March 2000

March SN Contents

Tech News

Surgical Fires Addressed in New Guide

FIRES ARE AN ISSUE IN SURGERY. They have resulted in fatalities and have caused operating rooms to be evacuated. “About one or two patients die per year,” says anesthesiologist Gerald Wolf, M.D., professor of anesthesiology, State University of New York, Health Science Center at Brooklyn. “They’re rare; maybe 100 a year in the United States out of two and one-half million operations. The incidence is very small, but when it does happen, it’s catastrophic.”

To address the cause and prevention of these fires, ASTM Standard Guide to Surgical Fires: Fire-Risk Assessment, Prevention, and Extinguishment was written by medical specialists in ASTM Subcommittee F29.08 on OR Fire Safety, under ASTM Committee F29 on Anesthetic and Respiratory Equipment. Currently being balloted and expected to be released this year, it offers prudent instruction on the risks of potentially flammable materials used in surgery to doctors, nurses, anesthesiologists, technicians, engineers, risk managers, and health administrators.

“I got interested in this when we had a fire in the operating room during a surgery on a child for a tonsillectomy,” says Wolf, the subcommittee chairman. “An electrosurgical unit ignited the endotracheal tube in the oxygen-enriched atmosphere of the anesthesia gases. There were three things involved: the ignition source, which was the electrosurgical unit; the oxidizing atmosphere, which in this case was high oxygen concentration, plus nitrous oxide, which is an anesthetic and can release oxygen; and also, the endotracheal tube, which was poly(vinyl chloride) and acted as a fuel.”

Wolf calls this a “fire triangle of fuel, oxidizer, and ignition source,” that is described in the guide: “During surgery, these three elements are typically present through the use of surgical instruments, breathing gases, and associated equipment. Consequently, each member of the surgical team is associated and should be concerned with a side of the fire triangle: surgeons with ignition sources (e.g., electrosurgical units, lasers, electrocautery units, fiberoptic illumination systems); anesthesia team with oxidizers (i.e., oxygen, nitrous oxide, medical compressed air, ambient air); and nurses with fuels (e.g., surgical drapes, prepping agents).

“Each member of the surgical team should understand the basics of surgical fires and communicate information on risks to other team members,” the guide states. “There is frequent overlap of the areas of association and concern. For example, tracheal tubes are fuels within the purview of anesthesia providers during laser surgery. Similarly, flammable ointments applied by surgeons intraoperatively are fuels under their domain.”

The subcommittee has ample players involved. “We tried to get together surgeons, anesthesiologists, and operating room nurses,” explains Wolf, “to come up with guidelines on methods to reduce the incidents and to take preventive measures. We also had some interested parties [on the committee] such as FDA, and ECRI which analyzes hospital incidents and sets up preventative methods.” The subcommittee includes makers of surgical drapes and medical devices. “We’re also trying to stimulate manufacturers, who are also on the committee, to come up with materials changes that will reduce the flammability,” he adds.

“We did some research,” he notes. “We applied basic combustion science to the operating room environment and looked at certain flammability limits and oxygen index determinations for certain materials we use in the operating room.”

Topics in the guide cover electrosurgically-ignited fires, fiberoptic light sources, laser safety practices, oropharyngeal surgery precautions and many others in over 50 pages of information.

For further technical details, contact Gerald Wolf, M.D., Dept. of Anesthesiology, State University of New York, HSC-Brooklyn, 450 Clarkson Ave., PO Box 6, Brooklyn, NY 11203 (718/270-2677). Committee F29 meets May 8-12 at ASTM in West Conshohocken. For meeting or membership information, contact F29 Staff Manager Teresa Cendrowska, ASTM (610/832-9718). //