 100% of cases of airway burns hospitals paid out

4. FIRE TRIAD n Fuel n Oxygen n Ignition

5. FUEL n Paper drapes n Cleansing agents n Endo Tubes

6. OXYGEN n Oxygen enriched area

7. IGNITION n Cautery n Light sources n Lasers

8. Benefits alcohol n Inexpensive n Readily available n Most effective antiseptic

9. Alcohol-New rules n Wicking on hair lines and in drapes n Prolonged drying time n Draping before drying leads to vapor pooling

10. Fire prevention n Packaged to avoid excess n Supplier instructions and warnings n No soaking or pooling n Complete dryness before draping n Time out to verify dryness

11. LASERS n High intensity at a point n Can reflect off of metal n Near flammable items

12. LASERS n 5 Major laser hazards: -eye injuries -skin and tissue burns -fire -toxic fume and smoke inhalation -electrical injuries

13. LASERS n Make fire safety part of the time out n Be sure cautery devices / laser probes are fully intact and clean (or can arc) n Communicate with the surgeon as to when O2 is in use near the laser n O2 off at least 60 sec before the use of the laser n Non-functioning equipment out of service

14. PREVENTION n Lowest possible Oxygen concentration n < 30% n Don’t tent n Non-flammable gasses n Avoid endo tube leakage n No pooling of liquids

15. PREVENTION n Avoid alcohol preps n Light sources off when not using n No lotions, make-up, or creams n No hairspray n Water based lubricant around hair n Oxygen off if near bovie

16. PREVENTION n Audible cautery tones n In the holder only

17. PREVENTION n Know where the pulls are n Know where the extinguishers are n Know where the Oxygen shut offs are n Know the number to call

18. PREVENTION n Communication n Drills n Review Fire Policy

19. Reporting n Compliance line n Risk management

20. FIRE POLICY n EOC MANUAL-LIFE SAFETY

21. RACE n R-Rescue n A- Alarm n C-Contain n E- Extinguish

22. Evacuation n O2 OFF IMMEDIATELY-TO ROOM AIR n Close doors n Mark area as searched n Stop all elective surgery when alarm sounds

23. Evacuation of Surgery in Progress n Stop all that can n Base decisions on cases in progress n Move with Diprivan drip if needed

24. Evacuation n Vertical n Horizontal

25. PASS n Pull n Aim n Squeeze n Sweep

26. Airway Fire n Laser surgery risk n Fill cuff with methylene blue so detect early rupture-see on laser beam n O2 to < 30 % (N20 and 02 support combustion)

27. Airway Fire n Disconnect O2 source n Remove tube quickly: -removes flame, retained heat -interrupts O2 supply to patient -keeps distal end of tube from collapsing

28. Airway Fire n Place burning tube into pre-established bucket of water n Mask ventilate with 100% O2 until able to re-intubate n Re-intubate with a smaller tube (laryngeal edema) n Maintain anesthetic state-possibly TIVA

29. Airway Fire n Stabilize once airway is reestablished n Rigid bronchoscopy-remove large FB and assess n Saline lavage to mainstem bronchus and trachea n Flex bronch-smaller particles n Direct laryngoscopy-fine FB

30. Airway Fire n May need tracheostomy- fear is laryngeal edema n 30-60%O2 post-op that is humidified (loss of cilia & strong chance of mucous plug) n PEEP to decrease atelectasis from loss of surfactant

31. Airway Fire n ABGS n CXR-to assess for lung damage n Steroid inhalants-for smoke inhalation & bronchospasm n Bronchodilators n Antibiotics n ICU