This report originally appeared in the August 2009 issue of DOTmed Business News

While surgeons must minimize distractions, patients face a complex assortment of fears and anxieties. The operating room is no place to yell "fire". Yet, with ever-advancing, power-hungry new technologies entering the operating room, it's possible that the incidence of devastating fires is showing a discomfiting rise. One problem is though there's a sense afoot that this is a growing threat, for numerous reasons O/R fires are not being fully reported. There isn't a national system for such reporting in place, admits Robert Caplan, M.D., chair of the American Society of Anesthesiologists (ASA) Task Force on Operating Room Fires. His group has suggested that the number exceeds 50 annually, and may go as high as 100. An independent advocacy group, the Pennsylvania Patient Safety Reporting System cites studies that say the number across the United States is closer to 650, with perhaps four times as many near misses. According to the most conservative estimates available, at least 20 patients are critically injured in OR fires annually, at least two of whom do not survive.

The reason anesthesiologists are at the forefront of the effort to get a handle on O/R fires is simple: the tools they use and the materials they work with, such as pressurized oxygen and nitrous oxide, put them at risk. Oxidizers make up one leg of what's called the "fire triad", found commonly in operating rooms everywhere. The other two parts of the triad are fuels, which include tracheal tubes, sponges, prepping agents like alcohol and acetone, and linens and drapes; and an ignition source, such as lasers, drills and electrosurgical devices. The latter, in particular, are becoming more prevalent due to their promise of accelerated healing time, which speeds recovery, and just as important these days, reduces hospital stays.
There is no question that the present health care environment presents new challenges and opportunities for disaster with which the medical community is only recently learning to contend. Accordingly, the ASA has taken the lead in raising awareness of the omnipresent danger of O/R fires, and has begun to set measures in place to address it. Last spring the organization's journal, Anesthesiology, published a white paper on the subject, a "Practice Advisory for the Prevention and Management of Operating Room Fires". The advisory breaks down the essential preventative approaches according to the key measures of education, preparation, prevention, and management. Each comes with its own set of standardized practices and a checklist of items and issues medical professionals are encouraged to reacquaint themselves with. The document is available free on-line at [http://tinyurl.com/mlgeh4 ].

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