McLaren Bay RegionFire DrillSurgery Lori A. Majeske, RN, CNORMSN StudentFerris State University

November 7, 2012

Objectives for presentation

Fire Preventionunderstand techniques to prevent firesidentify policies to use as reference

Fire Planeducate staff on current plandetermine strengths and weaknesses

Next stepscreate ongoing dialogue and team

approach to safely care for patients in the perioperative experience with surgeons and anesthesia providers

Sources of Information AORN Perioperative Standards and

Recommended Practices 2012 Edition ECRI Institute

Evidence based practice source for Healthcare Research and Quality FDA ASPF Anesthesia Patient Safety Foundation McLaren Bay Region Policies and Procedures

According to 2011 statistics, 550-650 surgical fires occur each year (Bruley, 2012)

The best method to fight fires is to prevent them from starting

McLaren Bay Region has various fire codes and regulations based on date of construction

According to Safety Policy #60 Fire Plan“Each member of the fire response team has specific responsibilities. As a fire can easily reach the flash over point within 2 or 3 minutes, the response time of members of the response team is a critical element in MBR’s ability to defend against fires. All members of the fire response team will be expected to respond to the area of activation as quickly as possible.” (Warszawski, 2012)

As stated in Safety Policy #19 Fire and Smoke Barrier Doors“The greatest loss of life in health care facilities results from smoke asphyxiation due to doors failing to close or be closed.” (Warszawski, 2012)

AORN Recommended Practices for a Safe Environment of Care

Recommendation IX

Potential hazards associated with fire safety in the practice setting should be identified, and safe practices

should be established

There are 12 associated items for this recommended practice

(Association of PeriOperative Nurses, 2012)

A written fire prevention plan and management should be developed by a multidisciplinary group

Ignition sources should be controlledThe tip of the bovie should be in a holster when not

in useESU provides an ignition source when not used

according to manufacturers recommendations Use of oxidizers, flammable solutions and volatile or

combustible chemicals or liquids Lasers, lights cords and light sources Fuel sources should be controlled

Scrub solutions be allowed to COMPLETELY dry to decrease potential to produce ignition by static electricity or sparks

Allow adequate dry time and any fumes to dissipate before applying drapes using bovie or laser or activating light cord

Prevent prep from pooling or soaking into table linens or patient hair Gowns and drapes should not be exposed to ignition

sources

Oxidizers should be controlled Oxygen and nitrous should be used with caution in the

presence of an ignition source

Oxygen enriched environments are created when concentration is greater than 21% -lowers the temperature and energy which fuels will ignite

Anesthesia circuits should be free of leaks

Suction should be used to evacuate anesthesia gas accumulation (WAGD)

Head and neck surgeries should use water soluble substances to cover facial hair

Oxygen concentration under drape should be minimized by tenting of drapes consider open draping

Using lowest possible concentration for adequate patient oxygen saturation

mixing oxygen with nonflammable gases such as medical air reduces risk

Precautions should be taken when operating in the GI tract Hydrogen and methane are flammableNitrous oxide is also considered an oxidizer

Risk of airways fires should be minimized by

Use radio opaque wet sponges in the back of the throat

Inflate ET tube with tinted solutions to improve visibility R/T cuff rupture

Use suction to evacuate oxygen build up

Using pulse oximetry to evaluate patient’s optimal oxygen saturation level

Inspect fire extinguishers

Have evacuation routes

(Bruley, 2012)

(Bruley, 2012)

Fire Extinguishers• For placement in each O.R.

and use on patient: CO2 Extinguisher• Has a cooling effect• Does not leave a residue • Not likely to injure patients or

personnel

Use the acronym PASSP PullA AimS SqueezeS Sweep

(Bruley, 2012)

According to AORN, Fire blankets should not be usedin an operating room (2012)

• They may trap fire next to or under the patient and cause more harm

• They can burn in an oxygen enriched environment

• They are less effective in controlling a fire then other methods

• Usage can lead to wound contamination or spread fire

(Bruley, 2012)

True or False

•Drapes are fire retardant treated. FalseThere are no fire retardant drapes. The technology does not exist to make a textile that is fire retardant in elevated O2 levels.

•Betadine™ skin prep is flammable.

False•Get a fire extinguisher first to fight the fire.

False•Lanugo hair is highly flammable in air. False

(Bruley, 2012)

Fires burn hotter and faster in an oxygen enriched environment. The image below shows a nasal cannula set on fire in room air (left) and in an oxygen enriched environment (right).

fda.gov

(2012)

Fires burn hotter and faster in an oxygen enriched environment. The image below shows a nasal cannula set on fire in room air (left) and in an

oxygen enriched environment (right).

•Burned tracheal tube from fatal fire during tracheostomy. •Tube was not removed immediately when fire started. Extinguishing Tracheal Tube: Pull out! (Bruley, 2012)

McLaren Bay Region Fire Plan

(Warszawski, 2012)

What is our plan?First, attempt to extinguish the fire with saline from back tableRemove drapes if on fireCall Code Red over stentophone

be sure to give location ie., room 1 or room1 ante room or room 1 equipment roomConsider dialing 2-2-2-2-2 give specific locationWhen code is called

if you are in a room, stay in your roomif you are in lounge, locker room, report to inner core if appropriate

Core coordinator will be incident command for departmentwill call rooms to determine case progress and notify of planstay in place or evacuate, will determine route

will determine staff assignments according to needswill send one person to switchboard or south tower desk to meet Security,Environmental Services, Facilities, Fire Departmentwill compile needed paperworkstaffing schedule, room assignments, break/lunch formnotify PPH and PACU to discuss patient and visitor status

What is our plan?Shelter in place is best defense but need to be aware of fire area as it relates to air handlerIn the event a procedure must be continued in another operating room, we need to consider air handler plans

identified on surgery floor plan located in each room Proceed through one set of fire doors each room will have route A and B

Designated person will go to Switchboard or South Tower Desk to escort responders to area

Fire Department, Security, Environmental Services, FacilitiesAlways use stairwell #4 or #9When the Fire Department is activated, EMS personnel also respond

to help evacuate and to care for Fire DepartmentElevators

cannot be used unless there are 2 barrier door separation and is totally separate

can only be determined by Fire DepartmentSmoke doors cannot be propped during evacuation Refer to Surgery policy #9 Emergency Preparedness in the OR

What is our plan?RememberWe are 100% sprinkledRooms 9 and 10 has smoke detectorsEvery incident will need to be considered separately as the department is dynamic. Standard procedures should be followed as necessary to provide safe care to patients.Only Security can call Code Clear

Surgery Floor PlanMain Hospital South Tower

(McLaren Bay Region, 2012)

See Route A and Route B(McLaren Bay Region, 2012)

Next steps• Revise policies• Begin fire risk assessment during time out• Continue to discuss near misses and learn from

each incident• Be aware of potential hazards in rooms and

remove as appropriate• Continue plan to complete fire drill with horizontal

and vertical evacuation with Bay City Fire Department

• Determine regroup location for department• Keep floor plan readily available• Review Critical Alarm Systems policy to determine

Who can set alarm, turn it off and service equipment

Questions?

ReferencesAmerican Society of Anesthesiologists. (2008). Practice advisory for the prevention and management of operating room fires. Anesthesiology 2008, 108, 786-801.

Association of PeriOperative Nurses. (2012). Perioperative standards and recommended practices. Denver, CO: AORN.

Bruley, M. E. (2012, October 12). New clinical guidance on surgical fire prevention and management, 1-47. Retrieved from http://www.aorn.org/Events/Webinars/Upcoming_Webinars.aspx#SurgicalFirePrevention

ECRI Insitiute. (n.d.). https://www.ecri.org/surgical_firesMcLaren Bay Region. (2012). McLaren bay region floor plan. . McLaren Bay Region Mechanical Documents, Bay City, MI.

Warszawski, K. (2012). Safety policy #19 fire plan. Retrieved from www.mclaren.org/BayRegion/intranet/policyand proc

Warszawski, K. (2012). Safety policy #60 fire plan. Retrieved from www.mclaren.org/BayRegion/intranet/policyand proc