Fire prevnting in the operating room

AORN Guidance Statement: Fire Prevention in the Operating RoomIntroductionproduces 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.4ard to patient and health care worker safety. In 2003,Almost everything in the perioperative arena canthe Joint Commission on Accreditation of Healthcarebe a fuel source, especially when an accelerant,Organizations (JCAHO) issued a sentinel event alertsuch as oxygen, is present. The items used to set uprelated to fires that occur during operative and inva-the sterile field and protect the patient (eg, linens,sive procedures. The bulletin raised the level ofdrapes, gowns, supplies, preps, gauzes, clothes)awareness about the dangers of surgical fires. Theshould all be considered fuel sources. The patient’sJoint Commission recommends that health carebody hair and body gases also can be fuel sources.5organizations prevent surgical fires by providing edu-The primary oxidizers in the surgical environmentcation and training for perioperative practitioners.1 Inare oxygen and nitrous oxide. Fires can occur whenJuly 2004, surgical fire prevention was added to thethe oxygen level in the atmosphere rises above the2005 National Patient Safety Goals for ambulatory level of ambient air (ie, 21%). Oxygen can escapeand office-based surgical facilities.2into the air when patients are given mask or nasalThe approach to developing policies and proce-oxygen. A level above 21% should be treated as andures to reduce fire risk should be multidisciplinaryoxygen-enriched environment.6and involve all professionals who provide patientcare. Facilities are encouraged to report surgical firesGuideline to JCAHO, ECRI, or the US Food and Drug Adminis-Educationtration (FDA). Systematic reporting of fires can helpEducation and training in fire risk reduction strategieseducate care providers about how and why firesfor perioperative RNs, surgical technologists, anesthe-occur and can help prevent fires in the future.1sia care providers, surgeons, and other personnel isBackgroundessential to promote and maintain a fire-safe perioper-ative environment. Health care industry representa-Fires involving surgical patients have been reportedtives and students should be included in fire drill edu-by hospitals and ambulatory surgical centers; somecation. Each perioperative team member is responsiblemedical device manufacturers, and other experts,for promoting a culture of fire safety. Preparation is thesuch as ECRI, for many years. There is no centralizedkey to ensuring readiness for preventing fires in thedatabase being collected by any agency at present onOR. Recommendations from ECRI include thatthe total number of surgical fires;3 however, data from♦ perioperative team members participate inECRI and the FDA estimate that approximately 100fire drills;surgical fires occur each year, resulting in approxi-♦ team members receive training on the use ofmately 20 patient injuries that are serious, with one tofire fighting equipment, rescue methods, andtwo deaths per year.1,4 The overriding considerationevacuation;with surgical fires is that they are 100% preventable.1,4♦ staff members know where medical gas pan-Fires occur when the elements that supportels and ventilation and electrical systems arecombustion—an ignition source, a fuel source, andlocated, which personnel are permitted toan oxidizer—come together. These three elementsshut them off, and when;are referred to as the “fire triangle.” All three ele-♦ staff members in the perioperative care set-ments are present in abundance during operativeting be shown how to initiate a “Code Red”and invasive procedures4 (Tables 1-3). Operatingor fire alarm at their facility; rooms in hospitals and ambulatory surgery suites,♦ staff members know specific protocols tophysicians’ offices, and endoscopy suites are somecontact the local fire department;4of the critical areas where fires occur, and they♦ students rotating through the perioperative areacontain all the elements that support combustion.are included in fire education and training; andIgnition sources are anything that produces heat;♦ health care industry representatives are edu-the two most common sources are the electrosurgi-cated on fire safety hazards in the periopera-cal unit (ESU) and the laser. Other equipment thattive area during their credentialing process.2005 Standards, Recommended Practices, and Guidelines143Fire PreventionTable 1FIRE RISK—IGNITIONIgnition sourcesStrategies to manageElectrosurgical unit (ESU)■ Use the lowest possible power setting.■ 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’sinstructions.■ 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 handpiece.■ 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 activeelectrode 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 anothermetal object that could conduct heat or cause arcing.3■ After prepping, allow prep to dry and fumes to evaporate. Wet prep and fumestrapped beneath drapes can ignite.4 ■ Provide multidisciplinary inservice programs on the safe use of ESUs based on the manufacturer’s instructions. Argon beam coagulator■ Argon beam coagulators combine the ESU spark with argon gas to concentrate and focus the ESU spark. Argon gas is inert and nonflammable, but because it isused 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 anothermetal object that could conduct heat or cause arcing.1Lasers■ Use a laser-specific endotracheal tube (ie, a tube that has laser-resistant coating or contains no material that will ignite) if head, neck, lung, or airway surgery isanticipated.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 thatinadvertent rupture may be detected during chest or upper airway surgery.■ Do not use uncuffed, standard endotracheal tubes in the presence of a laseror the ESU.■ If an endotracheal tube fire occurs, oxygen administration should be stopped, andall burning or melted tubes should be removed from the patient immediately.■ Prevent pooling of skin prep solutions.1442005 Standards, Recommended Practices, and GuidelinesFire PreventionTable 1, continuedFIRE RISK—IGNITIONIgnition sourcesStrategies 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.6Fiber optic light sources■ Ensure that the light source is in good working order.Fiber optic light cables■ Place the light source in standby, or turn it off when the cable is not connected.■ 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 ifthe light source is on.■ Ensure that light cables are in good working order and do not have broken lightfibers.7Power tools/drills/burrs■ Instruments/equipment that move rapidly during use generate heat. Always ensurethat 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.8Defibrillator paddles■ Select paddles that are the correct size for the patient (eg, pediatric 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 gapsshould be present before activating the defibrillator.9Electrical equipment■ Ensure that all equipment is periodically inspected by biomedical personnel for 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.10NOTES1. “Recommended practices for electrosurgery,” in7. “Recommended practices for endoscopic minimallyStandards, Recommended Practices, and Guidelinesinvasive 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 they8. ECRI, “The patient is on fire! A surgical fire primer,”occur, how to prevent them, how to put them out,” HealthMedical 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+is2004).+on+fire%22 (accessed 12 Jan 2005).4. “Recommended practices for skin preparation of9. ECRI, “Fires from defibrillation during oxygen admin-patients,” in Standards, Recommended Practices, andistration,” Health Devices 23 (July 1994) 307-308. AlsoGuidelines (Denver: AORN, Inc, 2004) 357-360.available at http://www.mdsr.ecri.org/summary/detail.aspx5. K A Ball, Lasers: The Perioperative Challenge (Den-?doc_id=8128&q=%22Fires+from+Defibrillation%22ver: AORN, Inc, 2004) 145.(accessed 12 Jan 2005).6. “Recommended practices for laser safety in practice10. “Recommended practices for safe care throughsettings,” in Standards, Recommended Practices, andidentification 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) 301-307.2005 Standards, Recommended Practices, and Guidelines145Fire PreventionTable 2FIRE RISK—FUELFuel sourcesStrategies to managePatient and staff linens■ Assess the flammability of all materials used in, on, or around the patient. DrapesLinens and drapes are made of synthetic or natural fibers. They may burn or Gownsmelt depending on the fiber content.1Towels■ Do not allow drapes or linens to come in contact with activated ignition sourcesLap pads(eg, laser, electrosurgical unit [ESU], light sources).2-4Sponges■ Do not trap volatile chemicals or chemical fumes beneath drapes.5Dressings■ Moisten drapes, towels, and sponges that will be in close proximity to ignitionTapessources (eg, laser, ESU).2,3Bed linens■ Ensure that oxygen does not accumulate beneath drapes.Caps/hats■ If drapes or linens ignite, pat out small fires with a wet sponge or towel. RemoveShoe coversburning material from the patient.■ Extinguish any burning material with the appropriate fire extinguisher or water, if appropriate.6Prep solutions■ Use flammable prep solutions with caution.■ 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 fumestrapped 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 absorbflammable prep solutions.5Skin degreasers, ■ These products may be used before skin prep to degrease or clean the skin or astinctures, aerosolspart of the dressing. These products may contain chemicals that are flammable(eg, ether in collodian). Allow all fumes to evaporate before surgery. The laser orESU should not be used after the dressing is in place.3Body tissue and ■ The patient’s own body can be a fuel source. Coat any body hair that is in closepatient hairproximity to an ignition source with a water-based jelly to retard ignition.4■ Ensure that surgical smoke from burning patient tissue is properly evacuated.Surgical smoke can support combustion if allowed to accumulate in a small orenclosed space (eg, the back of the throat).3Intestinal gases■ Patient intestinal gases are flammable. Electrosurgery or laser should be used withcaution whenever intestinal gases are present. Do not open the bowel with thelaser or ESU when it appears gas is present.■ Use suction during rectal surgery to remove any intestinal gases that may be present.3NOTES1. “Recommended practices for product selection in4. “Recommended practices for endoscopic minimallyperioperative 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 of2. “Recommended practices for laser safety in practicepatients,” in Standards, Recommended Practices, andsettings,” in Standards, Recommended Practices, andGuidelines (Denver: AORN, Inc, 2004) 357-360.Guidelines (Denver: AORN, Inc, 2004) 319-324.6. “A clinician’s guide to surgical fires: How they3. “Recommended practices for electrosurgery,” inoccur, how to prevent them, how to put them out,” HealthStandards, Recommended Practices, and GuidelinesDevices 32 (January 2003) 1-24.(Denver: AORN, Inc, 2004) 245-259.1462005 Standards, Recommended Practices, and GuidelinesFire PreventionTable 3FIRE RISK—OXIDIZERSOxidizersStrategies to manageOxygen (O2)■ Oxygen should be used with caution in the presence of ignition sources. Oxygenis 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 thatinadvertent 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 needfor 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 thedrapes.■ Ensure that drapes are tented to help prevent oxygen accumulation when mask or nasal O2 is used.2-4Nitrous oxide■ The strategies to manage O2 also should be used to manage risks associated withnitrous oxide.2-4Sevoflurane■ Temperatures greater than 200º F (99.33º C) may result from the degeneration of sevoflurane by desiccated absorbents (eg, soda lime). This can result in a fire in the anesthetic circuit. Scheduled replacement of the absorbent or pouringwater into the absorbent may prevent temperature buildup. Oxygen left running atthe end of the procedure dries out the absorbent. Remind the anesthesia careprovider to turn off the O2 at the end of each procedure.5 NOTES1. “A clinician’s guide to surgical fires: How they occur,4. “Recommended practices for endoscopic minimallyhow to prevent them, how to put them out,” Health Devicesinvasive surgery,” in Standards, Recommended Practices,32 (January 2003) 1-24.and Guidelines (Denver: AORN, Inc, 2004) 267-271.2. “Recommended practices for electrosurgery,” in5. M Laster, P Roth, E I Eger, “Fires from the interactionStandards, Recommended Practices, and Guidelinesof anesthetics with desiccated absorbent,” (Technology,(Denver: AORN, Inc, 2004) 245-259.Computing, and Simulation) Anesthesia and Analgesia 993. “Recommended practices for laser safety in practice(September 2004) 769-774.settings,” in Standards, Recommended Practices, andGuidelines (Denver: AORN, Inc, 2004) 319-324.A health care facility’s fire plan should be♦ Use of the acronym RACE as the responsereviewed and actively discussed, and the use of firecomponent of the fire safety plan:extinguishers should be demonstrated when staff– R—Rescue the individual that is involvedmembers are hired and at least annually. Peri-in the fire.operative clinical leaders must take additional– A—Alarm should be sounded as soon asaction to keep patients and staff members safe. Firepossible. drills should be conducted regularly based on– C—Confine the fire.local, state, and JCAHO guidelines. Fire drills– E—Extinguish the fire and evacuate ifshould include the following.required.52005 Standards, Recommended Practices, and Guidelines147Fire Prevention♦ Use of National Fire Protection Association♦ choosing a date and time;(NFPA) standards for classification of the dif-♦ developing a well-thought-out scenario(s);ferent types of fire extinguishers, including ♦ obtaining the facility fire drill evaluation– Class A: for use on wood, paper, cloth, andform, and modifying it where necessary;most plastics (eg, combustible materials);♦ completing a fire drill record, and noting all– Class B: for use on flammable liquids orparticipants and pertinent details;grease; and♦ identifying observers and their locations;– Class C: for use on energized electrical♦ designating surgical team members who willequipment.4participate in the event and briefing them on♦ The acronym PASS should be reviewed tothe scenario;operate the fire extinguisher.♦ reviewing fire safety/drill policy and proce-– P—Pull the pin.dures and their roles with staff members; – A—Aim nozzle at the base of the fire.♦ notifying facility administrators of the upcom-– S—Squeeze the handle.ing fire drill and posting signs;– S—Sweep the stream over the base of the♦ including the facility safety officer as a resourcefire.7and advisor;To enhance user skill and confidence, allow♦ discussing the drill in a debriefing session;every staff member time to practice handling the♦ evaluating the effectiveness of the staff mem-fire extinguisher. Teach staff members to use thebers and equipment used; andfire extinguisher with their back toward an escape♦ identifying areas for improvement and areasexit for easier access. Labels on the fire extin-of strength.8guisher should be checked for color, size, andEvery fire drill should be considered a forum forshape of the extinguisher to prevent personnellearning. Perioperative staff member preparednessassisting in extinguishing fires from using thewill ensure an effective and efficient response to awrong extinguisher (eg, water on an electrical fire).fire in a smooth and coordinated manner (SampleThe following information will help staff membersForms 1 and 2).become more competent.♦ Staff members should be shown where fireEvacuation planextinguishers are located in the perioperativeAll perioperative departments should develop andsetting.implement a well-rehearsed and well-thought-out♦ Operating room doors should be able tofire evacuation plan. Evacuation plans help ensureopen completely without equipment blockingthat all staff members are familiar with the properthem.evacuation routes and equipment that may be used♦ Staff members should know the location ofbefore or during an evacuation. In the event a fireall fire exits and ensure that these exits areoccurs in the perioperative area, personnel shouldclear and accessible at all times.follow the standard fire emergency response proce-♦ Surgical team members should know wheredure and activate RACE.the medical gas shutoff valves are and theirSurgical team duties in a fire evacuation. Eachfacility’s policy on who should turn them offsurgical suite should have designated fire responderand when.teams with defined responsibilities to take if a fire♦ Review roles of every staff member at theoccurs in the surgical suite. There should be a chainpoint of the fire’s origin and away from theof command that includes an authority who hasimmediate area.jurisdiction to manage the incident. If the OR must♦ Take staff members through evacuationbe evacuated, several steps should be taken by per-routes, both primary and secondary, to ansonnel responsible for the care of the patient in theevacuation location point beyond a firewall.4OR. First, surgical team members should becomeDepending on the size of the perioperative set-oriented in relation to where they are located, theting, planning for an initial fire drill may take up toproximity of the nearest exit, and how to safelythree months.5 Key points in planning a fire drillevacuate to that destination. The roles of the surgicalincludeteam may be as follows.1482005 Standards, Recommended Practices, and GuidelinesFire PreventionSample Form 1PERIOPERATIVE SERVICES OR CODE RED FIRE DRILL EVALUATION FORMFire drill date: ____________________________________Designated observer: __________________________________Criteria:YesNoComments■ Evacuation plan is posted.■ Randomly chosen staff member(s)describes evacuation routes,knows how to report a fire, andknows location of extinguisher.■ Fire extinguishersin place, seal intact, charged, properly mounted;labeled as to type and class of fire;serviced within past 12 months;checked monthly; andstaff member describes how to operate fire extinguisher by using PASS method.■ Fire exitsfree and unobstructed, andmarked 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 beor designated person of a fire and its location;moved immediately.– document the time the fire started;♦ The perioperative RN circulating should– establish how many people are in the– ensure the patient’s safety by remainingdepartment;with him or her and comforting him or her;– set up a communication point and identify– activate the fire alarm system and call thea person to staff it;fire code to alert all necessary personnel;– determine the state of ongoing surgery/– extinguish small fires or douse them withprocedures in each area;liquid if appropriate;– consult with the anesthesia care provider– remove any burning material from the patientin charge on how to handle each patient;or sterile field, and extinguish it on the floor;2005 Standards, Recommended Practices, and Guidelines149Fire PreventionSample Form 2PERIOPERATIVE SERVICES OR CODE RED FIRE DRILL RECORDFire drill date: ____________________________________Shift: ________________________________________________Fire drill start time: ________________________________Finish time: __________________________________________Designated observers: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________List fire drill participants and titles:ParticipantTitle________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________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 disconnectgical clothing by not stepping on it;any leads, lines, or other equipment that may– provide the scrub person and anesthesiabe needed for transporting the patient; andcare provider with needed supplies;– not delay leaving the OR suite.– collaborate with the anesthesia care♦ The scrub person shouldprovider on the need to turn off the med-– remove from the patient materials that mayical 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 placethe patient for transport, andthem with the patient for transporting out– assist with patient transfer from the OR tableof the OR;to a stretcher/bed for transport out of the OR. 1502005 Standards, Recommended Practices, and GuidelinesFire Prevention♦ The surgeon shouldRisk reduction strategies– remove from the patient materials that mayRisk reduction strategies involve educating surgicalbe on fire and help put out the fire;team members about the components of the fire– control bleeding and prepare the patienttriangle and developing policies and proceduresfor 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, ignitiongical 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 beif the patient is not in immediate danger; andcontained 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 shouldKeeping the sides of the fire triangle apart is critical. – shut off the flow of oxygen/nitrous oxide tothe patient or field and maintain breathingNOTESfor the patient with a valve mask respirator1. “Preventing surgical fires,” Sentinel Event Alert 29(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 shutoff2. “2005 Ambulatory care National Patient Safetyvalves;Goals,” Joint Commission on Accreditation of Healthcare– disconnect all electrically powered equip-Organization, http://jcaho.org/accredited+organizations/patient+safety/05+npsg/05_npsg_amb.htm (accessed 12ment on the anesthesia machine;Jan 2005).– disconnect any leads, lines, or other3. ECRI, “Surgical fires,” Operating Room Risk Man-equipment that may be anchoring theagement 2 (November 2004) 6.patient to the area;4. “A clinician’s guide to surgical fires: How they– maintain the patient’s anesthetic state andoccur, how to prevent them, how to put them out,”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; andMedical Device Safety Reports 21 (January 1992) 19-34.– place additional IV fluids on the bed forAlso available at http://www.mdsr.ecri.org/summary/transport with the patient, if time permits.detail.aspx?doc_id=8197&q=%22The+patient+is+on+fire♦ Ancillary personnel should%22 (accessed 12 Jan 2005).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 the7. L Salmon, “Fire in the OR: Prevention and pre-patient as directed by the circulating nurse, paredness,” AORN Journal 80 (July 2004) 42-54.– follow instructions for evacuating the8. D Stewart, “Fire and life safety for surgical serv-patient if needed, andices: What’s new and what to review,” SSM 9 (April2003) 26-31.– assist where directed.9. P M McCarthy, K A Gaucher, “Fire in the OR:Patients should be evacuated horizontally to a safeDeveloping a fire safety plan,” AORN Journal 79 (Marcharea on the same floor. It is very important to main-2004) 588-600.tain an accurate count of all patients and staff mem-bers during the evacuation. After evacuation of theScheduled for publication in the AORN Journal inroom, the last person to leave the room should close2005.the doors and place a wet towel at the base of them.After the fire, everything should be left in place sothe safety officer and the fire department can con-duct a thorough investigation of the cause of the fire.92005 Standards, Recommended Practices, and Guidelines151