operating room safety fires grand rounds presentation june 18, 2009 john chi, md...
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![Page 1: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/1.jpg)
Operating Room SafetyFires
Grand Rounds PresentationJune 18, 2009
John Chi, MD
Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient Care, Education and Research since 1870
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UCLA Medical Center, 1990
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UCLA Medical Center, 1990
• 26 year-old female struck by auto
• Blunt injuries to abdomen, chest
• Endotracheal intubation
• Emergency surgery
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OR Fire
• Surgery completed
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OR Fire
• Surgery completed
• Drapes ignited by cautery device
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OR Fire
• Surgery completed
• Drapes ignited by cautery device
• Flames spread rapidly and engulf patient
![Page 7: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/7.jpg)
OR Fire
• Surgery completed
• Drapes ignited by cautery device
• Flames spread rapidly and engulf patient
• Smoke forces OR staff to evacuate
![Page 8: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/8.jpg)
OR Fire
• Surgery completed
• Drapes ignited by cautery device
• Flames spread rapidly and engulf patient
• Smoke forces OR staff to evacuate
• OR sprinkler system does not activate
![Page 9: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/9.jpg)
OR Fire
• Surgery completed
• Drapes ignited by cautery device
• Flames spread rapidly and engulf patient
• Smoke forces OR staff to evacuate
• OR sprinkler system does not activate
• Fire Department arrives and controls fire
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Outcome
• Patient expires in the fire
• Operating room staff treated for minor burns and smoke inhalation
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Safety
“If you don't know what is going to happen, there is no way to stop it.”
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OR Fires
• Introduction
• Causes
• Outcomes
• Prevention
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Epidemiology
>30,000,000 surgeries per year
>2,000 reported hospital fires
30 reported OR fires
Source: American College of Surgeons,1997.
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Locations of Fires
18
15
9
7
2
0 5 10 15 20
Equipment
Head & Neck
Airway
Torso
Perineum
Number of Fires
Source: Tyco Healthcare Valleylab 2006.
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Locations of Fires
~ 65% of fires occur in the Head & Neck region because of the O2 rich environment
Source: ECRI. Devastation of patient fires. Health devices. 1992.
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OR Fires
• Introduction
• Causes
• Outcomes
• Prevention
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Requirements for Fire
Oxidizer + Fuel + Ignition = FIRE
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Oxidizers
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Oxidizers
• Oxygen
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Oxidizers
• Oxygen– Oxygen is denser than air
1.308 g/L O2 > 1.251 g/L N2
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Oxidizers
• Oxygen– Oxygen is denser than air
1.308 g/L O2 > 1.251 g/L N2
– Collects in low-lying areas
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Oxidizers
• Oxygen– Oxygen is denser than air
1.308 g/L O2 > 1.251 g/L N2
– Collects in low-lying areas– Absorbed and retained by fabrics
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Oxidizers
• Oxygen– Oxygen is denser than air
1.308 g/L O2 > 1.251 g/L N2
– Collects in low-lying areas– Absorbed and retained by fabrics
• Nitrous oxide
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Oxidizers
• Oxygen– Oxygen is denser than air
1.308 g/L O2 > 1.251 g/L N2
– Collects in low-lying areas– Absorbed and retained by fabrics
• Nitrous oxide– Releases oxygen when heat is applied
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OR Fuels
Source: ECRI. Devastation of patient fires. Health devices. 1992;21:3-39.
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OR Fuels
• Patient
Source: ECRI. Devastation of patient fires. Health devices. 1992;21:3-39.
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OR Fuels
• Patient
• Prepping agents
Source: ECRI. Devastation of patient fires. Health devices. 1992;21:3-39.
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OR Fuels
• Patient
• Prepping agents
• Ointments
Source: ECRI. Devastation of patient fires. Health devices. 1992;21:3-39.
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OR Fuels
• Patient
• Prepping agents
• Ointments
• Linens
Source: ECRI. Devastation of patient fires. Health devices. 1992;21:3-39.
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OR Fuels
• Patient
• Prepping agents
• Ointments
• Linens
• Equipment
Source: ECRI. Devastation of patient fires. Health devices. 1992;21:3-39.
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OR Fuels - Patient
• Hair• Surgical cap• Gown• GI tract gases
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OR Fuels – Prepping Agents
• Alcohol• Chlorhexidine• Acetone• Betadine
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Betadine??
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Betadine??
• Explodes in the presence of high oxygen or nitrous oxide concentrations at high temperatures
Source: Briscoe et al, 1976.
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Betadine??
• Explodes in the presence of high oxygen or nitrous oxide concentrations at high temperatures
Source: Briscoe et al, 1976.
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Betadine
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Betadine
Flammability of the Product: May be combustible at high temperature.
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Glycerin
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Glycerin
Flammability of the Product: May be combustible at high temperature.
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OR Fuels - Ointments
• Petrolatum• Benzoin• Paraffin• Aerosols
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OR Fuels - Linens
• Drapes• Dressings, sponges• Surgical gowns,
masks, caps• Mattresses• Sheets, blankets• Egg crates
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OR Fuels - Equipment
• Flexible endoscopes
• ECG wires
• Blood pressure cuff
• Tubing
• Gloves
• Anesthesia machine
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Flammability Standards
• OR equipment
• OR supplies
• OR gowns, masks, caps
• Anesthetics
Source: Sommers JR. Flammability standards. SSM 1998;2:41-4.
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Requirements for Fire
Oxidizer + Fuel + Ignition = FIRE
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OR Fire Survey
Source: Smith LP, Roy S. Accepted at AAO-HNS Annual Meeting, Sept 2009.
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OR Fire Survey
8,523 questionnaires
Source: Smith LP, Roy S. Accepted at AAO-HNS Annual Meeting, Sept 2009.
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OR Fire Survey
8,523 questionnaires
349 respondents
Source: Smith LP, Roy S. Accepted at AAO-HNS Annual Meeting, Sept 2009.
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OR Fire Survey
8,523 questionnaires
349 respondents
88 respondents > 1 Fire
Source: Smith LP, Roy S. Accepted at AAO-HNS Annual Meeting, Sept 2009.
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OR Fire Survey
8,523 questionnaires
349 respondents
88 respondents > 1 Fire
10 respondents = 2 Fires
Source: Smith LP, Roy S. Accepted at AAO-HNS Annual Meeting, Sept 2009.
![Page 50: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/50.jpg)
OR Fire Survey
8,523 questionnaires
349 respondents
88 respondents > 1 Fire
10 respondents = 2 Fires
2 respondents = 5 Fires
Source: Smith LP, Roy S. Accepted at AAO-HNS Annual Meeting, Sept 2009.
![Page 51: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/51.jpg)
Fire Scenarios
27% Endoscopic Airway Surgery
24% Oropharyngeal Electrocautery Surgery
23% Electrocautery Surgery under MAC
18% Tracheotomy
7% Endoscopic Light Cables
1% Anesthesia Machine
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Endoscopic Airway Surgery
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Endoscopic Airway Surgery
OXIDIZER: – Oxygen– Nitrous Oxide
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Endoscopic Airway Surgery
OXIDIZER: – Oxygen– Nitrous Oxide
FUEL: – ET Tube, LASER ET Tube– Flexible Bronchoscope, Drapes
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Endoscopic Airway Surgery
OXIDIZER: – Oxygen– Nitrous Oxide
FUEL: – ET Tube, LASER ET Tube– Flexible Bronchoscope, Drapes
IGNITION: – LASER - CO2 more often than KTP
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Laser Ignition of Drapes
Source: Wolf et al, 2004.
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Laser Ignition of Drapes
• Surgical drapes tested for time to ignition
Source: Wolf et al, 2004.
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Laser Ignition of Drapes
• Surgical drapes tested for time to ignition
• CO2 laser 15 W, 2 mm spot x 30 sec
Source: Wolf et al, 2004.
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Laser Ignition of Drapes
• Surgical drapes tested for time to ignition
• CO2 laser 15 W, 2 mm spot x 30 sec
21% O2 50% O2 95% O2
Source: Wolf et al, 2004.
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Laser Ignition of Drapes
• Surgical drapes tested for time to ignition
• CO2 laser 15 W, 2 mm spot x 30 sec
21% O2 50% O2 95% O2
Primary ignition – drapes
Secondary ignition – drapes on filter paper
Source: Wolf et al, 2004.
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Drapes Tested
• Nonwoven cellulose/polyester blend
• Polypropylene
• Reusable woven cotton/polyester blend
• Huck cotton towel drape adjunct
• Phenol polymer
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Time to Primary Ignition 21%
Material Ignited / Tested TTI
Phenol polymer 0 / 10 N/A
Polypropylene 0 / 10 N/A
Huck towel 8 / 10 11.9 sec
Cotton-poly 10 / 10 4.0 sec
Cellulose-poly 10 / 10 2.7 sec
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Time to Primary Ignition 50%
Material Ignited / Tested TTI
Phenol polymer 10 / 10 4.9 s
Polypropylene 9 / 10 0.14 s
Huck towel 10 / 10 2.3 s
Cotton-poly 10 / 10 1.1 s
Cellulose-poly 10 / 10 < 0.1 s
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Time to Primary Ignition 95%
Material Ignited / Tested TTI
Phenol polymer 10 / 10 0.68 s
Polypropylene 10 / 10 0.18 s
Huck towel 10 / 10 < 0.1 s
Cotton-poly 10 / 10 0.65 s
Cellulose-poly 10 / 10 < 0.1 s
![Page 65: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/65.jpg)
Time to Secondary Ignition 21%
Material Ignited / Tested TTI
Polypropylene & Filter Paper
10 / 10 4.7 s
Filter Paper alone
10 / 10 5.2 s
Filter paper was placed beneath the test material.
![Page 66: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/66.jpg)
Laser Study Conclusions
• Time to ignition decreases with increasing O2 concentration
• Polypropylene assumes the ignition characteristics of materials it contacts
![Page 67: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/67.jpg)
Oropharyngeal Electrocautery
![Page 68: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/68.jpg)
Oropharyngeal Electrocautery
OXIDIZER: – Oxygen
![Page 69: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/69.jpg)
Oropharyngeal Electrocautery
OXIDIZER: – Oxygen
FUEL: – ET Tube – Bovie Tip– Tonsil Sponge – Red Rubber Catheter
![Page 70: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/70.jpg)
Oropharyngeal Electrocautery
OXIDIZER: – Oxygen
FUEL: – ET Tube – Bovie Tip– Tonsil Sponge – Red Rubber Catheter
IGNITION: – Monopolar Electrocautery
![Page 71: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/71.jpg)
Fire risk: Monopolar v. Coblator
Source: Smith LP, Roy S, Laryngoscope, Accepted for publication.
![Page 72: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/72.jpg)
Fire risk: Monopolar v. Coblator
• Monopolar – Coagulate: 15 W
• Coblator – Ablate: 9, 7, 3 – Coagulate: 5, 3
Source: Smith LP, Roy S, Laryngoscope, Accepted for publication.
![Page 73: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/73.jpg)
Fire risk: Monopolar v. Coblator
• Degutted raw chicken
• 6.0 ET Tube
• 100% oxygen at 10 L/min
• 3 tonsil sponges
Source: Smith LP, Roy S, Laryngoscope, Accepted for publication.
![Page 74: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/74.jpg)
OP Fire Study Setup
![Page 75: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/75.jpg)
Monopolar Electrocautery
![Page 76: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/76.jpg)
After 45–55 secs of Monopolar
![Page 77: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/77.jpg)
After 45–55 secs of Monopolar
![Page 78: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/78.jpg)
After the fire
![Page 79: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/79.jpg)
Coblator Electrocautery
![Page 80: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/80.jpg)
After 4 minutes of Coblator
![Page 81: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/81.jpg)
After 4 minutes of Coblator
![Page 82: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/82.jpg)
After 20 minutes of Coblator
![Page 83: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/83.jpg)
After 20 minutes of Coblator
![Page 84: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/84.jpg)
Back to Monopolar for 25 secs
![Page 85: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/85.jpg)
Back to Monopolar for 25 secs
![Page 86: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/86.jpg)
OP Fire Study Conclusions
• Monopolar Electrocautery (>15 W) poses a fire risk
• Coblator Electrocautery did not produce fires
![Page 87: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/87.jpg)
Electrocautery Surgery (MAC)
![Page 88: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/88.jpg)
Electrocautery Surgery (MAC)
OXIDIZER: – Oxygen
![Page 89: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/89.jpg)
Electrocautery Surgery (MAC)
OXIDIZER: – Oxygen
FUEL: – Flash Fire – Drapes– EtOH Prep – Sponges
![Page 90: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/90.jpg)
Electrocautery Surgery (MAC)
OXIDIZER: – Oxygen
FUEL: – Flash Fire – Drapes– EtOH Prep – Sponges
IGNITION: – Monopolar Electrocautery – LASER– Thermocautery– Oxidizer to ignition source <5cm
![Page 91: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/91.jpg)
Arizona Medical Center,1998
![Page 92: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/92.jpg)
Arizona Medical Center,1998
• 73 year-old male with SDH for bilateral burr holes
• Oxygen via face mask at 6 L/min
• Iodofor surgical prep – (0.7% iodine, 74% Isopropyl EtOH)
• Drapes: Towels, Paper surgical drapes
• Monopolar Electrocautery
![Page 93: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/93.jpg)
OR Fire
![Page 94: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/94.jpg)
OR Fire
• “Pop”
![Page 95: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/95.jpg)
OR Fire
• “Pop”
• Smoke appears from beneath the drapes
![Page 96: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/96.jpg)
OR Fire
• “Pop”
• Smoke appears from beneath the drapes
• Drapes quickly removed
![Page 97: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/97.jpg)
OR Fire
• “Pop”
• Smoke appears from beneath the drapes
• Drapes quickly removed
• “Ball of flame” engulfs the patient’s head
![Page 98: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/98.jpg)
OR Fire
• “Pop”
• Smoke appears from beneath the drapes
• Drapes quickly removed
• “Ball of flame” engulfs the patient’s head
• Oxygen mask on fire
![Page 99: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/99.jpg)
OR Fire
• “Pop”
• Smoke appears from beneath the drapes
• Drapes quickly removed
• “Ball of flame” engulfs the patient’s head
• Oxygen mask on fire
• Fire smothered with drapes
![Page 100: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/100.jpg)
OR Fire
• “Pop”
• Smoke appears from beneath the drapes
• Drapes quickly removed
• “Ball of flame” engulfs the patient’s head
• Oxygen mask on fire
• Fire smothered with drapes
• Oxygen flow turned off
![Page 101: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/101.jpg)
Outcome
• Intubation
• 2nd degree burns of face, neck
• ICU x 2 months
• Pneumonia, Respiratory Failure
• Inpatient rehabilitation
![Page 102: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/102.jpg)
Simulated OR Fire
![Page 103: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/103.jpg)
Simulated OR Fire
• Life size manikin
• Oxygen supplied via face mask
• Positioned, prepped, and draped
• Monopolar electrocautery
![Page 104: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/104.jpg)
Simulation Setup
![Page 105: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/105.jpg)
Monopolar Electrocautery- POP
![Page 106: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/106.jpg)
Smoke – POP + 5 seconds
![Page 107: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/107.jpg)
Fire – POP + 13 seconds
![Page 108: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/108.jpg)
Fire – POP + 24 seconds
![Page 109: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/109.jpg)
Beneath the drapes
![Page 110: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/110.jpg)
Beneath the drapes
![Page 111: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/111.jpg)
Beneath the drapes
![Page 112: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/112.jpg)
Beneath the drapes
![Page 113: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/113.jpg)
Simulation Fire Requirements
Source: Barker SJ, Polson SJ, 2001.
![Page 114: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/114.jpg)
Simulation Fire Requirements
• Supplemental oxygen
Source: Barker SJ, Polson SJ, 2001.
![Page 115: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/115.jpg)
Simulation Fire Requirements
• Supplemental oxygen
• Closed space formed by drapes (Tenting)
Source: Barker SJ, Polson SJ, 2001.
![Page 116: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/116.jpg)
Simulation Fire Requirements
• Supplemental oxygen
• Closed space formed by drapes (Tenting)
• Alcohol-based preparation solution– Manufacturer’s label drying time 2-3 minutes– Drying time > 5 minutes No fire
Source: Barker SJ, Polson SJ, 2001.
![Page 117: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/117.jpg)
Oxygen Face Masks
![Page 118: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/118.jpg)
Oxygen Face Masks
• Melt when exposed to open flame
![Page 119: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/119.jpg)
Oxygen Face Masks
• Melt when exposed to open flame
• Do NOT burn without oxygen flow
![Page 120: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/120.jpg)
Oxygen Face Masks
• Melt when exposed to open flame
• Do NOT burn without oxygen flow
• Ignite, burn with oxygen flow > 3 L/min
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Tracheotomy
![Page 122: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/122.jpg)
Tracheotomy
OXIDIZER: – Oxygen
![Page 123: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/123.jpg)
Tracheotomy
OXIDIZER: – Oxygen
FUEL: – Flash Fire, ET Tube, Drape, Airway
![Page 124: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/124.jpg)
Tracheotomy
OXIDIZER: – Oxygen
FUEL: – Flash Fire, ET Tube, Drape, Airway
IGNITION: – Monopolar electrocautery
• Electrocautery to enter trachea• Electrocautery after airway incision
![Page 125: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/125.jpg)
Endoscopic Surgery
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Endoscopic Surgery
OXIDIZER: – Oxygen
![Page 127: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/127.jpg)
Endoscopic Surgery
OXIDIZER: – Oxygen
FUEL: – Drapes
• Cellulose-based: IGNITE• Polypropylene-based: MELT
![Page 128: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/128.jpg)
Endoscopic Surgery
OXIDIZER: – Oxygen
FUEL: – Drapes
• Cellulose-based: IGNITE• Polypropylene-based: MELT
IGNITION: – Endoscopic Light Cable– Temperature > 200º Celcius
![Page 129: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/129.jpg)
![Page 130: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/130.jpg)
![Page 131: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/131.jpg)
OR Fires
• Introduction
• Causes
• Outcomes
• Prevention
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Outcomes
![Page 133: Operating Room Safety Fires Grand Rounds Presentation June 18, 2009 John Chi, MD Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d4b5503460f94a28371/html5/thumbnails/133.jpg)
Analysis of Closed Claims
Source: Bhananker et al, 2006.
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Analysis of Closed Claims
Analysis of the closed claims of 35 US professional liability insurance companies
Source: Bhananker et al, 2006.
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Analysis of Closed Claims
Analysis of the closed claims of 35 US professional liability insurance companies
• 121 MAC-related claims reviewed
• 20 OR fires leading to burns
Source: Bhananker et al, 2006.
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OR Fires
• 95% involved head, neck, face
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OR Fires
• 95% involved head, neck, face
• 50% cited for substandard care
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OR Fires
• 95% involved head, neck, face
• 50% cited for substandard care
• 89% resulted in payment to plaintiff– Median $71,375– Range $8,175 to $321,323
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OR Fires
• Introduction
• Causes
• Outcomes
• Prevention
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Prevention
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Prevention
• Communication with OR Staff, Anesthesia
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Prevention
• Communication with OR Staff, Anesthesia
• Assess the OR fire risk
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Prevention
• Communication with OR Staff, Anesthesia
• Assess the OR fire risk
• Electrocautery – avoid Fuels + Oxidizers
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Prevention
• Communication with OR Staff, Anesthesia
• Assess the OR fire risk
• Electrocautery – avoid Fuels + Oxidizers
• Minimize available O2
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Prevention
• Communication with OR Staff, Anesthesia
• Assess the OR fire risk
• Electrocautery – avoid Fuels + Oxidizers
• Minimize available O2
• Prep Solutions – proceed with caution
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Prevention
• Communication with OR Staff, Anesthesia
• Assess the OR fire risk
• Electrocautery – avoid Fuels + Oxidizers
• Minimize available O2
• Prep Solutions – proceed with caution
• Fire Safety Training
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Summary
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Summary
• OR fires are preventable
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Summary
• OR fires are preventable
• Be aware of your surroundings
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Summary
• OR fires are preventable
• Be aware of your surroundings
Oxidizer + Fuel + Ignition = FIRE
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Thank You
• Lee Smith, MD
• James Kearney, MD
Otorhinolaryngology: Head and Neck Surgery at PENN Excellence in Patient Care, Education and Research since 1870