Fire in OR

It sounds like you are talking about 2 separate issues. The "airway fire" and the external patient fire. If it is an external fire, why would you need to extubate? If it is an airway fire, why take time to remove the drapes? I say get the tube out NOW. Some say turn off gas flow so you don't retract a burning "blowtorch through the airway. My thought is that, just like you can safely wave your hand over a flame because the exposure time is brief, you can remove the smoldering ETT through the airway. as long as you are quick. I would not want the ETT in the trachea burning for even a second longer. If the patient was a difficult intubation, that might change my plans, but probably not. I would probably just get ENT in there to get ready for an emergency surgical airway. If it is a laser in the airway case, they are probably right beside you anyway.

So, in summary, I think the issue in your post is clouded because you are discussing the alcohol based prep catching the patient on fire but discussing it in terms of an airway fire algorithm. Maybe I missed something though. Please clarify.

ruggerdoc123 said:

911

Click to expand...

HAHAHAHA

Tip of the day: An IV bag makes a great fire extinguisher.

Otherwise, the sequence you describe is the correct (i.e., recommended) one.

-copro

An airway fire is a fire in the airway. Your patient's trachea and surrounding structures are being scalded by a burning object, most likely an ETT. Airway fires are most commonly caused by lasers mixed with combustible gas(ie oxygen in a high FiO2). The fire you are describing is an OR fire on the patient involving prep solution or a cautery ignition catching things on fire that are outside the patient. I could see calling 911 for an OR fire, but not an airway fire. I still think you are talking about two different subjects.

I agree for a fire in the OR but for an airway fire 911 won't be very usefull.

ruggerdoc123 said:

Sure, I'll try to clarify as best I can. You have tons more experience than I do, but this is my understanding of the lecture. It's possible that I'm not recalling it correctly.

In an airway fire, the drapes are flammable, so you want to remove them. The fire could have spread under the patient at a site of pooled prep solution. Alternatively, if the patient is not intubated but on supplemental oxygen, if the oxygen is not vented properly, it can pool under the drapes and catch on fire. We were shown video of these situations and they were dramatic. There was no external sign that the patient was burning, based on the appearance of the intact drapes.

If you have a fire in the operating room, you need to call the fire department. There was a case where the smoke was so thick that the staff had to evacuate the OR and leave the patient behind. Nobody called 911 and there was equipment in the way of the fire extinguishers. The staff finally formed a human chain to unlock the bed and pull it out, but it was too late for the patient.

What surprised me most was how quickly the fire can spread and get out of control.

Click to expand...

I'm sure your hospital has an extremely detailed emergency plan that deals with fires anywhere in the hospital, including the OR's. You should look at it. Every single person in our hospital from CEO to Chief of Staff to volunteer and everyone in between is required to take the hospital's "life safety" test every two years (maybe a JCAHO requirement?)

An airway fire is often self limiting - removing the fuel (tube) and oxygen source and the fire goes out. I agree, I'd probably remove the drapes as well.

For any other fire in the OR, use the fire emergency plan your hospital has in place. Usually it's something like

R escue
A larm
C onfine
E xtinguish

Someone in the OR should be calling the HOSPITAL emergency number, usually the same one used for cardiac arrest. Calling 911 from the OR is not a great idea - takes too long and they really have no idea where OR 17 is located. Call your hospital emergency number - tell them you have a fire in the OR - they'll do the rest. They call the hospital-wide Code Red (or whatever your hospital calls it) and then 911. Each hospital is required to have staff members available to respond to fires, and each has certain responsibilities, just like in Code Blue.

One interesting tidbit - you know those medical gas shutoff valves you see out in the halls in the OR? What do YOU do with those in case of a fire? NOTHING! You have no idea how many other rooms or areas may be affected by closing those valves. Sure, you may have a fire in your room, but the next five rooms down the hall all have patients on O2, and you just shut off the supply to all those other patients. Your hospital likely has a very specific policy addressing this as well, and it will specify exactly who can make the decision to shut off those valves - you're not on that list.

Finally - have you ever had a real fire drill in the OR? If not, you should. We do it at least once a year, fairly unannounced. We'll take an unused OR, put a mannequin under the drapes, then call an OR team to set up a case. When they walk in the room, we give them a scenario, and tell them to do exactly what they would do in a real fire, and then shut up and watch the response. If you haven't been educated for this, it's both comical and scary as hell.

I was at SAMBA in May in San Diego. The guys from the ASA taskforce were there to present their work and get some feedback. One of them had done an experiment where they had an ETT filled with O2, maybe flowing O2 as well, I don't remember. It was clamped to a workbench. They lit the side of the ETT with a lighter. Once the flame got through the ETT, it was like a blowtorch! The end of the ETT was shooting flames! It took a few seconds for the ETT to turn into a sticky viscous mass of superheated jelly. If it's me, I'm getting that thing out of there ASAP!

I feel slightly boring that none of my patients have caught on fire yet 😀

I suppose if the ET tube was on fire, I'd yank it out fairly quickly after disconnecting him from the 02 supply.

Still getting flashbacks from when my examiner told me defib and O2 don't mix. But would be fun at the same time.

.......

Fortunately have not had an airaway fire and do not know of anyone who has had an airway fire. It is something i keep in mind though, especially during tracheostomies or HEENT surgeries.
In the case of trachs, i keep the FiO2 as low as possible while still holding sats. If i can't get the O2 down without the patient desatting, i really stress this to the surgeons so that they know to be extra careful about not using a bovie once they are near the airway.

If i had an airway fire, my plan, in one combined movement is to disconnect the ETT from the circuit, rip the cuff inflating tubing off the ETT, and yank it out. Then try to replace it with a new one asap before the airway edema really sets in, with no plans to extubate in the near future.

TheSandMan said:

If i had an airway fire, my plan, in one combined movement is to disconnect the ETT from the circuit, rip the cuff inflating tubing off the ETT, and yank it out. Then try to replace it with a new one asap before the airway edema really sets in, with no plans to extubate in the near future.

Click to expand...

good point.

i'd add that maybe try to replace the ETT with a big enough one to bronch through, if possible