Show:
Basic Principles
Fire Triangle
Evacuation
Fire Facts
Case Scenarios
100
What does PASS mean in fire safety and give an example of when you would use it
PULL AIM SQUEEZE SWEEP Burning drape on the floor
100
What are Four examples of Ignition Sources
Bovie Laser Argon Beam Defibrillator Fiberoptic Light Drill
100
What acronym is used during evacuation in a fire? What does it stand for?
What is R - Remove A - Alarm C - Confine E - Evacuate
100
Most fires happen where on the patient??
44% on head, neck or upper chest
100
An cystoscopy is being performed. One of the scrubbed team members places the unconnected active fiber-optic light cable on the sterile drapes, and the drape materials ignite. Evacuation of the room is not necessary. Discuss ignition source, risk factors, and steps you would take to extinguish fire.
What are •What was the ignition source (fiber-optic light) , fuel-(Drapes) , oxidizer(Oxygen) •Steps to extinguishing fire -Smother -Water on back table -Fire Extinguisher (PASS) •Risk Factors -Light Cable, Communication,
200
Give Three examples of high risk procedures........ What makes them high risk
What are Removal of lesions on the head, neck or face Bronchoscopy Tonsillectomy Tracheostomy Burr hole surgery Removal of laryngeal papillomas They are above the neck close to oxygen sources
200
Give four examples of Fuel Sources
Drapes Towels Skin Alcohol Based Prep Sponges Dressings Hair ET Tubes
200
What type of evacuation is used during a fire?? Where would we go??
What is Horizontal evacuation 351 building
200
Give examples of strategies you would implement to prevent a fire from occurring.
What are Promotes team communication & collaboration Identifies key elements that contribute to fire risks Insures awareness of fire risks in every case Encourages standardization of interventions for procedures at risk for fire where fire extinguisher is water on back table communication
200
The patient has been anesthetized and is ready to undergo a lipoma removal on the abdomen . The patient has been prepped with Chloraprep, which has pooled in the umbilical area. The surgeon makes the skin incision at the umbilicus, and then uses the electrosurgical bovie. When the bovie is activated, it sparks a flame in the area of the umbilicus. What is the ignition source, Risk Factors, and prevention strategies
What are • What was the ignition source(bovie) Risk Factor-Alcohol Based Prep Prevention-3 min dry
300
Give four examples of interventions you would implement in all surgical fires
What are Alert team members to the presence of a fire Stop the flow of breathing gases to the patient Extinguish the fire by smothering or using water or saline Push the back table away from the sterile field Remove burning material from the patient Assess for secondary fire Assess patient for injuries Notify appropriate personnel Complete an UOR Gather involved materials and supplies
300
Give an example of an oxidizer
What is an oxygen
300
Name four duties of the circulating nurse during evacuation
What are Call desk for help Help maintain patient’s anesthetic state and collect minimal drugs to carry on anesthesia during transport Disconnect gas lines for anesthesia, unplug all electrically powered equipment on anesthesia cart and help move the cart or machine out of the room Disconnect patient’s leads, lines, etc. Get the IV’s off poles and place them on the patient and OR table. Obtain an ambu bag for transport. Help move the operating room table or anesthesia cart Last person to leave is to close the door
300
About how many surgical fire occur each year in the US???
550-650 per year in the U.S.
300
The surgeon is performing a tonsillectomy on an otherwise healthy six-year-old child. The surgeon uses an Bovie in the mouth, and the ET tube catches fire. What steps would you take in an airway fire??
What are Act as fast as possible Remove the tracheal tube Stop the flow of all airway gases Remove all flammable and burning materials from airway Pour water or saline into the patient’s airway Once fire is extinguished reestablish ventilation Assess if whether tracheal tube fragments were left in airway consider bronchoscopy Use Fire Safe ET Tube
400
Give four examples of steps you would implement to control the oxygen rich environment in the ORs
What are Tent drapes to allow for free air flow Keep oxygen percentage as low as possible Deliver 5 L to 10 L/min of air under drapes If >30% concentration required, intubate or use laryngeal mask airway Stop supplemental O2 or nitrous oxide 1 min. before using ignition source Use an adhesive incision drape Communicate between surgical team Wet sponges
400
Give four examples of how you would control the Bovie Pencil
What are -Keep active electrode cords from coiling -Store the ESU pencil in a safety holster when not in use -Keep drapes or linens away from activated ESU -Moisten drapes if absorbent towels and sponges will be used close proximity to the ESU active electrode -Do not use an ignition source to enter the bowel when distended with gas. -Keep ESU active electrode away from oxygen or nitrous oxide -Keep the active electrode tip clean
400
Name two duties of the scrub during evacuation
What are Gather minimal instruments onto tray or basin and place on the OR table Control and maintain the surgical wound Help move the operating room table or anesthesia cart
400
What do we routinely do in cases to be prepared for fires???
When an alcohol based solution is used 3 minutes to dry Do not drape patient until flammable prep solution is fully dry and fumes have dissipated. Do not allow pooling of prep solution. Have water or saline on back table prior incision. Utilize standard draping procedures to prevent fumes from trapping beneath drapes. Check all electrical equipment before use. Protect all heat sources when not in use (ESU pencil in holster, laser in standby mode, light cords and drills not directly in drapes). Activate heat source only when active tip is visible and deactivate before heat source leaves surgical site. Properly position foot controls and remove when not in use.
400
You are relieving the RN circulator for lunch and notice that the light cord is frayed in the room where a colonoscopy is being performed. You notice some sparks coming from the frayed portion. What do you do??
What are Disconnect from wall/tower extinguish fire label for engineering to inspect before putting it back into service
500
If a fire were to occur what might we do after the fire to evaluate tools we have implemented???? What is this?
Root Cause Analysis After a serious safety event it is used to gather all involved and to evaluate and implement any other measures needed to prevent fires from happening in the future
500
Who is responsible for each part of the fire triangle. Oxidizer- Fuel- Ignition-
Oxidizer-Anesthesia Fuel-Scrub/circulator Ignition- Surgeon
500
How would you activate a Code Red??
Code Red 4444
500
If a procedure was identified as a high risk procedure above the chest with supplemental oxygen what are some important additional interventions to take??
Implement all Routine Fire Protocol measures. Prompt a discussion between surgical team on fire triangle and interventions for fire prevention. Discuss minimizing electrical surgical Unit (ESU) settings at time-out Encourage use of wet sponges. Coat facial hair with water-soluble lubricant. Staff will identify nearest fire extinguisher location. Use appropriate draping techniques to prevent oxygen accumulation when mask or nasal O2 is used. Oxygen concentration is monitored carefully during procedures that are high risk by the anesthesia provider. Anesthesia provider to stop supplemental oxygen for one minute before the use of electro cautery or laser for head, face, neck, and chest procedures.
500
The patient is having a supraclavicular lymph node removed. The alcohol based prep solution has pooled in the clavicle area and on the sheets. The patient is draped, without allowing adequate time for the solution to dry. The surgeon uses a blade to make the incision and immediately uses the bovie to cauterize the subcutaneous bleeding. There is a spark at the bovie tip, which ignites the fumes from the prep solution. The surgeon removes burning drapes, but the flames have spread to the sheets. What steps do you take to extinguish fire?? Prevention strategies?
What are Immediately extinguish all burning materials in, on, and around the patient with water or saline Stop the flow of all airway gases Remove all drapes, flammable, and burning material from the patient Burning material that has been removed from the patient can then be extinguished by other team member using the water mist fire extinguisher in the OR Evacuate if necessary