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A multidisciplinary approach to intraoperative fire safety
OCTOBER 1995, VOL 62, NO 4
A multidiscip/inury upproach to intraoperative fire safety afety awareness has become a critical component of practice in today’s hospitals. The oxygen-rich environment of OR suites has focused attention on fire safety, and perioperative educators are challenged to provide innovative and interesting fire safety education to staff members. This article describes the approach of our department at Green Hospital of Scripps Clinic, La Jolla, Calif. ASSESSMENT The perioperative managers and I met to discuss our departmental needs and possible solutions for fire safety. We decided to employ both theoretical and practical (ie, fire drill, actual evacuation) educational tools for optimal results. We also decided to use a multidisciplinary approach and involve all surgical services staff members (ie, main OR, postanesthesia care unit [PACU], cardiac catheterization laboratory [CCLI, outpatient OR). We chose a date on which to hold the fire drill, and we allowed eight weeks of preparation for the theoretical portion of the inservice program. PLANNING We decided that the theoretical portion of our fire safety program should include information about how fires start, the chemistry of fire, fire in an oxygen-rich environment, awareness of fire prevention, evacuation routes, and hospital and departmental policies and procedures. Our department has a self-learning module in
place for staff education, and we chose this vehicle to present the theoretical materials. We chose four items that each would be presented for two weeks: the hospital’s fire and disaster policy and procedure manual; two articles, titled “The Chemistry of Fire” and “Fires in the OR”;’ a fire safety scavenger hunt that required staff members to locate all fire extinguishers, oxygen and nitrous oxide shutoff valves, OR evacuation routes, and fire alarm pull boxes; and m information and instructions for the inservice program that included fire drill and evacuation scenario information and descriptions of the scenarios. We also chose a videotape titled “Fire Prevention in the OR: Know the Issues” to be shown the morning of the fire drilL2 We designed the fire safety practicum in cooperation with our hospital’s safety officer. We planned a multidisciplinary, hands-on fire drill to align with the hospital’s fire drill schedule. Our plan also provided for the hospital MICHELLE R. FENNELL, RN, MA, CNOR, C, is the OR nurse educator, Green Hospital Jolla, Calq.
of Scripjx Clinic, La
The author would like to arknowledge Barbara Keto Reed, RN, administrative director. surpical ser~v ces. Green Hospital ofS&ps clinic, La Jolla, Calif.for her sjmial contribution to this article.
636 AORN JOURNAL
telephone operators to respond to a simulated fire alarm from the OR. All personnel, including surgeons, anesthesiologists, and perfusion technologists, were enthusiastic about participating in the exercise. We titled the program “F.I.R.E. (ie, fire, inservice, and rehearsal for evacuation) in the OR.” We designed the practical portion of our fire safety program to provide hands-on experience with perioperative fire scenarios. We created the scenarios for each section of surgical services and distributed copies of the scenarios at staff meetings. The scenarios were as follows. m A coronary artery bypass graft procedure is in progress. Heavy smoke and noxious fumes rapidly begin coming into the OR through the ventilation system. The patient and necessary life-support and surgical equipment must be evacuated. m A total hip replacement procedure is in progress. A fire in another OR suite is out of control, causing heavy smoke and noxious fumes to pour into the room. The patient and necessary life-support and surgical equipment must be evacuated. m A craniotomy is in progress. The patient is prone and positioned in a three-point fixation device with attached headrest. Suddenly, the electroencephalogram monitoring device is on fire, producing electrical sparks and smoke. A spark ignites the surgical drapes. The fires murt
OCTOBER 1995, VOL 62, NO 4
be extinguished, and the patient and necessary life-support and surgical equipment must be evacuated. We instructed staff members to think about what they would do in each scenario because no one knew to which scenario they would be assigned until the morning of the inservice program. Throughout the surgery department, the fire scenarios generated lively discussions involving surgeons, anesthesiologists, circulating nurses, scrub personnel, perfusion technologists, and OR assistants. IMPLEMENTATION On the morning of the fire drill, all participants (ie, approximately 100 staff members) met in the hospital’s amphitheater. As people arrived, we showed an amateur videotape composed of various film clips of fire scenes and played an audiocassette of various firethemed songs. After all participants were present, we showed the videotape “Fire Prevention in the OR: Know the Issues.’’ After the videotape was finished, I read the f i e drill rules aloud and announced staff members’ assignments for the f i e scenarios. All staff members dispersed to their respective areas (eg, OR, CCL, PACU). Staff members set up the procedures, draped staff members posing as patients, and moved into position. Recorders (ie, staff members assigned to record
the scenario events) read the scenarios aloud to their groups. I assigned a recorder to each scenario, a charge nurse or ward clerk to each area, and extra people to help where needed. Each scenario included a surgeon, an anesthesiologist, a perfusion technologist as needed, a circulating nurse, scrub personnel, an OR assistant, and a patient. The staff members proceeded with the fire scenarios while the perioperative managers and I circulated throughout the department, observing and offering support. Someone from each group telephoned the OR front desk charge nurse. She activated the fire alarms and notified the hospital telephone operators. The operators then announced the simulated fires, and the hospital’s fieldisaster teams arrived. EVALUATION The recorders from each group of participants described their experiences and the sequence of events in their scenarios. We discussed the success of each group. The patient undergoing a coronary artery bypass graft procedure was evacuated while still connected to a cardiopulmonary bypass machine, and the patient and all necessary equipment were moved to a designated safety zone outside the OR. The patient undergoing total hip replacement was evacuated, and all necessary
NOTES 1. “Fires in the OR,” in Operating Room Risk Man-
agement (Delran, NJ: ECRI, February 1992);“The Chemistry of Fire,” in Fire Brigade Training Manual
(Quincy, Mass: National Fire Protection Association, 1983) 11-12. 2. Fire Prevention in the OR: Know the Issues (McGaw Park, Ill: Baxter Healthcare Corp, 1992) Videotape.
equipment and positioning aids were moved to an area outside the hospital. In the OR where the electroencephalogram monitoring device and surgical drapes caught on fire, both simulated f i e s were extinguished, and the patient undergoing a craniotomy was evacuated. Additionally, each group remembered to shut off the oxygen and nitrous oxide valves and alert the desk person of the emergency by telephone, according to procedure. The problems encountered by each group were similar: after they evacuated their patients, some equipment could not be plugged into electrical outlets because there were no adaptors. Also, no medications were available. The management team members and I discussed the identified problems. We researched solutions and presented our findings to the staff members at the next staff meeting. CONCLUSION The response from all staff members, including physicians, was very positive. Participants said that the theoretical information was helpful and that the f i e drill scenarios made them think about their actions, increased their awareness, and helped them identify potential problems. All participants agreed the fire safety program should continue as a multidisciplinary annual event. A
SUGGESTED READING “OR fires: Do you know what to do?’ Today’s OR Nurse 14 (September 1992)42. Finnegan, J M. “Staff education can prevent OR fires.” Today’s OR Nurse 16 (MayIJune 1994) 24-26. McCranie, J. “Fire safety in the operating room.” Today’s OR Nurse 16 (Januarypebruary 1994) 33-37. Norris, J L. “Fire safety in the operating room.” AANA Journal 62 (August 1994) 342-345.
637 AORN JOURNAL
A multidiscip/inury upproach to intraoperative fire safety afety awareness has become a critical component of practice in today’s hospitals. The oxygen-rich environment of OR suites has focused attention on fire safety, and perioperative educators are challenged to provide innovative and interesting fire safety education to staff members. This article describes the approach of our department at Green Hospital of Scripps Clinic, La Jolla, Calif. ASSESSMENT The perioperative managers and I met to discuss our departmental needs and possible solutions for fire safety. We decided to employ both theoretical and practical (ie, fire drill, actual evacuation) educational tools for optimal results. We also decided to use a multidisciplinary approach and involve all surgical services staff members (ie, main OR, postanesthesia care unit [PACU], cardiac catheterization laboratory [CCLI, outpatient OR). We chose a date on which to hold the fire drill, and we allowed eight weeks of preparation for the theoretical portion of the inservice program. PLANNING We decided that the theoretical portion of our fire safety program should include information about how fires start, the chemistry of fire, fire in an oxygen-rich environment, awareness of fire prevention, evacuation routes, and hospital and departmental policies and procedures. Our department has a self-learning module in
place for staff education, and we chose this vehicle to present the theoretical materials. We chose four items that each would be presented for two weeks: the hospital’s fire and disaster policy and procedure manual; two articles, titled “The Chemistry of Fire” and “Fires in the OR”;’ a fire safety scavenger hunt that required staff members to locate all fire extinguishers, oxygen and nitrous oxide shutoff valves, OR evacuation routes, and fire alarm pull boxes; and m information and instructions for the inservice program that included fire drill and evacuation scenario information and descriptions of the scenarios. We also chose a videotape titled “Fire Prevention in the OR: Know the Issues” to be shown the morning of the fire drilL2 We designed the fire safety practicum in cooperation with our hospital’s safety officer. We planned a multidisciplinary, hands-on fire drill to align with the hospital’s fire drill schedule. Our plan also provided for the hospital MICHELLE R. FENNELL, RN, MA, CNOR, C, is the OR nurse educator, Green Hospital Jolla, Calq.
of Scripjx Clinic, La
The author would like to arknowledge Barbara Keto Reed, RN, administrative director. surpical ser~v ces. Green Hospital ofS&ps clinic, La Jolla, Calif.for her sjmial contribution to this article.
636 AORN JOURNAL
telephone operators to respond to a simulated fire alarm from the OR. All personnel, including surgeons, anesthesiologists, and perfusion technologists, were enthusiastic about participating in the exercise. We titled the program “F.I.R.E. (ie, fire, inservice, and rehearsal for evacuation) in the OR.” We designed the practical portion of our fire safety program to provide hands-on experience with perioperative fire scenarios. We created the scenarios for each section of surgical services and distributed copies of the scenarios at staff meetings. The scenarios were as follows. m A coronary artery bypass graft procedure is in progress. Heavy smoke and noxious fumes rapidly begin coming into the OR through the ventilation system. The patient and necessary life-support and surgical equipment must be evacuated. m A total hip replacement procedure is in progress. A fire in another OR suite is out of control, causing heavy smoke and noxious fumes to pour into the room. The patient and necessary life-support and surgical equipment must be evacuated. m A craniotomy is in progress. The patient is prone and positioned in a three-point fixation device with attached headrest. Suddenly, the electroencephalogram monitoring device is on fire, producing electrical sparks and smoke. A spark ignites the surgical drapes. The fires murt
OCTOBER 1995, VOL 62, NO 4
be extinguished, and the patient and necessary life-support and surgical equipment must be evacuated. We instructed staff members to think about what they would do in each scenario because no one knew to which scenario they would be assigned until the morning of the inservice program. Throughout the surgery department, the fire scenarios generated lively discussions involving surgeons, anesthesiologists, circulating nurses, scrub personnel, perfusion technologists, and OR assistants. IMPLEMENTATION On the morning of the fire drill, all participants (ie, approximately 100 staff members) met in the hospital’s amphitheater. As people arrived, we showed an amateur videotape composed of various film clips of fire scenes and played an audiocassette of various firethemed songs. After all participants were present, we showed the videotape “Fire Prevention in the OR: Know the Issues.’’ After the videotape was finished, I read the f i e drill rules aloud and announced staff members’ assignments for the f i e scenarios. All staff members dispersed to their respective areas (eg, OR, CCL, PACU). Staff members set up the procedures, draped staff members posing as patients, and moved into position. Recorders (ie, staff members assigned to record
the scenario events) read the scenarios aloud to their groups. I assigned a recorder to each scenario, a charge nurse or ward clerk to each area, and extra people to help where needed. Each scenario included a surgeon, an anesthesiologist, a perfusion technologist as needed, a circulating nurse, scrub personnel, an OR assistant, and a patient. The staff members proceeded with the fire scenarios while the perioperative managers and I circulated throughout the department, observing and offering support. Someone from each group telephoned the OR front desk charge nurse. She activated the fire alarms and notified the hospital telephone operators. The operators then announced the simulated fires, and the hospital’s fieldisaster teams arrived. EVALUATION The recorders from each group of participants described their experiences and the sequence of events in their scenarios. We discussed the success of each group. The patient undergoing a coronary artery bypass graft procedure was evacuated while still connected to a cardiopulmonary bypass machine, and the patient and all necessary equipment were moved to a designated safety zone outside the OR. The patient undergoing total hip replacement was evacuated, and all necessary
NOTES 1. “Fires in the OR,” in Operating Room Risk Man-
agement (Delran, NJ: ECRI, February 1992);“The Chemistry of Fire,” in Fire Brigade Training Manual
(Quincy, Mass: National Fire Protection Association, 1983) 11-12. 2. Fire Prevention in the OR: Know the Issues (McGaw Park, Ill: Baxter Healthcare Corp, 1992) Videotape.
equipment and positioning aids were moved to an area outside the hospital. In the OR where the electroencephalogram monitoring device and surgical drapes caught on fire, both simulated f i e s were extinguished, and the patient undergoing a craniotomy was evacuated. Additionally, each group remembered to shut off the oxygen and nitrous oxide valves and alert the desk person of the emergency by telephone, according to procedure. The problems encountered by each group were similar: after they evacuated their patients, some equipment could not be plugged into electrical outlets because there were no adaptors. Also, no medications were available. The management team members and I discussed the identified problems. We researched solutions and presented our findings to the staff members at the next staff meeting. CONCLUSION The response from all staff members, including physicians, was very positive. Participants said that the theoretical information was helpful and that the f i e drill scenarios made them think about their actions, increased their awareness, and helped them identify potential problems. All participants agreed the fire safety program should continue as a multidisciplinary annual event. A
SUGGESTED READING “OR fires: Do you know what to do?’ Today’s OR Nurse 14 (September 1992)42. Finnegan, J M. “Staff education can prevent OR fires.” Today’s OR Nurse 16 (MayIJune 1994) 24-26. McCranie, J. “Fire safety in the operating room.” Today’s OR Nurse 16 (Januarypebruary 1994) 33-37. Norris, J L. “Fire safety in the operating room.” AANA Journal 62 (August 1994) 342-345.
637 AORN JOURNAL