Surgical fires are rare but dangerous events that require immediate and coordinated response from all members of the operating room (OR) team, with anesthesia providers playing a crucial role. The rapid progression of a fire, especially in an oxygen-enriched environment, means that anesthesia professionals must act swiftly to suppress the fire, protect the patient, and minimize injury. Effective fire management hinges on stopping the flow of oxygen, removing flammable materials, coordinating with the surgical team for fire suppression, and ensuring the patient's safety and evacuation if necessary.
Anesthesia Provider’s Role in Fire Suppression and Patient Safety
The anesthesia provider’s immediate priority in the event of a surgical fire is to stop the flow of oxygen or other oxidizers, such as nitrous oxide, which can fuel the fire. Oxygen sources, especially in open delivery systems like nasal cannulas or face masks, are significant contributors to surgical fires. Therefore, the first critical step is to disconnect the oxygen supply as quickly as possible to prevent further combustion. In an airway fire the ASA advisory calls for four actions performed as nearly simultaneously as possible: remove the tracheal tube, stop the flow of all airway gases, remove any other flammable or burning material from the airway, and pour saline or water into the airway. The tube is removed because it acts as a conduit for the fire and can cause airway burns or pulmonary damage. Once the fire is out, ventilation is re-established, by mask with air if the patient tolerates it, the removed tube is examined for missing fragments, and the airway is inspected by rigid bronchoscopy before reintubation when injury is suspected.
Flammable materials in the OR, such as drapes, gauze, or alcohol-based prep solutions, must be removed or extinguished to prevent the fire from spreading. Anesthesia providers should work in tandem with other surgical team members to ensure that any combustible materials near the patient are moved away from the fire. The use of moist sponges or saline-soaked materials in the surgical field can also help reduce the risk of combustion.
Protocols for Fire Extinguishment and Coordination with the Surgical Team
Fire extinguishment in the OR requires precise coordination between the anesthesia provider and the surgical team. Once the oxygen flow has been stopped, and flammable materials removed, the next step is to use appropriate fire suppression methods. The anesthesia provider should ensure that the team is equipped with fire extinguishers, typically carbon dioxide (CO2) extinguishers, which are recommended for use in the OR due to their effectiveness and reduced risk of contamination. All OR personnel must be familiar with the location and proper use of fire extinguishers, which can quickly suppress fires involving surgical drapes or equipment.
Clear communication is essential throughout the process. The team leader, often the surgeon or anesthesia provider, should announce the fire immediately to initiate the fire response protocol. The surgical team should stop the procedure and focus on extinguishing the fire and protecting the patient. Moistening drapes and removing any materials that could fuel the fire are key actions to prevent further spread. The anesthesia provider, in coordination with other OR staff, should reassess the patient’s airway and ventilation needs after the fire is extinguished, ensuring that ventilation is re-established in a safe and controlled manner without reintroducing high oxygen levels that could reignite the fire.
Patient Evacuation and Care Following a Fire
If the fire cannot be controlled quickly or if the fire causes significant damage, the next priority is to evacuate the patient from the OR. For a fire on or around the patient that saline and smothering do not put out, the sequence is a CO2 extinguisher, then evacuation of the patient, closing the OR door behind the team and shutting off the medical gas supply to the room. Evacuation should be conducted in a safe and orderly manner, ensuring that the patient is moved away from the fire and to a safe location where continued care can be administered. Anesthesia providers play a key role in managing the patient’s airway and ensuring that ventilation is maintained throughout the evacuation process, especially if the patient requires mechanical ventilation.
Once the patient has been evacuated to safety, the anesthesia provider should assess the patient for fire-related injuries, such as burns to the airway, skin, or surrounding tissues. If the patient’s airway has been compromised due to a tracheal tube fire, immediate steps must be taken to secure the airway, which may include intubation, bronchoscopy to evaluate airway damage, and ventilation support. Additionally, patients should be evaluated for exposure to harmful combustion byproducts like carbon monoxide or cyanide, and treated accordingly.
After a surgical fire, the anesthesia provider must coordinate with burn specialists or transfer the patient to a burn center if necessary for specialized care. Comprehensive documentation of the fire, response measures, and patient injuries should also be completed to facilitate ongoing care and to aid in any future safety reviews.
