Friday, December 16

Surgical Fires: Woman's face ignites during surgery

Miami woman's face ignites in 'flash fire' during surgery

The article about this incident, w/photos is located here:

Fires during surgery? Not as unusual as you might think! Here's the second one in the same week!

Washington man's face catches fire during routine surgical procedure: It's second such incident in a week nationwide 

Immediately followed by this post on a Legal Malpractice website: Two surgical fires in one week may lead to malpractice suits 

Overview of Surgery Fires

Authorities suspect the Fire Triangle might be responsible. According to the FDA: Fires can occur when the three elements of the “fire triangle” come together. In the surgery room it looks like this:
 Oxidizer: Gases used during surgery, such as oxygen and nitrous oxide, and room air
 Fuel: Flammable objects, including surgical drapes, alcohol-based skin preparations, airway tubing, and even the patient’s hair or body
 Heat: Tools such as electrosurgical (tissue-cutting) tools, lasers, fiber-optic lights and cables that can generate heat or sparks and cause a fire
 Surgeries of the head, neck and upper chest pose a greater risk of fire, especially if the patient is receiving extra oxygen through a breathing mask or nasal tubing.
I know you want to know more about it. From "The Patient is on Fire!" A Surgical Fires Primer (
Most people have heard of the fire triangle: heat, fuel, and oxidizer. When these three components come together in the proper proportions, a fire—the rapid chemical reaction of fuel with oxygen, resulting in the release of heat and light energy—is bound to occur. Diminish or remove any element of the triangle, and a fire can be prevented or extinguished.
 Each side of the triangle contains obvious (and some not-so-obvious) components that are commonly found in the OR environment. Each member of the surgical team controls a specific side of the triangle: surgeon, heat sources; nurse, fuels; anesthesiologist, oxidizers. By understanding the fire triangle and how to properly manage its components, the surgical team can prevent fires.
Heat and ignition sources. Heat input from a variety of sources increases the oxidation rate of a fuel-oxygen mixture until combustion occurs. In addition to the overhead surgical lights, some of the heat sources found in the OR are defibrillators; electrosurgical or electrocautery units (ESUs, ECUs); heated probes; drills and burs; argon beam coagulators; fiberoptic light sources and cables; and lasers used with the free-beam (bare-fiber) method or with contact tips or fibers. These sources produce temperatures from several hundred to a few thousand degrees Fahrenheit, enough to ignite most fuels, including most drapes. In addition, incandescent sparks can be produced by ESUs or high-speed drills and burs; lasers can also cause sparks when the energy hits instruments or the laser fiber becomes damaged. These sparks, or even glowing embers of charred tissue, can provide enough initial heat to ignite some fuels, especially in oxygen-enriched atmospheres (OEAs).
Also, for a few seconds after deactivation, a heated ESU or ECU probe tip, fiberoptic cable tip, or laser contact tip can retain enough heat to melt plastics or ignite some fuels. While these devices must be in contact with a material to heat it, a laser can heat a fuel from a few centimeters to several meters away. A fiberoptic light source may take a minute or so to heat a drape to the point of combustion, while a laser can cause almost instantaneous ignition. By ensuring that these heat sources are not directed toward or allowed to come in contact with fuels, OR staff can prevent fires.
Fuels. A fuel is anything that can burn, including almost everything that comes in contact with patients, as well as the patients themselves. As shown in the "Fuels Commonly Encountered in Surgery" table below, fuels abound in the OR; note that, in addition to the many items that are generally known to burn, many other items that are not generally thought of as flammable are listed.
Some prepping agents and a few ointments required during surgery are volatile and extremely flammable, more so than many other fuels. For example, liquid alcohol from a wet, dripping prep can pool under the patient and generate vapors beneath the drapes for quite some time. Concentrated alcohol vapors trapped under drapes or above areas still wet with alcohol can be easily ignited by heat or sparks (see "Proper Prepping Techniques," below). Open bottles or basins containing volatile solutions (e.g., alcohol from suture packs, acetone degreaser) should be closed or removed from the sterile area as soon as possible after use.
Under the right conditions, some surgical ointments can burn. For example, petroleum-based ointments used in an OEA will ignite when enough heat is present to cause vaporization. These materials must vaporize and mix with oxygen to allow ignition. Globs of ointment are not easy to ignite because their mass absorbs considerable heat before vaporizing. Thin layers, however, have a low mass per area and need less heat to cause vaporization; thus, they are more ignitable.
 In contrast, water-based lubricants, such as K-Y Jelly, are mostly water and will not burn; heat simply vaporizes the water in the lubricant, cooling the area. In fact, water-based lubricants can be used to coat hair to make it fire resistant.

I DID NOT know that about lube! I'm thinking, KY could save some eyebrows not only during surgeries but BBQ season...Sure when you show up to the BBQ with a Costco sized container of KY Jelly, people WILL wonder, especially if they were expecting you to bring the pasta salad. But the conversation about fire safety has to start somewhere. I'm just thinking, starting with some lubricant is not a bad idea. At a bbq or in a surgical suite...

Preventing Fires in the Operating Room

But I digress, this post is about Surgery Fires. Turns out, Surgery Fires are preventable. I know. Such a surprise. Here is how to prevent them (in case you are asked)

Extinguishing Operating Room Fires
Because fire prevention is NEVER 100% effective, here is how to put OUT a surgery room fire from the ECRI Institute :

More info is available at:

Surgical Fires in the News
FDA Surgical Fire Initiative
Inside Edition Reports on Surgical Fires
Surgical Fires: Chronological Bibliography 1949-2009