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    OR Fires Highly Avoidable yet Still Prevalent

    By Jennifer Huddleston, staff writer     

    An abstract in the December 2008 edition of Current Opinion in Anesthesiology reported that burn injuries comprise 20 percent of monitored anesthesia care-related malpractice claims, and 95 percent of those involved head and/or neck surgery. [1] Each year, surgical fires affect between 550 and 650 patients, 20 or 30 of whom suffer severe burns. Approximately one or two of these patients die. [2]

    The exact frequency of operating room (OR) fires is difficult to establish because there currently is no mandatory national reporting system in place for such events.
    [3] The first detailed figures regarding OR fires, based on information from the Pennsylvania Patient Safety Reporting System, revealed there is approximately one fire for every 87,646 operations—or 28 fires each year—in Pennsylvania, one state that requires hospitals to report medical errors including OR fires. [4]

    According to Mark Bruley, vice president of accident and forensic investigations at the ECRI Institute, a patient safety advocacy agency, about 65 percent of surgical fires happen inside the patient’s airway or on the upper body. A quarter of fires occur elsewhere on the patient’s body and 10 percent occur inside the body cavity.
    [5]

    About 70 percent of these fires are caused by electrosurgical tools that use high-frequency electrical currents, and 20 percent are ignited by hot wires, defibrillators, burrs or light sources. The remaining 10 percent are attributed to lasers.
    [6] High-risk procedures include cataract and other eye surgery, tracheostomy, tonsillectomy and the removal of lesions on the face, head and neck. [7]

    In a 2008 Practice Advisory, the American Society of Anesthesiologists (ASA) aims to provide information to help prevent these fires, to identify the steps needed to respond to an OR fire and to reduce adverse outcomes of such an event. Preventing OR fires requires group effort from surgeons, nurses and anesthesiologists.
    [8]

    The ASA Practice Advisory recommends that all anesthesiologists participate in fires drills with the entire OR team during specified training time and that the procedure for preventing and managing fires be posted everywhere surgeries are performed. The ASA also encourages all OR team members to assess fire risks for each procedure and to agree on how to both prevent and manage a fire in each specific situation.
    [9]

    While OR fires are relatively rare when compared to the 50 million surgeries performed each year,
    [10] it’s up to the entire surgical team to recognize the elements of high-risk situations in order to prevent the adverse consequences and related effects of OR fires, including minor or major burns, disfigurement, infection, psychological trauma, extended hospitalization, additional procedures, liability and death. [11]


    [1]  Rinder, Christine Stowe. "Fire Safety in the Operating Room.” Current Opinion in Anesthesiology. December 2008.
    [2] Aleccia, JoNel. “On Fire in the OR: Hundreds Are Hurt Every Year.” MSNBC. Sept. 25, 2008.
    [3] The American Society of Anesthesiologists Task Force on Operating Room Fires. “Practice Advisory for the Prevention and Management of Operating Room Fires.” Anesthesiology. May 2008.
    [4] Aleccia, JoNel. “On Fire in the OR: Hundreds Are Hurt Every Year.” MSNBC. Sept. 25, 2008.
    [5]  Ibid.
    [6]  Ibid.
    [7] The American Society of Anesthesiologists Task Force on Operating Room Fires. “Practice Advisory for the Prevention and Management of Operating Room Fires.” Anesthesiology. May 2008.
    [8]  Ibid.
    [9]  Ibid.
    [10] Aleccia, JoNel. “On Fire in the OR: Hundreds Are Hurt Every Year.” MSNBC. Sept. 25, 2008.
    [11] The American Society of Anesthesiologists Task Force on Operating Room Fires. “Practice Advisory for the Prevention and Management of Operating Room Fires.” Anesthesiology. May 2008.



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