Resources and Tools for Preventing Surgical Fires
Reference Articles and Advisories
- American Society of Anesthesiologists (ASA) Task Force on Operating Room Fires – Practice Advisory for the Prevention and Management of Operating Room Fires
This updated version of the practice advisory was published in: Anesthesiology. 2013 Feb;118(2):271-290.
Association of periOperative Registered Nurses (AORN) – OR Fire Extinguisher Placement (2013)
Center for Medicare & Medicaid Services (CMS) - Use of Alcohol-based Skin Preparations in Anesthetizing Locations (PDF - 79KB) (2007)
"FDA Seeks to Prevent Surgical Fires"
ENT Today. April 2012 Issue. Official publication of the Triological Society (The American Laryngological, Rhinological, and Otological Society, Inc.)
This article provides recommendations for otolaryngologists on how to minimize the risk of surgical fires. It also mentions the Preventing Surgical Fires Initiative.
The Joint Commission Sentinel Event Alert - Preventing Surgical Fires (2003)
“Operating Room Fires: A Closed Claims Analysis"
Anesthesiology. 2013 May;118(5):1133-9.
Mehta SP, Bhananker SM, Posner KL, Domino KB.
"Surgical Fire Injuries Continue to Occur: Prevention May Require More Cautious Use of Oxygen"
Anesthesia Patient Safety Foundation's APSF Newsletter
Winter 2012 Issue (volume 26, No. 3, pg 41 and 43)
This article lists conditions that put patients at risk for surgical fires and steps anesthesia professionals can take to decrease the likelihood of a surgical fire, including reassessment of the administration of supplemental oxygen using the included algorithm.
APSF Fire Prevention Algorithm (updated March 2013)
Poster in three sizes to download and print (Anesthesia Patient Safety Foundation)
"Surgical Fires: Trends Associated with Prevention Efforts"
Pa Patient Saf Advis 2012 Dec;9(4):130-5
John R. Clarke, MD
Editor, Pennsylvania Patient Safety Advisory
Clinical Director, Pennsylvania Patient Safety Authority
Professor of Surgery, Drexel University
Mark E. Bruley, CCE
Vice President, Accident and Forensic Investigation, ECRI Institute
Editorial Advisory Board, Pennsylvania Patient Safety Advisory
From the Abstract: "Surgical fires remain a significant enough risk to justify use of a Fire Risk Assessment Score and adherence to the recommendations of the American Society of Anesthesiologists Task Force on Operating Room Fires and those of the Anesthesia Patient Safety Foundation."
"Surgical Fires in Laser Laryngeal Surgery-Are We Safe Enough?"
Soham Roy, MD and Lee P. Smith, MD
Otolaryngol Head Neck Surg. 2015 Jan;152(1):67-72
Education Programs for Healthcare Providers
- Fundamental Use of Surgical Energy (FUSE) Educational Program for OR Safety – Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) NEW
SAGES’ FUSE program was developed in collaboration with gynecologic (AAGL), urologic (AUA), anesthesia (ASA), and nursing colleagues (AORN). FUSE covers a wide variety of topics in the use of surgical energy and has a specific focus in the prevention and management of fires in the operating room. This interactive, web-based program is a multimedia-enhanced didactic curriculum . Free access, CME and CEU certificates, and a high-stakes, multiple choice cognitive certifying exam are available options. The program was designed to certify that a successful candidate has demonstrated the knowledge fundamental to the safe use of surgical energy-based devices in the operating room, endoscopic suite and other procedural areas.
Fire Codes Relevant to Healthcare Facilities
From the National Fire Protection (NFPA):
Fire Risk Assessment Tools
Surgical Fire Risk Assessment Tools
Christiana Care Health System (Wilmington, DE) has developed and integrated a fire risk assessment in their universal protocol. Examples of this protocol, as well as an accompanying presentation are available on their website.
Fire Safety Tool Kit
The Association of periOperative Registered Nurses (AORN) has created a fire safety tool kit. The Tool Kit contains slide shows to teach OR fire safety, fire risk assessment tool,
fire safety competency tool, description of the perioperative team member roles in a fire, fire drill scenarios for the hospital & ambulatory settings, instructions on how to create an OR fire drill, fire drill evaluation tool, a Fire Safety Poster and references. The toolkit also includes two testimonial videos.
Fires in the OR (Dartmouth-Hitchcock Medical Center)
This video shows a modified time out procedure that includes a discussion of the steps each operating room team member would take to prevent a fire and the steps they would take if a fire occurred.
Fire Extinguisher Recommendations for Operating Rooms
Please see the current recommendations from these initiative partners: